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*Finger-to-nose test is usually abnormal<ref name="pmid19918420">{{cite journal| author=Mehrabian S, Raycheva MR, Petrova EP, Tsankov NK, Traykov LD| title=Neurosyphilis presenting with dementia, chronic chorioretinitis and adverse reactions to treatment: a case report. | journal=Cases J | year= 2009 | volume= 2 | issue= | pages= 8334 | pmid=19918420 | doi=10.4076/1757-1626-2-8334 | pmc=2769430 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19918420 }} </ref> | *Finger-to-nose test is usually abnormal<ref name="pmid19918420">{{cite journal| author=Mehrabian S, Raycheva MR, Petrova EP, Tsankov NK, Traykov LD| title=Neurosyphilis presenting with dementia, chronic chorioretinitis and adverse reactions to treatment: a case report. | journal=Cases J | year= 2009 | volume= 2 | issue= | pages= 8334 | pmid=19918420 | doi=10.4076/1757-1626-2-8334 | pmc=2769430 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19918420 }} </ref> | ||
Tests may include the following: | Tests may include the following::<ref name="CDC2016">http://www.cdc.gov/std/tg2015/syphilis.htm Accessed on September 28th, 2016</ref><ref name="pmid18159528">{{cite journal| author=Ratnam S| title=The laboratory diagnosis of syphilis. | journal=Can J Infect Dis Med Microbiol | year= 2005 | volume= 16 | issue= 1 | pages= 45-51 | pmid=18159528 | doi= | pmc=2095002 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18159528 }} </ref><ref name="pmid25428245">{{cite journal| author=Morshed MG, Singh AE| title=Recent trends in the serologic diagnosis of syphilis. | journal=Clin Vaccine Immunol | year= 2015 | volume= 22 | issue= 2 | pages= 137-47 | pmid=25428245 | doi=10.1128/CVI.00681-14 | pmc=4308867 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25428245 }} </ref><ref name="pmid22942884">{{cite journal| author=Tsang RS, Radons SM, Morshed M| title=Laboratory diagnosis of syphilis: A survey to examine the range of tests used in Canada. | journal=Can J Infect Dis Med Microbiol | year= 2011 | volume= 22 | issue= 3 | pages= 83-7 | pmid=22942884 | doi= | pmc=3200370 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22942884 }} </ref><ref name="pmid25428245">{{cite journal| author=Morshed MG, Singh AE| title=Recent trends in the serologic diagnosis of syphilis. | journal=Clin Vaccine Immunol | year= 2015 | volume= 22 | issue= 2 | pages= 137-47 | pmid=25428245 | doi=10.1128/CVI.00681-14 | pmc=4308867 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25428245 }} </ref><ref name="pmid24278076">{{cite journal| author=Pastuszczak M, Wojas-Pelc A| title=Current standards for diagnosis and treatment of syphilis: selection of some practical issues, based on the European (IUSTI) and U.S. (CDC) guidelines. | journal=Postepy Dermatol Alergol | year= 2013 | volume= 30 | issue= 4 | pages= 203-10 | pmid=24278076 | doi=10.5114/pdia.2013.37029 | pmc=3834708 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24278076 }} </ref> | ||
*[[Dark field microscopy|Darkfield]] examinations and tests to detect ''[[T. pallidum]]'' in lesion [[exudate]] or tissue are the definitive methods for diagnosing early [[syphilis]]. | |||
* | *Although no ''[[T. pallidum]]'' detection tests are commercially available, some laboratories provide locally developed [[PCR]] tests for the detection of [[T. pallidum|''T. pallidum''.]] | ||
* | |||
* | *A presumptive diagnosis of [[syphilis]] is possible with the use of two types of serologic tests: | ||
