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Gu H, Xu Y, Xu J, Zhuang J. A rare case report of bilateral vestibulopathy due to otosyphilis. Medicine (Baltimore) 2024; 103:e38149. [PMID: 38758873 PMCID: PMC11098173 DOI: 10.1097/md.0000000000038149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/16/2024] [Indexed: 05/19/2024] Open
Abstract
RATIONALE Bilateral vestibulopathy is an important cause of imbalance. There are multiple etiologies of bilateral vestibulopathy (BVP), but reports of BVP due to otosyphilis are rare. PATIENT CONCERNS A 39-year-old male was referred to our medical center due to vertigo, persistent dizziness and gait disturbance for 2 months. DIAGNOSES Bilateral vestibulopathy due to otosyphilis was considered in this case, as confirmed through analyses of vestibular function, laboratory tests, and penicillin treatment. INTERVENTIONS The patient was was treated with a high dose of penicillin G (24 × 106 IU/d) for 14 days. OUTCOMES The patient's symptoms had improved greatly following treatment, with dizziness and gait disturbance having completely resolved at 3 months following hospital discharge. LESSONS Bilateral vestibulopathy should be considered when evaluating patients with acute or subacute persistent dizziness. Clinicians should also be aware of the potential for otosyphilis among patients who report BVP.
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Affiliation(s)
- Huanhuan Gu
- Department of Neurology, Second Affiliated Hospital of Naval Medical University, Shanghai, Huangpu District, Shanghai, China
| | - Yixin Xu
- Department of Neurology, Second Affiliated Hospital of Naval Medical University, Shanghai, Huangpu District, Shanghai, China
| | - Jin Xu
- Department of Neurology, Second Affiliated Hospital of Naval Medical University, Shanghai, Huangpu District, Shanghai, China
| | - Jianhua Zhuang
- Department of Neurology, Second Affiliated Hospital of Naval Medical University, Shanghai, Huangpu District, Shanghai, China
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2
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Hamill MM, Ghanem KG, Tuddenham S. State-of-the-Art Review: Neurosyphilis. Clin Infect Dis 2024; 78:e57-e68. [PMID: 37593890 DOI: 10.1093/cid/ciad437] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Indexed: 08/19/2023] Open
Abstract
We review key concepts in the diagnosis, treatment, and follow-up of individuals with neurosyphilis. We describe the epidemiology of syphilis in the United States, highlight populations that are markedly affected by this infection, and attempt to estimate the burden of neurosyphilis. We describe the cardinal clinical features of early and late (tertiary) neurosyphilis and characterize the clinical significance of asymptomatic neurosyphilis in the antibiotic era. We review the indications for cerebrospinal fluid (CSF) examination and the performance characteristics of different CSF assays including treponemal and lipoidal antibodies, white cell count, and protein concentration. Future biomarkers and the role of imaging are briefly considered. We review preferred and alternative treatments for neurosyphilis and evidence for their use, including evidence for the use of enhanced intramuscular benzathine penicillin G to supplement intravenous penicillin.
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Affiliation(s)
- Matthew M Hamill
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Khalil G Ghanem
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan Tuddenham
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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3
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Rodríguez-Martín M, Cantón-Benito E, Méndez-Legaza JM, Veiga-Alonso A, González-Aguado R, Morales-Angulo C. Sudden hearing loss secondary to syphilis. Am J Otolaryngol 2024; 45:104234. [PMID: 38430842 DOI: 10.1016/j.amjoto.2024.104234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/23/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Syphilis is a sexually transmitted disease caused by the spirochete Treponema pallidum, whose incidence has increased significantly in recent years. Some patients may develop sudden hearing loss (SHL) against the background of otosyphilis. OBJECTIVES The objective of our study was to determine whether routine lues serology is useful in patients presenting with sudden hearing loss. METHODS For this purpose, all cases of SHL treated in our hospital during a period of 6 years were propectively collected. The frequency of positivity for syphilis in these patients, the treatment received, and their evolution were determined. RESULTS Of the total number of patients evaluated during that period, 71 underwent serological screening for syphilis, of whom 2 (2.8 %) presented positive screening antibodies. In one of them, the RPR was normal and had been treated with lues a few years before. After treatment there was no improvement. The other patient, diagnosed with otosyphilis with unconfirmed suspected neurological disease, showed normalization of hearing after specific treatment. CONCLUSIONS Since it is a potentially curable disease, despite the low overall frequency of syphilis in patients with SHL it is advisable to perform serological screening for syphilis in high risk patients (e.g., incarceration, multiple recent sexual partners, men who have sex with men) or atypical clinical presentation (e.g., concurrent neuropathies).
