Antibiotic therapy for adults with neurosyphilis

Abstract

Description of the condition Neurosyphilis is an infection of the central nervous system (CNS) caused by Treponema pallidum, a spirochete capable of infecting almost any organ or tissue in the body causing protean clinical manifestations (Conde-Sendín 2002; Philip 2014). Neurosyphilis is a tertiary manifestation of syphilis. In many cases it goes unnoticed although approximately one-third of people infected with T. pallidum display cerebrospinal fluid (CSF) abnormalities, such as pleocytosis, elevated protein concentration, or reactivity of serological test, suggestive of invasion of the CNS by T. pallidum. Between 1% to 5% of patients with neurosyphilis develop neurological symptoms (Berger 2014; Marra 2009; O'Donnell 2005). The epidemiology of neurosyphilis has largely paralleled that of syphilis in general (Berger 2014). By the early 1950s, a dramatic decline occurred as a consequence of the widespread use of antibiotics (Berger 2014). However, incidence has increased due to the onset of the acquired immunodeficiency syndrome pandemic (van der Bij 2005). Currently, early neurosyphilis is more common than late neurosyphilis, and is most frequently seen in patients with human immunodeficiency virus (HIV) infection (van der Bij 2005). Worldwide, it was estimated that by 1999, 11.6 million new cases of syphilitic infection occurred per year (Berger 2014). In 1999, there were approximately 107,000 new cases in North America, 136,000 new cases in Western Europe, 3.8 million new cases in Sub-Saharan Africa, 4 million cases in South Asia, and 2.9 million cases in Latin America (Berger 2014). A study conducted in The Netherlands showed an incidence of neurosyphilis of 0.47 per 10,000 adults, about 60 new cases per year, and suggests that given the frequency of atypical manifestations of the disease, reintroduction of screening of neurosyphilis has to be considered (Daey 2014).