神经梅毒的抗生素治疗

神经梅毒是梅毒螺旋体侵犯中枢神经系统引起的病变,随着梅毒发病率的增高,神经梅毒的病例也屡见报道。青霉素能有效治疗神经梅毒,但是在治疗中也存在诸多困惑。文中简要介绍神经梅毒的分类及诊断,主要探讨神经梅毒的青霉素治疗方案、其他抗生素治疗神经梅毒的研究、治疗中可能出现的反应、治疗HIV(+)的神经梅毒患者和特殊神经梅毒患者的要求,以及治疗目标和疗效评估,并指出治疗中存在的矛盾。     

Ocular syphilis resurgence in an urban underserved community in the United States

AIM: To evaluate the clinical characteristics, demographics, and visual outcomes of patients with ocular syphilis at an urban hospital to increase awareness and assist in earlier diagnosis and treatment of the resurgent disease.METHODS: A retrospective chart review was performed on patients with ICD-9 and ICD-10 diagnosis codes correlating with syphilis or syphilis-related ocular diseases between 2010 and 2019. Variables evaluated included age, gender, race, vision, ocular findings, human immunodeficiency virus (HIV) status and men who have sex with men status, recreational drug and alcohol use.RESULTS: Ocular syphilis was diagnosed in 40 patients (53 eyes) of a total of 229 patients who tested positive for syphilis via serum and/or cerebrospinal fluid treponemal testing from 2010-2019. Among patients with ocular syphilis, most patients were males, aged 45 or above and Black, and had no diagnosed HIV infection. Approximately 50% patients had 20/40 vision or better. Nearly 50% had non-granulomatous anterior uveitis as their initial presentation, and 49% of patients had involvement of the posterior segment. Neovascular glaucoma (5.7%), papillitis (7.5%), vasculitis (5.7%), and retinal detachment (5.7%) were rarer presentations of the disease and were associated with a poorer visual prognosis.CONCLUSION: Given the increased prevalence and protean manifestations of syphilis, early diagnosis and treatment are paramount. More studies on ocular syphilis are warranted to understand this resurging disease.     

22例麻痹性痴呆临床分析

目的 探讨麻痹性痴呆的临床表现和特征以及早期诊断.方法 回顾性分析经临床和实验室确诊的22例GPI患者的有关临床资料.结果 22例患者中均有不同程度的智能下降,合并精神异常、行为异常、视幻觉或听幻觉及脑梗死等;所有患者血液、脑脊液快梅毒螺旋体血凝试验阳性;其影像学检查可发现异常.误诊率为45.45%(10/22).结论 麻痹性痴呆应重视梅毒血清和脑脊液抗体的检查,结合MRI等影像学资料,可提高其诊断准确性.     

Neurosyphilis presenting as autoimmune limbic encephalitis: A case report and literature review

Rationale:Neurosyphilis presenting as limbic encephalitis (LE) is an important differential diagnosis of autoimmune LE (ALE) defined by Graus in 2016. However, data on the clinical differences and similarities between neurosyphilis presenting as LE and ALE are limited. Herein, we report neurosyphilis presenting as ALE that fulfilled the main items of the Graus ALE criteria. Moreover, a literature review of neurosyphilis presenting as LE was performed.Patient concerns:A 66-year-old Japanese man developed nonconvulsive status epilepticus. He presented with progressive personality change and working memory deficits within 3 months prior to admission. A hyperintense lesion localized in the bilateral medial temporal area was observed on T2-weighted fluid-attenuated inversion recovery brain magnetic resonance imaging. Cerebrospinal fluid analysis showed mild pleocytosis and the presence of oligoclonal band. However, in-house assays did not detect antineuronal antibodies. Electroencephalogram showed lateralized rhythmic delta activity in the right temporal area. The serum and cerebrospinal fluid serological and antigen tests for syphilis had positive results.Diagnosis:ALE was initially suspected based on the patient’s symptoms and ancillary test findings that fulfilled the Graus ALE criteria. However, based on the positive confirmatory test results for syphilis, a diagnosis of neurosyphilis was eventually made.Intervention:The patient received intravenous midazolam, oral levetiracetam, and lacosamide to control nonconvulsive status epilepticus. In addition, he was treated with intravenous benzylpenicillin at a dose of 24 million units/day for 14 days.Outcomes:The patient’s cognitive function relatively improved after antibiotic treatment. However, he presented with persistent mild working memory deficit, which was evaluated with the Wechsler Adult Intelligence Scale, 3rd edition. Therefore, on day 103 of hospitalization, he was transferred to another hospital for rehabilitation and long-term care due to limitations in performing activities of daily living.Lessons:The present case was diagnosed with neurosyphilis presenting as ALE, but meanwhile, in most case, neurosyphilis presenting as LE developed at a slower progressive rate, and it had a broader or restricted involvement on brain MRI than ALE based on the literature review. Therefore, an appropriate differential diagnosis of LE can be obtained by identifying clinical differences between the 2 conditions.     

