New Hypotheses on the Pathogenesis of Neurosyphillis: A Case Report and Comprehensive Review of the Medical Literature

Author(s): Lourdes de Fatima Ibanez Valdes*


Background: Neurosyphilis (Ns)-including auditory and ocular forms, is the clinical consequence of infection of the central nervous system by Treponema pallidum (TP). Ns is a Sexually Transmitted Disease (STD) with several stages and development, leading to 6.3 million new infections each year. Up to date the pathogenesis of Ns related to oxidative stress (reactive oxygen species), cytokines, chemokines, mitochondrial activation, and microglial polarization remains unknown. The main aim of this review is to find confident answers the following questions:

  1. How often is Ns reported in the medical literature of Sub-Saharan Africa?
  2. What is the most probable pathophysiology of Ns based on the last publications?

Method: We searched the medical literature comprehensively, looking for published Medical Subject Heading (MeSH) terms like "Pathogenesis of neurosyphilis” OR "meningovascular syphilis," OR "syphilitic meningomyelitis" OR "Pathogenesis of secondary syphilis," OR "early secondary syphilis," OR "late neurosyphilis" OR "Immunology of neurosyphilis."

Results: All selected manuscripts were peer-reviewed, and we found only two publications delivering new hypotheses on the pathogenesis of Neurosyphilis (Ns).

Case report: An 18-year-old lady complained of a 5-day history of inability to walk properly due to weakness in her lower limbs and lower back pain. She had no shortness of breath, headache, fever, cough, or difficulty talking. She denies any recent infection or trauma prior to the onset of her symptoms. The final diagnosis of early Ns was confirmed by laboratory investigations on serum and the Cerebrospinal Fluid (CSF) protein level was slightly elevated, and the Treponema pallidum hemagglutination assay and rapid plasma reagin test were positive in both serum and CSF samples.

Comments and concluding remarks: We hypothesized in cases with Ns that the endothelia cell induce a signaling pathway able to modify the cytoskeleton and endothelial junctions at the blood brain barrier, allowing the extravasation of harmful material, which must be removed to the cervical lymphatic chain through the cleaning system composed by the meningeal lymphatic system, glymphatic system, aquaporin 4 and corpus amylacea as we reported for similar situations recently plus an increase expression of almost all before cited elements at the same time.

As far as we know, this is the first article proposing a new hypothesis on the pathogenesis of Ns based on the role played by oxidative stress (reactive oxygen species), cytokines, chemokines, mitochondrial activation, Microglial polarization and many other mentioned proteins and enzymes. As far we know it is the first publication about these novel hypotheses on Ns.

image 10.4303/JDAR/236278

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