1887

Chapter 25 : Neurosyphilis in AIDS

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Ebook: Choose a downloadable PDF or ePub file. Chapter is a downloadable PDF file. File must be downloaded within 48 hours of purchase

Buy this Chapter
Digital (?) $15.00

Preview this chapter:
Zoom in
Zoomout

Neurosyphilis in AIDS, Page 1 of 2

| /docserver/preview/fulltext/10.1128/9781555815691/9781555813697_Chap25-1.gif /docserver/preview/fulltext/10.1128/9781555815691/9781555813697_Chap25-2.gif

Abstract:

The presence of cerebrospinal fluid (CSF) abnormalities does not necessarily predict the development of neurosyphilis. The characteristic spinal cord syndrome associated with parenchymatous neurosyphilis is tabes dorsalis. A more rapid development of neurosyphilis in HIV-infected individuals than would otherwise be expected may result from the impairment of delayed hypersensitivity. Despite the associated immunosuppression, serum nontreponemal titers at the time of presentation of neurosyphilis in the HIV-infected individual are typically high, averaging 1:128. In general, those neurologic manifestations occurring early in syphilis, namely, asymptomatic neurosyphilis and syphilitic meningitis, are readily treatable and typically resolve without neurologic sequelae. Dependence on the CSF for determining the adequacy of treatment for neurosyphilis in HIV-infected individuals often yields inaccurate results, due to the frequency with which CSF abnormalities are detected with HIV infection alone. Neurosyphilis is broadly defined as the occurrence of neurological complications due to infection with . While the diagnosis of syphilis is relatively straightforward with serum tests for demonstration of treponeme or immune response to this pathogen, the diagnosis of neurosyphilis is more complicated. The goal of neurosyphilis treatment is to reach treponemicidal levels of penicillin in the CSF. The best determinant of treatment adequacy for neurosyphilis is the resolution of CSF abnormalities, although it often yields inaccurate results in HIV patients because of irregularities due to HIV infection alone. HIV-seropositive patients should be monitored for neurosyphilis relapse for at least 2 years following treatment.

Citation: Berger J, Berger A. 2009. Neurosyphilis in AIDS, p 363-373. In Goodkin K, Shapshak P, Verma A (ed), The Spectrum of Neuro-AIDS Disorders. ASM Press, Washington, DC. doi: 10.1128/9781555815691.ch25

Key Concept Ranking

Magnetic Resonance Imaging
0.42199063
0.42199063
Highlighted Text: Show | Hide
Loading full text...

Full text loading...

Figures

Image of FIGURE 1
FIGURE 1

Penile chancre (reproduced from the USPHS files).

Citation: Berger J, Berger A. 2009. Neurosyphilis in AIDS, p 363-373. In Goodkin K, Shapshak P, Verma A (ed), The Spectrum of Neuro-AIDS Disorders. ASM Press, Washington, DC. doi: 10.1128/9781555815691.ch25
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of FIGURE 2
FIGURE 2

Maculopapular rash of secondary syphilis (reproduced from the USPHS files).

Citation: Berger J, Berger A. 2009. Neurosyphilis in AIDS, p 363-373. In Goodkin K, Shapshak P, Verma A (ed), The Spectrum of Neuro-AIDS Disorders. ASM Press, Washington, DC. doi: 10.1128/9781555815691.ch25
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of FIGURE 3
FIGURE 3

A timeline for the evolution of neurosyphilis. (Reproduced from Victor and Ropper, 2000.)

Citation: Berger J, Berger A. 2009. Neurosyphilis in AIDS, p 363-373. In Goodkin K, Shapshak P, Verma A (ed), The Spectrum of Neuro-AIDS Disorders. ASM Press, Washington, DC. doi: 10.1128/9781555815691.ch25
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of FIGURE 4
FIGURE 4

Syphilitic meningitis at autopsy in an AIDS patient.

Citation: Berger J, Berger A. 2009. Neurosyphilis in AIDS, p 363-373. In Goodkin K, Shapshak P, Verma A (ed), The Spectrum of Neuro-AIDS Disorders. ASM Press, Washington, DC. doi: 10.1128/9781555815691.ch25
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of FIGURE 5
FIGURE 5

Meningovascular syphilis with right middle cerebral artery infarction.

