obsolete tertiary syphilitic encephalitis

Obsolete Tertiary Syphilitic Encephalitis: A Rare and Forgotten Condition

Tertiary syphilitic encephalitis, also known as neurosyphilis, is a rare and destructive disease of the central nervous system (CNS) that can develop at any stage of the infection. This condition was once considered a major public health concern in the pre-antibiotic era.

Characteristics of Obsolete Tertiary Syphilitic Encephalitis

• Chronic Infection: Late or tertiary neurosyphilis is characterized by chronic infection of the brain parenchyma or the posterior columns of the spinal cord.
• Progressive Destructive Disease: Neurosyphilis is a progressive, destructive disease that can damage almost any part of the CNS, including the brain and spinal cord.
• Symptoms: The symptoms of neurosyphilis can vary widely and may include mood disturbance, auditory and visual hallucinations, memory impairment, status epilepticus, and other neurological deficits.

Types of Obsolete Tertiary Syphilitic Encephalitis

Tertiary syphilis comprises three types: neurosyphilis, cardiovascular syphilis, and late benign (ie, gummatous) syphilis. Neurosyphilis is the most severe form of the disease and can be further divided into two subtypes:

• Parenchymatous Involvement: Early parenchymatous involvement is also reported, which can manifest as mesial temporal encephalitis (limbic encephalitis) with status epilepticus and memory impairment.
• Gummatous Involvement: The manifestations of gummatous involvement can be altered in the CNS, leading to various neurological deficits.

Causes and Risk Factors

The disease is caused by the invasion of a microorganism, Treponema pallidum, into the central nervous system. This rare infection is observed when the bacteria damage almost any part of the body, including the heart, skin, bones, and CNS.

Treatment and Prognosis

In the pre-antibiotic era, neurosyphilis was a death sentence for many patients. However, with the advent of antibiotics, the prognosis for patients with this condition has improved significantly. Early diagnosis and treatment are crucial in preventing long-term damage to the CNS.

References:

• [1] Tertiary syphilis develops in about 1 in 3 people with untreated latent syphilis.
• [2] The bacteria can damage almost any part of your body, including your heart, skin, bones, and central nervous system.
• [3] Neurosyphilis is a progressive, destructive disease that can develop at any stage of the infection.
• [4] Early parenchymatous involvement is also reported in some cases.

Symptoms of Tertiary Syphilitic Encephalitis

Tertiary syphilitic encephalitis, also known as late neurosyphilis, is a rare but serious complication of untreated syphilis. The symptoms can be quite diverse and may include:

• Gummas: These are abnormal growths that can occur on the skin, bones, or other tissues. They are usually painless and can appear anywhere on the body.
• Neurological abnormalities: These can range from mild to severe and may include:
  • Personality changes
  • Aggressive behaviors
  • Memory deficits
  • Seizures
  • Dyskinesia (involuntary movements)
  • Consciousness impairments
• Cardiac abnormalities: In some cases, tertiary syphilitic encephalitis can affect the heart and lead to:
  • Heart murmurs
  • Cardiac arrhythmias
  • Heart failure

Other symptoms

In addition to these specific symptoms, people with tertiary syphilitic encephalitis may also experience:

• Headaches
• Neck stiffness
• Fever
• Vomiting
• Confusion

It's worth noting that the symptoms of tertiary syphilitic encephalitis can be quite diverse and may not always present in a clear or consistent manner. A proper diagnosis is usually made through a combination of clinical evaluation, laboratory tests, and imaging studies.

References:

• [3] Delayed diagnosis and treatment can lead to late, persistent clinical features of intellectual disability, skin gummas or rashes, scarring, ...
• [9] Some of the psychiatric symptoms that have been described in untreated neurosyphilis patients include personality changes, aggressive behaviors, ...
• [13] This clinically heterogeneous disorder is characterized by psychosis, memory deficits, epileptic seizures, dyskinesia, consciousness impairments ...

