course/outcome of neurosyphilis: Correction

[Guest guest]

The outcome of neurosyphilis in the penicillin age is not nearly as

good as I suggested (working from memory) recently. I finally

unearthed this paper in my car.

=======================================

" Neurosyph. in the modern era " 2004 M TImmermans, J Carr

[Here] we rev. the dx features and lab. findings in 161 pts w

neurosyph, to our knowledge the largest such series de3scribed since

the onset of the antibiotic era.

[this was in S Africa.]

[Of the 102 patients with a firm dx of syphilis 6 were HIV positive.]

Avg duration of tx was 14.9 days in hospital, the commonest tx being

20 million units of penicillin G daily. Evidence of recurrence of

neurosyphilis, based on clinical deterioratin, a rising CSF VDRL

titre, or worsening of markers of disease activity in CSF, was found

in 20 patients (12%).

The outcome was known in 92 cases. 21 pts recovered completely, 40

suffered residual cognitive loss, 10 had psych. disorders, 7 had

residual seizures, 7 had resid hemiparesis, one suffered from tabes

dorsalis, and 6 died.

[Guest guest]

What, you have an archeological dig going on in there?

penny

" " wrote:

I finally unearthed this paper in my car.

>

> =======================================

>

[Guest guest]

err, that's not so encouraging. :-(

penny

> =======================================

>

> " Neurosyph. in the modern era " 2004 M TImmermans, J Carr

>

>

> The outcome was known in 92 cases. 21 pts recovered completely, 40

> suffered residual cognitive loss, 10 had psych. disorders, 7 had

> residual seizures, 7 had resid hemiparesis, one suffered from tabes

> dorsalis, and 6 died.

[Guest guest]

I'm kind of a slob, not too extreme. Lets just say I've /occasionally/

had to re-xerox a paper or two

Also, the ones I got when I had fibro/flu and raynauds are 100% water-

wrinkled, as is my Mattman text, cause I used to spend 2 hours a day

reading in a hot bath. So those ones take up about 3x as much space in

my filing box. Also the highlighting on them is all bled all over the

page, but you can still see where it came from.

> I finally unearthed this paper in my car.

> >

> > =======================================

> >

[Guest guest]

No indeed... I dont know if explicit exploration of ongoing

inflammation has been done. The thing is, the lesions of tertiary

syphilis (I think this includes the central lesions?) are necrotic-

granulomatous. Ie, the granulomas ultimately turn to goo, as happens

in TB but does not happen in sarc. In the old clinical monographs are

pictures of syphilis patients with no noses. If the central lesions

are indeed also necrotic, permenant damage is a strong theory, it

seems to me.

THing is I dont think you need necrotizing granulomas to lose alot of

neurons (ie have damage)... but I dont know anything about all that.

COnsequentally I'm not certain just how much the presence of necrosis

should bolster the permanent damage argument.

<pennyhoule@y...> wrote:

> err, that's not so encouraging. :-(

>

> penny

> > =======================================

> >

> > " Neurosyph. in the modern era " 2004 M TImmermans, J Carr

> >

> >

> > The outcome was known in 92 cases. 21 pts recovered completely, 40

> > suffered residual cognitive loss, 10 had psych. disorders, 7 had

> > residual seizures, 7 had resid hemiparesis, one suffered from

tabes

> > dorsalis, and 6 died.