神经梅毒伴发精神症状研究进展

近10年来,神经梅毒发病率不断增加。精神症状是许多神经梅毒患者的首发症状,但表现多样且非特异。本文介绍了神经梅毒患者精神症状的表现,实验室和影像学诊断及治疗研究进展。     

晚期神经梅毒——麻痹性痴呆3例临床分析

目的:分析麻痹性痴呆的临床特征,为其早期诊治提供参考。方法:回顾性分析3例晚期神经梅毒——麻痹性痴呆患者临床特点并复习相关文献。结果:3例均为中年男性,均有非婚性生活史。3例均以神经精神症状为主,2例突发癫痫样抽搐。梅毒血清学检查甲苯胺红不加热血清试验(TRUST)和梅毒螺旋体颗粒凝集试验(TPPA)均阳性。脑脊液白细胞数升高,性病研究实验室试验(VDRL)阳性,2例脑脊液蛋白量增多。脑影像学检查无异常。结论:麻痹性痴呆误诊率高,中老年人有神经精神症状或初发癫痫者应排除神经梅毒,及早诊治可明显改善预后。     

RPR持续阳性梅毒患者脑脊液梅毒检测的意义

目的　观察RPR持续阳性梅毒患者无症状神经梅毒的发生情况 ,并探讨其临床意义。方法　对 69例经过数疗程常规驱梅治疗但RPR持续阳性 ( 1年以上 )且无神经系统临床表现的梅毒患者的脑脊液进行梅毒抗体检测。结果　有 16例梅毒患者脑脊液存在梅毒抗体。结论　部分RPR持续阳性梅毒患者存在无症状神经梅毒 ,可能是RPR持续阳性的原因之一。     

50例麻痹性痴呆患者认知障碍特征

目的探讨麻痹性痴呆（GPI）患者认知障碍的特征。 方法选取首都医科大学附属北京地坛医院神经内科确诊的麻痹性痴呆患者50例及同期相匹配的无症状型神经梅毒（ANS）患者50例作为研究对象,采用简易精神状态量表（MMSE）评估各组患者认知障碍情况,比较不同痴呆程度GPI患者量表评分,采用多因素线性回归分析GPI患者MMSE评分的影响因素。 结果GPI组患者MMSE总分（22.50 ± 5.26）低于ANS组（28.60 ± 1.56）,差异有统计学意义（t = 7.852、P < 0.001）。两组患者MMSE各分项得分比较显示,GPI组患者定向力（6.78 ± 2.50）、注意力与计算力（3.16 ± 1.82）、回忆力（1.48 ± 1.05）和语言能力（7.28 ± 1.49）等均显著低于ANS组（9.68 ± 0.55、4.30 ± 1.07、2.70 ± 0.54、8.00 ± 0.00）,差异均有统计学意义（t = 8.006、P = 0.000,t = 3.811、P < 0.001,t = 7.271,P < 0.001,t = 3.428、P = 0.001)。中重度GPI患者的定向力、记忆力、回忆力及语言能力等各分项得分低于轻度组,但差异无统计学意义（t = 0.791、P = 0.433,t = 0.350、P = 0.728,t = 0.250,P = 0.804,t = 1.452、P = 0.153）。多因素线性回归分析显示,年龄影响MMSE评分,GPI患者年龄越大,MMSE评分越低（β =-0.365、P < 0.001）。 结论麻痹性痴呆患者存在全面性认知功能下降,年龄因素对认知障碍具有影响。