**FTA-ABS | :*Nontreponemal tests (e.g., [[VDRL|venereal disease research laboratory (VDRL)]] and [[RPR|rapid plasma reagent test]]) and | ||
** | :*Treponemal tests (e.g., [[FTA-ABS|fluorescent treponemal antibody absorbed (FTA-ABS) tests]], the ''[[T. pallidum]]'' passive particle agglutination (TP-PA) assay, various [[Enzyme linked immunosorbent assay (ELISA)|enzyme immunoassays]], and [[Chemiluminescence|chemiluminescence immunoassays]]). | ||
*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|autoimmune conditions]], older age, and injection-drug use.<ref name="pmid7548285">{{cite journal |author=Nandwani R, Evans DT |title=Are you sure it's syphilis? A review of false positive serology |journal=[[International Journal of STD & AIDS]] |volume=6 |issue=4 |pages=241–8 |year=1995 |pmid=7548285 |doi= |url= |accessdate=2012-02-16}}</ref><ref name="urlwww.aphl.org">{{cite web |url=http://www.aphl.org/aphlprograms/infectious/std/Documents/LaboratoryGuidelinesTreponemapallidumMeetingReport.pdf |title=www.aphl.org |format= |work= |accessdate=2012-12-19}}</ref> Therefore, persons with a reactive nontreponemal test should receive a treponemal test to confirm the diagnosis of [[syphilis]]. | |||
===Nontreponemal test=== | |||
*Includes [[Venereal disease research laboratory (VDRL) test|VDRL]] and [[Rapid plasma reagent|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 === | |||
*Include [[FTA-ABS|fluorescent treponemal antibody absorbed (FTA-ABS) tests]], ''[[T. pallidum]]'' passive particle agglutination (TP-PA) assay, [[Enzyme linked immunosorbent assay (ELISA)|enzyme immunoassays]], and [[Chemiluminescence|chemiluminescence immunoassays]] | |||
*[[Antibody titer]]<nowiki/>s, once positive, remain positive for the rest of the patient's life, regardless of treatment or disease activity | |||
*Cannot be used for monitoring treatment response | |||
*Screening using trepenomal tests may help identify individuals previously treated for [[syphilis]], those with untreated or incompletely treated [[syphilis]], and persons with false-positive results | |||
=== Special laboratory findings in neurosyphilis === | |||
[[Neurosyphilis]] is often initially suspected based on clinical findings with positive serologic tests and finally confirmed through [[Lumbar puncture|lumbar puncture(LP)]]. | |||
Abnormalities in the [[CSF]] consistent with disease include:<ref name="pmid27606153">{{cite journal| author=Henao-Martínez AF, Johnson SC| title=Diagnostic tests for syphilis: New tests and new algorithms. | journal=Neurol Clin Pract | year= 2014 | volume= 4 | issue= 2 | pages= 114-122 | pmid=27606153 | doi=10.1212/01.CPJ.0000435752.17621.48 | pmc=4999316 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27606153 }} </ref> | |||
* [[Pleocytosis]], often lymphocytic predominant | |||
* Mild protein elevation | |||
* Positive CSF [[Venereal disease research laboratory (VDRL) test|VDRL]]. | |||
* CSF [[Fluorescent treponemal antibody absorbtion (FTA-ABS) test|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== | ==Treatment options== | ||
Revision as of 16:35, 15 February 2018
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Tabes dorsalis |
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Tabes dorsalis On the Web |
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For the WikiDoc page for this topic, click here
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 includes syphilitic myelopathy and other symptoms of nerve damage. Syphilitic myelopathy is a complication of untreated syphilis that involves muscle weakness and abnormal sensations.
What are the symptoms of Tabes dorsalis?
- Lightning pains[1]
- Impaired sensation and proprioception[2]
- Hypesthesias[3]
- Progressive sensory ataxia(inability to feel the lower limbs)[4]
- Diminished reflexes or loss of reflexes[5]
- Poor coordination or loss of coordination[6]
- Unsteady gait(locomotor ataxia)[7]
- Sexual function problems[8]
In Tabes dorsalis, there are also symptoms of nervous system damage, including:
- Mental illness
- Stroke
- Vision changes
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]
When to seek urgent medical care?