Citation: Berger J, Berger A. 2009. Neurosyphilis in AIDS, p 363-373. In Goodkin K, Shapshak P, Verma A (ed), The Spectrum of Neuro-AIDS Disorders. ASM Press, Washington, DC. doi: 10.1128/9781555815691.ch25
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of FIGURE 6
FIGURE 6

Cerebral gumma in neurosyphilis on MRI.

Citation: Berger J, Berger A. 2009. Neurosyphilis in AIDS, p 363-373. In Goodkin K, Shapshak P, Verma A (ed), The Spectrum of Neuro-AIDS Disorders. ASM Press, Washington, DC. doi: 10.1128/9781555815691.ch25
Permissions and Reprints Request Permissions
Download as Powerpoint

References

/content/book/10.1128/9781555815691.ch25
1. Berbel-Garcia, A.,, J. Porta-Etessam,, A. Martinez-Salio,, M. Millan-Juncos,, D. A. Perez-Martinez,, R. A. Saiz-Diaz, and, M. Toledo-Heras. 2004. Magnetic resonance image-reversible findings in a patient with general paresis. Sex. Transm. Dis. 31:350352.
2. Berger, J. R. 1987. Syphilis of the spinal cord, p. 491–538. In R. Davidoff (ed.), The Handbook of the Spinal Cord, vol. 5. Marcel-Dekker, New York, NY.
3. Berger, J. R. 1991. Neurosyphilis in human immunodeficiency virus type 1-seropositive individuals. A prospective study. Arch. Neurol. 48:700702.
4. Berger, J. R. 1992. Spinal cord syphilis associated with human immunodeficiency virus infection: a treatable myelopathy. Am. J. Med. 92:101103.
5. Berger, J. R.,, H. Waskin,, L. Pall,, G. Hensley,, I. Ihmedian, and, M. J. Post. 1992. Syphilitic cerebral gumma with HIV infection. Neurology 42:12821287.
6. Berry, C. D.,, T. M. Hooton,, A. C. Collier, and, S. A. Lukehart. 1987. Neurologic relapse after benzathine penicillin therapy for secondary syphilis in a patient with HIV infection. N. Engl. J. Med. 316:15871589.
7. Bordon, J.,, C. Martinez-Vazquez,, J. de la Fuente-Aguado,, B. Sopena,, A. Ocampo-Hermida,, J. Nunez-Torron,, T. Rodriguez-Sousa,, M. Alvarez-Fernandez, and, T. del Blanco. 1999. Response to standard syphilis treatment in patients infected with the human immunodeficiency virus. Eur. J. Clin. Microbiol. Infect. Dis. 18:729732.
8. Brandon, W. R.,, L. M. Boulos, and, A. Morse. 1993. Determining the prevalence of neurosyphilis in a cohort coinfected with HIV. Int. J. STD AIDS 4:99101.
9. Brightbill, T. C.,, I. H. Ihmeidan,, M. J. Post,, J. R. Berger, and, D. A. Katz. 1995. Neurosyphilis in HIV-positive and HIV-negative patients: neuroimaging findings. AJNR Am. J. Neuroradiol. 16:703711.
10. Burstain, J. M.,, E. Grimprel,, S. A. Lukehart,, M. V. Norgard, and, J. D. Radolf. 1991. Sensitive detection of Treponema pallidum by using the polymerase chain reaction. J. Clin. Microbiol. 29:6269.
11. Carey, L. A.,, M. J. Glesby,, L. M. Mundy,, E. M. Janis, and, E. W. Hook III. 1995. Lumbar puncture for evaluation of latent syphilis in hospitalized patients. High prevalence of cerebrospinal fluid abnormalities unrelated to syphilis. Arch. Intern. Med. 155:16571662.
12. Centers for Disease Control. 1988. Recommendations for diagnosing and treating syphilis in HIV-infected patients. Morb. Mortal. Wkly. Rep. 37:600608.
13. Centers for Disease Control and Prevention. 2002a. Primary and secondary syphilis—United States, 2000-2001. Morb. Mortal. Wkly. Rep. 51:971973.
14. Centers for Disease Control and Prevention. 2002b. Sexually transmitted diseases treatment guidelines 2002. MMWR Recomm. Rep. 51(RR-6):178.
15. Chan, D. J. 2005. Syphilis and HIV co-infection: when is lumbar puncture indicated? Curr. HIV Res. 3:9598.
