Neuroborreliosis and Neurosyphilis

John J. Halperin, MD, FAAN, FIDSA Neuroinfectious Disease p. 1439-1458 October 2018, Vol.24, No.5 doi: 10.1212/CON.0000000000000645
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PURPOSE OF REVIEW: This article presents an overview of the current diagnosis and management of two spirochetal infections of the nervous system, neuroborreliosis (Lyme disease) and neurosyphilis, focusing on similarities and differences. Although neuroborreliosis was first identified almost a century ago, much confusion remains about how to accurately diagnose this quite treatable nervous system infection. Well-established diagnostic tools and therapeutic regimens exist for neurosyphilis, which has been well-known for centuries.

RECENT FINDINGS: Serologic testing targeting the C6 antigen may simplify diagnostic testing in neuroborreliosis while improving accuracy. Historically, screening for syphilis has used a reaginic test followed by a treponeme-specific assay; alternative approaches, including use of well-defined recombinant antigens, may improve sensitivity without sacrificing specificity. In neuroborreliosis, measurement of the chemokine CXCL13 in CSF may provide a useful marker of disease activity in the central nervous system.

SUMMARY: Lyme disease causes meningitis, cranial neuritis, radiculitis, and mononeuropathy multiplex. Cognitive symptoms, occurring either during (encephalopathy) or after infection (posttreatment Lyme disease syndrome) are rarely, if ever, due to central nervous system infection. Posttreatment Lyme disease syndrome is not antibiotic responsive. Syphilis causes meningitis, cranial neuritis, chronic meningovascular syphilis, tabes dorsalis, and parenchymal neurosyphilis. The organism remains highly sensitive to penicillin, but residua of chronic infection may be irreversible.

Address correspondence to Dr John J. Halperin, Department of Neurosciences, Overlook Medical Center, 99 Beauvoir Ave, Summit, NJ 07901, john.halperin@atlantichealth.org.

RELATIONSHIP DISCLOSURE: Dr Halperin serves on the editorial board of Neurology and has received personal compensation for serving as a section editor for Current Neurology and Neuroscience Reports and as a speaker for the American Academy of Neurology, Infectious Diseases Society of America, and University of Kansas Medical Center. Dr Halperin receives royalties from CABI and UpToDate, Inc and holds stock in Abbott Laboratories, AbbVie Inc, and Johnson & Johnson. Dr Halperin has given expert medical testimony in various medical malpractice cases related to Lyme disease.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Halperin reports no disclosure.

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© 2018 American Academy of Neurology