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neurosyphilis complicated by anti-γ-aminobutyric acid-B receptor encephalitis: A case report

World Journal of Clinical Cases 2024年第11期12卷 1960-1966页

作者： Ya-Xiu Fang Xiao-Ming Zhou Dong Zheng Guang-Hui Liu Peng-Bo Gao Xiao-Zhen Huang Zhi-Cheng Chen Hui Zhang Lin Chen Ya-Fang Hu Department of Neurology The Affiliated Brain Hospital of Guangzhou Medical UniversityGuangzhou 510000Guangdong ProvinceChina Department of Neurology Nanfang HospitalSouthern Medical UniversityGuangzhou 510000Guangdong ProvinceChina

BACKGROUND Syphilis is an infectious disease caused by Treponema pallidum that can invade the central nervous system,causing *** cases of anti-N-methyl-Daspartate receptor autoimmune encephalitis(AE)secondary to neurosyphilis have been *** report a neurosyphilis patient with anti-γ-aminobutyric acid-B receptor(GABABR)*** SUMMARY A young man in his 30s who presented with acute epileptic status was admitted to a local *** was diagnosed with neurosyphilis,according to serum and cerebrospinal fluid(CSF)tests for *** 14 d of antiepileptic treatment and anti-Treponema pallidum therapy with penicillin,epilepsy was controlled but serious cognitive impairment,behavioral,and serious psychiatric symptoms were *** was then transferred to our *** Mini-Mental State Examination(MMSE)crude test results showed only 2 *** magnetic resonance imaging revealed significant cerebral atrophy and multiple fluidattenuated inversion recovery high signals in the white matter surrounding both lateral ventricles,left amygdala and bilateral ***-GABABR antibodies were discovered in CSF(1:3.2)and serum(1:100).The patient was diagnosed with neurosyphilis complicated by anti-GABABR AE,and received methylprednisolone and *** treatment,his mental symptoms were *** impairment was significantly improved,with a MMSE of 8 *** anti-GABABR antibody titer decreased to 1:*** patient received methylprednisolone and penicillin after *** months later,the patient’s condition was stable,but the serum anti-GABABR antibody titer was 1:*** This patient with neurosyphilis combined with anti-GABABR encephalitis benefited from immunotherapy.

关键词： Anti-γ-aminobutyric acid-B receptor GABABR neurosyphilis Tissue-based assay Magnetic resonance imaging Mini-mental state examination Case report

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Varied Outcomes Based on Six Criteria Across Four Continents in the Same Patients with Suspected neurosyphilis: A Multicenter Cross-sectional Study in Three Regions of China

Varied Outcomes Based on Six Criteria Across Four Continents...

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2024年全国皮肤病防治学术年会

作者：柯吴坚南方医科大学皮肤病医院

Background: There are no gold standard for neurosyphilis diagnosis,which can result in the varied outcomes of a single patient being underdiagnosed and overdiagnosed, thereby obscuring the actual incidence or prevalence of ***: We conducted a multicenter cross-sectional study of 1633patients with suspected neurosyphilis from three regions in China to examine their diagnoses using six criteria from four continents. To standardize the six neurosyphilis diagnostic criteria, different diagnosis categories were classified as "treat for neurosyphilis"(TNS).Results: Among the 1633 patients, the diagnosis rate of TNS varied greatly based on the different criteria(P neurosyphilis within and across countries, which could result in divergent outcomes in same patients. Our findings emphasize the need for establishing universally applicable diagnostic criteria and ultimately enhance patient outcomes worldwide.

关键词： neurosyphilis diagnostic criteria gold standard multicenter cross-sectional study

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Enhancing a Diagnostic Prediction Model for neurosyphilis Using Serum Treponema pallidum Specific IgG Antibodies via Luciferase Immunosorbent Assay to Minimize Lumbar Puncture in HIV-Negative Patients Suspected of neurosyphilis:A Two-Center Cross-Sectional

Enhancing a Diagnostic Prediction Model for Neurosyphilis Us...