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Affiliation(s)
- Minerva Rodríguez-Martín
- Department of Otolaryngology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Elena Cantón-Benito
- Department of Microbiology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - José Manuel Méndez-Legaza
- Department of Microbiology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Aida Veiga-Alonso
- Department of Otolaryngology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Rocío González-Aguado
- Department of Otolaryngology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Carmelo Morales-Angulo
- Department of Otolaryngology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain; Faculty of Medicine, University of Cantabria, Spain; IDIVAL, Santander, Cantabria, Spain.
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4
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Navarrete J, Saavedra-Portales S. Syphilis for dermatologists: Current concepts. Clin Dermatol 2024; 42:134-154. [PMID: 38142790 DOI: 10.1016/j.clindermatol.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
Dermatologists are familiar with the classic aspects of syphilis. Our objective in this update is to display novel features of sexually acquired syphilis, its pathophysiology, natural history, atypical clinical variants, skin of color, clinical pearls, and prospects. Textbook knowledge, congenital syphilis, epidemiology, and historical data are excluded.
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Affiliation(s)
- Jorge Navarrete
- Department of Dermatology, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; Department of Dermatology and Sexually Transmitted Infections Clinic, Hospital Padre Hurtado, Santiago, Chile.
| | - Stephanie Saavedra-Portales
- Department of Dermatology and Sexually Transmitted Infections Clinic, Hospital San Juan de Dios, Santiago, Chile
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Kurtzman JS, Sioshansi PC. Infectious causes and mimickers of meniere's disease. Curr Opin Otolaryngol Head Neck Surg 2023; 31:332-339. [PMID: 37387674 DOI: 10.1097/moo.0000000000000909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
PURPOSE OF REVIEW To review the evidence of a possible viral etiology of Meniere's disease, the role of antiviral therapy, as well as other infectious disease processes that may mimic Meniere's disease. Better understanding of the etiology of Meniere's disease and the role of various infectious disease processes may allow for more effective diagnosis and management. RECENT FINDINGS There is evidence that viral infections - to Herpes simplex virus, cytomegalovirus, Epstein Barr virus, influenza, adenovirus, Coxsackie virus B, and Varicella Zoster Virus - may be involved in the development of Meniere's disease, however the evidence is inconsistent and the underlying mechanism remains theoretical. Nevertheless, antiviral therapy may be effective for a subset of patients with Meniere's disease. Lastly, other infectious diseases including Lyme disease and syphilis can present with symptoms similar to Meniere's disease. It is important to discern these from Meniere's disease to determine the appropriate treatment. SUMMARY There is a paucity of high-quality evidence to support a viral etiology of Meniere's disease, and the current evidence appears circumstantial and inconsistent. Additional research is necessary to establish the mechanism and causative pathogens. Antiviral therapy may provide therapeutic benefit for a subset of patients with Meniere's disease. Furthermore, clinicians should be aware of other infectious mimics of Meniere's disease and include them in the differential diagnosis of patients presenting with Meniere's-like symptoms. Research on this subject continues to evolve, and data from these studies represent a growing repository of evidence that can be used to guide clinical decision-making.
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Affiliation(s)
- Joey S Kurtzman
- Department of Otolaryngology - Head & Neck Surgery, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
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Chen X, Zheng X, Chen Y, Xu S. Otosyphilis as a rare cause of secondary benign paroxysmal positional vertigo: a case report. J Int Med Res 2023; 51:3000605231153317. [PMID: 37365906 DOI: 10.1177/03000605231153317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Otosyphilis is a rare cause of audiovestibular dysfunction that can easily be misdiagnosed. Here, we report a rare case in which a patient presented with secondary benign paroxysmal positional vertigo (BPPV) 2 weeks after symptoms of otosyphilis appeared. The Dix-Hallpike test showed a classical response in the head-hanging left position. The patient was treated with intravenous penicillin G and the canalith repositioning maneuver, which completely resolved the vertigo. The patient's audiovestibular symptoms resolved gradually. The elevated cerebrospinal fluid (CSF) white blood cell (WBC) count returned to normal and the results of the Treponema pallidum particle agglutination (TPPA) test were negative at the 3-month follow-up. This report suggests that otosyphilis should be considered in the differential diagnosis of audiovestibular dysfunction in patients at risk. Additionally, clinicians should remain vigilant about the possibility of secondary BPPV in patients with otosyphilis who report positional vertigo.
