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Kaur B, Khanna D. A Narrative Review of the Many Psychiatric Manifestations of Neurosyphilis: The Great Imitator. Cureus 2023; 15:e44866. [PMID: 37814742 PMCID: PMC10560128 DOI: 10.7759/cureus.44866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/07/2023] [Indexed: 10/11/2023] Open
Abstract
Neurosyphilis is an infection of the central nervous system caused by the spirochete, Treponema pallidum. New syphilis infections have been increasing around the world each year. This disease was much of a concern in the pre-penicillin era, where when left untreated many cases progressed to tertiary syphilis which can commonly manifest as neurosyphilis. Of particular interest, neurosyphilis has been linked to masquerading itself as various psychiatric conditions. This narrative review focuses on exploring psychiatric manifestations of neurosyphilis as well as the importance of screening in psychiatric settings and clinicians maintaining high clinical suspicion of the disease. A systematic search was conducted for published articles from 2003 to 2023 using PubMed, EMBASE, and Google Scholar. A total of 66 articles met the criteria and were used for detailed analysis, where psychiatric manifestations and clinical progression of patients were discussed in detail. Psychiatric manifestations that were explored include dementia, delirium, depression, mania, personality changes, and psychosis. One of the most common manifestations of neurosyphilis appears to be severe neurocognitive impairment. There are also rare psychiatric conditions neurosyphilis mimics that have been described in literature such as Capgras syndrome and Geschwind syndrome. A narrative review of the literature revealed a low level of clinical awareness of neurosyphilis as a possible etiology of various psychiatric disorders. This resulted in delayed or inaccurate diagnosis and consequently delayed initiation of adequate treatment. Considering that many psychiatric manifestations of neurosyphilis are reversible with proper treatment, it is imperative to implement routine screening for syphilis among psychiatric patients.
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Affiliation(s)
- Baneet Kaur
- Department of Medicine, Nova Southeastern University Dr. Kiran C. Patel College Of Osteopathic Medicine, Clearwater, USA
| | - Deepesh Khanna
- Department of Foundational Sciences, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
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Djukic M, Eiffert H, Lange P, Giotaki I, Seele J, Nau R. Serological testing for syphilis in the differential diagnosis of cognitive decline and polyneuropathy in geriatric patients. BMC Geriatr 2023; 23:274. [PMID: 37147588 PMCID: PMC10161663 DOI: 10.1186/s12877-023-03981-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 04/18/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND In the 19th century, neurosyphilis was the most frequent cause of dementia in Western Europe. Now dementia caused by syphilis has become rare in Germany. We studied whether routine testing of patients with cognitive abnormalities or neuropathy for antibodies against Treponema pallidum has therapeutic consequences in geriatric patients. METHODS A Treponema pallidum electrochemiluminescence immunoassay (TP-ECLIA) is routinely performed in all in-patients treated at our institution with cognitve decline or neuropathy and no or insufficient previous diagnostic workup. Patients with a positive TP-ECLIA treated from October 2015 to January 2022 (76 months) were retrospectively evaluated. In cases of positive TP-ECLIA, further specific laboratory investigations were performed to assess whether antibiotic therapy was indicated. RESULTS In 42 of 4116 patients (1.0%), TP-ECLIA detected antibodies directed against Treponema in serum. Specifity of these antibodies was ensured by immunoblot in 22 patients (11 × positiv, 11 × borderline values). Treponema-specific IgM was detectable in the serum of one patient, in 3 patients the Rapid Plasma Reagin (RPR) test, a modified Venereal Disease Research Laboratory test (VDRL), in serum was positiv. CSF analysis was performed in 10 patients. One patient had CSF pleocytosis. In 2 other patients, the Treponema-specific IgG antibody index was elevated. 5 patients received antibiotic therapy (4 × ceftriaxone 2 g/d i.v., 1 × doxycycline 300 mg/d p.o.). CONCLUSION In approx. 1‰ of patients with previously undiagnosed or not sufficiently diagnosed cognitive decline or neuropathy, the diagnostic workup for active syphilis resulted in a course of antibiotic treatment.
