What does the remedial method of neurosyphilis have?

Neurosyphilis (neurosyphilis) is a disease caused by Treponema pallidum (Treponema pallidum) infecting the nervous system, which is divided into congenital and acquired syphilis. So, what are the treatments for neurosyphilis?

Penicillin was used to treat all types of neurosyphilis. The lowest serum concentration of penicillin was 0.03 μ g / ml and the highest effective serum concentration was 0.1 μ g / ml. It is generally believed that the therapeutic effect is related to the duration of the disease, but not to the dose of penicillin.

one. Dosage and usage of penicillin

At present, there are two schemes to treat neurosyphilis with penicillin at home and abroad.

(1) 900000 U of water-soluble procaine penicillin (procaine penicillin G) was injected intramuscularly once a day for 15 to 20 days.

(2) 2.4 million U of benzylpenicillin (benzylpenicillin G) was injected intramuscularly once a week for 3 weeks. Considering that the above dose failed to restore the increase of white blood cells in cerebrospinal fluid or that Treponema pallidum in tissues was highly virulent, some authors suggested that a larger dose of procaine penicillin should be injected intramuscularly every 12 hours for a total of 15 to 20 days big ass , with a total amount of more than 20 million units.

In 1998, the use of penicillin recommended by the American Centers for Disease Control and Prevention for the treatment of neurosyphilis was: ① water-soluble crystal penicillin G, 2 million ~ 4 million U, intravenous drip, every 4 hours, a total of 14 days; ② procaine penicillin, 2.4 million U, intramuscular injection, once a day, while oral administration of probenecid (probenecid) 500mg 4 times a day for a total of 10 days.

Other scholars believe that after the above treatment, 2.4 million U of benzylpenicillin (benzylpenicillin G) can be injected intramuscularly once a week for 3 weeks, and the curative effect may be better.

All patients who have been treated should be followed up regularly. Generally in the first year after treatment, once every 3 months, including serum syphilis test, if the recovery is good, it will be reexamined every half a year to a year later. Cerebrospinal fluid examination is generally performed every six months to one year, until the cerebrospinal fluid and serum have returned to normal, and patients are generally followed up for at least 3 years.

two. Retreatment problem

In the follow-up observation after treatment, if you find that the last treatment failed, you should consider retreatment. The main manifestation of treatment failure is that the infection of neurosyphilis is still active, if it is found that the clinical symptoms continue to develop, the number of cells in cerebrospinal fluid still increases after treatment; 6 months after treatment butts rose toy , the number of cells in cerebrospinal fluid still does not return to normal; those whose titers of serum or cerebrospinal fluid VDRL do not decrease or increase should be treated again.

three. Gibbs-Heights reaction (Jarish-Herxheimer reaction)

It refers to the systemic reaction and local syphilis damage caused by exotoxin released by a large number of killed Treponema pallidum within the first 24 hours of penicillin treatment. This reaction can reach the peak of symptoms within a few hours. Systemic symptoms are characterized by high fever and redness of the skin, which can be relieved after about 24 hours. Local reactions in patients with neurosyphilis can lead to sudden aggravation of the original visual impairment and aggravation of mental symptoms such as insanity and delirium in patients with paralytic dementia, and occasional seizures. Gee-Heigh reaction can be seen at the beginning of any form of syphilis treatment, especially in serum-positive early syphilis, but neurosyphilis seems to be rare. In order to prevent this reaction, steroids can be used to prevent it before penicillin is used, but the effect is still inconclusive.

four. Tetracycline and erythromycin

Patients who are allergic to penicillin can be treated with erythromycin or tetracycline. These two drugs are effective in the treatment of early syphilis, but not in the treatment of advanced neurosyphilis. Tetracycline was taken orally with 500mg once every 6 hours for 30 days. The dose of erythromycin is the same as tetracycline. Tetracycline is not suitable for pregnant women and children because it can affect teeth and bones.

five. Symptomatic treatment

Patients with convulsions were given antiepileptic drugs such as carbamazepine (imipramine) and diazepam. Patients with bladder disorders should be treated with aseptic catheterization to treat urinary retention and flush the bladder regularly. Patients with spinal tuberculosis who have lightning-like pain can take painkillers including tramadol (tramadol) sustained-release tablets, but should prevent addiction. Visceral crisis can be controlled by atropine.

After reasonable treatment of neurosyphilis remote control vibrator , asymptomatic neurosyphilis was the best, followed by meningeal neurosyphilis and vascular neurosyphilis, spinal tuberculosis and paralytic dementia were better, and congenital neurosyphilis was poor.
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