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Affiliation(s)
- Xiang Chen
- Department of Internal Medicine, Shengsi County People's Hospital, Zhoushan City, China
| | - Xiaofen Zheng
- Department of Internal Medicine, Shengsi County People's Hospital, Zhoushan City, China
| | - Yingzhi Chen
- Department of Internal Medicine, Shengsi County People's Hospital, Zhoushan City, China
| | - Shanhu Xu
- Department of Neurology, Zhejiang Hospital, Hangzhou City, China
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7
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Grundfast KM, Jamil TL. Evaluation and Management of Tinnitus: Are There Opportunities for Improvement? Otolaryngol Head Neck Surg 2023; 168:45-58. [PMID: 35349391 DOI: 10.1177/01945998221088286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/02/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To review current information about diagnosis and management of tinnitus aiming to identify opportunities for achieving a cost-effective, efficient, evidence-based approach that meets the needs of tinnitus sufferers. DATA SOURCES PubMed/MEDLINE. REVIEW METHODS In total, 249 relevant published reports were reviewed. Pertinent keywords and MeSH terms identified reports via PubMed and EMBASE. Acknowledged experts were consulted on ways to improve tinnitus management. CONCLUSIONS There may be opportunities to improve evaluation and management of patients with tinnitus using modern modes of communication and a multidisciplinary therapeutic approach. IMPLICATIONS FOR PRACTICE Tinnitus can adversely affect quality of life while being time-consuming and costly to evaluate and manage. Based on both personal experience and the reports of others, patients with tinnitus who choose to see a physician primarily want to know two things: (1) that the tinnitus that is so distressing will not remain at the same level of severity forever and (2) that something can be done to help cope with the tinnitus that is so annoying. Recent advancements in internet communications, social media, information technology, artificial intelligence, machine learning, holistic medical care, mind-body integrative health care, and multidisciplinary approaches in medical therapeutics may be possibly making new ways of meeting the needs of patients with tinnitus.
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Affiliation(s)
- Kenneth M Grundfast
- Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Otology Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Taylor L Jamil
- Boston University School of Medicine, Boston, Massachusetts, USA
- Boston University School of Public Health, Boston, Massachusetts, USA
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Jackson DA, McDonald R, Quilter LAS, Weinstock H, Torrone EA. Reported Neurologic, Ocular, and Otic Manifestations Among Syphilis Cases-16 States, 2019. Sex Transm Dis 2022; 49:726-732. [PMID: 35819903 PMCID: PMC9481702 DOI: 10.1097/olq.0000000000001673] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Syphilis can cause neurologic, ocular, or otic manifestations, possibly resulting in permanent disability or death. In 2018, the Centers for Disease Control and Prevention began collecting syphilis clinical manifestation data via the National Notifiable Diseases Surveillance System. We present the first reported US syphilis neurologic, ocular, and otic manifestation prevalence estimates. METHODS We reviewed 2019 National Notifiable Diseases Surveillance System data to identify jurisdictions reporting 70% or greater of syphilis cases 15 years or older with clinical manifestation data (considered "complete reporting"). Among these jurisdictions, we determined reported neurologic, ocular, and otic manifestation prevalence, stratified by demographic, behavioral, and clinical characteristics. RESULTS Among 41,187 syphilis cases in 16 jurisdictions with complete reporting, clinical manifestations were infrequently reported overall: neurologic (n = 445, 1.1%), ocular (n = 461, 1.1%), otic (n = 166, 0.4%), any (n = 807, 2.0%). Reported clinical manifestation prevalence was highest among cases 65 years or older (neurologic, 5.1%; ocular, 3.5%; otic, 1.2%) and those reporting injection drug use (neurologic: 2.8%; ocular: 3.4%; otic: 1.6%). Although reported neurologic and ocular manifestation prevalence was slightly higher among human immunodeficiency virus (HIV)-infected versus HIV-negative persons, approximately 40% of cases with manifestations were HIV-negative. Reported otic manifestation prevalence was similar regardless of HIV status. When stratifying by HIV status and syphilis stage, reported prevalence was highest among HIV-infected persons with unknown duration/late syphilis (neurologic, 3.0%; ocular, 2.3%; otic, 0.7%). CONCLUSIONS Reported neurologic, ocular, and otic manifestation prevalence was low among syphilis cases, but these data are likely an underestimate given potential underreporting. Reported clinical manifestation frequency, including among HIV-negative persons, emphasizes the importance of evaluating all syphilis cases for signs/symptoms of neurosyphilis, ocular syphilis, and otosyphilis.