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Affiliation(s)
- Marija Djukic
- Institute of Neuropathology, Universitätsmedizin Göttingen, Göttingen, Germany
- Department of Geriatrics, Protestant Hospital Göttingen-Weende, An der Lutter 24, Göttingen, 37075, Germany
| | - Helmut Eiffert
- Institute of Neuropathology, Universitätsmedizin Göttingen, Göttingen, Germany
- Amedes MVZ for Laboratory Medicine, Medical Microbiology and Infectiology, Göttingen, Germany
| | - Peter Lange
- Department of Neurology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Ioanna Giotaki
- Department of Neurology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Jana Seele
- Institute of Neuropathology, Universitätsmedizin Göttingen, Göttingen, Germany
- Department of Geriatrics, Protestant Hospital Göttingen-Weende, An der Lutter 24, Göttingen, 37075, Germany
| | - Roland Nau
- Institute of Neuropathology, Universitätsmedizin Göttingen, Göttingen, Germany.
- Department of Geriatrics, Protestant Hospital Göttingen-Weende, An der Lutter 24, Göttingen, 37075, Germany.
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A Case Report of Neurosyphilis Limbic Encephalitis With Reversible Geschwind Syndrome and Mood Disorder. J Psychiatr Pract 2019; 25:222-226. [PMID: 31083037 DOI: 10.1097/pra.0000000000000390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Limbic encephalitis is an inflammatory process of the limbic structures, with polymorphic clinical features, caused by paraneoplastic and nonparaneoplastic conditions and infections. We describe a case of neurosyphilis limbic encephalitis, presenting with reversible Geschwind syndrome (hyperreligiosity and hypergraphia) and mood disorder due to the predominant involvement of left mesial temporal structures in a previously healthy 34-year-old, left-handed woman. Because neurosyphilis can mimic common neuropsychiatric syndromes, it should be included in the differential diagnosis of psychiatric disorders with suspected general medical causes. This case of nondominant limbic encephalopathy caused by syphilis infection highlights the relevance of a careful investigation for secondary psychotic, mood, and personality disorders when assessing new-onset psychiatric illness and the importance of a multidisciplinary approach to provide a better outcome in patients with neurosyphilis.
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Endres D, Dersch R, Hottenrott T, Perlov E, Maier S, van Calker D, Hochstuhl B, Venhoff N, Stich O, van Elst LT. Alterations in Cerebrospinal Fluid in Patients with Bipolar Syndromes. Front Psychiatry 2016; 7:194. [PMID: 28008318 PMCID: PMC5144108 DOI: 10.3389/fpsyt.2016.00194] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 11/18/2016] [Indexed: 01/22/2023] Open
Abstract
Bipolar disorder (BD) is a severe and lifelong condition. Primary endogenic polygenetic forms are common. Secondary organic forms have received increasing interest recently due to the detection of immunological encephalopathies that mimic various psychiatric syndromes, including BD. However, only limited data about routine findings of cerebrospinal fluid (CSF) analyses in BD are available. Therefore, we investigated the frequency of alterations in the CSF in patients with BD and the association with autoantibodies, cerebral magnetic resonance imaging, and electroencephalography findings. CSF samples of patients with BD collected from January 1998 until December 2015 were analyzed retrospectively. Patients with preexisting causes for alterations in the CSF (e.g., patients with obvious past or current neurological disorders) were excluded. In total, 63 patients with BD fulfilled the inclusion criteria for the study. In 1.6% of the patients with BD, an increased white blood cell count was found in the CSF. Increased albumin quotients were found in 12.9% of the patients, oligoclonal bands (OCBs) in 1.6%, and increased immunoglobulin (Ig) G indices in 3.2% (OCBs were not measured in case of increased IgG indices). No significant differences in CSF findings were found between patients with manic and depressive episodes. The main findings of this open uncontrolled study are that alterations in the CSF may be found in a small, but potentially relevant, subgroup of patients with BD. These findings are discussed in light of the new concepts of mild encephalitis and immunological encephalopathy. The detection of patients with possibly secondary organic bipolar syndromes could open up new causal treatment options with immunomodulatory medication.
