Öz
"The great imitator" syphilis is a disease that involves multisystem involvement caused by Treponema pallidum. Neurosyphilis, which is the central nervous system involvement of syphilis, is generally seen in secondary and tertiary stages, but it can occur at any stage. With the increasing number of syphilis cases, the risk of neurosyphilis has also increased in cases that are untreated or inadequately treated 4-10 years after the primary infection. Therefore, it is a disease that should be considered in the differential diagnosis of neurological and psychiatric disorders. Neurological involvement can manifest as motor and sensory impairment, ophthalmic and auditory symptoms, cranial nerve paralysis, and signs of meningitis. Ocular findings related to the disease are important markers of central nervous system (CNS) involvement. The most common psychiatric disorders observed are dementia, depression, and grandiosity. In this context, three cases of neurosyphilis followed in our clinic in 2023, which are rarely encountered but have been increasing in number, are shared to draw attention to the subject.
Anahtar Kelimeler
Kaynakça
- Abdelnabi M, Rimu A, Siddiqui S, Mora B, Guerin C. Ocular syphilis mimicking Vogt-Koyanagi-Harada syndrome: a diagnostic dilemma. Proc (Bayl Univ Med Cent). 2023;36(3):380-2. https://doi.org/10.1080/08998280.2023.2187184
- Bettuzzi T, Jourdes A, Robineau O, Alcaraz I, Manda V, Molina JM, Mehlen M, Cazanave C, Tattevin P, Mensi S, Terrier B, Régent A, Ghosn J, Charlier C, Martin-Blondel G, Dupin N. Ceftriaxone compared with benzylpenicillin in the treatment of neurosyphilis in France: a retrospective multicentre study. Lancet Infect Dis. 2021 Oct;21(10):1441-7. doi: 10.1016/S1473-3099(20)30857-4. Epub 2021 May 26. Erratum in: Lancet Infect Dis. 2021 Aug 5;: PMID: 34051142.
- Can Güngör F, Karamustafalıoğlu N, Genç A, Yener F, İlnem C. Neurosyphilis in the differential diagnosis of late onset psychiatric disorders: case reports. Klinik Psikofarmakol Bülteni. 2011;21(3):258-61. https://doi.org/10.5455/bcp.20110627111639
- CDC. Neurosyphilis, Ocular Syphilis, and Otosyphilis, Centers for Disease Control and Prevention,https://www.cdc.gov/std/treatment-guidelines/neurosyphilis.htm, (erişim tarihi 15.07.2023)
- Gurses C, Bilgic B, Topcular B, et al. Clinical and magnetic resonance imaging findings of HIV-negative patients with neurosyphilis. J Neurol. 2007;254(3):368-74. https://doi.org/10.1007/s00415-006-0380-z
- Hocaoğlu Çiçek GŞ. Psikiyatrik belirtiler ile başvuran nörosifiliz: bir olgu sunumu. Süleyman Demirel Üniv Tıp Fak Derg. 2022;29(4):681-6. https://doi.org/10.17343/sdutfd.1134041
- Janier M, Unemo M, Dupin N, Tiplica GS, Potocnik M, Patel R. 2020 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol. 2021;35(3):574-88. https://doi.org/10.1111/jdv.16946
- Klein A, Fischer N, Goldstein M, Shulman S, Habot-Wilner Z. The great imitator on the rise: ocular and optic nerve manifestations in patients with newly diagnosed syphilis. Acta Ophthalmol. 2019;97(4):e641-7. https://doi.org/10.1111/aos.13963
- Kocasoy Orhan E, Çakar A, Akman-Demir G. Sinir Sistemi İnfeksiyonları, İstanbul Tıp Fakültesi Nöroloji Anabilim Dalı, http://www.itfnoroloji.org/infeksiyon/infection.htm (erişim tarihi 17.12.2023)
- Nicoll A, Hamers FF. Are trends in HIV, gonorrhoea, and syphilis worsening in western Europe? BMJ. 2002;324(7349):1324-7. https://doi.org/10.1136/bmj.324.7349.1324
- Özdemir Yalçınsoy K, Cakar Ozdal P. Ocular syphilis. Eur Eye Res. 2022;2(3):124-34. https://doi.org/ 10.14744/eer.2022.57966
- Prokosch V, Thanos S. Emerging syphilitic optic neuropathy: critical review and recommendations. Restor Neurol Neurosci. 2008;26(4-5):279-89. https://doi.org/10.1136/bmj.324.7349.1324
- Ropper AH. Neurosyphilis. N Engl J Med. 2019;381(14):1358- 63. https://doi.org/10.1056/NEJMra1906228
- Russouw HG, Roberts MC, Emsley RA, Truter R. Psychiatric manifestations and magnetic resonance imaging in HIV-negative neurosyphilis. Biol Psychiatry. 1997;41(4):467-73. https://doi.org/10.1016/S0006-3223(96)00060-1
- Shuja SH, Naeem U, Eqbal F, Shuja MH. Ceftriaxone - A plausible intervention for treating neurosyphilis? Ann Med Surg (Lond). 2022;82:104662. https://doi.org/10.1016/j.amsu.2022.104662. Smith GT, Goldmeier D, Migdal C. Neurosyphilis with optic neuritis: an update. Postgrad Med J. 2006;82(963):36-9. https://doi.org/ 10.1136/pgmj.2004.020875
- Telci Ş, Dankı D, Dilbaz N, Uz E, Bayram G. Psikotik özelliklerle seyreden bir nörosifiliz olgusu, Yeni Sempozyum Derg. 2006;44(1):34-6.