16. Chung, W. M.,, F. D. Pien, and, J. L. Grekin. 1983. Syphilis: a cause of fever of unknown origin. Cutis 31:537540.
17. Clark, E.,, and N. Danbolt. 1964. The Oslo study of the natural course of untreated syphilis: an epidemiologic investigation based on a re-study of the Boeck-Bruusgrad material. Med. Clin. N. Am. 48:613624.
18. Cosottini, M.,, M. Mascalchi,, G. Zaccara, and, G. Arnetoli. 1997. Reversal of syphilitic hydrocephalus with intravenous penicillin. Can. J. Neurol. Sci. 24:343344.
19. Darmstadt, G. L.,, and J. P. Harris. 1989. Luetic hearing loss: clinical presentation, diagnosis, and treatment. Am. J. Otolaryngol. 10:410421.
20. Davis, L. E.,, and J. W. Schmitt. 1989. Clinical significance of cerebrospinal fluid tests for neurosyphilis. Ann. Neurol. 25:5055.
21. Dowell, M. E.,, P. G. Ross,, D. M. Musher,, T. R. Cate, and, R. E. Baughn. 1992. Response of latent syphilis or neurosyphilis to ceftriaxone therapy in persons infected with human immunodeficiency virus. Am. J. Med. 93:481488.
22. Faber, W. R.,, J. D. Bos,, P. J. Rietra,, H. Fass, and, R. V. Van Eijk. 1983. Treponemicidal levels of amoxicillin in cerebrospinal fluid after oral administration. Sex. Transm. Dis. 10:148150.
23. Fernandez-Guerrero, M. L.,, C. Miranda,, C. Cenjor, and, F. Sanabria. 1988. The treatment of neurosyphilis in patients with HIV infection. JAMA 259:14951496.
24. Fleming, W. 1964. Syphilis through the ages. Med. Clin. N. Am. 48:587612.
25. Flood, J. M.,, H. S. Weinstock,, M. E. Guroy,, L. Bayne,, R. P. Simon, and, G. Bolan. 1998. Neurosyphilis during the AIDS epidemic, San Francisco, 1985-1992. J. Infect. Dis. 177:931940.
26. Goldmeier, D.,, and P. Hay. 1993. A review and update on adult syphilis, with particular reference to its treatment. Int. J. STD AIDS 4:7082.
27. Gordon, S. M.,, M. E. Eaton,, R. George,, S. Larsen,, S. A. Lukehart,, J. Kuypers,, C. M. Marra, and, S. Thompson. 1994. The response of symptomatic neurosyphilis to high-dose intravenous penicillin G in patients with human immunodeficiency virus infection. N. Engl. J. Med. 331:14691473.
28. Han, J. H.,, C. C. Lee, and, R. S. Crupi. 2004. Meningovascular syphilis and improvement with tissue-plasminogen activator (T-PA). Am. J. Emerg. Med. 22:426427.
29. Harris, D. E.,, D. S. Enterline, and, R. D. Tien. 1997. Neurosyphilis in patients with AIDS. Neuroimaging Clin. N. Am. 7:215221.
30. Hay, P. E.,, J. R. Clarke,, D. Taylor-Robinson, and, D. Goldmeier. 1990. Detection of treponemal DNA in the CSF of patients with syphilis and HIV infection using the polymerase chain reaction. Genitourin. Med. 66:428432.
31. Hernandez-Aguado, I.,, F. Bolumar,, R. Moreno,, F. J. Pardo,, N. Torres,, J. Belda,, A. Espacio, et al. 1998. False-positive tests for syphilis associated with human immunodeficiency virus and hepatitis B virus infection among intravenous drug abusers. Eur. J. Clin. Microbiol. Infect. Dis. 17:784787.
32. Hollander, H. 1988. Cerebrospinal fluid normalities and abnormalities in individuals infected with human immunodeficiency virus. J. Infect. Dis. 158:855858.
33. Holtom, P. D.,, R. A. Larsen,, M. E. Leal, and, J. M. Leedom. 1992. Prevalence of neurosyphilis in human immunodeficiency virus-infected patients with latent syphilis. Am. J. Med. 93:912.
34. Hook, E. W., III,, S. A. Baker-Zander,, B. L. Moskovitz,, S. A. Lukehart, and, H. H. Handsfield. 1986. Ceftriaxone therapy for asymptomatic neurosyphilis. Case report and Western blot analysis of serum and cerebrospinal fluid IgG response to therapy. Sex. Transm. Dis. 13(Suppl. 3):S185S188.
