Tabes Dorsalis: Definition, Treatment, Symptoms, Homeopathy

Tabes Dorsalis

Introduction / Definition (Expert Homeopathy: Dr. Anutosh Chakraborty)

This disease involves a progressive degeneration of the dorsal roots, dorsal root ganglia, and posterior column; as a result, proprioception and vibration sense are impaired.

It usually occurs in the last stage of syphilis late, but early involvement is reported. Although cerebrospinal fluid (CSF) attacks usually occur early in syphilis sometimes complicated with meningitis, the clinical syndrome of dorsalis tabs, one of the two symptoms of late neurosyphilis, usually occurs years, usually twenty to thirty years later.

The pathogenesis of dorsalis tabs follows the pattern of syphilis elsewhere: an inflammatory response against treponema and gummas (caseous necrosis in granulomata). Other studies support the attack of large myelinated muscle fibers by Treponema pallidum and subsequent neuronal degeneration. Cellular penetration into the spinal cord indicates T-helper cells, macrophages that produce cytokines that strengthen the inflammatory process.

Men who have sex with men and patients infected with the human immunodeficiency virus (HIV), or PLWH (patients living with HIV), are at greater risk for neurosyphilis, especially the first types. HIV coinfection is most common with neurosyphilis in the U.S. Therefore, clinical suspicion of neurosyphilis in PLWH should remain strong for neurological, visual, or otologic signs or symptoms. Neurosyphilis can be symptomatic and undetectable. In asymptomatic neurosyphilis, which is an inflammation without symptoms, the lumbar puncture of the CSF test is controversial.

However, many feel it is important, especially for PLWH, to establish a diagnosis if available because treatment with penicillin at higher and higher doses than primary and secondary syphilis can delay or prevent the development of clinically visible neurosyphilis when it develops as late neurosyphilis.


Etiology / Causation

Man is the only person in control of the nature of Treponema pallidum. Treponemes are helical spirochetal bacteria, small and air-coated. They can be seen in a dark field microscope or immunofluorescence.

Infection of Tabes Dorsalis with Treponema pallidum, if left untreated or untreated, can lead to late neurosyphilis with two types, common paresis (also known as "syphilitic dementia," "dementia paralytica" or "paretic neurosyphilis" and "paretic neurosyphilis"). also known as "locomotor ataxia". Treponema pallidum can be transmitted upwards from the mother to the fetus and sexually. In addition, it can also be transmitted through blood transfusions, solid organ transplants, and easy contact with infected patients with minimal skin damage and mucous membranes.
  1. Late syphilis
  2. More in men
  3. Age 20 -50 years
  4. Toxins

Pathophysiology

Treponema pallidum enters the body through scratches on the skin and tight mucous membranes and travels through lymphatics and blood within a few hours. Bacteria can infect the CNS in primary syphilis with symptomatic CNS involvement showing in 30% of patients with primary syphilis. Most exposure is resolved in people with weakened immune systems.

The duration of syphilis is equal to the number of items included. An estimate of 500 and more organisms is required in the event of disease.

The stages of syphilis, based on clinical findings and time, and infrequent clinical manifestations, are relatively new (two to six weeks after infection, with ulcers and ulcers), second (1 to 2 months after onset, with skin lesions and infectious lesions) short and in higher education, 10 to 60 years after infection, consisting of the heart (e.g. aortic division), ocular syphilis, otic syphilis, gummatous disease and late neurosyphilis ( common paresis and dorsalis tabs and meningovascular disease and meningomyelitis).


Symptoms / Signs of Tabes Dorsalis

Onset is insidious

Pre Ataxic Stage:
  1. Lightening pains (Sharp-shooting pain at thigh to limb)
  2. Girdle sensation: Feeling of cord drawn tightly around the body.
  3. Paresthesia or numbness in the soles of feet
  4. Eye symptoms: Argyll Robertson's Pupils
  5. Loss of pupillary reflex response to light
  6. Diplopia
  7. Ptosis
  8. Squint
  9. Mitosis(abnormal contraction of the pupils)
Ataxic Stage:
  1. Ataxia, Areflexia, loss of position
  2. Sensory loss in paresthesia
  3. Ataxic gait: wide-based gait and foot slap
Impotence
Trophic changes:
  1. Perforating ulcer of the foot
  2. Charcot's joint
Bladder disturbances; retention of urine, imperfect sphincter control.


