Spirochetal diseases in general: syphilis , Lyme disease

Chronic Neurologic Manifestations of Lyme Disease
Loggian, Kaplan, Steere
,,,,,,,Discussion.....These chronic neurologic abnormalities began months
to years after the onset of infection, sometimes after long periods of
latency, as in neurosyphilis....The typical response of our patients to antibiotic therapy supports the role of spirochetal infection in the pathogenisis of each of the syndromes described here......The likely reason
for relapse is failure to eradicate the spirochete.......This is
reminiscent of far advanced neurosyphilis.......
This last article is one of many studies that show continuing symptoms are
most likely due to persistence of the spirochete.

source: Mandell, Douglas and Bennett's Principles and Practice of
Infectious Diseases fourth edition
pg. 2119- ..."Syphilis can be aquired by sexual contact, by passage
through the placenta (congenital syphilis), by kissing, by transfusion of
fresh human blood, or by accidental direct inoculation..........Syphilis
can be spread by kissing or touching a person who has an active lesions on
the lips, oral cavity, breasts or genitals. Conversly, an infected patient
may inoculate syphilis to the area on the body that is kissed. (Wet nurses often spread the disease to infants, especially those from upper-class
European families for whom the use of a wet nurse was a socially recognized status symbol.)..............Accidental direct inoculation can occur by a neddle prick or when handling infected clinical material. Indeed, syphilis
of the fingers is most common in medical personnel......some of these
contacts will have no evidence of active disease............Within hours to days after T. pallidum penetrates the intact mucous membrane or gains
access through abraded skin, it........disseminates throughout the body.
This occurs soon......as evidenced by the fact that patients who have
received blood transfusions from syphilitic donors in the seronegative incubation period have become infected. Virtually any organ in the body can
be invaded, including the CNS.....as few as four spirochetes can establish
an infection. The organism divides every 30-33 hours.....A prospective
study involving 431 black men with seropositive latent syphilis of 3 or
more years duration was undertaken in 1932 (the infamous Tuskeegee study, 1932-1962). ......As a result of these studies, the variable waxing and
waning course and the unpredictable progression to late syphilis was documented......................
Clinical Manifestations- It was once an adage of medicine that "he who
knew syphilis knew medicine." Penicillin therapy changed all that, but one
of its legacies is the frequency of DELAYED and/or ERRONEOUS DIAGNOSES that occurs today................
Secondary syphilis-......It is remarkable that, at a time when the host's
local immune process appears to be bringing the primary lesions under
control the spirochete disseminates widely and achieves its greatest numbers..........All the different rashes may be present at one time and
become widely distributed to involve the entire body, especially on the
palms and soles.............Constitutional symptomatology is also commonly manifested in secondary syphilis. ........low-grade fever, malaise, pharyngitis, laryngitis, anorexia, weight loss,arthralgias, and generalized painless lymphadenopathy. Enlargement of the epitrochlear lymph nodes is a unique finding that should always suggest the diagnosis.............CNS
becomes involved in up to 40% of patients.....Headache and meningismus are common, increased cerebrospinal fluid.....acute aseptic meningitis......Spirochetes have also been isolated from the CSF of
patients with no CSF abnormalities. Individual cranial nerves, especially II-VIII, can be involved......Virtually any organ in the body can be
involved. The gastrointestinal tract may also become extensively infiltrrated and/or ulcerated and can be misdiagnosed as a lymphoma or
other cancer. Anterior uveitis, usually mild and asymptomatic, occurs ......uveitis is made worse by steroid treatment. .....Synovitis, osteitis
and periosteitis can also occur. These cases are often characterized by nocturnal pain that is increased by heat........The differential diagnosis
of SECONDARY syphilis is extensive, and the appellation "The Great
Imitator" is appropriate...............a pregnant woman with latent
syphilis can infect her fetus in utero, and an infection can be transmitted
via transfused contaminated blood......Late syphilis is a slowly
progressive inflammatory disease that can affect any organ in the body and
can produce clinical illness years after the initial infection......The differential diagnosis of systemic diseases includes tuberculosis,
rheumatoid arthritis, sarcoidosis, and ocular Toxocara canis
infections.....The conditions from which neurosyphilis must be
differentiated are numerous. They include any degenerative neurologic
process, disorders that cause chronic inflammation ( e.g. tuberculosis,
fungal or sarcoid meningitis, tumors, subdural hematoma, Alzheimer's
disease, multiple sclerosis, chronic alcoholism), or any disorder affecting
the vasculature of the CNS. The axiom that syphilis can mimic any disease
is particularly apropos with regard to the CNS.........the diagnosis can be very difficult to make.....T. pallidum cannot be cultured in vitro............protean manifestations are the hallmark of syphilis.
Older clinicians were never surprised by "unusual findings," and today's clinician should not be either.........One of the more difficult situations
to interpret is the persistent positive.... test (chronic persister") after apparently adequate therapy. This may be a biologically false reaction or indicates persistent active infection or reinfection.............." The article goes on to explain the problems with testing and the problems are
not few. The spirochete that causes syphilis enters the CNS early and can
hide in areas sequestered from the immune system "in areas where adequate levels of penicillin are not easily achieved, for example, the anterior
chamber of the eye, the CNS, and the labyrinth of the inner ear. ........ However, there ....is now little doubt that T. pallidum may persist after treatment, particularly in the CNS......All patients with ....neurosyphilis must be carefully followed .....at least 5 years.........Re-treatment
should be considered whenever (1) clinical signs and symptoms persist or recur............ numerous treatment failures have been recorded........ Therefore, it can be implied that the most effective antibiotic treatment
would be to ensure an adequate blood level over a prolonged period of
time.... an increasing number of clinicians now treat syphilis with a combination of prolonged therapy to ensure the most devastating sequela of syphilis, neurosyphilis, does not occur. This is especially true when
there is evidence to suggest that the host may be immunocompromised...........Treponema pallidum has evolved mechanisms to
evade host immune defenses and establish chronic infection " ------------------------------