35. Inoue, R.,, S. Katayama,, T. Kusakabe,, T. Mori, and, S. Hori. 1995. Cerebral gumma showing linear dural enhancement on magnetic resonance imaging case report. Neurol. Med. Chir. (Tokyo) 35:813817.
36. Johns, D. R.,, M. Tierney, and, D. Felsenstein. 1987. Alteration in the natural history of neurosyphilis by concurrent infection with the human immunodeficiency virus. N. Engl. J. Med. 316:15691572.
37. Katz, D. A.,, and J. R. Berger. 1989. Neurosyphilis in acquired immunodeficiency syndrome. Arch. Neurol. 46:895898.
38. Katz, D. A.,, J. R. Berger, and, R. C. Duncan. 1993. Neurosyphilis. A comparative study of the effects of infection with human immunodeficiency virus. Arch. Neurol. 50:243249.
39. Kellett, M. W.,, G. R. Young, and, N. A. Fletcher. 1997. Paraparesis due to syphilitic aortic dissection. Neurology 48:221223.
40. Kuo, I. C.,, M. A. Kapusta, and, N. A. Rao. 1998. Vitritis as the primary manifestation of ocular syphilis in patients with HIV infection. Am. J. Ophthalmol. 125:306311.
41. Lair, L.,, and A. M. Naidech. 2004. Modern neuropsychiatric presentation of neurosyphilis. Neurology 63:13311333.
42. Lanska, M. J.,, D. J. Lanska, and, J. W. Schmidley. 1988. Syphilitic polyradiculopathy in an HIV-positive man. Neurology 38:12971301.
43. Liotta, E. A.,, G. W. Turiansky,, B. J. Berberian,, V. I. Sulica, and, M. M. Tomaszewski. 2000. Unusual presentation of secondary syphilis in 2 HIV-1 positive patients. Cutis 66:383386, 389.
44. Lukehart, S. A.,, E. W. Hook III,, S. A. Baker-Zander,, A. C. Collier,, C. W. Critchlow, and, H. H. Handsfield. 1988. Invasion of the central nervous system by Treponema pallidum: implications for diagnosis and treatment. Ann. Intern. Med. 109:855862.
45. Malone, J. L.,, M. R. Wallace,, B. B. Hendrick,, A. LaRocco, Jr.,, E. Tonon,, S. K. Brodine,, W. A. Bowler,, B. S. Lavin,, R. E. Hawkins, and, E. C. Oldfield III. 1995. Syphilis and neurosyphilis in a human immunodeficiency virus type-1 seropositive population: evidence for frequent serologic relapse after therapy. Am. J. Med. 99:5563.
46. Morrison, R. E.,, S. M. Harrison, and, E. C. Tramont. 1985. Oral amoxycillin, an alternative treatment for neurosyphilis. Genitourin. Med. 61:359362.
47. Musher, D. M.,, R. J. Hamill, and, R. E. Baughn. 1990. Effect of human immunodeficiency virus (HIV) infection on the course of syphilis and on the response to treatment. Ann. Intern. Med. 113:872881.
48. Phan, T. G.,, E. R. Somerville, and, S. Chen. 1999. Intractable epilepsy as the initial manifestation of neurosyphilis. Epilepsia 40:13091311.
49. Polnikorn, N.,, R. Witoonpanich,, M. Vorachit,, S. Vejjajiva, and, A. Vejjajiva. 1980. Penicillin concentrations in cerebrospinal fluid after different treatment regimens for syphilis. Br. J. Vener. Dis. 56:363367.
50. Roberts, M. C.,, R. A. Emsley, and, G. P. Jordaan. 1992. Screening for syphilis and neurosyphilis in acute psychiatric admissions. S. Afr. Med. J. 82:1618.
51. Rockwell, D. H.,, A. R. Yobs, and, M. B. Moore, Jr. 1964. The Tuskegee Study of Untreated Syphilis; the 30th year of observation. Arch. Intern. Med. 114:792798.
52. Rolfs, R. T.,, M. R. Joesoef,, E. F. Hendershot,, A. M. Rompalo,, M. H. Augenbraun,, M. Chiu,, G. Bolan,, S. C. Johnson,, P. French,, E. Steen,, J. D. Radolf,, S. Larsen, et al. 1997. A randomized trial of enhanced therapy for early syphilis in patients with and without human immunodeficiency virus infection. N. Engl. J. Med. 337:307314.