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Affiliation(s)
- Dominique Endres
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg , Freiburg , Germany
| | - Rick Dersch
- Department for Neurology, University Medical Center Freiburg , Freiburg , Germany
| | - Tilman Hottenrott
- Department for Neurology, University Medical Center Freiburg , Freiburg , Germany
| | - Evgeniy Perlov
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg , Freiburg , Germany
| | - Simon Maier
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg , Freiburg , Germany
| | - Dietrich van Calker
- Department for Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany; Forensic Psychiatric Service, University of Bern, Bern, Switzerland
| | - Benedikt Hochstuhl
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg , Freiburg , Germany
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg , Freiburg , Germany
| | - Oliver Stich
- Department for Neurology, University Medical Center Freiburg , Freiburg , Germany
| | - Ludger Tebartz van Elst
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, University Medical Center Freiburg , Freiburg , Germany
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Abstract
OBJECTIVE Neurosyphilis is caused by dissemination into the central nervous system of Treponema pallidum. Although the incidence of syphilis in the Netherlands has declined since the mid-1980s, syphilis has re-emerged, mainly in the urban centres. It is not known whether this also holds true for neurosyphilis. METHODS The epidemiology of neurosyphilis in Dutch general hospitals in the period 1999-2010 was studied in a retrospective cohort study. Data from the Dutch sexually transmitted infection (STI) clinics were used to analyse the number of patients diagnosed with syphilis in this period. RESULTS An incidence of neurosyphilis of 0.47 per 100 000 adults was calculated, corresponding with about 60 new cases per year. This incidence was higher in the western (urbanised) part of the Netherlands, as compared with the more rural areas (0.6 and 0.4, respectively). The number of patients diagnosed with syphilis in STI clinics increased from 150 to 700 cases in 2004 and decreased to 500 new cases in 2010. The sex ratio was in favour of men, yielding a percentage of 90% of the syphilis cases and of 75% of the neurosyphilitic cases. The incidence of neurosyphilis was highest in men aged 35-65 years, and in women aged 75 years and above. The most frequently reported clinical manifestation of neurosyphilis was tabes dorsalis. In this study, 15% of the patients were HIV seropositive. CONCLUSION The incidence of neurosyphilis in a mixed urban-rural community such as the Netherlands is comparable to that in other European countries. Most patients are young, urban and men, and given the frequent atypical manifestations of the disease reintroduction of screening for neurosyphilis has to be considered.
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Friedrich F, Aigner M, Fearns N, Friedrich ME, Frey R, Geusau A. Psychosis in neurosyphilis -- clinical aspects and implications. Psychopathology 2014; 47:3-9. [PMID: 23711816 DOI: 10.1159/000350059] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 02/09/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The World Health Organization estimates that 10-12 million new syphilis infections occur each year. Without treatment, years to decades after initial infection, 30% of affected individuals may develop tertiary syphilis, which can manifest as neurosyphilis. The aim of this review is to evaluate the research literature examining the psychopathological manifestations of psychosis in association with neurosyphilis. METHOD The authors performed a systematic electronic search for published studies (1995-2012). The following databases were used: Medline, Embase and the Cochrane Library as well as the search engines Scopus and Google Scholar. RESULTS 61 articles were used for detailed analysis. Psychotic symptoms due to neurosyphilis are numerous and can inform differential diagnosis for many psychotic manifestations according to ICD-10 or DSM-IV. CONCLUSION Due to our results, current epidemiological data, and the difficulties in differential diagnosis of neurosyphilis, routine screening tests are still recommended in the psychiatric field. Long-term psychiatric input, with periodic syphilis titre controls, seems indicated in individuals affected by neurosyphilis with psychiatric symptoms. Furthermore, individuals with mental health problems may be at higher risk of acquiring syphilis.
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Affiliation(s)
- F Friedrich
- Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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KATUNIN GL, MELEKHINA LYE, FRIGO NV. Neurosyphilis: epidemiology, pathogenesis, clinical course and laboratory diagnostics. VESTNIK DERMATOLOGII I VENEROLOGII 2013. [DOI: 10.25208/vdv563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The article describes the key achievements and problems related to studying neurosyphilis. It also shows the dynamics of neurosyphilis incidence in Russia and abroad from the early twentieth century and up to present. The article also describes issues related to the pathogenesis, clinical course and pathomorphism of the disease. The authors present current approaches to the laboratory diagnostics of neurosyphilis.
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Dickmann PJ, Nelson KJ. A 43-Year-Old Man with Memory and Behavior Disturbance. Psychiatr Ann 2012. [DOI: 10.3928/00485713-20121203-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Oberlerchner H, Stromberger H. [Fates at the psychiatric hospital of Klagenfurt during National Socialism]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2012; 27:79-83. [PMID: 22990646 DOI: 10.1007/s40211-012-0034-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/20/2012] [Indexed: 06/01/2023]
Abstract
In this article the fate of Mr. B. is described as an example for the fate of hundreds of mentally ill patients of the "Landes-Irrenanstalt of Klagenfurt", murdered during the era of National Socialism. This extraordinary fate marks two outstanding aspects of history of medicine, the treatment of syphilis with malaria and the organised mass murder of mentally ill people during the cynic era of National Socialism. Beyond this historical perspective reconstructive biographical work together with relatives is presented as a proactive duty of psychiatric institutions.
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Affiliation(s)
- Herwig Oberlerchner
- Abteilung für Psychiatrie und Psychotherapie, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt, Österreich
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