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![]() įor the reasons outlined, we performed routine testing of patients with cognitive abnormalities or neuropathy for antibodies against TP. Because of the variety of existing and developing techniques for the diagnosis of neurosyphilis, clinical suspicion continues to play the main role. A positive TP-AI can persist after adequately cured infection. The assessment of the synthesis of TP-specific antibodies in CSF by the Treponema-specific antibody index (TP-AI) is a sensitive method to prove that the bacteria entered the central nervous system (CNS) and produced a local immune reaction. Among the diagnostic tests for neurosyphilis, the Venereal Disease Research Laboratory (VDRL) test and the Rapid Plasma Reagin (RPR) test in the cerebrospinal fluid (CSF) are considered the most specific. For these reasons, neurosyphilis is a diagnostic challenge. Probably as a consequence of antibiotic treatment courses for other indications with partial effectivity also against Treponema pallidum (TP), atypical forms, which cannot be categorized into one of the classical forms, are becoming increasingly common. In the last decades, after the introduction of antibiotic treatment, many cases of neurosyphilis with symptoms not fitting into the classical forms of secondary and tertiary syphilis have been published (e.g. Neuropathy is a typical symptom of tabes dorsalis occurring 15 to 25 years after infection. It may occur in meningovascular neurosyphilis (often occurring from 5 to 12 years after infection), but the most frequent cause of syphilitic dementia is general paresis (usually occurring from 10 to 25 years after infection). In newer guidelines, syphilis serology is not considered mandatory for the differential diagnosis of dementia, but is recommended “in individual cases” not further specified (e.g., ).ĭementia is a symptom of late (“tertiary”) forms of syphilis. Traditionally, laboratory tests on the differential diagnosis of dementia included syphilis serology in addition to a complete blood count, electrolyte and metabolic screen, thyroid panel, vitamin B12 and folate levels, urinalysis, chest radiograph and electrocardiogram, and head CT scan. As a consequence of penicillin treatment, syphilis infections and syphilis-caused dementia have become rare in developed countries. Syphilis was very frequent, there was no adequate treatment for early syphilis, and life expectancy was low, i.e., degenerative dementias were much rarer than today. In the 19th century and the first half of the 20th century, neurosyphilis world-wide was the most frequent cause of dementia. 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.Ĭognitive decline and neuropathy are two key symptoms of tertiary syphilis. 5 patients received antibiotic therapy (4 × ceftriaxone 2 g/d i.v., 1 × doxycycline 300 mg/d p.o.). In 2 other patients, the Treponema-specific IgG antibody index was elevated. CSF analysis was performed in 10 patients. 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. Specifity of these antibodies was ensured by immunoblot in 22 patients (11 × positiv, 11 × borderline values). In 42 of 4116 patients (1.0%), TP-ECLIA detected antibodies directed against Treponema in serum. In cases of positive TP-ECLIA, further specific laboratory investigations were performed to assess whether antibiotic therapy was indicated. Patients with a positive TP-ECLIA treated from October 2015 to January 2022 (76 months) were retrospectively evaluated. MethodsĪ 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. We studied whether routine testing of patients with cognitive abnormalities or neuropathy for antibodies against Treponema pallidum has therapeutic consequences in geriatric patients. Now dementia caused by syphilis has become rare in Germany. In the 19th century, neurosyphilis was the most frequent cause of dementia in Western Europe.
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