Neurosyphilis

neuroinfection

1. By, Ms. Ekta S Patel II Year M.Sc Nursing MSN(Neuroscience) NEUROSYPHILIS

2. Introduction :

3. Neurosyphilis is an infection of any part of the nervous system resulting from infection by spirochete Treponema pallidum . It develops after inadequate treatment of elderly syphilis. Primary infection of syphilis is characterized by a chancre (firm and painless genital ulcer). A secondary bacteremic stage may occur 2-12 weeks later and these results in generalized mucocutaneous lesions ( palmar – plantar rash) and lymphadenopathy.

4. Following latent period of 15-20 years tertiary syphilis manifest as a slowly progressive systemic inflammatory disease of skin ( gummas ), heart ( aortitis ), and eyes ( choriorentinitis ). Tertiary neurosyphilis develops in 7% of patients with untreated primary syphilis and result in chronic meningeal and parenchymal inflammation.

5. Definition:

6. Neurosyphilis is defined as syphilis of the spinal cord characterized by degeneration of sensory neurons and stabbing pains in the trunk and legs and unsteady gait and incontinence and impotence.

7. Aetiology and risk factors:

8. The main cause of neurosyphilis is from the bacteria that cause syphilis which is called the Treponema pallidum.

9. Pathophysiology:

10.   Pathophysiology is extensive and includes the meninges, blood vessels, brain, spinal cord and peripheral nerves.

11. Clinical manifestation:

12. This condition produces three main diseases. The classical manifestation includes:

13. Meningovascular syphilis: The infection involves the meninges and blood vessels causing them to be inflamed and thickened. Blood vessel wall become narrowed. Episode of thrombosis occur causing sudden paralysis of one of the cranial nerves or the limbs. CSF shows slightly raised lymphocyte count and blood Wasserman reaction (WR) will usually be positive. Many part of nervous system can be involved. 

14. Tabes dorsalis : The sign and symptoms of this disorder are mainly due to degeneration of the dorsal (posterior) part of the spinal cord (tubes wasting). Here the sensory roots are affected. Patient will have; Lightning pains Girdle pains Loss of position sense

15. Tendon reflex will be absent, so no bladder control will be present. Ulcers on feet due to loss of sensation. Gross destructive changes in knees and other joints leads to disorganized joints Charcot’s joint. Argyll Robertson pupil

16. General paralysis of the insane (GPI): In this type of neurosyphilis the nervous cell of the brain are involved. Many of them die and the brain atrophies or shrinks.

17. Other sign and symptoms are, Slow mental deterioration leading to dementia. Prominent psychiatric features. Patient may have grandiose delusions, emotional changes. Fits.

18. Diagnostic evaluation:

19. Some have collected clinical and laboratory features and entered them into templates; six such diagnostic categories, as derived could be outline as follows: Category 1: neuropsychiatric disorders Category 2: cerebrovascular accident Category 3: ocular Category 4: myelopathy Category 5: seizure Category 6: brainstem/ cranial nerves

20. Management:

21.   Primary and secondary syphilis can be treated with benzathine penicillin 24 million units IM weekly for 3 months. Neurosyphilis whether latent or active is treated with penicillin G2 to 4 million units IV every 4 th hours for 10 days.

22. Nursing management: Nurse should be aware that no barrier nursing precautions are necessary during tertiary stage of disease. All the patients with neurosyphilis should be encouraged to be as active and independent as possible.

23. Epilepsy is a common symptom of meningovascular and general paralytic form of neurosyphilis, so seizure precaution should be provided in the care. Patients with delusions of grandeur should not be contraindicated. Ways and means should be found to deter any acceptable behaviour. Sometime tranquilizer may give to calm the patient.

24. The patient with tables dorsalis should be thought to take particular care of skin and painless ulcer of feet. They should wear comfortable easy fitting shoes to prevent development of corn and abrasion on feet: Charcot’s joints

25. Patient should be encouraged to participate in physiotherapy to strengthen muscle, improve co-ordination and correct posture and gait. Patient partner’s blood should be tested to know, if they have contact syphilis. Every effort should be taken to maintain the patient nutrition and general health.

26. Summary

27. ?

28. Thank you