Histopathology

In histologic tests, degeneration and subsequent deterioration of the dorsal roots can be visualized leading to a change in the affected torque column to a poor white. Unfortunately, living organisms are not seen in most cases of spinal cord injuries.

Perivascular penetration of multiple CD4 + and CD8 + T lymphocytes, macrophages, plasma cells, and small vessel abolition. Gummas, i.e., necrosis with medial cases surrounded by an inflamed area showing a granulomatous appearance, can be seen anywhere in the CNS.


Investigation / Evaluation

Since Treponema pallidum cannot be cultivated in a cultural environment, serology and CSF tests are the pillars of diagnosis. VDRL (Venereal Disease Research Laboratory) and RPR (immediate plasma reagin) are nontreponemal tests used to diagnose syphilis. They can be administered with blood or CSF. They are also used to perform quantification when considering re-infection. FTA-ABS (fluorescent treponemal antibody-absorbed-absorbed) tests,

TPPA (Treponema pallidum particle agglutination assay), and EIAs (enzyme immunoassays) are more effective treponemal tests than VDRL in infected patients; dysfunctional effects help rule out asymptomatic cases. If the patient has a good serology of syphilis and neurologic signs and symptoms that elevate neurosyphilis, then lumbar piercing is indicated to diagnose neurosyphilis. Diagnosis of asymptomatic neurosyphilis is difficult, especially in patients with HIV.

Recent studies have demonstrated the role of CXCL13 in the diagnosis of non-infectious patients to distinguish between symptomatic patients with symptomatic HIV patients. CXCL 13 levels increase in HIV-positive patients associated with dorsalis tabs. The limit for lumbar puncture in HIV-positive patients, albeit poorly defined, is low. Some authors feel that CD4 cell counts less than 350 cells/ml and RPR greater than 1:32 in PLWH and syphilis are reliable indicators of neurosyphilis and require fatal rupture.

CSF in neurosyphilis usually shows an increase in protein intake (45 to 75 mg/dl), CSF pleocytosis (10 to 50 WBCs / microliter), and positive VDRL. Pleocytosis and protein concentrations are not determined by dorsalis tabs and can be embarrassing for HIV infection and do not necessarily match the severity of the disease. Some studies suggest that in HIV-infected patients, the CSF count of more than 20 cells per microliter should be the standard diagnostic standard. The valid CSF VDRL is clear, but the test itself is not sensitive.

On the other hand, CSF treponemal tests are sensitive but not specified. VDRL and RPR are helpful in detecting re-infection, which is defined as four-fold (two-fold proliferation) in VDRL and RPR tests, which is more pronounced than CSF pleocytosis and in protein purification tests, especially in early syphilis. RPR and VDRL are also followed in response to treatment, but serofast individuals present a diagnostic problem since being serofast, i.e., not showing a change in titer after treatment, does not always indicate treatment failure. One has to remember to compare the change of title in the same test, i.e., RPR to RPR or VDRL to VDRL.

Prompt testing of plasma reagin is prescribed to help distinguish between acute or chronic infections. Treponema pallidum particle agglutination tests are prescribed to distinguish between syphilis infection and false positives. If VDRL or RPR does not work and the treponema test is effective, one of the following is the cause: early syphilis, treated syphilis, or untreated syphilis.

Magnetic resonance imaging (MRI) detection on dorsalis tabs is rarely seen. Inflammation and stiffness of the upper extremity in the affected part of the spinal cord with gadolinium-related stiffness (flip-flop mark) and band-like enhancement (candlestick appearance, more common findings) on MRI suggest severe spinal inflammation.

It is important to emphasize that dorsalis tabs are actually a clinical diagnosis in most cases since, although the CSF profile (white cells, proteins, VDRL, treponemal tests) is usually abnormal, abnormal.
  1. Lumbar puncture
  2. Wasserman or VDRL reaction +ve

Treatment / Management (This paragraph is taken from "modern medicine google source" except the 4th paragraph)

The treatment for neurosyphilis, including tabes dorsalis, is penicillin, as is the case with primary and secondary syphilis; only the dose and duration of treatment vary. Benzathine penicillin G is the drug of your choice. In high-grade syphilis with standard CSF, treatment is 7.2 million units of penicillin given to IM as 3 times a week 2.4 million units per injection.