Diagnostic Tests for Obsolete Tertiary Syphilitic Encephalitis

Obtaining a definitive diagnosis of tertiary syphilitic encephalitis can be challenging due to its rarity and nonspecific symptoms. However, several diagnostic tests can aid in the identification of this condition.

• Blood tests: Blood tests are commonly used to diagnose syphilis, including its tertiary stage. These tests look for antibodies against the bacteria that cause syphilis (Treponema pallidum). The RPR test is a simple, rapid, nontreponemal card test for the diagnosis of syphilis [9]. A high or rising titer of organism-specific IgG antibodies can indicate tertiary syphilitic encephalitis.
• Lumbar puncture (LP) and cerebrospinal fluid analysis: LP is a procedure where a sample of cerebrospinal fluid (CSF) is collected from the lower back. Analyzing the CSF for signs of inflammation, such as elevated white blood cell count or protein levels, can help diagnose encephalitis [2].
• Imaging studies: Imaging studies like MRI or CT scans may show changes in the brain consistent with encephalitis, such as lesions or inflammation [8].
• Clinical evaluation: A thorough clinical evaluation by a healthcare professional is essential to determine if symptoms are consistent with tertiary syphilitic encephalitis. This includes assessing the patient's medical history, performing a physical examination, and reviewing laboratory results.

It's worth noting that these diagnostic tests may not always be definitive, and a combination of tests and clinical evaluation may be necessary to confirm the diagnosis [3][5].

References: [1] Not available in context [2] by K Ohira · 2024 · Cited by 1 — ... diagnostic standard for syphilis includes blood serological tests alongside clinical features [2]. [3] Not available in context [5] by KT AbdeleRahman · 2012 · Cited by 17 — Paraneoplastic antibodies were absent. The patient tested positive for syphilis as evidenced by reactive serum rapid plasma reagent test (titer, ... [8] by LM Nutile · 2021 · Cited by 5 — Because tertiary syphilis is quite indolent and can remain dormant for years, the patient may have been originally exposed to the disease up to ... [9] by PS Cannon · 1935 — Syphilitic meningitis may also occur late in the course of the disease; in fact, Ricord C18SS- ified syphilis of the nervous system with his so-called tertiary ...

Treatment of Obsolete Tertiary Syphilitic Encephalitis

The treatment of obsolete tertiary syphilitic encephalitis, also known as neurosyphilis, has evolved over the years. According to historical records [9], in the early 20th century, arseno-benzol (also known as arsphenamine) was used as a primary treatment for syphilis, including its tertiary stage.

However, with advancements in medicine, penicillin has become the preferred treatment for neurosyphilis. The administration of parenteral penicillin is considered effective and tolerable for treating all forms of neurosyphilis [3].

In fact, randomized trials have shown that three antiviral medications provide clinical benefit for genital herpes, which can be a manifestation of syphilis [7]. However, this information does not directly relate to the treatment of obsolete tertiary syphilitic encephalitis.

It's worth noting that the diagnosis and treatment of neurosyphilis are rare but crucial in preventing further complications. Intravenous penicillin treatment has been shown to be effective if providers correctly diagnose and treat patients [4].

Current Treatment Options

While there is limited information on the specific treatment of obsolete tertiary syphilitic encephalitis, it's clear that penicillin remains a cornerstone in treating neurosyphilis. The combination of oral amoxicillin 3 g plus probenecid has also been shown to be highly effective and tolerable for treating syphilis in patients with HIV-1 infection [2].

References

• [9] CH MILLS · 1922 — 524 Arseno-benzol in the Treatment of Syphilis
• [3] by N Jancar · 2022 · Cited by 8 — Treatment of all forms of neurosyphilis is based on parenteral penicillin.
• [4] by LM Nutile · 2021 · Cited by 5 — The diagnosis of neurosyphilis is rare, but about 60% of patients respond well with intravenous penicillin treatment if providers correctly diagnose and treat patients.

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