Neurosyphilis and Lyme neuroborreliosis

Purpose of review Neurosyphilis (NS) and Lyme neuroborreliosis (LNB) are spirochetal diseases with distinct clinical manifestations. The diagnosis of NS remains challenging due to imperfect diagnostic criteria and testing modalities. With LNB, misconceptions about diagnosis and treatment lead to considerable morbidity and drug related adverse effects. Recent findings Although studies continue investigating alternate approaches and new diagnostic tests for NS, few data exist to change current approaches to diagnosis, management or follow up. In the diagnosis of LNB, the chemokine CXCL13 shows promising diagnostic accuracy. A systematic review discourages the use of cell-based assays when investigating Lyme disease. Clinical studies show no benefit from extended antibiotic treatment for patients with unspecific symptoms labelled as having Lyme disease. Summary The diagnosis of NS may be delayed due to a lack of specificity of findings, low suspicion for syphilis, and/or similarities in presentation to other diseases. A high index of suspicion for syphilis is required provide timely diagnosis and management of NS. Fortunately, penicillin remains the treatment of choice. Overdiagnosis and overtreatment in patients labelled as having Lyme disease can be avoided by an evidence-based approach towards diagnosis and treatment.
Source: Current Opinion in Neurology - Category: Neurology Tags: CNS INFLAMMATORY DISORDERS: INFECTIOUS DISEASES: Edited by Erich Schmutzhard Source Type: research

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Trop Doct. 2021 Nov 18:494755211049031. doi: 10.1177/00494755211049031. Online ahead of print.ABSTRACTSpirochaetes comprise a heterogenous group of gram negative, motile, spiral shaped bacteria. Some of these pathogens are known to cause numerous human diseases such as Lyme disease, relapsing fever, syphilis and leptospirosis. However, intestinal spirochetosis is a rare condition. Patients frequently present with long-term complaints of loose stools, abdominal pain and weight loss and rectal bleeding. Hence to establish a diagnosis an endoscopy with biopsy is required. In this article, we describe four such cases, having d...
Source: Tropical Doctor - Category: Tropical Medicine Authors: Source Type: research
Many diseases in medicine have been dubbed “Great Imitators” to include syphilis and, more recently, Lyme disease. In the orthopedic world, patellar instability can be added to that list. I recently offered to see a young athlete who injured his knee. He was from the high school football team that my partner takes care of. He had an effu sion and was difficult to examine, so I assumed that he had an ACL injury, sent the boy off for an MRI, and arranged for follow-up with him. I later learned that the player actually had a patellar dislocation and had a TT-TG measurement of 25 mm.
Source: Clinics in Sports Medicine - Category: Sports Medicine Authors: Tags: Foreword Source Type: research
AbstractBackground/Aims Dactylitis is commonly associated with psoriatic arthritis, and regularly presents at Rheumatology clinics. We discuss a case where progressive systemic symptoms lead to the consideration of alternate diagnoses.Methods A 46-year-old Nepalese woman presented to the Rheumatology department with a 3 month history of diffuse swelling of the right middle finger proximal interphalangeal joint, with the appearance of dactylitis. There was pain on movement, but no other joint involvement. Simultaneously she noticed blu rred and decreased vision, which on review by the ophthalmologists, was diagnos...
Source: Rheumatology - Category: Rheumatology Source Type: research
Syphilis is a global, re-emerging sexually transmitted infection and congenital syphilis remains a major cause of adverse pregnancy outcomes due to bacterial infection in developing nations with a high rate of fetus loss. The molecular mechanisms involved in pathogenesis of the causative agent, Treponema pallidum subsp. pallidum remain poorly understood due to the difficulties of working with this pathogen, including the inability to grow it in pure culture. To reduce the spread of syphilis, we must first increase our knowledge of the virulence factors of T. pallidum and their contribution to syphilis manifestations. Tp095...
Source: Frontiers in Microbiology - Category: Microbiology Source Type: research
Lyme and Covid-19 are replacing syphilis as the great masquerader. They share many puzzling symptoms and are all easily missed.
Source: Healthcare News - Category: Pharmaceuticals Authors: Tags: Healthcare /healthcare Innovation /innovation Editors' Pick editors-pick Source Type: news
Abstract Leptospira interrogans, Borrelia burgdorferi, and Treponema pallidum are important pathogenic spirochetes. The incidence of human diseases caused by pathogenic spirochetes, e.g., leptospirosis, Lyme disease, and syphilis, has been recently increasing, posing a threat to public health. Mechanisms of spirochete pathogenicity are not yet fully understood, and no safe and effective vaccine to prevent and control the infection by pathogenic spirochetes is currently available.In this article, we review the progress of research into the pathogenic spirochete vaccine, mainly in terms of vaccine types.The developm...
Source: International Journal of Clinical Chemistry - Category: Chemistry Authors: Tags: Clin Chim Acta Source Type: research
We present a case of a man with genital condyloma acuminatum with a positive T. pallidum IHC stain but negative T. pallidum serologies and no syphilitic symptoms. It has been shown that the T. pallidum antibody IHC can cross-react, staining other spirochetes, including Borrelia burgdorferi and the Brachyspira family of intestinal spirochetes. Because of the proximity of our patient's lesions to the anus, and the persistently negative T. pallidum serologies, we believe nontreponemal spirochetes colonized the condyloma, giving a false-positive T. pallidum IHC. This cross-reactivity is a potential diagnostic pitfall and is im...
Source: The American Journal of Dermatopathology - Category: Pathology Tags: Brief Report Source Type: research
The “Christmas tree” orientation of scaling lesions along the skin tension (Langer) lines in pityriasis rosea is well known. This pattern is best appreciated on complete examination of the trunk, in which the eruption follows the long axis of the V-shaped lines of the upper chest and back, emanating around the axillae, and running transversely along the abdominal wall and lower back. Secondary syphilis has a similar presentation. When patients present with asymptomatic, larger, nonscaling patches along Langer lines, another condition deserves diagnostic consideration.
Source: Journal of the American Academy of Dermatology - Category: Dermatology Authors: Tags: JAAD Online Source Type: research
AbstractPurpose of reviewTo explore and critically appraise the published data on the current and emerging treatment modalities for neuroretinitis.Recent findingsThe optimum treatment strategy for neuroretinitis due toBartonella henselae in immunocompetent individuals is not clear and a matter of debate. The role of systemic corticosteroids in infectious neuroretinitis and the optimum immunosuppressive regimen for use in recurrent idiopathic neuroretinitis also remains ill defined.SummaryThere is no class 1 evidence to support a specific treatment strategy for neuroretinitis. For uncomplicatedB. henselae–associated n...
Source: Current Treatment Options in Neurology - Category: Neurology Source Type: research
We describe a 20-year-old woman with left seventh nerve palsy secondary to latent syphilis of unknown duration, with complete recovery after penicillin G benzathine. In addition to reactive rapid plasma reagin and positive T. pallidum particle agglutination testing, Lyme enzyme-linked immunosorbent assay was equivocal, and Lyme Western blot was positive for immunoglobulin M. In syphilis, Lyme enzyme-linked immunosorbent assay may be falsely positive, but Western blot is known to remain negative. Similarly, in LD, fluorescent treponemal antibody absorption testing may be falsely positive, but rapid plasma reagin remains non...
Source: Infectious Diseases in Clinical Practice - Category: Infectious Diseases Tags: Case Reports Source Type: research
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