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Affiliation(s)
- David A Jackson
- From the Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Zhou J, Zhang H, Tang K, Liu R, Li J. An Updated Review of Recent Advances in Neurosyphilis. Front Med (Lausanne) 2022; 9:800383. [PMID: 36203756 PMCID: PMC9530046 DOI: 10.3389/fmed.2022.800383] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
Neurosyphilis is caused by Treponema pallidum invading the central nervous system, of which the incidence is increasing worldwide. Due to its variable clinical manifestations, diagnosis of neurosyphilis remains challenging, especially the asymptomatic form. This review focuses on recent advances in neurosyphilis, including epidemiology, clinical manifestations, laboratory findings, comorbidities, diagnosis, treatment, prognosis, and basic research. The expansion of men who have sex with men and the infection of human immunodeficiency virus mainly accounted for the increasing incidence of neurosyphilis. The rate of some historically described forms of neurosyphilis in the pre-antibiotic era declined significantly; atypical features are more prevalent. Neurosyphilis, regarded as a great mimicker for neuro-ophthalmic, audio-vestibular, and psychiatric disorders, often presents concomitantly with other diseases, including metabolic disorders. Studies on long non-coding RNAs, miRNAs, chemokines, and metabolites in peripheral blood and cerebrospinal fluid may facilitate exploring the pathogenesis and identifying novel biomarkers of neurosyphilis. The drug resistance of Treponema pallidum to penicillin has not been reported; ceftriaxone was proposed to be more effective than penicillin, whereas few randomized controlled trials supported this view. This study may pave the way for further research, especially the diagnosis and treatment of neurosyphilis.
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Affiliation(s)
- Jia Zhou
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hanlin Zhang
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Keyun Tang
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Runzhu Liu
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jun Li
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Jun Li
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He S, Messner AH, Mirani G. Otosyphilis: A Rare Cause of Reversible Hearing Loss in a Teenage Male. Cureus 2022; 14:e23468. [PMID: 35494944 PMCID: PMC9038597 DOI: 10.7759/cureus.23468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/05/2022] Open
Abstract
A high index of suspicion and a thorough neurotologic examination at the onset of presentation are imperative to generate the diagnosis of otosyphilis. Complete audiologic recovery is rare but possible in approximately 20%-25% of patients after appropriate treatment. We present a case of reversible hearing loss secondary to otosyphilis in a teenage male patient with a new diagnosis of human immunodeficiency virus (HIV). Audiology findings were consistent with mixed hearing loss. Lumbar puncture results were consistent with neurosyphilis. Prompt treatment with a 14-day course of intravenous penicillin led to the complete recovery of hearing. In this case report, the pathophysiology, symptomology, and management of otosyphilis are discussed.
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11
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Otosyphilis with Clinical and Serologic Responses with Weekly Intramuscular Penicillin: A Case Report and Literature Review. Case Rep Infect Dis 2022; 2022:3152383. [PMID: 35251721 PMCID: PMC8896948 DOI: 10.1155/2022/3152383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/03/2022] [Indexed: 12/03/2022] Open
Abstract
With the increasing prevalence of syphilis in different parts of the world, it is important to be cognizant of serious forms of syphilis. Otosyphilis is a rare form of syphilis with an extremely high rate of complications. Early diagnosis is essential to prevent a complete loss of hearing and decrease mortality. We present a unique case of otosyphilis who presented with left hearing loss, tinnitus, and vertigo, with audiometric findings confirming the hearing loss. An MRI brain showed asymmetric enhancement of the left cochlea and vestibular apparatus. She initially received oral steroids and trans-tympanic steroid injections with transient improvement of symptoms. She was diagnosed with syphilis through contact tracing after her ex-boyfriend tested positive. She received three weekly doses of intramuscular penicillin. Interestingly, her symptoms, rapid plasma regain (RPR) titer, and audiometry findings markedly improved. Once a diagnosis of otosyphilis was established, she received 14 days of intravenous penicillin.
