Neurosyphilis in the Netherlands: Then and now

In 1927 the Viennese psychiatrist Julius Wagner – Jauregg was awarded the Nobel Prize for Physiology or Medicine for his contribution to the development of malariafever therapy, specially for patients with General Paralysis of the Insane (GPI), a neuropsychiatric complication of syphilitic infection. Patients were injected with blood containing malaria parasites. The high fevers that resulted from the development of malaria were believed to help to cure these patients. In the first part of this thesis a group of 105 patients with GPI who died in a Dutch psychiatric hospital in the period 1924-1954 is described. Malariafevertherapy was administered to 43 of the GPI-patients and these patients had a longer survival time after admittance than those treated otherwise. Following the introduction of antibiotic therapy the incidence all manifestations of syphilitic disease decreased. However, in the epidemiological part of this study an increase in the incidence of syphilis the Netherlands in the first decade of this century was detected, in accordance with the worldwide increase in the incidence of syphilis. Moreover, every year 60 new patients, predominantly males, were diagnosed with neurosyphilis. A recent cohort of 34 neurosyphilis patients (1 woman and 33 men) are described, who displayed a striking wide array of signs and symptoms and a wide age range (31-84 years). As early diagnosis and treatment of neurosyphilis result in better treatment outcome, reintroduction of screening for syphilis in neurological, psychiatric and geriatric patients should be considered

Clinical Presentation of General Paralysis of the Insane in a Dutch Psychiatric Hospital, 1924-1954

General paralysis of the insane (GPI) or dementia paralytica was once a fatal complication of syphilitic infection and a major reason for psychiatric hospitalization. Nowadays, physicians consider GPI to be exceptional. It should be noted, however, that syphilis re-emerged worldwide at the turn of the 20th to 21st century and a revival of GPI can, therefore, be expected. Advanced diagnosis is crucial in that treatment in the early, inflammatory phase is warranted before irreversible tissue damage occurs. Therefore, a renewed clinical awareness of the broad spectrum of psychiatric and neurologic signs and symptoms of GPI is needed. In this historical cohort study, comprising 105 patients with GPI admitted to the Dutch Vincent van Gogh Psychiatric Hospital in the period 1924-1954, the clinical presentation of this invalidating disorder is investigated and described in detail. (C) 2015 S. Karger AG, Base

Neurosyphilis mimicking autoimmune encephalitis: A case report and review of the literature

Neurosyphilis may imitate a wide range of neurological and psychiatric diseases, including autoimmune encephalitis. To avoid further cognitive decline and morbidity, early recognition and adequate treatment are of particular importance in both neurosyphilis and autoimmune encephalitis. In case of a strong clini

Clinical presentation of laboratory confirmed neurosyphilis in a recent cases series

Objective: The worldwide increase in the incidence of syphilis necessitates alertness to the occurrence of neurosyphilis. Early recognition of neurosyphilis allows for timely treatment, leading to a better treatment outcome. This retrospective study aims to describe the clinical presentation of neurosyphilis in a recent series of neurosyphilis patients. Method: All patients were included with a new, laboratory confirmed, diagnosis of neurosyphilis in the period 2004-2018. The clinical data were analysed. Results: 34 neurosyphilis patients (1 woman and 33 men) were identified. Age varied from 31-84 years (median age: 44 years). A history of syphilis infection was known for 11 (32%) patients; 12 (35%) patients were HIV seropositive. The distribution of the clinical syndromes was as follows: 16 patients with early neurosyphilis (acute meningitis, meningovasculitis and/or uveitis), 9 patients with late neurosyphilis (General Paralysis of the Insane and/or Tabes Dorsalis), 2 patients with symptoms of both early and late neurosyphilis, 6 patients with asymptomatic neurosyphilis and in 1 patient insufficient data were available to determine a clinical syndrome. Early neurosyphilis was seen in all age categories, late neurosyphilis only occurred in patients > 40 years. Conclusions: Neurosyphilis occurs in adults in all age groups, in men more frequent than in women, often in HIV-infected patients, and can present with a wide range of clinical syndromes. Usually no previous infection with syphilis is known

Malaria Fever Therapy for General Paralysis of the Insane: A Historical Cohort Study

Background/Aims: This year marks the 100th anniversary of the first malaria fever treatment (MFT) given to patients with general paralysis of the insane (GPI) by the Austrian psychiatrist and later Nobel laureate, Julius Wagner-Jauregg. In 1921 Wagner-Jauregg reported an impressive therapeutic success of MFT and it became the standard treatment for GPI worldwide. In this study, MFT practice in the Dutch Vincent van Gogh psychiatric hospital in GPI patients who had been admitted in the period 1924-1954 is explored. Methods: To identify patients with GPI, cause-of-death statistics was used. Data on MFT were retrieved from annual hospital reports and individual patient records. Results: Data on MFT were mentioned in the records of 43 out of 105 GPI patients. MFT was practiced in a wide range of patients with GPI, including those with disease duration of more than 1 year, up to 70 years of age, and those with a broad array of symptoms and comorbidities, such as (syphilitic) cardiac disease. Inocu-lation with malaria was done by patient- to- patient transmission of infected blood. Conclusions: MFT practice and mortality rates in MFT- treated patients correspond to similar findings worldwide. MFT was well tolerated and MFT- treated patients had a significantly longer survival. (C) 2017 S. Karger AG, Base