Meningeal syphilis (as known as syphilitic aseptic meningitis or meningeal neurosyphilis) is a chronic form of syphilis infection that affects the central nervous system. Treponema pallidum, a spirochate bacterium, is the main cause of syphilis, which spreads drastically throughout the body and can infect all its systems if not treated appropriately. Treponema pallidum is the main cause of the onset of meningeal syphilis and other treponemal diseases, and it consists of a cytoplasmic and outer membrane that can cause a diverse array of diseases in the central nervous system and brain. Early symptomatic neurosyphilis (or acute syphilitic meningitis or neurorecurrence) is the onset of meningeal syphilis. The symptoms arise as a result of inflamed meninges, which eventually lead up to signs of meningitis. Treponema pallidum invades the nervous system within three to eighteen months after the primary infection. The initial series of events is asymptomatic meningitis, which can remain in the human body system and produce more damage within the body. Every form of neurosyphilis has meningitis as a component; however, every case differs in severity. The individual is infected with syphilis through a gram negative bacteria that only humans can obtain. Syphilis has four stages of infection, which are primary, secondary, latent, and tertiary. If syphilis is not treated, the disease can affect various other systems in the body, including the brain, heart, and vessels. The infection of the heart and vessels leads to meningovascular syphilis, which is usually presented during the secondary stage of syphilis. If syphilis is prolonged, it can affect the nervous system, which is known as neurosyphilis. Meningeal syphilis is a component of neurosyphilis, which usually occurs in the tertiary stage of syphilis.
Signs and symptoms
Asymptomatic asymptomatic invasion of the central nervous system by Treponema is common within a few months of primary infection
General symptoms of meningeal syphilis symptoms of meningitis can occur at any time after the infection however, it usually appears within two years symptoms may include headache, stiff neck, cranial nerve palsies, convulsions, and mental confusion patient is afebrile
General symptoms of neurosyphilis Personality change Ataxia Stroke Visual Impairment Bladder incontinence Hearing Loss Seizures Headache
General signs of neurosyphilis
Hyporeflexia Sensory impairment Dementia Mania Charcot Joint Hypotonia Optic Atrophy Argyll Robertson pupil Argyll Robertson pupil constricts with accommodation but it is not reactive to light This sign is usually evident in the tertiary stage of syphilis
Clinical features The types of neurosyphilis include asymptomatic, acute syphilitic meningitis, meningovascular syphilis, parenchymatous syphilis (which includes general paresis and tabes dorsalis), and optic atrophy.
Anatomy of disease
Meningitis inflames and breaks down any protective membrane and cells surrounding the brain, spinal cord, and other parts of the nervous system. Bacterial meningitis is normally caused by a bacterial infection that enters the bloodstream and enters the blood–brain barrier. The blood–brain barrier consists of tight junctions. These tight junctions help to enclose endothelial cells that line the brain capillaries. Only certain water-soluble substances can move across the blood–brain barrier, while lipid-soluble substances can easily move across the blood–brain barrier. However, when any form of bacteria gets through to the blood–brain barrier, a bacterial infection can result in the cerebrospinal fluid. This fluid circulates through the brain and spinal cord, and it is produced in the choroid plexuses. The meninges consists of three connective tissues that cover the spinal cord and brain. They are lined with vertebral cavities, which is used as protection for the central nervous system. When the cerebrospinal fluid is infected, the meninges become inflamed and can start to deteriorate. This inflammation of the membranes causes meningitis.
Pathophysiology
Syphilis is a sexually transmitted infection that is brought upon by the gram negative bacteria, Treponema pallidum. Treponema pallidum are various spiral shaped motile bacteria of the family spirochaetaceae. Their genus features include spirochetes, which means that they are spiral with axial filaments (endoflagellum). These bacteria are poorly visible on Gram stain, but they have a gram-negative envelope. Some distinguishing features of the bacteria include a thin spirochete, which is not reliably seen on gram stain. The bacteria's outer membrane has endotoxin-like lipids. Their axial filaments consists of endoflagella and periplasmic flagella. The creatures cannot be cultured in lab, and they are an obligate pathogen. Humans are the only host for this bacteria, and the bacteria can get through the body by minute abrasions of the skin or mucous membranes. The reservoir is in the human genital tract, and its transmission is transmitted sexually or across the placenta.
Stages of disease The four main stages of syphilis are the primary, secondary, latent, and tertiary stages:
Primary stage The first sign of syphilis can occur during the first few weeks of exposure. This exposure in particular is caused by the spirochete, Treponema pallidum. Usually within two to twelve weeks, a red, circular sore (which is known as a chancre) is present where the bacteria first entered the body. There may be multiple sores that are not visible on the body, and they are usually difficult to find. Commonly, these chancres are visible on the penis, anus, rectum, vagina, and cervix; however, they are usually difficult to identify even though it is a localized disease. The sores may go undetected, and it may only be identified after getting tested. The lesion does not induce any pain; however, it can lead to an ulcer that can secrete mucus, swelling, or tenderness in the infected area. These lesions can be healed without treatment within one to two months of exposure. The diagnosis can include dark-field or fluorescent microscopy of lesion; however, fifty percent of patients will be negative by nonspecific serology. If the infected individual does not treat the infection properly, the syphilis can progress to the secondary stage.
Secondary stage
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