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12
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Thomas JP, Dazert S, Prescher A, Voelter C. Aetiology of Ludwig van Beethoven's hearing impairment: hypotheses over the past 100 years - A systematic review. Eur Arch Otorhinolaryngol 2021; 278:2703-2712. [PMID: 33230590 PMCID: PMC8266716 DOI: 10.1007/s00405-020-06467-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/28/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Even 250 years after Beethoven's birth, the irrevocable cause of his hearing impairment remains unclear despite multiple publications by different professional groups. This study aimed to analyse the development of the most likely aetiologies during the last 100 years by a systematic review of the relevant medical literature. METHODS A systematic review of medical literature in PubMed®, PubMed Central®, and Web of Science® for the period 1920-2020 was conducted. Medical publications between 1920 and 1935 were additionally searched manually by review of reference lists. Studies were eligible when a statement regarding the most likely aetiology of the hearing loss of Beethoven was the aimed objective of the publication. RESULTS 48 publications were included. The following aetiologies were supposed: otosclerosis (n = 10), syphilis (n = 9), Paget's disease (n = 6), neural deafness (n = 5), immunopathy with inflammatory bowel disease, neural deafness with otosclerosis, sarcoidosis or lead intoxication (n = 2), and systemic lupus erythematosus, trauma, labyrinthitis or inner ear disease (n = 1). There is an ongoing effort with a mean publication frequency in this topic of 0.48/year. From 1920 to 1970, otolaryngologists were the group with the highest interest in this field (67%), whereas since 1971 most authors have belonged to non-otolaryngologic subspecialities (81%). CONCLUSION Over the past 100 years, otosclerosis and syphilis were predominantly supposed to be the underlying causes. The hypothesis of syphilis-although rejected for a long time-has had a remarkable revival during the past 20 years. Regarding the outcome following therapeutic intervention by cochlear implantation, the differential diagnosis of neural deafness would be relevant today.
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Affiliation(s)
- Jan Peter Thomas
- Department of Otorhinolaryngology, Head and Neck Surgery, Katholisches Klinikum, Ruhr University Bochum, Bleichstr. 15, 44787, Bochum, Germany.
- Department of Otorhinolaryngology, Head and Neck Surgery, St.-Johannes-Hospital, Academic Teaching Hospital of the University of Münster, Johannesstr. 9-17, 44137, Dortmund, Germany.
| | - Stefan Dazert
- Department of Otorhinolaryngology, Head and Neck Surgery, Katholisches Klinikum, Ruhr University Bochum, Bleichstr. 15, 44787, Bochum, Germany
| | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy, RWTH Aachen University, Wendlingweg 2, 52057, Aachen, Germany
| | - Christiane Voelter
- Department of Otorhinolaryngology, Head and Neck Surgery, Katholisches Klinikum, Ruhr University Bochum, Bleichstr. 15, 44787, Bochum, Germany
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13
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Traidl S, Angela Y, Stender A, Kulberg A, Tronnier M, Prenzler NK, Wattjes MP, Kapp A, Stangel M, Schacht V, Werfel T. A rare case of neuro- and otosyphilis in secondary syphilis. J Eur Acad Dermatol Venereol 2021; 35:e823-e826. [PMID: 34242450 DOI: 10.1111/jdv.17512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/12/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022]
Affiliation(s)
- S Traidl
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany.,Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hannover, Germany
| | - Y Angela
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - A Stender
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Germany
| | - A Kulberg
- Department of Dermatology, Venereology, and Allergolgy, HELIOS Hospital, Hildesheim, Germany
| | - M Tronnier
- Department of Dermatology, Venereology, and Allergolgy, HELIOS Hospital, Hildesheim, Germany
| | - N K Prenzler
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Hannover, Germany
| | - M P Wattjes
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - A Kapp
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - M Stangel
- Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hannover, Germany.,Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Germany.,Center for Systems Neuroscience, University of Veterinary Medicine Hannover, Hannover, Germany
| | - V Schacht
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - T Werfel
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany.,Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hannover, Germany
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14
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Hearing Loss Due to Otosyphilis: Imaging Case of the Month. Otol Neurotol 2021; 42:e1634-e1635. [PMID: 34172666 DOI: 10.1097/mao.0000000000003244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The number of cases of syphilis has increased in the United States and in many high-income nations. Otosyphilis is a less recognized complication of syphilis that can lead to irreversible sensorineural hearing loss. Different pathophysiological mechanisms have been proposed to explain hearing loss in otosyphilis. We review the literature on otosyphilis in adults and propose the need for future work in this field to identify better ways to diagnose, treat, and manage this disease. Patients with syphilis should be screened routinely for hearing loss, and all patients with new, sudden, or fluctuating sensorineural hearing loss should be evaluated for syphilis.