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2024年全国皮肤病防治学术年会

作者：柯吴坚南方医科大学皮肤病医院

Background In an effort to minimize the need for invasive lumbar puncture(LP) among suspected neurosyphilis(NS) cases without HIV infection, we investigated the supplementary utility of serum IgG antibodies targeting specific Treponemal pallidum antigens—TP15, TP17, and TP47—via luciferase immunosorbent assay(LISA) for NS diagnosis. Concurrently, we developed a predictive model for NS diagnosis integrating demographic data, neurological manifestations, serum nontreponemal test(NTT) and treponemal test(TT) *** An inclusive cohort of 816 patients exhibiting suspected neurosyphilis(NS)symptoms from two medical centers in Northern and Southern China participated in this study. The diagnostic efficacy of serum anti-TP15, TP17, and TP47 antibodies,assessed via LISA, was evaluated using the area under the receiver operating characteristic curve(AUC). Employing a random allocation, all participants were divided into distinct training and validation sets at a 6:4 ratio. These datasets were instrumental in the development and subsequent validation of predictive models for NS diagnosis through stepwise logistic *** The Log2 Relative Light Units(RLU) of serum LISA-TP15, LISA-TP17, and LISATP47, assessed via LISA, exhibited a consistent elevation in confirmed NS >Probable NS > N-NS categories(P<0.001). Analysis of the AUC highlighted the superior diagnostic performance of serum LISA-TP17 and LISA-TP47 in NS identification in comparison to serum NTT titers(AUC 0.81 vs AUC 0.74, P<0.001;AUC 0.81 vs AUC 0.74, P=0.006), while no significant disparity emerged between serum LISA-TP15 and serum NTT titers(AUC 0.74 vs AUC 0.74, P=0.75). Model 1,encompassing sex, neurological symptoms, and serum NTT titers, served as predictive factors. Model 2 augmented these factors by incorporating serum LISATP17 and LISA-TP47. Evaluation across development and validation datasets revealed that Model 2 showcased improved discrimination, calibration(as demonstrated by AUC, R

关键词： neurosyphilis Diagnosis LISA Prediction Model Two-Center Validation

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Development, validation and clinical utility of a suite of diagnostic models for diagnosis of neurosyphilis in HIV-uninfected syphilis patients

Development, validation and clinical utility of a suite of d...

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2024年全国皮肤病防治学术年会

作者：柯吴坚南方医科大学皮肤病医院

Background: The ability to accurately identify the absolute risk of neurosyphilis diagnosis for syphilis patients would allow preventative and therapeutic interventions to be delivered to patients at high-risk, sparing patients at low-risk from unnecessary care. We aimed to develop, validate, and evaluate the clinical utility of simplified clinical diagnostic models for neurosyphilis diagnosis in syphilis patients without HIV ***: We developed and validated machine learning models with a uniform set of predictors based on six authoritative diagnostic guidelines across four continents to predict neurosyphilis using routinely collected data from real-world clinical practice in China and the United States. Model performance was measured through both internal and external validation in terms of discrimination and calibration, and clinical utility was evaluated using decision curve ***: The final simplified clinical diagnostic models included neurological symptoms, cerebrospinal fluid(CSF) protein, CSF white blood cell, and CSF venereal disease research laboratory test/rapid plasma reagin. The models showed good calibration with rescaled Brier score of 0.989(95% CI 0.984-0.995) and excellent discrimination(the minimum value of area under the receiver operating characteristic curve, 0.843;95% CI 0.809-0.877) when externally validated. Decision curve analysis demonstrated that the models were useful across a range of neurosyphilis probability thresholds between 0.33 and 0.66 compared to the alternatives of managing all syphilis patients as if they do or do not have ***: The simplified clinical diagnostic models comprised of readily available data show compelling performance, are transportable across clinical settings,and have clinical utility over a broad range of probability thresholds. The models with a uniform set of predictors can simplify the sophisticated clinical diagnosis of neurosyphilis, and guide decisions on

关键词： neurosyphilis Syphilis Clinical diagnostic model Risk-differentiated Diagnosis

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Malignant syphilis accompanied with neurosyphilis in a malnourished patient: A case report

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World Journal of Clinical Cases 2019年第16期7卷 2406-2412页

作者： Gai Ge Dong-Mei Li Ying Qiu Hong-Jun Fu Xiang-Yu Zhang Dong-Mei Shi Jining Medical University Jining 272067Shandong ProvinceChina Georgetown University Medical Center WashingtonDC 20057United States Department of Dermatology Jining No. 1 People’s HospitalJining 272067Shandong ProvinceChina Department of Pathology Jining No. 1 People’s HospitalJining 272067Shandong ProvinceChina Department of Dermatology and Laboratory of Medical Mycology Jining No. 1 People’s HospitalJining 272067Shandong ProvinceChina

