[Rapidly progressive dementia due to neurosyphilis (general paralysis). A treatable case of dementia]. / Demencia rápidamente progresiva por neurosífilis (parálisis general). Un caso tratable de demencia.

Rapidly progressive dementias are conditions of impairment in more than one cognitive domain with functional compromise that progress in less than 1 to 2 years; and neurosyphilis is one of the etiologies. Syphilis is a chronic bacterial infection that causes a series of highly variable clinical conditions during the first 2 to 3 years, followed by a prolonged latent stage that can progress to a tertiary infection stage. After a period of years, or even decades, a third of people with untreated latent syphilis will have clinical manifestations of tertiary syphilis such as neurosyphilis. We present the case of a 41-year-old man who consulted for prostration symptoms, preceded by progressive behavioral cognitive alterations of 18 months of evolution. A dementia picture was found associated with pharmacological parkinsonism secondary to risperidone, so this treatment was suspended. Neuroimaging showed severe cerebral atrophy; serum and cerebrospinal fluid (CSF) reactive VDRL, in addition to a slight increase in CSF proteins. The diagnosis of late neurosyphilis was made and treated with crystalline penicillin G 1 400 000 IU every 4 h for 14 days with an excellent response. Our case allows us to reflect on the importance of requesting diagnostic studies of syphilis in young patients who present a rapidly evolving dementia, since this disease has a treatment that can partially or totally reverse the symptoms.

Las demencias rápidamente progresivas son cuadros de deterioro en más de un dominio cognitivo con compromiso funcional que progresan en menos de 1 a 2 años; y la neurosífilis es una de las etiologías. La sífilis es una infección bacteriana crónica que causa una serie de cuadros clínicos muy variables durante los primeros 2 a 3 años, seguido de una etapa latente prolongada que puede evolucionar a una etapa de infección terciaria. Luego de un período de años, o incluso décadas, un tercio de las personas con sífilis latente no tratada tendrá manifestaciones clínicas de sífilis terciaria como neurosífilis. Presentamos el caso de un varón de 41 años de edad que consultó por cuadro de postración, precedido por alteraciones cognitivas conductuales progresivas de 18 meses de evolución. Se constató cuadro demencial asociado a parkinsonismo farmacológico secundario a risperidona, por lo que se suspendió dicho tratamiento. Las neuroimágenes mostraron una atrofia cerebral grave; VDRL reactiva en suero y líquido cefalorraquídeo (LCR); además de un leve aumento de proteínas en LCR. Se realizó el diagnóstico de neurosífilis tardía iniciando tratamiento con penicilina G cristalina 1 400 000 UI cada 4 h por 14 días con excelente respuesta. Nuestro caso nos permite reflexionar sobre la importancia de solicitar estudios diagnósticos de sífilis en pacientes jóvenes que presentan cuadro de demencia rápidamente progresiva, ya que esta enfermedad tiene un tratamiento que puede revertir parcial o totalmente los síntomas.

Demencia rápidamente progresiva por neurosífilis (parálisis general). Un caso tratable de demencia / Rapidly progressive dementia due to neurosyphilis (general paralysis). A treatable case of dementia

Resumen Las demencias rápidamente progresivas son cuadros de deterioro en más de un dominio cognitivo con compromiso funcional que progresan en menos de 1 a 2 años; y la neurosífilis es una de las etiologías. La sífilis es una infección bacteriana crónica que causa una serie de cuadros clínicos muy variables durante los primeros 2 a 3 años, seguido de una etapa latente prolongada que puede evolucionar a una etapa de infección terciaria. Luego de un período de años, o incluso décadas, un tercio de las personas con sífilis latente no tratada tendrá manifestaciones clínicas de sífilis terciaria como neurosífilis. Presentamos el caso de un varón de 41 años de edad que consultó por cuadro de postración, precedido por alteraciones cognitivas conductuales progresivas de 18 meses de evolución. Se constató cuadro demencial asociado a parkinsonismo farmacológico secundario a risperidona, por lo que se suspendió dicho tratamiento. Las neuroimágenes mostraron una atrofia cerebral grave; VDRL reactiva en suero y líquido cefalorraquídeo (LCR); además de un leve aumento de proteínas en LCR. Se realizó el diagnóstico de neurosífilis tardía iniciando tratamiento con penicilina G cristalina 1 400 000 UI cada 4 h por 14 días con excelente respuesta. Nuestro caso nos permite reflexionar sobre la importancia de solicitar estudios diagnósticos de sífilis en pacientes jóvenes que presentan cuadro de demencia rápidamente progresiva, ya que esta enfermedad tiene un tratamiento que puede revertir parcial o totalmente los síntomas.

