Summary about Disease
Tabes dorsalis is a slow degeneration of the nerve cells and nerve fibers that carry sensory information to the brain. These nerve fibers are located in the posterior (dorsal) columns of the spinal cord. It is a late manifestation of untreated syphilis, typically occurring decades after the initial infection. The condition leads to a variety of neurological problems, primarily affecting sensory perception, balance, and coordination.
Symptoms
Symptoms of tabes dorsalis are progressive and can vary significantly from person to person. Common symptoms include:
Lightning pains: Sudden, sharp, stabbing pains in the legs, arms, face, or trunk.
Ataxia: Impaired coordination and balance, leading to a wide-based, unsteady gait.
Paresthesias: Numbness, tingling, or prickling sensations, often in the feet and legs.
Loss of reflexes: Diminished or absent reflexes, particularly in the knees and ankles.
Urinary problems: Difficulty starting or stopping urination, urinary incontinence.
Visual problems: Optic atrophy (degeneration of the optic nerve), leading to vision loss.
Argyll Robertson pupils: Pupils that constrict in accommodation (focusing on a near object) but do not react to light.
Sensory loss: Reduced ability to feel pain, temperature, vibration, and position (proprioception).
Charcot joints: Progressive degeneration of weight-bearing joints (knees, ankles, feet) due to loss of sensation.
Gastric crises: Episodes of severe abdominal pain, nausea, and vomiting.
Causes
Tabes dorsalis is caused by damage to the spinal cord resulting from Treponema pallidum, the bacterium that causes syphilis. This damage occurs in the late stages of untreated or inadequately treated syphilis, typically 10-30 years after the initial infection. The bacteria invade and destroy the nerve fibers in the dorsal columns of the spinal cord, disrupting the transmission of sensory information.
Medicine Used
The primary treatment for tabes dorsalis is antibiotics to eradicate the underlying syphilis infection. The antibiotic of choice is usually:
Penicillin: High doses of intravenous penicillin are typically administered over a period of several weeks. While antibiotics can halt the progression of the disease, they cannot reverse the nerve damage that has already occurred. Additional medications may be used to manage the symptoms:
Pain relievers: Medications to manage lightning pains, ranging from mild analgesics to anticonvulsants (e.g., gabapentin, pregabalin) or opioids.
Medications for bladder dysfunction: To improve urinary control.
Is Communicable
Tabes dorsalis itself is not directly communicable. However, the underlying syphilis infection is communicable. Syphilis can be transmitted through:
Sexual contact: Vaginal, anal, or oral sex with an infected person.
Mother to child: During pregnancy (congenital syphilis). If the syphilis infection is treated early, it prevents the progress to tabes dorsalis and transmission to others.
Precautions
The most important precaution is to prevent syphilis infection in the first place:
Safe sex practices: Using condoms consistently and correctly during sexual activity.
Regular STI screening: Especially for individuals with multiple partners or a history of STIs.
Prenatal care: Pregnant women should be screened for syphilis to prevent congenital syphilis. If syphilis is diagnosed, it is crucial to:
Complete the full course of antibiotic treatment: As prescribed by a doctor.
Inform sexual partners: So they can be tested and treated if necessary.
Follow-up appointments: To ensure the infection is cleared and to monitor for any complications.
How long does an outbreak last?
Tabes dorsalis is not an "outbreak" in the traditional sense of an acute infection. It's a chronic, progressive condition that develops years after the initial syphilis infection. Once the nerve damage begins, it is generally considered irreversible. The progression of symptoms can vary, with periods of stability followed by periods of worsening. Treatment with antibiotics can halt further progression of the syphilis infection but cannot undo existing nerve damage.
How is it diagnosed?
Diagnosis of tabes dorsalis involves a combination of factors:
Medical history: Including a history of syphilis infection (or risk factors for syphilis).
Neurological examination: Assessing reflexes, sensation, coordination, and gait.
Blood tests:
Venereal Disease Research Laboratory (VDRL) or Rapid Plasma Reagin (RPR) tests: To screen for syphilis.
Fluorescent Treponemal Antibody Absorption (FTA-ABS) test or Treponema Pallidum Particle Agglutination Assay (TPPA): To confirm the presence of syphilis antibodies.
Lumbar puncture (spinal tap): To analyze cerebrospinal fluid (CSF) for:
VDRL test: To detect syphilis in the CSF.
Elevated protein levels: Suggesting inflammation or nerve damage.
Elevated white blood cell count: Suggesting infection or inflammation.
Imaging studies:
MRI of the spinal cord: To rule out other conditions that may be causing similar symptoms. Although MRI findings in tabes dorsalis can be subtle.
Timeline of Symptoms
The timeline of tabes dorsalis development is highly variable:
Primary Syphilis: Initial infection, often with a painless sore (chancre) at the site of entry.
Secondary Syphilis: Occurs weeks to months after the primary infection, characterized by a rash, fever, and other systemic symptoms.
Latent Syphilis: A period with no symptoms, which can last for years or decades.
Tertiary Syphilis: Occurs 10-30 years after the initial infection. Tabes dorsalis is a form of tertiary syphilis affecting the nervous system. Progression of Tabes Dorsalis Symptoms:
Early: Vague sensory disturbances, such as numbness, tingling, or mild pain in the legs.
Intermediate: Development of lightning pains, ataxia, urinary problems, and visual disturbances.
Late: Severe ataxia, Charcot joints, significant sensory loss, and progressive neurological deficits. The rate of progression varies from person to person.
Important Considerations
Early diagnosis and treatment of syphilis are crucial to prevent the development of tabes dorsalis.
Even with treatment, the nerve damage caused by tabes dorsalis may be irreversible, leading to long-term disability.
Management of tabes dorsalis focuses on symptom relief and supportive care.
Patients with tabes dorsalis require ongoing medical care and monitoring.
Family members and sexual partners of individuals with syphilis should be tested and treated if necessary.
Neurological complications may continue to worsen even after treatment. Therefore, rehabilitation, pain management, and supportive care are very important for quality of life.