Neuroborreliosis and Neurosyphilis

Research output: Contribution to journalReview article

3 Citations (Scopus)

Abstract

PURPOSE OF REVIEW This article presents an overview of the current diagnosis and management of two spirochetal infections of the nervous system, neuroborreliosis (Lyme disease) and neurosyphilis, focusing on similarities and differences. Although neuroborreliosis was first identified almost a century ago, much confusion remains about how to accurately diagnose this quite treatable nervous system infection. Well-established diagnostic tools and therapeutic regimens exist for neurosyphilis, which has been well-known for centuries. RECENT FINDINGS Serologic testing targeting the C6 antigen may simplify diagnostic testing in neuroborreliosis while improving accuracy. Historically, screening for syphilis has used a reaginic test followed by a treponeme-specific assay; alternative approaches, including use of well-defined recombinant antigens, may improve sensitivity without sacrificing specificity. In neuroborreliosis, measurement of the chemokine CXCL13 in CSF may provide a useful marker of disease activity in the central nervous system. SUMMARY Lyme disease causes meningitis, cranial neuritis, radiculitis, and mononeuropathy multiplex. Cognitive symptoms, occurring either during (encephalopathy) or after infection (posttreatment Lyme disease syndrome) are rarely, if ever, due to central nervous system infection. Posttreatment Lyme disease syndrome is not antibiotic responsive. Syphilis causes meningitis, cranial neuritis, chronic meningovascular syphilis, tabes dorsalis, and parenchymal neurosyphilis. The organism remains highly sensitive to penicillin, but residua of chronic infection may be irreversible.

Original languageEnglish (US)
Pages (from-to)1439-1458
Number of pages20
JournalCONTINUUM Lifelong Learning in Neurology
Volume24
Issue number5, Neuroinfectious Disease
DOIs
StatePublished - Oct 1 2018
Externally publishedYes

Fingerprint

Neurosyphilis
Lyme Disease
Syphilis
Neuritis
Infection
Meningitis
Chemokine CXCL13
Lyme Neuroborreliosis
Tabes Dorsalis
Mononeuropathies
Antigens
Central Nervous System Infections
Neurobehavioral Manifestations
Radiculopathy
Brain Diseases
Penicillins
Nervous System
Central Nervous System
Anti-Bacterial Agents

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Genetics(clinical)

Cite this

Halperin, John. / Neuroborreliosis and Neurosyphilis. In: CONTINUUM Lifelong Learning in Neurology. 2018 ; Vol. 24, No. 5, Neuroinfectious Disease. pp. 1439-1458.
@article{3613c8895c184cccbb9a601d500772aa,
title = "Neuroborreliosis and Neurosyphilis",
abstract = "PURPOSE OF REVIEW This article presents an overview of the current diagnosis and management of two spirochetal infections of the nervous system, neuroborreliosis (Lyme disease) and neurosyphilis, focusing on similarities and differences. Although neuroborreliosis was first identified almost a century ago, much confusion remains about how to accurately diagnose this quite treatable nervous system infection. Well-established diagnostic tools and therapeutic regimens exist for neurosyphilis, which has been well-known for centuries. RECENT FINDINGS Serologic testing targeting the C6 antigen may simplify diagnostic testing in neuroborreliosis while improving accuracy. Historically, screening for syphilis has used a reaginic test followed by a treponeme-specific assay; alternative approaches, including use of well-defined recombinant antigens, may improve sensitivity without sacrificing specificity. In neuroborreliosis, measurement of the chemokine CXCL13 in CSF may provide a useful marker of disease activity in the central nervous system. SUMMARY Lyme disease causes meningitis, cranial neuritis, radiculitis, and mononeuropathy multiplex. Cognitive symptoms, occurring either during (encephalopathy) or after infection (posttreatment Lyme disease syndrome) are rarely, if ever, due to central nervous system infection. Posttreatment Lyme disease syndrome is not antibiotic responsive. Syphilis causes meningitis, cranial neuritis, chronic meningovascular syphilis, tabes dorsalis, and parenchymal neurosyphilis. The organism remains highly sensitive to penicillin, but residua of chronic infection may be irreversible.",
author = "John Halperin",
year = "2018",
month = "10",
day = "1",
doi = "10.1212/CON.0000000000000645",
language = "English (US)",
volume = "24",
pages = "1439--1458",
journal = "CONTINUUM Lifelong Learning in Neurology",
issn = "1080-2371",
publisher = "Lippincott Williams and Wilkins",
number = "5, Neuroinfectious Disease",

}

Neuroborreliosis and Neurosyphilis. / Halperin, John.

