Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Ten years ago it might have been predicted that neurosyphilis would disappear, but this has not happened. It has altered in character so that almost all of the cases seen are meningovascular in type. Even with the acceleration of neurosyphilis that occurs with immunodeficiency it is unlikely that there will be a resurgence of tabes dorsalis, general paralysis of the insane (GPI) or gummatous involvement of the central nervous system. These entities are still reported as single cases in the literature and this is unlikely to change. Diagnostic vigilance is required in respect of meningovascular syphilis which presents in so many different guises, and it seems prudent to advocate that all patients admitted to hospital with a neurological or psychiatric disorder should have syphilis serology checked routinely, though it no longer seems necessary to perform the tests routinely on outpatients. Advances in serological testing have made the diagnosis of syphilis easier to establish, and further advances in the diagnosis of neurosyphilis are likely with the perfection of techniques to culture treponemes in the cerebrospinal fluid (CSF) or the detection of surface antigens in the CSF. Although syphilis remains a treatable disease the impact of AIDS has necessitated modifications to the treatment regime. It is now recommended that patients who are HIV-positive and who have early syphilis should be treated as for neurosyphilis, as the former regime for treating primary syphilis may not be adequate.
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PMID:Neurosyphilis yesterday and today. 158 38

Neurosyphilis is caused by the bacterium Treponema pallidum subspecies pallidum (T. pallidum). The organism gains entry into the central nervous system (CNS) early (primary syphilis or chancre phase) in the course of infection. While most patients are able to mount an immune response that effectively clears CNS invasion without long-term complications, a minority go on to develop asymptomatic or symptomatic neurosyphilis. Neurosyphilis has been divided into early and late stages. The early stages include asymptomatic meningitis, symptomatic meningitis, gumma, and meningovascular syphilis, while the late stages include dementia paralytica and tabes dorsalis. Ocular and otologic syphilis can occur at any time but often accompany the acute meningitis of early neurosyphilis. The diagnosis of symptomatic neurosyphilis requires meeting clinical, serologic, and cerebrospinal fluid (CSF) criteria, while the diagnosis of asymptomatic neurosyphilis relies on serologic and CSF criteria alone. In the last several decades, a persistent rise in syphilitic meningitis and other forms of early neurosyphilis have been seen in the human immunodeficiency virus-positive population, principally in men who have sex with men. This article reviews the clinical presentation, diagnosis, and treatment of neurosyphilis, and it addresses the controversy regarding the role of lumbar puncture early in the course of infection.
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PMID:Neurosyphilis. 3153 85