53. Rompalo, A. M.,, M. R. Joesoef,, J. A. O’Donnell,, M. Augenbraun,, W. Brady,, J. D. Radolf,, R. Johnson,, R. T. Rolfs,and the Syphilis and HIV Study Group. 2001. Clinical manifestations of early syphilis by HIV status and gender: results of the syphilis and HIV study. Sex. Transm. Dis. 28:158165.
54. Rosahn, P. 1947. Autopsy studies in syphilis. Information supplement #21. Washington DC: US Public Health Service Venereal Disease Division. J. Vener. Dis. 649.
55. Russouw, H. G.,, M. C. Roberts,, R. A. Emsley, and, R. Truter. 1997. Psychiatric manifestations and magnetic resonance imaging in HIV-negative neurosyphilis. Biol. Psychiatry 41:467473.
56. Smith, J. L.,, S. F. Byrne, and, C. R. Cambron. 1990. Syphiloma/gumma of the optic nerve and human immunodeficiency virus seropositivity. J. Clin. Neuroophthalmol. 10:175184.
57. Stepper, F.,, G. Schroth, and, M. Sturzenegger. 1998. Neurosyphilis mimicking Miller-Fisher syndrome: a case report and MRI findings. Neurology 51:269271.
58. Timmermans, M.,, and J. Carr. 2004. Neurosyphilis in the modern era. J. Neurol. Neurosurg. Psychiatry 75:17271730.
59. Tramont, E. C. 1976. Persistence of Treponema pallidum following penicillin G therapy. Report of two cases. JAMA 236:22062207.
60. Victor, M.,, and A. H. Ropper. 2000. Adams and Victor’s Principles of Neurology, 7th ed. McGraw-Hill, New York, NY.
61. Whang, K. K.,, M. G. Lee,, W. Lew, and, J. B. Lee. 1992. Production and characterization of monoclonal antibodies to Treponema pallidum. J. Dermatol. Sci. 4:2632.
62. Winston, A.,, D. Hawkins,, S. Mandalia,, F. Boag,, B. Azadian, and, D. Asboe. 2003. Is increased surveillance for asymptomatic syphilis in an HIV outpatient department worthwhile? Sex. Transm. Infect. 79:257259.
63. Winston, A.,, D. Marriott, and, B. Brew. 2005. Early syphilis presenting as a painful polyradiculopathy in an HIV positive individual. Sex. Transm. Infect. 81:133134.
64. Yim, C. W.,, N. M. Flynn, and, F. T. Fitzgerald. 1985. Penetration of oral doxycycline into the cerebrospinal fluid of patients with latent or neurosyphilis. Antimicrob. Agents Chemother. 28:347348.
65. Yinnon, A. M.,, P. Coury-Doniger,, R. Polito, and, R. C. Reichman. 1996. Serologic response to treatment of syphilis in patients with HIV infection. Arch. Intern. Med. 156:321325.
66. Zambrano, W.,, G. M. Perez, and, J. L. Smith. 1987. Acute syphilitic blindness in AIDS. J. Clin. Neuroophthalmol. 7:15.
67. Zifko, U.,, D. Wimberger,, K. Lindner,, G. Zier,, W. Grisold, and, E. Schindler. 1996. MRI in patients with general paresis. Neuroradiology 38:120123.

Tables

Generic image for table
TABLE 1

Syphilis of the spinal cord

Citation: Berger J, Berger A. 2009. Neurosyphilis in AIDS, p 363-373. In Goodkin K, Shapshak P, Verma A (ed), The Spectrum of Neuro-AIDS Disorders. ASM Press, Washington, DC. doi: 10.1128/9781555815691.ch25
Generic image for table
TABLE 2

Diagnosing neurosyphilis in the face of HIV infection

Citation: Berger J, Berger A. 2009. Neurosyphilis in AIDS, p 363-373. In Goodkin K, Shapshak P, Verma A (ed), The Spectrum of Neuro-AIDS Disorders. ASM Press, Washington, DC. doi: 10.1128/9781555815691.ch25

This is a required field
Please enter a valid email address
Please check the format of the address you have entered.
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error