Patients should be tested for HIV before treatment. With clinically visible neurosyphilis, treatment with intravenous injection of aqueous crystalline penicillin G (18 to 24 million units per day) or intramuscular injection of aqueous procaine penicillin G (2.4 million units/day) is followed. by probenecid (500 mg four times a day) for 10 to 14 days. If signs and symptoms persist in conjunction with clinical trials of intermittent serologies and CSF tests, other penicillin studies should be given. The chance of relapse is high in HIV-positive patients. Treatment of primary neurosyphilis often binds the progression of the disease and is often symptomatic. Late treatment of neurosyphilis, however, can catch the progression of the disease with ongoing symptomatology.

Doxycycline (100 mg orally, twice a day) or tetracycline (400 mg orally, twice a day) for 4 weeks is indicated for the first HIV-negative syphilis patients with penicillin allergies outside of pregnancy. If penicillin desensitization is not possible, ceftriaxone (2 g / day IM or IV for 10 to 14 days) may be used for penicillin-allergic patients with neurosyphilis, although a combination of penicillin and ceftriaxone is possible. . Some studies have reported the use of ceftriaxone and dexamethasone as an effective alternative to penicillin G. treatment. The use of azithromycin is less preferred due to its resistance and should only be used when doxycycline does not occur or is contraindicated in pregnant women.

Some treatments have symptoms and depend on the types of signs and symptoms. Analgesics such as opiates and valproate can be given for problems associated with severe pain. Physical therapy or occupational therapy may be used to prevent muscle damage and weakness. Sexual partners should be given antiretroviral drugs.

Physiotherapy
Light massage
Slow, rhythmic exercise (Frenkel's exercise)
Breathing and trunk exercise
Rehabilitation.


Different Diagnosis

The posterior tabs should be separated from other causes of nonsyphilitic myelopathy, which show similar clinical features. Regardless of the etiology and pathogenesis, spinal diseases that mainly involve the dorsal column have similar symptoms. They should be discharged from the clinic and for informal and treponemal tests, and a thorough examination to make a proper diagnosis and timely treatment of dorsalis tabs. These are:

Vascular Disease Myelopathy

Ischemia, hemorrhage, arteriovenous deformities, and venous blockage all turn into spinal cord tissue hypoxia because of diminished perfusion. Neuronal death after vascular trauma is one of the most common causes of spinal manipulation and physical dysfunction. Clinically, the presentation of neurologic deficits mimics other causes of myelitis, which can be detected by proper clinical examination, and examination (MRI).

Genetic and Other Problems Destroying Death

Spinal cord infections are common, including hereditary spastic paraplegia, amyotrophic lateral sclerosis, spinal muscular atrophy, Friedreich ataxia, and adrenomyeloneuropathy. All of these have features of continuous neurodegeneration and state removal. Muscle atrophy and weakness, ataxia, paraplegia, and loss of nerves are common, but their association with diabetes, cerebellar disease, scoliosis, and the absence of syphilitic lesions, as well as nontreponemal and treponemal test, helps to remove dorsalis tabs. MRI of the brain and spine is important to make an accurate diagnosis.

Post Infectious

Myelitis may be associated with a variety of events, including bacteria (tuberculosis, staphylococci, streptococci, Pseudomonas, Escherichia coli, etc.), Bacteria (Cytomegalovirus, varicella-zoster virus), mold, and insects (toxoplasmosis, cysticercosis, hydatid disease). Myelitis during a continuous spinal infection leads to a reduction in spinal cord infections, but these are not particularly found in certain areas other than varicella, which is always present in the nerve ganglia.

Spinal

Neoplastic myelopathies are rare. Patients presenting with signs and symptoms of spinal dysfunction should be kept under high suspicion of making a diagnosis. Even MRI scans can be confusing with dorsalis tabs. Complete clinical evaluation, nontreponemal and treponemal testing, as well as competent tests performed by neurologists, may be required to achieve clarification.