BACKGROUND Syphilis is a common sexually transmitted disease caused by the Treponema pallidum (***).Malignant syphilis is a rare presentation of secondary ***,we present a case diagnosed with malignant syphilis accompanied with *** SUMMARY A 56-year-old man present with a 2-mo history of spreading ulcerous and necrotic papules and nodules covered with thick crusts over the face,trunk,extremities,and *** patient was diagnosed with malignant syphilis accompanied by neurosyphilis based on the characteristic morphology of the lesions,positive serological and cerebrospinal fluid tests for syphilis,brain magnetic resonance imaging,and histopathology,along with resolution of the lesions following the institution of penicillin *** lesions and neurological condition successfully resolved after a course of treatment with *** We suggest that neurosyphilis should be considered whenever people have psychiatric symptoms without cutaneous lesions or human immunodeficiency virus.

关键词： Malignant syphilis Secondary syphilis neurosyphilis Jarisch-Herxheimer reaction Case report

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Concurrent tuberculous transverse myelitis and asymptomatic neurosyphilis:A case report

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World Journal of Clinical Cases 2021年第31期9卷 9645-9651页

作者： Lu-Yan Gu Jun Tian Ya-Ping Yan Department of Neurology Second Affiliated Hospital of Zhejiang University School of MedicineHangzhou 310009Zhejiang ProvinceChina

BACKGROUND Tuberculous myelitis is a rare manifestation of tuberculosis(TB)that is usually caused by hematogenous spread of Mycobacterium tuberculosis(MTB).neurosyphilis is a neurological disease that occurs when Treponema pallidum invades the brain or the spinal ***,these two diseases involving the spinal cord are rare and cases of concurrent tuberculous transverse myelitis and asymptomatic neurosyphilis have seldom been *** SUMMARY A 56-year-old man presented with numbness and pain of both lower limbs for 2 wk and dysuria for 1 *** serology and cerebrospinal fluid(CSF)analysis supported the diagnosis of neurosyphilis and the patient was treated with intravenous ceftriaxone at first,but symptoms still ***,magnetic resonance images revealed multiple lesions along the cervicothoracic junction,and chest computed tomography showed a typical TB *** DNA was detected in the CSF sample by metagenomic next-generation *** the patient was diagnosed with tuberculous myelitis combined with asymptomatic ***,quadruple anti-TB drug standardized therapy was empirically used and his neurological symptoms improved *** Patients can have coinfection with tuberculous transverse myelitis and asymptomatic *** with neurosyphilis should be examined for other pathogens.

关键词： Tuberculous myelitis neurosyphilis Metagenomic next-generation sequencing Case report

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Optic neuritis combined with hepatitis B and neurosyphilis

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Chinese Medical Journal 2013年第18期126卷 3580-3581页

作者： JIANG Zhao-cai LIU Zi-hao LI Hong-yang WEI Shi-hui Department of Ophthalmology General Hospital of People's Liberation Amay Beijing 100853 China

Optic neuritis is defined as inflammation of the optic nerve. Pain and vision loss are common symptoms ofoptic neuritis. The most frequent cause of optic neuritis is multiple sclerosis： other reasons include viral and bacterial infections, such as hepatitis B and syphilis. We describe a case of a 60-year-old man with a 3-year history of decreased vision acuity in his right eye and a 1-year history of decreased vision acuity in his left eye with light headedness who was admitted to the Neuro- ophthalmological Department of the General Hospital of Chinese People＇s Liberation Army. He had a 2-year past medical history of hypertension and blood pressure instability. None of his family members suffered from vision loss and he had no systemic diseases, especially diabetes mellitus as well as drug usage or toxic exposure.

关键词： optic neuritis hepatitis B neurosyphilis

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Limbic Encephalitis as the First Manifestation of neurosyphilis: A Diagnostic Challenge

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Case Reports in Clinical Medicine 2022年第1期11卷 19-24页

作者： Wadi Bnouhanna Basma Marzouk Mounia Rahmani Maria Benabdeljlil Saadia Aidi Department of Neurology A and Neuropsychology Hospital of Specialties Ibn Sina University Hospital Faculty of Medicine and Pharmacy of Rabat Mohammed V University Rabat Morocco

Limbic encephalitis (LE) is a clinical entity related to a mesial temporal lesion resulting in a combination of anterograde memory dysfunction, behavioral changes, and seizures. The most common causes of limbic encephalitis are Herpes Simplex Virus (HSV) encephalitis, autoimmune encephalitis. neurosyphilis is an exceptional aetiology. The early diagnosis and management of the disease determine the prognosis. This clinical course highlights the diagnostic challenge limbic encephalitis can cause and the importance of considering neurosyphilis in patients with specific or unspecific neurological symptoms. We report a case of a mesiotemporal form of neurosyphilis revealed by a LE.