Both
Borrelia burgdoferi and Treponema pallidum enter the CNS early. They can
go to places that antibiotics can't reach . The first stage of both
diseases goes away with or without treatment.


georgia
_______________________________



Source: Bad Blood The Tuskegee Syphilis Experiment by James H.
Jones.
"Secondary syphilis gives way in most cases, even without
treatment, to a period of latency that may last from a few weeks to thirty years. As if by magic, all symptoms of the disease seem to disappear, and
the syphilitic patient does not associate with the disease's earlier
symptoms the occasional skin infections, periodic chest pains, eye
disorders, and vague discomforts that may follow. But the spirochetes do
not vanish once the disease becomes latent. They bore into the bone
marrow, lymph glands, vital organs, and central nervous systems of their victims. In some cases the disease seems to follow a policy of peaceful coexistence, and its hosts are able to enjoy full and long lives. Even so, autopsies in such cases often reveal syphilitic lesions in vital organs as contributing causes of death. For many syphilitic patients, however, the disease remains latent only two or three years. Then the delusion of a
truce is shattered by the appearance of signs and symptoms that denote the tertiary stage.
"It is during late syphilis, as the tertiary stage is also called,
that the disease inflicts the greatest damage. Gummy or rubbery tumors (so-called gummas), the characteristic lesions of late syphilis, appear resulting from the concentration of spirochetes in the body's tissues with destruction of vital structures. These tumors often coalesce on the skin forming large ulcers covered with a crust consisting of several layers of
dried exuded matter. Their assaults on bone structure produce
deterioration that resembles osteomyelitis or bone tuberculosis. The small tumors may be absorbed , leaving slight scarred depressions, or they may
cause wholesale destruction of the bone, such as the horrible mutilation
that occurs when nasal and palate bones are eaten away. The liver may be attacked, here the result is scarring and deformity of the organ that
impede circulation in the intestines.
"The cardiovascular and central nervous systems are frequent and often fatal targets of late syphilis. The tumors may attack the walls of the
heart or the blood vessels. When the aorta is involved, the walls become weakened, scar tissue forms over the lesion, the artery dilates, and the
valves of the heart no longer open and close properly and begin to leak.
The stretching of the vessel walls may produce an aneurysm, a balloonlike
bulge in the aorta. If the bulge bursts, and sooner or later most do, the result is sudden death.
"The results of neurosyphilis are equally devastating. Syphilis is
spread to the brain through the blood vessels, and while the disease can
take several forms, the best known is paresis, a general softening of the
brain that produces progressive paralysis and insanity. Tabes dorsalis, another form of neurosyphilis, produces a stumbling, foot-slapping gait in
its victims due the destruction of nerve cells in the spinal cord.
Syphilis can also attack the optic nerve, causing blindness, or the eighth cranial nerve, inflicting deafness."
__________________________
Lyme Disease and its Neurologic Complications
Michael F. Finkel, M.D.
..........Conclusion: Lyme disease presents a new set of challenges to physicians. Once again, a spirochetal disease is manifesting itself as a "great imitator" to primary care physicians as well as specialists. The
full impact of the disease is not yet known, as it is presently underrecognized, underreported, and undertreated.....

Chronic Neurologic Manifestations of Lyme Disease
Loggian, Kaplan, Steere
,,,,,,,Discussion.....These chronic neurologic abnormalities began months
to years after the onset of infection, sometimes after long periods of
latency, as in neurosyphilis....The typical response of our patients to antibiotic therapy supports the role of spirochetal infection in the pathogenisis of each of the syndromes described here......The likely reason
for relapse is failure to eradicate the spirochete.......This is
reminiscent of far advanced neurosyphilis.......
This last article is one of many studies that show continuing symptoms are
most likely due to persistence of the spirochete.

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