- Woolston SL, Dhanireddy S, Marrazzo J. Ocular syphilis: a clinical review. Curr Infect Dis Rep. 2016;18(11):36. https://doi.org/ 10.1007/s11908-016-0542-9
- Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015 Jun 5;64(RR-03):1-137. Erratum in: MMWR Recomm Rep. 2015;64(33):924.
- Wöhrl S, Geusau A. Neurosyphilis is unlikely in patients with late latent syphilis and a negative blood VDRL-test. Acta Derm Venereol. 2006;86(4):335-9. https://doi.org/ 10.2340/00015555-0092
- Zhou J, Zhang H, Tang K, Liu R, Li J. An Updated Review of Recent Advances in Neurosyphilis. Front Med (Lausanne). 2022;9:800383. doi: 10.3389/fmed.2022.800383. https://doi.org/ 10.3389/fmed.2022.800383
Öz
“Büyük taklitçi” sifiliz, Treponema pallidum’un neden olduğu multisistemik tutulum yapan bir hastalıktır. Nörosifiliz, yani sifilizin santral sinir sistemi (SSS) tutulumu genellikle sekonder ve tersiyer evrelerinde görülmekle birlikte her evrede karşımıza çıkabilir. Artan sifiliz olgu sayılarına paralel olarak primer enfeksiyondan 4-10 yıl sonra tedavi edilmeyen veya yetersiz tedavi gören olgularda nörosifiliz riski de artmıştır. Bu nedenle nörolojik ve psikiyatrik bozuklukların ayırıcı tanısında akılda tutulması gereken bir hastalıktır. Nörolojik tutulumda motor ve duyusal etkilenme, oftalmik ve işitsel semptomlar, kranial sinir paralizileri, menenjit semptom ve bulguları görülebilir. Hastalığa bağlı oküler bulgular SSS tutulumunun önemli belirteçlerindendir. En sık görülen psikiyatrik bozukluklar ise demans, depresyon ve grandiyozitedir. Burada kliniğimizde nadir olarak karşılaştığımız ancak artan sayılarla birlikte 2023 yılında takip edilen, farklı nörolojik ve oküler bulgular ile başvurmuş olan üç nörosifiliz olgusu konuya dikkat çekmek amacı ile paylaşılmıştır.
Anahtar Kelimeler
Etik Beyan
Hastadan olgunun yayınlanması için aydınlatılmış onam alınmıştır.
Kaynakça
- Abdelnabi M, Rimu A, Siddiqui S, Mora B, Guerin C. Ocular syphilis mimicking Vogt-Koyanagi-Harada syndrome: a diagnostic dilemma. Proc (Bayl Univ Med Cent). 2023;36(3):380-2. https://doi.org/10.1080/08998280.2023.2187184
- Bettuzzi T, Jourdes A, Robineau O, Alcaraz I, Manda V, Molina JM, Mehlen M, Cazanave C, Tattevin P, Mensi S, Terrier B, Régent A, Ghosn J, Charlier C, Martin-Blondel G, Dupin N. Ceftriaxone compared with benzylpenicillin in the treatment of neurosyphilis in France: a retrospective multicentre study. Lancet Infect Dis. 2021 Oct;21(10):1441-7. doi: 10.1016/S1473-3099(20)30857-4. Epub 2021 May 26. Erratum in: Lancet Infect Dis. 2021 Aug 5;: PMID: 34051142.