Call your health care provider if you have:
- Loss of coordination
- Loss of muscle strength
- Loss of sensation
Diagnosis
Physical examination may show:
- Positive romberg test is one of the most important findings in physical examination of patients with tabes dorsalis[9]
- Patient is usually oriented to persons, place, and time
- Hyporeflexia or areflexia may be seen[3]
- Impaired balance bilateral Babinski's Reflex may be present[8]
- Bilateral muscle weakness mostly in lower limbs may be seen[10]
- Argyll Robertson pupils may be present[11]
- Bilateral sensory loss in the extremity mostly in lower limbs may be seen[12]
- Broad base gate and Sensory ataxic gait is usually seen in patients with tabes dorsalis[12]
- Cranial nerve palsy caused by gummatous neurosyphilis may be seen[13]
- Finger-to-nose test is usually abnormal[14]
Tests may include the following::[15][16][17][18][17][19]
- Darkfield examinations and tests to detect T. pallidum in lesion exudate or tissue are the definitive methods for diagnosing early syphilis.
- 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:
- Nontreponemal tests (e.g., venereal disease research laboratory (VDRL) and rapid plasma reagent test) and
- Treponemal tests (e.g., fluorescent treponemal antibody absorbed (FTA-ABS) tests, the T. pallidum passive particle agglutination (TP-PA) assay, various enzyme immunoassays, and chemiluminescence immunoassays).
- 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
- Include fluorescent treponemal antibody absorbed (FTA-ABS) tests, T. pallidum passive particle agglutination (TP-PA) assay, enzyme immunoassays, and chemiluminescence immunoassays
- Antibody titers, once positive, remain positive for the rest of the patient's life, regardless of treatment or disease activity
- Cannot be used for monitoring treatment response
- Screening using trepenomal tests may help identify individuals previously treated for syphilis, those with untreated or incompletely treated syphilis, and persons with false-positive results
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
The goals of treatment are to cure the infection and slow the progression of the disorder. Treating the infection helps prevent new nerve damage and may reduce symptoms, but it does not reverse existing nerve damage.
For neurosyphilis, aqueous penicillin G (by injection) is the drug of choice. Some patients with penicillin allergies may have to be desensitized to penicillin so that they can be safely treated with it.
Symptoms of existing neurologic damage need to be treated. People who are unable to eat, dress themselves, or take care of themselves may need help. Rehabilitation, physical therapy, and occupational therapy may help people who have muscle weakness.
You may needanalgesics to control pain. These may include over-the-counter medications such as aspirin or acetaminophen for mild pain, or narcotics for more severe pain. Anti-epilepsy drugs such as carbamazepine may help treat lightning pains.
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
- Complications of late-stage syphilis infection, which may include:
- Inflammation of the aorta (aortitis) with aortic aneurysm
- Disease of the heart valves
- Damage to bones, skin, and other organs
- Complications of neurosyphilis, including dementia, stroke, eye disease
- Difficulty with walking and balance
- Paralysis
Sources
http://www.nlm.nih.gov/medlineplus/ency/article/000729.htm
- ↑ MAO S, LIU Z (2009). "Neurosyphilis manifesting as lightning pain". Eur J Dermatol. 19 (5): 504–6. doi:10.1684/ejd.2009.0712. PMID 19487174.
- ↑ Vora SK, Lyons RW (2004). "The medical Kipling--syphilis, tabes dorsalis, and Romberg's test". Emerg Infect Dis. 10 (6): 1160–2. doi:10.3201/eid1006.031117. PMC 3323152. PMID 15224672.
- ↑ 3.0 3.1 Pandey S (2011). "Magnetic resonance imaging of the spinal cord in a man with tabes dorsalis". J Spinal Cord Med. 34 (6): 609–11. doi:10.1179/2045772311Y.0000000041. PMC 3237288. PMID 22330117.
- ↑ Sabre L, Braschinsky M, Taba P (2016). "Neurosyphilis as a great imitator: a case report". BMC Res Notes. 9: 372. doi:10.1186/s13104-016-2176-2. PMC 4964046. PMID 27465246.
- ↑ Smikle MF, James OB, Prabhakar P (1988). "Diagnosis of neurosyphilis: a critical assessment of current methods". South Med J. 81 (4): 452–4. PMID 3358168.
- ↑ Mehrabian S, Raycheva M, Traykova M, Stankova T, Penev L, Grigorova O; et al. (2012). "Neurosyphilis with dementia and bilateral hippocampal atrophy on brain magnetic resonance imaging". BMC Neurol. 12: 96. doi:10.1186/1471-2377-12-96. PMC 3517431. PMID 22994551.