Mixed Spinal Cord Myelopathy

Other causes of myelopathy include immune-mediated, healthy, metabolic, and toxic myelopathies. Metabolic and nutritional factors include vitamin B-12 deficiency, copper deficiency, lathyrism, and excessive zinc intake. Vitamin B12 deficiency leads to reduced joint damage to the dorsal and lateral spinal cord. When combined with megaloblastic anemia, hemogram, and nontreponemal and treponemal tests, it helps to differentiate between dorsalis tabs. Copper myelopathy also includes the posterior column of the spine such as dorsalis tabs. Some toxins such as nitrous oxide and heroin intoxication produce a column of myelopathy in the back and back. MRI findings help to remove these myelopathies from the dorsalis tabs.

Non-Syphilitic study Argyll Robertson

Pupillary detection of near-light separation is audible when strongly defined and well maintained, such as the pathognomonic neurosyphilis. Ophthalmological contact with pupillary abnormalities is recommended when considering dorsalis tabs. Other diseases or organizations that mimic Argyll Robertson's student, such as diabetes, Adie student, Lyme disease, sarcoidosis, and multiple sclerosis, may interfere with the proper diagnosis of dorsalis tabs, especially in the placement of active RPR and VDRL.


Complications

Dorsalis tabs often progress with neurological dysfunction including ataxia, paralysis, loss of sensitivity and sensitivity, bladder dysfunction, and loss of sexual function. In some cases, it is exacerbated by visceral complications in about 15% of patients, i.e., severe epigastric pain with pain associated with vomiting, mainly due to an upset stomach.

Charcot arthropathy is not uncommon but a well-known problem with dorsalis tabs. Loss of sensitivity and information resulting from the retrieval of dominant nerve endings results in a lack of protection against mechanical trauma and associated trophic lesions.

Argyll Robertson's student, along with loss of vision, is another common sequence of neurosyphilis. Patients treated with penicillin for neurosyphilis may show a rise in temperature, chills, and skin rashes six to 48 hours after starting drug treatment. This reaction is known as the Jarisch Herxheimer reaction, which occurs from 8% to 75% of cases with multiple neurosyphilis cases.

Experimental evidence suggests that lipoprotein spirochetes trigger an inflammatory and cytokine production, which is responsible for this reaction. There is no acceptable treatment for Jarisch Herxheimer's reaction. Some doctors have used steroids, others, nonsteroidal anti-inflammatory drugs (NSAIDs).


Prevention and Patient education

Syphilis is mainly sexually transmitted, by experts who recently called this an increase in epidemics. With proper health efforts, sex education, and affordable and widespread access to condoms and other physical barriers, syphilis can be easily controlled.

Perinatal screening for the presence of syphilis in pregnant women is also required as an ongoing public health tool. Education includes early childhood education on the dangers, especially later, of unsafe sex and the use of recreational drugs, especially in the context of sexual relationships.

Education should also include introducing the signs and symptoms of sexually transmitted diseases and the absence of stigma and embarrassment in seeking appropriate medical help from the patient and his or her partners. The need to continue treatment until completion is also very important to refer to patients with STIs, and to discontinue them until approved by the medical provider.

Patients should be encouraged to visit doctors and nurses without hesitation in case of spinal cord injury because many people in developing countries hide the disease because of uncomfortable feelings.


Homeopathic approach (Expert Homeopathy: Dr. Anutosh Chakraborty)

Homeopathy believes in constitutional treatment. Here given some specific medicines for this condition:
Early-stage: Belladonna 30
Enuresis and urinary symptoms: Belladonna, Equisetum, Causticum
Pains: Arnica montana, Belladonna, Fluoric acid, Kalmia
Gastric symptoms: Argentum Bit, Nux Vom
Ocular symptoms: Belladonna, Conium
Syphilitic: Kali iod
Vesical and anal symptoms: Alumina, Nux Vom

Some concepts on related diseases

Syphilis definition?

Syphilis is a sexually transmitted disease (STD). Syphilis can be transmitted through sex without a condom, sharing needles and syringes from mother to baby during pregnancy.

Syphilis is not transmitted by sharing food, hugging, or using the same toilet as someone with syphilis.

Syphilis can be treated with antibiotics, but it is important that you get tested and treated early, as, without treatment, it can cause permanent health problems.


