German guidelines on the diagnosis and treatment of neurosyphilis
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(2020) 2:33
Neurological Research and Practice
GUIDELINES
Open Access
German guidelines on the diagnosis and treatment of neurosyphilis Matthias Klein1* , Klemens Angstwurm2, Stefan Esser3, Kathrin Hahn4, Matthias Maschke5, Simone Scheithauer6, Helmut Schoefer7, Matthias Sturzenegger8, Brigitte Wildemann9 and Jörg Weber10
Abstract Introduction: In view of the importance of neurosyphilis and the difficulties encountered in diagnosing it, the S1 guideline “Neurosyphilis” has been published by the German Society for Neurology (DGN) in accordance with the stipulations of the Association of the Scientific Medical Societies in Germany (AWMF). The present article is an abridged translation of that German guideline. Main recommendations: (a) Neurosyphilis can manifest as early neurosyphilis (meningitis, meningovascular neurosyphilis or syphilitic gummas) or late neurosyphilis (tabes dorsalis, general paresis). (b) The following diagnostic criteria help to establish the presence of probable neurosyphilis (always point iv, accompanied by any two of points i to iii): (i) subacute or chronic neuro-psychiatric symptoms; (ii) increased cerebrospinal fluid (CSF) cell count or signs of blood–CSF barrier disruption; (iii) positive effect of anti-neurosyphilis antibiotic therapy on clinical course and CSF findings; (iv) positive TPHA/TPPA or FTA test in serum. (c) The diagnosis of neurosyphilis is confirmed by the subsequent detection of intrathecal production of antibodies against Treponema pallidum. (d) In neurosyphilis, treatment with intravenous penicillin or ceftriaxone for 14 days is recommended. (e) The following parameters can be used to assess a therapeutic effect: clinical findings, serum VDRL, and CSF cell count. Conclusion: The German guideline on the diagnosis and treatment of neurosyphilis is a practical tool to support clinicians in diagnosing and treating patients with neurosyphilis. This article is an abridged translation of this guideline (Klein MW, J.; Angstwurm, K.; Esser, S.; Hahn, K.; Matschke, M.; Scheithauer, S.; Schoefer, H.; Sturzenegger, M.; Wildemann, B. Neurosyphilis, S1-Leitlinie. Deutsche Gesellschaft für Neurologie, Leitlinien für Diagnostik und Thearpie in der Neurologie 2020).
Introduction This article is an abridged translation of the German guideline on the diagnosis and therapy of neurosyphilis [1]. Syphilis is an infectious disease caused by Treponema pallidum, a Gram-negative bacterium of the Spirochaetaceae family. It is almost exclusively sexually transmitted. Around one third of the infected patients develop clinical signs of infection. Syphilis occurs in several stages [2, 3]. After a regional infection at the entry point (primary syphilis), a chronic recurrent disease can * Correspondence: [email protected] 1 Department of Neurology, LMU Klinikum Muenchen, Marchioninistr. 15, 81377 Munich, Germany Full list of author information is available at the end of the article
develop (secondary syphilis), with variable manifestations, followed by a latency phase lasting from
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