Abstract Rapidly progressive dementias are conditions of impairment in more than one cognitive domain with functional compromise that progress in less than 1 to 2 years; and neurosyphilis is one of the etiologies. Syphilis is a chronic bacterial infection that causes a series of highly variable clinical conditions during the first 2 to 3 years, followed by a prolonged latent stage that can progress to a tertiary infection stage. After a period of years, or even decades, a third of people with untreated latent syphilis will have clinical manifestations of tertiary syphilis such as neurosyphilis. We present the case of a 41-year-old man who consulted for prostration symptoms, preceded by progressive behavioral cognitive alterations of 18 months of evolution. A dementia picture was found associated with pharmacological parkinsonism secondary to risperidone, so this treatment was suspended. Neuroimaging showed severe cerebral atrophy; serum and cerebrospinal fluid (CSF) reactive VDRL, in addition to a slight increase in CSF proteins. The diagnosis of late neurosyphilis was made and treated with crystalline penicillin G 1 400 000 IU every 4 h for 14 days with an excellent response. Our case allows us to reflect on the importance of requesting diagnostic studies of syphilis in young patients who present a rapidly evolving dementia, since this disease has a treatment that can partially or totally reverse the symptoms.

A case study of the influence of local weather on Aedes aegypti (L.) aging and mortality.

The survival rate of mosquitoes is an important topic that affects many aspects of decision-making in mosquito management. This study aims to estimate the variability in the survival rate of Ae. aegypti, and climate factors that are related to such variability. It is generally assumed that the daily probability of mosquito survival is independent of natural environment conditions and age. To test this assumption, a three-year fieldwork (2005-2007) and experimental study was conducted at Fortaleza-CE in Brazil with the aim of estimating daily survival rates of the dengue vector Aedes aegypti under natural conditions in an urban city. Survival rates of mosquitoes may be age-dependent and statistical analysis is a sensitive approach for comparing patterns of mosquito survival. We studied whether weather conditions occurring on a particular day influence the mortality observed on that particular day. We therefore focused on the impact of daily meteorological fluctuations around a given climate average, rather than on the influence of climate itself. With regard to survival time, multivariate analyses using the stepwise logistic regression model, adjusted for daily temperature, relative humidity, and saturated vapor pressure deficit (SVPD), suggest that age, the seasonal factor, and the SVPD were the most dependent mortality factors. Similar results were obtained using the Cox proportional hazard model, which explores the relationships between the survival and explanatory variables.

The influence of local environment on the aging and mortality of Aedes aegypti (L.): case study in Fortaleza-CE, Brazil.

It is generally assumed that the daily probability of survival of mosquitoes is independent of age. To test this assumption we have conducted a three-year experimental fieldwork study (2005-2007) at Fortaleza-CE in Brazil, determining daily survival rates of the dengue vector Aedes aegypti (L.). Survival rates of adult Ae. aegypti may be age-dependent and the statistical analysis is a sensitive approach for comparing patterns of mosquito survival. The mosquito survival data were better fit by a Weibull survival function than by the more traditionally used Gompertz or logistic survival functions. Gompertz, Weibull, or logistic survival functions often fit the survival, and the tails of the survival curves usually appear to fall between the values predicted by the three functions. We corroborate that the mortality of Ae. aegypti in semi-natural conditions may no more be considered as a constant phenomenon during the life of adult mosquitoes but varies according to the age and environmental conditions under a tropical climate. This study estimates the variability in the survival rate of Ae. aegypti and environmental factors that are related to such variability. The statistical analysis shows that the fitting ability, concerning the hazard function, was in decreasing order: Seasonal Cox, the three-parameter Gompertz, and the three-parameter Weibull, that was similar to the three-parameter logistic. The advantage of using the Cox model is that it is convenient for exploring the relationship between survival and several explanatory variables. The Cox model has the advantage of preserving the variable in its original quantitative form and of using a maximum of information. The survival analyses indicate that mosquito mortality is both age- and environment-dependent.