Clinical aspects, from past to present

The Geneva Brain Bank covers a range of different pathologies, most of them psychiatric or related to the neurocognitive effects of a primary disease, as in the case of neurosyphilis. Although this disease has been known since the sixteenth century, medical understanding of it remains incomplete for historical, epidemiological, biological and technical reasons. Descriptions of neurosyphilis come from the pre-penicillin era (prior to 1950), and very little research has been done on it since, due to a lack of interest in what is an easily treatable infection, the difficulty of diagnosis and the scarcity of clinical trials involving patients with infectious diseases of the brain.

Even with modern medical imaging techniques, studying the interactions between a pathogen and the central nervous system remains difficult. In living patients, the only specimens available for diagnostic and pathogenesis studies consist of cerebrospinal fluid taken by lumbar puncture, a complex procedure that is not without its risks. The purpose of this module is to help fill these gaps in the biological data and to shed light on current clinical knowledge. Access to historic brain tissue provides a rare and valuable opportunity to study the disease retrospectively from a number of different angles.

We will analyse the following: 1) the pharmaceutical impact, by comparing pre- versus post- penicillin era cases; 2) coinfections and comorbidities (tuberculosis, HIV, neurodegenerative diseases); and 3) the genetic evolution of strains and phenotypic profiles (antibiotic resistance and the severity of infection). Use of AI will make it easier to cross-reference information from each module and will stimulate clinical applications in the context of the current resurgence of syphilis.