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Abstract
PURPOSE OF REVIEW In the context of a resurgence of syphilis worldwide, it can be anticipated that a rise in cases of ocular, otic, and neurosyphilis will also be seen. This article reviews the current epidemiology, manifestations, and approach to management and treatment. RECENT FINDINGS Although studies continue investigating alternate approaches and new diagnostic tests for ocular and neurosyphilis, few data exist to change current diagnostic algorithms and approaches to diagnosis, management, or follow up. SUMMARY The diagnosis of neurologic and eye/ear involvement with syphilis may be delayed because of a lack of specificity of findings, low suspicion for syphilis, fluctuation in symptoms, and/or similarities in presentation to other diseases. A high index of suspicion for syphilis and re-education about the protean manifestations of syphilis by all clinicians is required provide timely diagnosis and management of ocular, otic, and neurosyphilis.
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Syphilis 2021 - die Infektionszahlen steigen stetig. ÄSTHETISCHE DERMATOLOGIE & KOSMETOLOGIE 2021. [PMCID: PMC7878652 DOI: 10.1007/s12634-021-1430-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Syphilis 2020 - die Infektionszahlen steigen stetig. GYNÄKOLOGIE + GEBURTSHILFE 2020. [PMCID: PMC7714672 DOI: 10.1007/s15013-020-3175-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Marra CM, Maxwell CL, Ramchandani M, Tantalo LC, Sahi SK, Dunaway SB, Litvack JR. Hearing loss in individuals at risk for neurosyphilis. Int J STD AIDS 2020; 31:1178-1185. [PMID: 32928054 DOI: 10.1177/0956462420947584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Otosyphilis is a serious complication of syphilis.329 participants enrolled in a study of cerebrospinal fluid (CSF) abnormalities in syphilis underwent portable audiometry (250 Hz to 8000 Hz at 5-75 dB); it was repeated in 33 after otosyphilis treatment. Treponema pallidum spp pallidum (T. pallidum) DNA in blood was quantitated by polymerase chain reaction. Odds ratios (ORs) or hazard ratios (HRs) with 95% confidence intervals (CIs) were determined by logistic, ordinal or Cox regression.166 (50.5%) had normal hearing; 15 (4.6%) had low frequency (LF) loss alone, 93 (28.3%) had high frequency (HF) loss alone, and 55 (16.7%) had both. Adjusted odds of any hearing loss were higher with detectable blood T. pallidum DNA (3.00 [1.58-5.69], p = 0.001), CSF pleocytosis (2.02 [1.12-3.66], p = 0.02), and older age (2.22 per 10-year increase, [1.70-2.91], p < 0.001). HRs of normalization of LF and HF loss were lower for older individuals (0.20 [0.07-0.63, p = 0.005] and 0.22 [0.05-0.94, p = 0.04]), and HRs for normalization of HF loss were lower for those with more severe loss (0.09 [0.02-0.43], p = 0.002), and in those with CSF pleocytosis (0.32 [0.11-0.96], p = 0.04).Older age and CSF pleocytosis increase the likelihood of otosyphilis and impair hearing recovery after otosyphilis treatment.
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Affiliation(s)
- Christina M Marra
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - Clare L Maxwell
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - Meena Ramchandani
- Department of Medicine (Infectious Diseases), University of Washington School of Medicine, Seattle, WA, USA.,Public Health - Seattle & King County HIV/STD Program, Seattle, WA, USA
| | - Lauren C Tantalo
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - Sharon K Sahi
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - Shelia B Dunaway
- Department of Medicine (Infectious Diseases), University of Washington School of Medicine, Seattle, WA, USA
| | - Jamie R Litvack
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
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Affiliation(s)
- Khalil G Ghanem
- From the Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore (K.G.G.); and the Department of Medicine and Division of Infectious Diseases and Immunology, University of Massachusetts Medical Center, Worcester (S.R., P.A.R.)
| | - Sanjay Ram
- From the Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore (K.G.G.); and the Department of Medicine and Division of Infectious Diseases and Immunology, University of Massachusetts Medical Center, Worcester (S.R., P.A.R.)
| | - Peter A Rice
- From the Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore (K.G.G.); and the Department of Medicine and Division of Infectious Diseases and Immunology, University of Massachusetts Medical Center, Worcester (S.R., P.A.R.)
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