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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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: Forbes.com 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
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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
Discussion Facial nerve palsy has been known for centuries, but in 1821 unilateral facial nerve paralysis was described by Sir Charles Bell. Bell’s palsy (BP) is a unilateral, acute facial paralysis that is clinically diagnosed after other etiologies have been excluded by appropriate history, physical examination and/or laboratory testing or imaging. Symptoms include abnormal movement of facial nerve. It can be associated with changes in facial sensation, hearing, taste or excessive tearing. The right and left sides are equally affected but bilateral BP is rare (0.3%). Paralysis can be complete or incomplete at prese...
Source: PediatricEducation.org - Category: Pediatrics Authors: Tags: Uncategorized Source Type: news
ConclusionsOur results show that Tp0136 facilitates differential level of binding to cell lines representing various host tissues, which highlights the importance of this protein in colonization of human organs byT.pallidum and resulting syphilis pathogenesis.
Source: PLoS Neglected Tropical Diseases - Category: Tropical Medicine Authors: Source Type: research
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