The difficulties of diagnosis of neurosyphilis at the modern stage
https://doi.org/10.51793/OS.2021.24.10.005
Abstract
At the modern stage in Russia, we can observe the tendency of increase in recording cases of neurosyphilis against the background of reduction of morbidity rate of syphilitic infection in general. Increase of neurosyphilis morbidity reflects the situation of frequency increase of primary forms of syphilis in the end of the 90s – beginning of the 2000s, when our country faced with epidemic of this disease. Most experts assume that treponema pallidum always penetrates in the nervous system, in some cases its presence being transitory, in other cases, we observe asymptomatic persistence, and in some, neurosyphilis manifests. Currently, most often syphilis therapy takes place on outpatient basis with repository forms ((Benzathine benzylpenicillins) which create long (during several days and up to 18-21 days after one-time administration), but low concentration of penicillin in the body. These drugs badly overcome blood-brain barrier, consequently, if syphilitic meningitis is latent and not diagnosed, liquor sanation is not achieved, and potential development of neurosyphilis manifest forms is retained. The authors describe the difficulties of diagnosis of neurosyphilis and a clinical case of ischemic stroke in a young patient with neurosyphilis. Diagnosis of syphilis was confirmed by laboratory studies; liquor tests and clinical data allowed to diagnose meningovascular syphilis. The authors highlight that special attention should be paid to observance of algorithm of clinical-laboratory examination of patients if they have disorders in functions of central and peripheral nervous systems, organs of vision and hearing, regardless of remoteness of supposed infection and supposed seroresistance. As neurosyphilis is interdisciplinary problem, complex clinical-laboratory and clinical-instrumental examination of patients is required, involving medical specialists of different profiles.
About the Authors
T. L. Vizilo
FSBEI HE Kemerovo State Medical University of the Healthcare Ministry of the Russian Federation
Россия
Россия
Tatiana L. Vizilo, Dr. of Sci. (Med.), Professor
22A Voroshilova str., Kemerovo, 650056
T. V. Poponnikova
FSBEI HE Kemerovo State Medical University of the Healthcare Ministry of the Russian Federation
Россия
Россия
Tatiana V. Poponnikova, Dr. of Sci. (Med.), Professor
22A Voroshilova str., Kemerovo, 650056
I. F. Fedoseeva
FSBEI HE Kemerovo State Medical University of the Healthcare Ministry of the Russian Federation
Россия
Россия
Irina F. Fedoseeva, MD, Assistant Professor
22A Voroshilova str., Kemerovo, 650056
E. D. Vasenina
Novokuznetsk branch of Kemerovo Cardiology Center named after L. S. Barbarash
Россия
Россия
Ekaterina D. Vasenina, Head of the Department of Neurology
35 Kuznetsova str., Novokuznetsk, 654041
References
1. Skalnaya A., Fominykh V., Ivashchenko R. et al. Neurosyphilis in the modern era: Literature review and case series // Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia. 2019; 69: 67-73. DOI: 10.1016/j.jocn.2019.08.033.
2. Chebotarev V. V., Chebotareva N. V. Aktualna li problema sifilisa segodnya? [Is the problem of syphilis topical today?] // Klinicheskaya dermatologiya i venerologiya. 2015; 14 (3): 52-56. https://doi.org/10.17116/klinderma201514352-56.
3. Krasnoselskikh T. V., Sokolovsky E. V. Soveremennye standarty terapii sifilisa: sravnenie rossiyskikh i zarubezhnykh klinicheskikh rekomendatsiy (Soobschenie II) [Modern standards of syphilis therapy: comparison of Russian and foreign clinical guidelines (Message II)] // Vestnik dermatologii i venerologii. 2015; 2: 23-40.
4. Marra C. et al. Enhanced molecular typing of treponema pallidum: geographical distribution of strain types and association with neurosyphilis // J Infect Dis. 2010; 202: 1380.
5. Marra C. M. et al. Toll-like receptor polymorphisms are associated with increased neurosyphilis risk // Sex Transm Dis. 2014; 41 (7): 440-446.
6. Dmitriev G. A. Neyrosifilis: problem i resheniya. [Neurosyphilis: problems and solutions]. Moscow: Binome, 2016. 376 p.
7. Poverennova I. E., Khivintseve E. V., Oleynik A. N., Zakharov A. V. Neyrosifilis kak faktor riska razvitiya ostrogo narusheniya mozgovogo krovoobrascheniya [Neurosiphilis as a risk factor for development of acute disorder of cerebral blood flow] // Izvestiya Samarskogo nauchnogo tsentra Rossiyskoy Akademii Nauk. 2015; 5 (2): 403-407.
8. Kalashnikova L. A., Dobrynina L. A., Legenko M. S., Dreval M. V., Nuzhny E. P., Loseva O. K. Neyrosifilis s postepenno narastayuschey mozzhechkovoy atoksiey i ishemicheskimi insultami [Neurosyphilis with gradually increasing cerebellar ataxia and ischemic strokes] // Nervnye bolezni. 2019; 1: 28-33. DOI: 10.24411/2071-5315-2018-12076.
