Treponema pallidum.docx

OK, good evening,everybody, today we talk about the diagnosis and therapy of neurophillisis. Syphilis is a sexually transmitted disease caused by Treponema pallidum. Human beings are the only host. The disease has been known about and studied since at least the early 16th century. 1.At first,What is neurosyphilis? Neurosyphilis refers to infection of CNS by treponema pallidum, subspecies pallidum,which can occur at any time after initial infection. As the picture shown ,The Pathogens are spirochetes, which are thin, delicate, helically coiled organisms,which are measuring 5-20 m in length. They are readily destroyed by soap and water, drying, or temperatures higher than 42C. This spiral bacterium can be seen with dark-field microscopy or immunofluorescence. The bacterium gains access to the body by way of minute abrasions of the skin or mucous membranes. Its subsequent attachment to host cells involves the action of a mucopolysaccharidase.2.There are five different possible forms of neurosyphilis:which include : Asymptomatic Neurosyphilis, Meningeal Neurosyphilis, Meningovascular Neurosyphilis, Tabes Dorsalis, General Paresis.3Now, we first learn about Asymptomatic Neurosyphilis.This is the most common type of neurosyphilis. It usually occurs before the symptoms from syphilis become visible. In this form of neurosyphilis, you wont feel sick or experience any signs of neurologic disease, Asymptomatic neurosyphilis is characterized by a reactive nontreponemal CSF serology result. But the CSF usually reveals elevated protein levels, lymphocytic pleocytosis, and a glucose level within the reference range; It is reported that ,Of patients with neurosyphilis , 10% have CSF protein values of less than 46 mg/dL, 70% have CSF protein values of 46-100 mg/dL, and 10% have CSF protein values greater than 100 mg/dL. While The CSF WBC count is normal in 70% of patients;It is 4 times more likely to be lymphocytic rather than characterized by polymorphonuclear neutrophils3.The second type is acute Meningeal Neurosyphilis .This form of the disease usually shows up anywhere from a few weeks to a few years after a person contracts syphilis. Patients with acute syphilitic meningitis have signs of meningeal irritation ,Which includes nausea, vomiting, a stiff neck, and headache. It may also cause a loss of hearing or vision.Cranial neuropathies are common ,including cranial nerves7, 8, 6, and 2,which show different manifestations. But, fever is unusual.4.The third is meningovascular syphilis.The most common presentation of this type is a stroke syndrome involving the middle cerebral artery or the branches of the basilar artery . The pathology of meningovascular syphilis is endarteritis with perivascular inflammation .This causes fibroblastic proliferation of the intima, thinning of the media, and fibrous and inflammatory changes in the adventitia, with lymphocytic and plasma cell infiltration.Rarely, aneurysmal dilation results. Luminal narrowing leads to cerebrovascular thrombosis, ischemia, and infarction.5.Tabes Dorsalis Tabes dorsalis is a slowly degenerative disease involving the posterior columns and posterior roots of the spinal cord. This form of neurosyphilis is rare. Its symptoms include pains in the abdomen, arms, and legs; loss of pain sensation, loss of peripheral reflexes, bladder incontinence, difficulties with balance, an altered walk, and impairment of vibration and position senses.6.The last type is General Paresis .This disease is sometimes referred to as dementia paralytica. Typically, it occurs approximately 20-30 years after the initial infection. It represents a chronic progressive frontotemporal damage with resultant ongoing loss of cortical function. This form can appear decades after a person is infected with syphilis and can cause lasting mental damage. However, it is fairly rare today because of advances in the screening, treatment, and prevention of sexually transmitted infections. If it develops, general paresis may lead to several health problems, including: Paranoia ,mood swings,emotional troubles,personality changes,loss of the ability to utilize languageIt can also progress to dementia. 7.Now is about Testing for Neurosyphilis .The first is Physical Exam.To find out if a man have neurosyphilis, your may start by Physical Exam: including muscle reflexes and the function of cranial nerves and so on Blood Test is necessary.There are a variety of blood tests that will show whether a man currently have syphilis or if he had an infection in the past. The VDRL test and the rapid plasma reagin (RPR) test are nontreponemal tests, whereas FTA-ABS and MHA-TP (microhemagglutination assay-T pallidum ) are treponemal tests. The latter two are very reactive tests in secondary, latent, tertiary, and quaternary syphilis. They confirm the diagnosis.Lumbar puncture is necessary too. This procedure will provide a sample of the fluid around your brain and spinal cord. CSF abnormalities include elevated protein levels and pleocytosis, which are found in up to 70% of patients. In addition, the CSF VDRL test rsult is also reactive. Imaging TestsYou might also order a CT or MRI scan. These tests allow you to look at the spinal cord, brain, and brainstem, which can also show evidence of the disease.At last ,is Treatment Options for Neurosyphilis . The antibiotic penicillin is used to treat syphilis and neurosyphilis. It may be injected or taken orally. The usual regimen lasts 10 to 14 days. The antibiotics probenecid and ceftriaxone are often used in conjunction with penicillin. Depending on the case, your patients may need to stay in the hospital while being treated. Neurosyphilis is especially co