How to prevent it?

Sex and syphilis
Syphilis is usually transmitted through vaginal, anal, or oral sex without a condom or toothpaste, and by a person with syphilis. A person can transmit syphilis even if they have no symptoms.

Syphilis causes sores or rashes. Contact with these sores and rashes is the main way in which syphilis is transmitted. This means that the infection can be transmitted through sexual or sexual contact, even if you do not ejaculate (or cum).


How do prevent syphilis from being transmitted sexually?

Using condoms and dental dams properly and consistently are the best way to prevent syphilis from being transmitted. Be sure to use a new condom each time and remember that a condom or toothpaste should cover sores or rashes or you will not be protected.

Syphilis can be transmitted by sharing sex toys. To reduce the risk of syphilis, avoid sharing your sex toys or make sure they are washed and covered with a new condom during each use.

Regular checking for syphilis and other STDs is important, especially if you have multiple sexual partners. Talking to your partners about your sexual health and knowing the circumstances of others helps you to protect your sexual health.

Sharing needles and blood transfusions
Syphilis can be transmitted by sharing needles and syringes. To reduce your risk, avoid sharing needles or syringes. Learn more about getting new needles and injecting safely.

It is possible that syphilis is transmitted through blood transfusions, but this is not uncommon as many places test blood for infections involving syphilis before transfusion. If you are worried about a blood transfusion, talk to your healthcare provider.


Syphilis and pregnancy

Syphilis can be transmitted from mother to baby during pregnancy (this is called congenital syphilis). To avoid transmitting syphilis, it is important for women to get tested for syphilis during pregnancy. Pregnant women are advised to get tested for their first appointment before giving birth, and after any time they think they are at risk of getting syphilis.

If you are diagnosed with syphilis, a health care worker will give you antibiotics to treat your and your baby's infections. It is important that you take the medicine because without it syphilis can be harmful to your baby, and increase the risk of miscarriage and stillbirth. Talk to your doctor or health worker for more information and advice.


Locomotor Ataxia

Ataxia describes a lack of muscle control or a combination of voluntary movements, such as walking or picking up objects. A symptom of a lower condition, ataxia can affect a variety of movements and cause difficulty with speech, eye movements, and swallowing.

Prolonged ataxia is usually caused by an injury to the part of your brain that controls muscle contraction (cerebellum). Many conditions can cause ataxia, including alcohol abuse, certain medications, stroke, tumor, cerebral palsy, brain damage, and multiple sclerosis. Genetic defects can also cause a condition.


Argyll Robertson's Pupils

Argyll Robertson's pupils (ARP) are small pupils who reduce in size to a nearby object (that is, they stay) but are not bound when exposed to light i.e., they do not respond to light (less when exposed to light). They are a specific symptom of neurosyphilis; however, Argyll Robertson's readers can also be a symptom of diabetic neuropathy. In general, sedentary but non-responsive students are said to show less light separation (i.e., a lack of light response, direct and positive, with the preservation of the mitotic response to the adjacent stimulus (residence/meeting).

AR students are less common in the developed world. There is an ongoing interest in basic pathophysiology, but the lack of cases makes further research difficult.


Dementia Paralytica

general loss of psychological abilities, including memory debilitation and at least one of the accompanying: aphasia, apraxia, agnosia, or weakened coordination, arranging, and unique reasoning abilities. Avoids loss of psychological capacity because of hindered awareness (like insanity), discouragement, or other mental issues


Jarisch Herxheimer's reaction

This systematic reaction, also known as Herxheimer's reaction, was extensively described in the treatment of syphilis. It is believed to be caused by the release of endotoxins such as large amounts of Treponema pallidum killed by antibiotics. It has been documented in tick-borne diseases such as Lyme disease, leptospirosis, and recurrent flu, all of which are spirochaetal. One study suggested that it was more common in patients with Lyme disease treated with cefuroxime. This device may not be accurate as it is not a feature of neonatal syphilis or non-childhood syphilis. The response can be expected in 50-75% of primary or secondary syphilis, and in 16% of primary latent but rare cases of end-stage syphilis. It has been suggested that it is more difficult for HIV-positive patients (1, 2).

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