In: CONTINUUM Lifelong Learning in Neurology, Vol. 24, No. 5, Neuroinfectious Disease, 01.10.2018, p. 1439-1458.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Neuroborreliosis and Neurosyphilis

AU - Halperin, John

PY - 2018/10/1

Y1 - 2018/10/1

N2 - PURPOSE OF REVIEW This article presents an overview of the current diagnosis and management of two spirochetal infections of the nervous system, neuroborreliosis (Lyme disease) and neurosyphilis, focusing on similarities and differences. Although neuroborreliosis was first identified almost a century ago, much confusion remains about how to accurately diagnose this quite treatable nervous system infection. Well-established diagnostic tools and therapeutic regimens exist for neurosyphilis, which has been well-known for centuries. RECENT FINDINGS Serologic testing targeting the C6 antigen may simplify diagnostic testing in neuroborreliosis while improving accuracy. Historically, screening for syphilis has used a reaginic test followed by a treponeme-specific assay; alternative approaches, including use of well-defined recombinant antigens, may improve sensitivity without sacrificing specificity. In neuroborreliosis, measurement of the chemokine CXCL13 in CSF may provide a useful marker of disease activity in the central nervous system. SUMMARY Lyme disease causes meningitis, cranial neuritis, radiculitis, and mononeuropathy multiplex. Cognitive symptoms, occurring either during (encephalopathy) or after infection (posttreatment Lyme disease syndrome) are rarely, if ever, due to central nervous system infection. Posttreatment Lyme disease syndrome is not antibiotic responsive. Syphilis causes meningitis, cranial neuritis, chronic meningovascular syphilis, tabes dorsalis, and parenchymal neurosyphilis. The organism remains highly sensitive to penicillin, but residua of chronic infection may be irreversible.

AB - PURPOSE OF REVIEW This article presents an overview of the current diagnosis and management of two spirochetal infections of the nervous system, neuroborreliosis (Lyme disease) and neurosyphilis, focusing on similarities and differences. Although neuroborreliosis was first identified almost a century ago, much confusion remains about how to accurately diagnose this quite treatable nervous system infection. Well-established diagnostic tools and therapeutic regimens exist for neurosyphilis, which has been well-known for centuries. RECENT FINDINGS Serologic testing targeting the C6 antigen may simplify diagnostic testing in neuroborreliosis while improving accuracy. Historically, screening for syphilis has used a reaginic test followed by a treponeme-specific assay; alternative approaches, including use of well-defined recombinant antigens, may improve sensitivity without sacrificing specificity. In neuroborreliosis, measurement of the chemokine CXCL13 in CSF may provide a useful marker of disease activity in the central nervous system. SUMMARY Lyme disease causes meningitis, cranial neuritis, radiculitis, and mononeuropathy multiplex. Cognitive symptoms, occurring either during (encephalopathy) or after infection (posttreatment Lyme disease syndrome) are rarely, if ever, due to central nervous system infection. Posttreatment Lyme disease syndrome is not antibiotic responsive. Syphilis causes meningitis, cranial neuritis, chronic meningovascular syphilis, tabes dorsalis, and parenchymal neurosyphilis. The organism remains highly sensitive to penicillin, but residua of chronic infection may be irreversible.

UR - http://www.scopus.com/inward/record.url?scp=85054069642&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85054069642&partnerID=8YFLogxK

U2 - 10.1212/CON.0000000000000645

DO - 10.1212/CON.0000000000000645

M3 - Review article

C2 - 30273247

AN - SCOPUS:85054069642

VL - 24

SP - 1439

EP - 1458

JO - CONTINUUM Lifelong Learning in Neurology

JF - CONTINUUM Lifelong Learning in Neurology

SN - 1080-2371

IS - 5, Neuroinfectious Disease

ER -