9. Cohen D., Shpitalni G., Lifshitz Y., Anani S., Eyal A., Segal G. A Stroke in the Young with Surprising Recovery // Eur. J. Case Rep. Intern Med. 2019; 6 (5): 000200. DOI: 10.12890/2019_000200.
10. Mavlyutova G. I., Kochergina O. S., Rakhmatullina E. F. Neyrosifilis [Neurosyphilis] // Prakticheskaya meditsina. 2014; 2.
11. Ahbeddou N., El Alaoui Taoussi K., Ibrahimi A., Ait Ben Haddou E. H., Regragui W., Benomar A., Yahyaoui M. Stroke and syphilis: A retrospective study of 53 patients // Rev. Neurol. (Paris). 2018; 174 (5): 313-318. DOI: 10.1016/j.neurol.2017.07.014.
12. Dologlanin S. I., Kryuchkov M. S. Porazheniya nervnoy sistemy pri neyrosifilise [Lesions of nervous system in neurosyphilis] // Sinergiya nauk. 2017. V. 2, № 9. Pp. 134-138.
13. Bichun E. A., Chukhlovina M. L., Zaslavsky D. V., Egorova Yu. S., Parkhomenko S. I. Klinicheskie osobennosti pozdnego neyrosifilisa na sovremennom etape [Clinical features of late neurosyphilis at the modern stage] // Fundamentalnye issledovaniya. 2014; 10-8: 1461-1466.
14. Voznyuk I. A., Zaslavsky D. V., Bichun E. A., Chukhlovina M. L., Savello V. E., Shumakova T. A. Neotlozhnaya nevrologiya: mezenkhemalny i parenkhimatozny neurosifilis (diagnostichesky algoritm). [Emergency neurology: mesenchymal and parenchymatous neurosyphilis (diagnostic algorithm)]. Methodical guidelines for doctors. Saint-Petersburg, 2018. 32 p.
15. Kovkova G. Yu., Vintonyak A. P., Matusevich S. L. et al. Osobennosti sotsialnogo statusa bolnykh neyrosifilisom [Features of social status of neurosyphilis patients] // Universitetskaya meditsina Urala. 2017. V. 3, № 3 (10). Pp. 19-21.
16. Shprakh V. V., Kostina U. S. Osobennosti rannego neyrosifilisa u VICh-infitsirovannykh bolnykh [Features of early neurosyphilis in patients with HIV infection] // Sibirskoe meditsinskoe obozrenie. 2018; 1 (109): 66-71.
17. Krasnoselskikh T. V., Manasheva E. B., Gezey M. A. Problemy diagnostiki i lecheniya sifilisa pri koinfektsii virusom immunodefitsita cheloveka [Problems of diagnostics and treatment of syphilis in coinfection with human immunodeficiency virus] // HIV-infections and immunosuppressions. 2018; 10 (2): 43-53. https://doi.org/10.22328/2077-9828-2018-10-2-43-53.
18. Dmitriev G. A. et al. Diagnostika neyrosifilisa: sovremennye nauchno-prikladnye podkhody [Diagnostic of neurosyphilis: modern scientific-applied approaches] // Klinicheskaya dermatologiya i venerologiya. 2019. V. 18. №. 2. Pp. 130-136.
19. Krasnoselskikh T. V., Sokolovsky E. V. Neyrosifilis: Nereshennye problem i nevyuchennie uroki (chast II) [Neurosyphilis: unsolved problems and unlearned lessons (part II)] // Sovremennye problem dermatovenerologii, immunologii i vrachebnoy kosmetologii. 2011; 6: 7-11.
20. Clinical guidelines «Syphilis» / Approved by the Russian Community of Dermatovenerologists and Cosmetologists at XVI all-Russian conference of dermatovenerologists and cosmetologists. Moscow, June 16th 2016.
21. Federal clinical guidelines on managing patients with syphilis. Moscow, 2015. 44 p.
22. Vizilo T. L., Pisareva I. A., Agadjanyan G. I. Differentsialnaya diagnostika ishemicheskikh insultov i opukholey golovnogo mozga [Differential diagnostics of ischemic strokes and cerebral tumors] // Politravma. 2009; 1: 58-61.
23. Subbotin A. V., Semenov V. A., Etenko D. A., Moshneguts S. V., Gurevich I. N. Redky sluchay ostrogo ishemicheskogo insulta v rezultate skleroziruyuschego sifiliticheskogo porazheniya sonnykh arteriy [A rare case of acute ischemic stroke as a result of sclerosing lesion of carotid arteries] // Fundamentalnaya i klinicheskaya meditsina, 2017; 1: 121-126.
Review
For citations:
Vizilo T.L., Poponnikova T.V., Fedoseeva I.F., Vasenina E.D. The difficulties of diagnosis of neurosyphilis at the modern stage. Lechaschi Vrach. 2021;(10):28-35. (In Russ.) https://doi.org/10.51793/OS.2021.24.10.005
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