- ↑ Gue JW, Wang SJ, Lin YY, Liao KK, Wong WW (1993). "Neurosyphilis presenting as tabes dorsalis in a HIV carrier". Zhonghua Yi Xue Za Zhi (Taipei). 51 (5): 389–91. PMID 8334567.
- ↑ 8.0 8.1 Ahamed S, Varghese M, El Agib el N, Ganesa VS, Aysha M (2009). "Case of neurosyphilis presented as recurrent stroke". Oman Med J. 24 (2): 134–6. doi:10.5001/omj.2009.29. PMC 3273935. PMID 22334859.
- ↑ 9.0 9.1 French P (2007). "Syphilis". BMJ. 334 (7585): 143–7. doi:10.1136/bmj.39085.518148.BE. PMC 1779891. PMID 17235095.
- ↑ Matijosaitis V, Vaitkus A, Pauza V, Valiukeviciene S, Gleizniene R (2006). "Neurosyphilis manifesting as spinal transverse myelitis". Medicina (Kaunas). 42 (5): 401–5. PMID 16778468.
- ↑ Thompson HS, Kardon RH (2006). "The Argyll Robertson pupil". J Neuroophthalmol. 26 (2): 134–8. doi:10.1097/01.wno.0000222971.09745.91. PMID 16845316.
- ↑ 12.0 12.1 Tso MK, Koo K, Tso GY (2008). "Neurosyphilis in a non-HIV patient: more than a psychiatric concern". Mcgill J Med. 11 (2): 160–3. PMC 2582679. PMID 19148316.
- ↑ Vogl T, Dresel S, Lochmüller H, Bergman C, Reimers C, Lissner J (1993). "Third cranial nerve palsy caused by gummatous neurosyphilis: MR findings". AJNR Am J Neuroradiol. 14 (6): 1329–31. PMID 8279327.
- ↑ Mehrabian S, Raycheva MR, Petrova EP, Tsankov NK, Traykov LD (2009). "Neurosyphilis presenting with dementia, chronic chorioretinitis and adverse reactions to treatment: a case report". Cases J. 2: 8334. doi:10.4076/1757-1626-2-8334. PMC 2769430. PMID 19918420.
- ↑ http://www.cdc.gov/std/tg2015/syphilis.htm Accessed on September 28th, 2016
- ↑ Ratnam S (2005). "The laboratory diagnosis of syphilis". Can J Infect Dis Med Microbiol. 16 (1): 45–51. PMC 2095002. PMID 18159528.
- ↑ 17.0 17.1 Morshed MG, Singh AE (2015). "Recent trends in the serologic diagnosis of syphilis". Clin Vaccine Immunol. 22 (2): 137–47. doi:10.1128/CVI.00681-14. PMC 4308867. PMID 25428245.
- ↑ Tsang RS, Radons SM, Morshed M (2011). "Laboratory diagnosis of syphilis: A survey to examine the range of tests used in Canada". Can J Infect Dis Med Microbiol. 22 (3): 83–7. PMC 3200370. PMID 22942884.
- ↑ Pastuszczak M, Wojas-Pelc A (2013). "Current standards for diagnosis and treatment of syphilis: selection of some practical issues, based on the European (IUSTI) and U.S. (CDC) guidelines". Postepy Dermatol Alergol. 30 (4): 203–10. doi:10.5114/pdia.2013.37029. PMC 3834708. PMID 24278076.
- ↑ Nandwani R, Evans DT (1995). "Are you sure it's syphilis? A review of false positive serology". International Journal of STD & AIDS. 6 (4): 241–8. PMID 7548285.
|access-date=requires|url=(help) - ↑ "www.aphl.org" (PDF). Retrieved 2012-12-19.
- ↑ Henao-Martínez AF, Johnson SC (2014). "Diagnostic tests for syphilis: New tests and new algorithms". Neurol Clin Pract. 4 (2): 114–122. doi:10.1212/01.CPJ.0000435752.17621.48. PMC 4999316. PMID 27606153.