Alʹmanah Kliničeskoj Mediciny (Jul 2016)
THE STRUCTURES OF CEREBROSPINAL FLUID IN DIAGNOSTICS AND TREATMENT EFFICACY ASSESSMENT IN PATIENT WITH NEUROSYPHILIS
Abstract
Background: In the last years, there has been an increase in cases of latent and late neurosyphilis. Due to the wide implementation of antibiotics, there is a significant reduction in sensitivity of serological and general clinical tests used for diagnosis of this disease. The situations are not uncommon when it is not possible to exclude or confirm the invasion of Treponema pallidum into the nervous system structures. Absence of objective diagnostic criteria for neurosyphilis hints the timely administration of an adequate treatment aimed at prevention of an irreversible derangement of the nervous system and to the patient death. Aim: To search for new diagnostic symptoms of an injury to the brain structures caused by Treponema pallidum in patients with previous syphilis, based on a new technology of assessment of solid phase structures of cerebrospinal fluid. Materials and methods: One hundred and thirty one patient that had been treated for various forms of syphilis were recruited to this study. In addition to generally accepted clinical and laboratory assessments, including various serological methods, all patients underwent clinical and serological assessment of cerebrospinal fluid (CSF). According to the results of this assessment, all patients were categorized into three groups. Group 1 (n=27) consisted of patients with early asymptomatic neurosyphilis, group 2 (n=46), with late meningovascular neurosyphilis, group 3 (n=58), those without diagnosed neurosyphilis but with strong positive serum tests, negative CSF serology and negative VDRL test. An innovative method of marginal dehydration of biological fluids was used. The method is included into the Lithos-system diagnostic technology and allows for evaluation of the structures of CSF systems “lipid – water”, “lipid – protein – water” after their transition from liquid crystal phase into a solid phase. These structures called anisomorphons are seen only at polarized microscopy. The control group comprised 24 patients from in-patient department of neurology and neurosurgery with serous meningitis (n=8), as well as with purulent meningitis and meningoencephalitis (n=16) of bacterial etiology. Results: The morphological sign of a destructive process in central nervous system of neurosyphilis patients was represented by amorphous ovals that were absent in normal CSF. In group 1 patients, the amorphous ovals were found in small numbers within basic anisomorphons – dendrites. In group 2 patients, multiple separated amorphous ovals were detected as spheres, as well as basic anisomorphons – dendrites, fully filled with spheres made of amorphous ovals. Based on these characteristics, in 2 patients from group 3, early asymptomatic neurosyphilis was diagnosed, and in 5 patients, late meningovascular syphilis. At follow-up of 22 patients from group 2, positive trend towards normalization of CSF anisomorphons were seen only after 6 months of additional specific treatment. Conclusion: Assessment of CSF anisomorphon contents in patients with neurosyphilis by means of marginal dehydratation may serve as an additional diagnostic criterion of an early or late phase of neurosyphilis, help decide on the sanitation of the central nervous system and assess the treatment efficacy.
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