关键词： Limbic Encephalitis neurosyphilis Brain MRI

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Hepatitis: A Case of Infectious and Autoimmune Hepatitis Occurring with neurosyphilis

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Advances in Infectious Diseases 2023年第2期13卷 227-232页

作者： Karnan Rajkumar Anas Mahmoud Nader Mekheal Mohamed Abdalla Matthew Grossman Walid Baddoura Department of Medicine St. George’s University School of Medicine True Blue Grenada Department of Internal Medicine St. Joseph’s University Medical Center Paterson NJ USA Department of Gastroenterology St. Joseph’s University Medical Center Paterson NJ USA

The liver is an organ that withstands a lot of insults due to various things such as infection, toxins and even our own immune system. There are injuries to the liver that are relatively common in medicine such as viral hepatitis caused by different strains of Hepatitis A-E, autoimmune hepatitis, and injury by drugs such as acetaminophen. However, syphilis causing hepatitis is not seen often and there are certain features that distinguish syphilitic hepatitis that should be reported more to distinguish its characteristic features.

关键词： Infectious Hepatitis Autoimmune Hepatitis neurosyphilis Syphilitic Hepatitis

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Circulating MicroRNAs as Potential Biomarkers in the Diagnosis of neurosyphilis: A Case Control Study

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International Journal of Dermatology and Venereology 2021年第1期4卷 16-25页

作者： Kai-Qi Wu Su-Fang Zhang Chao-Hui Bao Xin Zou Xin Gu Cui-Ni Wang Wei-Ming Gong Mei Shi Yong-Liang Lou Jian Huang Ping-Yu Zhou Sexually Transmitted Disease Institute Shanghai Skin Disease HospitalShanghai 200050China Key Laboratory of Laboratory Medicine(Ministry of Education) School of Laboratory Medicine and Life SciencesWenzhou Medical UniversityWenzhouZhejiang 325035China Shanghai Skin Disease Hospital Clinical School of Anhui Medical UniversityShanghai 200050China Key Laboratory of Systems Biomedicine(Ministry of Education)and Collaborative Innovation Center of Systems Biomedicine Shanghai Center for Systems BiomedicineShanghai Jiao Tong UniversityShanghai 200240China

Objective:Laboratory diagnosis of neurosyphilis(NS)remains a great *** study was the aimed to identify miRNA candidates as biomarkers to distinguish between NS,non-neurosyphilis,and healthy controls(HCs).Methods:We analyzed miRNA expression profiles in peripheral blood mononuclear cells(PBMCs)from six patients with NS,eight patients with secondary syphilis(SS),and five HCs using microarray *** differentially expressed miRNAs were validated in 33 NS samples,31 SS samples,and 30 HC samples using TaqMan miRNA real-time qPCR(qRT-PCR).Results:Thirty-nine miRNAs were differentially expressed in SS and NS patients compared with *** miRNAs were randomly selected to validate their expression levels in the same samples used in microarray assay by *** miRNAs were upregulated in SS and NS samples compared with ***-PCR analysis of the expression of the 13 miRNAs in a second cohort(76 samples)showed that the average expression levels of nine miRNAs were higher in SS than in NS(SS:0.185,NS:0.136,P=3.8E-10),while the expressions of the other four miRNAs were lower in SS than in NS(SS:0.000757,NS:0.000873,P=0.022).ROC curve analysis of the 13 miRNAs showed the area under the curve value to be 1.00 for distinguishing SS patients from HCs,1.00 for distinguishing NS patients from HCs,1.00 for distinguishing SS and NS patients from HCs,and 0.968 for distinguishing NS from SS ***:The present study is the first one that identified differentially expressed miRNAs in PBMCs from patients with *** results suggest that the 13 candidate miRNAs in PBMCs may be novel noninvasive biomarkers for NS diagnosis.

关键词： diagnosis microRNAs neurosyphilis peripheral blood mononuclear cells syphilis

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