Tabes dorsalis (patient information)

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Tabes dorsalis

Overview

What are the symptoms?

What are the causes?

When to seek urgent medical care?

Diagnosis

Treatment options

Where to find medical care for Tabes dorsalis?

What to expect (Outlook/Prognosis)?

Possible complications

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2] Varun Kumar, M.B.B.S.

Overview

Tabes dorsalis is a form of neurosyphilis, which is a complication of late or tertiary syphilis infection. Syphilis is a sexually transmitted infectious disease. The infection damages the spinal cord and peripheral nervous tissue. Most symptoms of tabes dorsalis include, lightning pains, impaired sensation and proprioception, hypesthesias, progressive sensory ataxia(inability to feel the lower limbs), diminished reflexes or loss of reflexes, Poor coordination or loss of coordinatio, Unsteady gait(locomotor ataxia) and Sexual function problems. patients with tabes dorsalis has abnormal VDRL and RPR test result and the diagnosis should be confirmed by some other special tests. Penicillin is the treatment of choice for tabes dorsalis that kills all treponema pallidum bacteria but sever spinal damage may be permanent. Common complications of tabes dorsalis include; Dementia, stroke, eye disease, Paralysis and charcot arthropathy(Charcot joint).

What are the symptoms of Tabes dorsalis?

What causes Tabes dorsalis?

Tabes dorsalis is a form of neurosyphilis, which is a complication of late or tertiary syphilis infection. Syphilis is a sexually transmitted infectious disease. The infection damages the spinal cord and peripheral nervous tissue.[9]

Diagnosis

Physical examination may show:

Tests may include the following::[15][16][17][18][17][19]

  • Although no T. pallidum detection tests are commercially available, some laboratories provide locally developed PCR tests for the detection of T. pallidum.
  • A presumptive diagnosis of syphilis is possible with the use of two types of serologic tests:
  • The use of only one type of serologic test is insufficient for diagnosis because each type of test has limitations, including the possibility of false-positive test results in persons without syphilis.
  • False-positive nontreponemal test results can be associated with various medical conditions unrelated to syphilis, including autoimmune conditions, older age, and injection-drug use.[20][21] Therefore, persons with a reactive nontreponemal test should receive a treponemal test to confirm the diagnosis of syphilis.

Nontreponemal test

  • Includes VDRL and RPR tests
  • Antibody titers may correlate with disease activity
  • May reverse following treatment
  • Used to follow treatment response
  • A fourfold change in titer is necessary to demonstrate significant difference between two nontreponemal tests
  • Results from two tests cannot be compared directly with each other

Trepenomal tests

Special laboratory findings in neurosyphilis

Neurosyphilis is often initially suspected based on clinical findings with positive serologic tests and finally confirmed through lumbar puncture(LP).

Abnormalities in the CSF consistent with disease include:[22]

  • Pleocytosis, often lymphocytic predominant
  • Mild protein elevation
  • Positive CSF VDRL.
  • CSF FTA-ABS can be used but is not specific

CSF abnormalities alone can not make or rule out the diagnosis of neurosyphilis. Every result should be placed in context with the clinical scenario and special finding in imaging and laboratory tests of each patient.

Treatment options

Penicillin, administered intravenously, is the treatment of choice of tabes dorsalis.. Preventive treatment for those who come into sexual contact with an individual with tabes dorsalis is important. CNS involvement can occur during any stage of syphilis. However, CSF laboratory abnormalities are common in persons with early syphilis, even in the absence of clinical neurological findings. No evidence exists to support variation from recommended treatment for early syphilis for patients found to have such abnormalities. If clinical evidence of neurologic involvement is observed (e.g., cognitive dysfunction, motor or sensory deficits, ophthalmic or auditory symptoms, cranial nerve palsies, and symptoms or signs of meningitis), a CSF examination should be performed. Syphilitic uveitis or other ocular manifestations frequently are associated with neurosyphilis and should be managed according to the treatment recommendations for neurosyphilis. Patients who have neurosyphilis or syphilitic eye disease (e.g., uveitis, neuroretinitis, and optic neuritis) should be treated with the recommended regimen for neurosyphilis; those with eye disease should be managed in collaboration with an ophthalmologist. A CSF examination should be performed for all patients with syphilitic eye disease to identify those with abnormalities; patients found to have abnormal CSF test results should be provided follow-up CSF examinations to assess treatment response. Associated pain can be treated with opiates, valproate, or carbamazepine. Patients may also require physical or rehabilitative therapy to deal with muscle wasting and weakness

Where to find medical care for Tabes dorsalis?

Directions to Hospitals Treating Tabes dorsalis

What to expect (Outlook/Prognosis)?

Progressive disability is possible if the disorder is left untreated.

Possible complications

Common complications of tabes dorsalis include:[23][12]

Sources

http://www.nlm.nih.gov/medlineplus/ency/article/000729.htm

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  15. http://www.cdc.gov/std/tg2015/syphilis.htm Accessed on September 28th, 2016
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  23. Kaynak G, Birsel O, Güven MF, Oğüt T (2013). "An overview of the Charcot foot pathophysiology". Diabet Foot Ankle. 4. doi:10.3402/dfa.v4i0.21117. PMC 3733015. PMID 23919113.