- Can Güngör F, Karamustafalıoğlu N, Genç A, Yener F, İlnem C. Neurosyphilis in the differential diagnosis of late onset psychiatric disorders: case reports. Klinik Psikofarmakol Bülteni. 2011;21(3):258-61. https://doi.org/10.5455/bcp.20110627111639
- CDC. Neurosyphilis, Ocular Syphilis, and Otosyphilis, Centers for Disease Control and Prevention,https://www.cdc.gov/std/treatment-guidelines/neurosyphilis.htm, (erişim tarihi 15.07.2023)
- Gurses C, Bilgic B, Topcular B, et al. Clinical and magnetic resonance imaging findings of HIV-negative patients with neurosyphilis. J Neurol. 2007;254(3):368-74. https://doi.org/10.1007/s00415-006-0380-z
- Hocaoğlu Çiçek GŞ. Psikiyatrik belirtiler ile başvuran nörosifiliz: bir olgu sunumu. Süleyman Demirel Üniv Tıp Fak Derg. 2022;29(4):681-6. https://doi.org/10.17343/sdutfd.1134041
- Janier M, Unemo M, Dupin N, Tiplica GS, Potocnik M, Patel R. 2020 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol. 2021;35(3):574-88. https://doi.org/10.1111/jdv.16946
- Klein A, Fischer N, Goldstein M, Shulman S, Habot-Wilner Z. The great imitator on the rise: ocular and optic nerve manifestations in patients with newly diagnosed syphilis. Acta Ophthalmol. 2019;97(4):e641-7. https://doi.org/10.1111/aos.13963
- Kocasoy Orhan E, Çakar A, Akman-Demir G. Sinir Sistemi İnfeksiyonları, İstanbul Tıp Fakültesi Nöroloji Anabilim Dalı, http://www.itfnoroloji.org/infeksiyon/infection.htm (erişim tarihi 17.12.2023)
- Nicoll A, Hamers FF. Are trends in HIV, gonorrhoea, and syphilis worsening in western Europe? BMJ. 2002;324(7349):1324-7. https://doi.org/10.1136/bmj.324.7349.1324
- Özdemir Yalçınsoy K, Cakar Ozdal P. Ocular syphilis. Eur Eye Res. 2022;2(3):124-34. https://doi.org/ 10.14744/eer.2022.57966
- Prokosch V, Thanos S. Emerging syphilitic optic neuropathy: critical review and recommendations. Restor Neurol Neurosci. 2008;26(4-5):279-89. https://doi.org/10.1136/bmj.324.7349.1324
- Ropper AH. Neurosyphilis. N Engl J Med. 2019;381(14):1358- 63. https://doi.org/10.1056/NEJMra1906228
- Russouw HG, Roberts MC, Emsley RA, Truter R. Psychiatric manifestations and magnetic resonance imaging in HIV-negative neurosyphilis. Biol Psychiatry. 1997;41(4):467-73. https://doi.org/10.1016/S0006-3223(96)00060-1
- Shuja SH, Naeem U, Eqbal F, Shuja MH. Ceftriaxone - A plausible intervention for treating neurosyphilis? Ann Med Surg (Lond). 2022;82:104662. https://doi.org/10.1016/j.amsu.2022.104662. Smith GT, Goldmeier D, Migdal C. Neurosyphilis with optic neuritis: an update. Postgrad Med J. 2006;82(963):36-9. https://doi.org/ 10.1136/pgmj.2004.020875
- Telci Ş, Dankı D, Dilbaz N, Uz E, Bayram G. Psikotik özelliklerle seyreden bir nörosifiliz olgusu, Yeni Sempozyum Derg. 2006;44(1):34-6.
- Woolston SL, Dhanireddy S, Marrazzo J. Ocular syphilis: a clinical review. Curr Infect Dis Rep. 2016;18(11):36. https://doi.org/ 10.1007/s11908-016-0542-9
- Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015 Jun 5;64(RR-03):1-137. Erratum in: MMWR Recomm Rep. 2015;64(33):924.
- Wöhrl S, Geusau A. Neurosyphilis is unlikely in patients with late latent syphilis and a negative blood VDRL-test. Acta Derm Venereol. 2006;86(4):335-9. https://doi.org/ 10.2340/00015555-0092
- Zhou J, Zhang H, Tang K, Liu R, Li J. An Updated Review of Recent Advances in Neurosyphilis. Front Med (Lausanne). 2022;9:800383. doi: 10.3389/fmed.2022.800383. https://doi.org/ 10.3389/fmed.2022.800383
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Mikrobiyoloji (Diğer) |
| Bölüm | Olgu Sunumları |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Nisan 2024 |
| Yayımlandığı Sayı | Yıl 2024 Cilt: 38 Sayı: 1 |
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