Neurosyphilis with Hydrocephalus: A Case Report
AbstractNeurosyphilis is defined as central nervous system involvement by treponema pallidum bacteria. Symptomatic neurosyphilis can be manifested as acute or subacute meningitis (a type of meningitis) that emulates other bacterial infections. Hydrocephalus and cranial nerve paralysis (VII and IX) may occur. In this article, we report a case of congenital hydrocephalus neurosyphilis, with a significant improvement in neurological condition after treatment with penicillin-G. The infant was a 2.5-month-old boy who referred to the emergency department because of fever. On initial examination, the head had been larger than usual. The patient was evaluated with suspicion of sepsis. Cerebrospinal fluid (CSF) analysis was consistent with meningitis and hydrocephalus found in ultrasound. Due to lack of response to antibiotic and anti-tuberculosis (TB) treatments in improvement of CSF analysis, ultimately after positive CSF serology in favor of syphilis, treatment changed into penicillin; then clinical and laboratory findings were improved. The rare manifestation of congenital syphilis as hydrocephalus and the appropriate treatment response to penicillin were interesting points for the introduction of this patient. We presented a case of neurosyphilis, which was characterized by a cognitive and neurological deficits, hydrocephaly, and myoclonus, as well as irritability and hearing loss. Since syphilis is easily diagnosed and treatable, it should be considered and evaluated in patients with cognitive defects and motor disorders. Misdiagnosis of syphilis is a serious medical mistake that may cause long-term consequences.
DaeyOuwens IM, Koedijk FD, Fiolet AT, van Veen MG, van den Wijngaard KC, Verhoeven WM, et al. Neurosyphilis in the mixed urbanrural community of the Netherlands. Acta Neuropsychiatr 2014; 26(3): 186-92.
Feigin RD, Cherry J. Feigin and Cherry's textbook of pediatric infectious diseases: Expert consult. Philadelphia, PA: Saunders/Elsevier; 2009.
Centers for Disease Control and Prevention. STD surveillance case definitions [Online]. [cited 2013]; Available from: URL: https://www.cdc.gov/std/stats/casedefinitions- 2014.pdf.
Kimberlin DW, Brady MT, Jackson MA, Long SS. Red book: 2015 report of the committee on infectious diseases. Elk Grove Village, IL: American Academy of Pediatrics; 2015.
Kliegman RM, Stanton BM, Geme J, Schor NF. Nelson textbook of pediatrics E-Book. Philadelphia, PA: Elsevier Health Sciences; 2015.
Dobson SR. Congenital syphilis: Clinical features and diagnosis [Online]. [cited 2016]; Available from: URL: https://www.uptodate.com/contents/congenital -syphilis-clinical features-and-diagnosis.
Remington JS. Infectious diseases of the fetus and newborn infant. Philadelphia, PA: Saunders/Elsevier; 2011.
Lukehart SA, Godornes C, Molini BJ, Sonnett P, Hopkins S, Mulcahy F, et al. Macrolide resistance in treponemapallidum in the united
states and Ireland. N Engl J Med 2004; 351(2): 154-8.
Toptan T, Ozdilek B, Kenangil G, Ulker M, Domac FM. Neurosyphilis: A case report. North Clin Istanb 2015; 2(1): 66-8.
Tang W, Huang S, Chen L, Yang L, Tucker JD, Zheng H, et al. Late Neurosyphilis and Tertiary Syphilis in Guangdong Province, China: Results from a Cross-sectional Study. Sci Rep 2017; 7: 45339.
Xiang T, Li G, Xiao L, Chen S, Zeng H, Yan B, et al. Neuroimaging of six neurosyphilis cases mimicking viral encephalitis. J Neurol Sci 2013; 334(1-2): 164-6.
Akahira-Azuma M, Kubota M, Hosokawa S, Kaneshige M, Yasuda N, Sato N, et al. Republication: Two premature neonates of congenital syphilis with severe clinical manifestations. Trop Med Health 2015; 43(3): 165-70.
Tomori MO. Assessing knowledge and practice of prevention of mother to child transmission of hiv documentation among health workers in Oyo state, south west, Nigeria. Texila International Journal of Public Health 2016; 4(4).
Marra CM, Maxwell CL, Dunaway SB, Sahi SK, Tantalo LC. Cerebrospinal fluid treponemapallidum particle agglutination assay for neurosyphilis diagnosis. J Clin Microbiol 2017; 55(6): 1865-70.
Marks M, Jarvis JN, Howlett W, Mabey DCW. Neurosyphilis in Africa: A systematic review. PLoS Negl Trop Dis 2017; 11(8): e0005880.
Dumaresq J, Langevin S, Gagnon S, Serhir B, Deligne B, Tremblay C, et al. Clinical prediction and diagnosis of neurosyphilis in HIV-infected patients with early Syphilis. J Clin Microbiol 2013; 51(12): 4060-6.
Workowski KA, Berman SM. Centers for disease control and prevention sexually transmitted disease treatment guidelines. Clin Infect Dis 2011; 53(Suppl 3): S59-S63.
Tuddenham S, Obeng C, Ghanem KG. Neurosyphilis and ophthalmic syphilis in persons with negative rapid plasma reagin and positive treponemal antibody test results. Sex Transm Dis 2015; 42(6): 347-9.
Winer RL, Hughes JP, Feng Q, O'Reilly S, Kiviat NB, Holmes KK, et al. Condom use and the risk of genital human papillomavirus
infection in young women. N Engl J Med 2006; 354(25): 2645-54.
Baird JK. Evidence and implications of mortality associated with acute Plasmodium vivax malaria. Clin Microbiol Rev 2013; 26(1): 36 57.