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Neurosyphilis.

O J Kolar, J E Burkhart

    The British Journal of Venereal Diseases
    |August 1, 1977
    PubMed
    Summary

    Normal cerebrospinal fluid (CSF) tests do not rule out late neurosyphilis. Specific markers like CSF plasma cells and elevated immunoglobulins (IgG, IgM) indicate active, treatable central nervous system syphilis.

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    Area of Science:

    • Neurology
    • Infectious Diseases
    • Immunology

    Background:

    • Late syphilis can manifest with neuropsychiatric symptoms.
    • A reactive Fluorescent Treponemal Antibody Absorption (FTA-ABS) test suggests syphilis.
    • Central nervous system (CNS) involvement in syphilis, or neurosyphilis, requires accurate diagnosis.

    Purpose of the Study:

    • To identify reliable indicators of active neurosyphilis in patients with neuropsychiatric symptoms.
    • To determine if normal CSF cell counts and protein levels exclude CNS syphilis.

    Main Methods:

    • Analysis of cerebrospinal fluid (CSF) and serum from patients with neuropsychiatric symptoms and reactive FTA-ABS tests.
    • Evaluation of CSF cell counts, total protein, immunoglobulin G (IgG) concentration, and immunoelectropherogram.
    • Assessment of serum immunoglobulin M (IgM) levels.

    Main Results:

    • Normal CSF cell count and total protein did not exclude late neurosyphilis.
    • Presence of plasma cells in CSF, elevated CSF IgG, and abnormal IgG immunoelectrophoresis suggested active neurosyphilis.
    • Increased serum IgM levels also indicated active disease.

    Conclusions:

    • Abnormal neuropsychiatric symptoms with a reactive FTA-ABS test warrant further investigation for neurosyphilis, even with normal CSF cell counts and protein.
    • Specific CSF and serum immune markers are crucial for diagnosing active, treatable neurosyphilis.

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