[Current aspects of neurosyphilis: therapy-resistant cases with high-dosage penicillin?]

The occurrence of atypical and abortive cases of neurosyphilis in the last two decades has tended to make this rather infrequent, treatable condition difficult to diagnose; therefore it is advisable to perform large-scale serologic tests among neurologic and psychiatric patients. The diagnosis is confirmed by the detection of treponema antibodies in the central nervous system (TPHA index, ITpA index). When serologic test results are positive, secondary diagnostic criteria are provided by pathologic CSF findings (elevated cell count, humoral immune reaction). The course of the disease and the CSF parameters are favourably influenced by appropriate therapy. Over the last two decades, there has been an increase in the number of reports of cases refractory to the low-dose penicillin treatment recommended by the WHO and the CDC until two years ago. There have also been reports of treponema resistance in association with this therapeutic strategy and furthermore of failure to detect CSF concentrations of penicillin capable of eradicating the spirochetes. Counter measures have been taken worldwide in the last few years in the form of high-dose penicillin therapy (approx. 20 million IU/day for 2 to 3 weeks), in the hope that this would eliminate the resistance. We observed two patients treated with 18 and 24 million IU penicillin for 10 and 14 days respectively. The pathogens remained resistant, and the disease continued to progress. In one of these cases, immunologic processes might have been predominantly responsible for the resistance to the treatment, while in the other resistant pathogens can be assumed to be responsible. Repeated courses of treatment with higher doses of penicillin and/or with ceftriaxone finally succeeded.(ABSTRACT TRUNCATED AT 250 WORDS)