Prevalence Of Neurosyphilis Research Articles

Clinical Features and Corrected Factors with Neurosyphilis in HIV/Syphilis Co-Infected Patients Based on Stage of Syphilis

Abstract Objective: Neurosyphilis is challenging to diagnose, especially in patients with human immunodeficiency virus (HIV)/syphilis co-infection. The aim of this study was to profile the clinical features of neurosyphilis and evaluate the correlation between neurosyphilis and clinical or laboratory factors among patients with HIV/syphilis co-infection. Methods: We retrospectively analyzed the data of 479 HIV/syphilis co-infected patients examined between August 2009 and September 2018. A multivariate logistic regression model was used to identify factors correlated with neurosyphilis. Results: The overall prevalence of neurosyphilis was 21.7%. The prevalence of neurosyphilis differed among patients with primary (11.1%), secondary (20.1%), and latent syphilis (29.1%). The prevalences of neurosyphilis in patients with serological non-response and serofast patients were 26.1% and 6.3%, respectively, while 12.5% of patients with serological relapse had neurosyphilis. Patients with secondary and latent syphilis had serum rapid plasma reagin (RPR) titers (per unit) of 1.44-fold [95% confidence interval (CI): 1.08–1.93, P = 0.014] and 2.73-fold (95% CI: 1.49–5.00, P = 0.001), respectively, which increased the risk of confirmed neurosyphilis. Among patients with latent syphilis, a serum RPR titer of ≥1:32 and peripheral blood CD4 cell count of ≤350/mL were significantly associated with neurosyphilis, with adjusted odds ratios of 9.45 (95% CI: 1.86–48.03, P = 0.007) and 3.75 (95% CI: 1.11–12.66, P = 0.033), respectively. Conclusion: A serum RPR titer of ≥1:32 and a peripheral blood CD4 cell count of ≤350/mL have predictive value in screening for neurosyphilis among HIV-positive patients with latent syphilis.

Early symptomatic neurosyphilis and ocular syphilis: A comparative study between HIV-positive and HIV-negative patients

ObjectivesSince the 2000s, there has been an increase in prevalence of neurosyphilis (NS) and ocular syphilis (OS). As data about symptomatic NS/OS is limited, this study aims to assess the characteristics of symptomatic NS/OS, according to HIV status. MethodsWe compared the clinical and biological presentation of early symptomatic NS/OS and its outcome in HIV-positive and HIV-negative patients. ResultsNinety-six patients (93% men, 49% HIV-positive) were included from 2000 to 2016 in two centers, with 67 (69%) having OS, 15 (16%) NS, and 14 (14%) both. HIV-positive patients were younger (P=0.006) and more likely to be males having sex with males (P=0.00048) or to have a history of syphilis (P=0.01). Among 81 OS, there were 43 posterior uveitis (57%), and bilateral involvement was more common in HIV-positive patients (62% versus 38%, P=0.045). Among 29 NS there were 21 cases of cranial nerve involvement (72%), seven meningitis (24%) and 11 paresthesia (38%). Involvement of the VIIIth cranial nerve was the most common (16 cases). Treponemal tests were more commonly found positive in cerebrospinal fluid in HIV-positive patients (88% versus 76%, P=0.04). Visual acuity (VA) always improved after treatment (initial VA logMAR 0.8±0.8 versus 0.1±0.1 at 3 months), but 32% and 18% of the patients still had neurological or ocular impairment respectively six and 12 months after treatment. Non-treponemal serological reversion was observed in 43/50 patients (88%) at six months. ConclusionHIV infection has no consequence on the outcome of NS and OS. Sequelae are common, emphasizing the importance of prevention, and screening, and questioning enhanced treatment.

Frequency of Screening and Prevalence of Neurosyphilis in Stroke Population

Background and Aims: Syphilis and stroke are high prevalent diseases in south Brazil and estimates of concomitance and possible role of syphilis in acute stroke are lacking. Our aims are to estimate the prevalence of syphilis and neurosyphilis (NS) in a cohort of tertiary stroke center. Methods: We reviewed all hospital records of stroke/transitory ischemic attack (TIA) using International Classification of Diseases, 10th revision, at discharge, frequency of syphilis screen, serology positivity, cerebrospinal fluid (CSF) analysis, and prevalence of NS in this stroke population applying CDC criteria. Results: Between 2015 and 2016, there were 1,436 discharges for cerebrovascular events and in 78% (1,119) of these cases, some syphilis screening was performed. We have found a frequency of positive serology for syphilis of 13% (143/1,119), and higher stroke severity was the main determinant for non-screening. Applying standard NS criteria, 4.7% (53/1,119) cases with CSF analysis had NS diagnosis: 8 based on CSF-Venereal Disease Research Laboratory (VDRL) positive and 45 based on abnormal CSF white cells or protein, but CSF VDRL negative. NS VDRL positive cases were younger, had higher serum VDRL title, had more frequent HIV infection, and received NS treatment more often. Demographic and clinical characteristics were not different between NS VDRL negative and non-NS cases. Conclusion: Positive syphilis serology is frequent in patients with acute stroke/TIA in our region. Acute post-stroke CSF abnormalities make the diagnosis of NS difficult in the context of CSF VDRL negative.

IMMUNOLOGICAL ASPECTS OF NEUROSYPHILIS

Reduced incidence of syphilis was reported in Russia over last years, along with increased prevalence of neurosyphilis. The issues of the mechanisms of the damage of nervous system and the immune response to syphilis are actual. Origin of syphilis antibodies from cerebrospinal fluid of patients with neurosyphilis is considered. The role of intrathecal immunoglobulin production and dysfunction of blood-brain barrier in patients infected with syphilis is of special importance. The aim of the research was to analyze the immunological aspects of neurosyphilis. Polymorphonuclear leukocytes have been shown to play an important role in infection with Treponema pallidium during clearance of the pathogenes. Potential virulence factors of Treponema pallidium have been discovered. It has been found that cell-mediated immune response is very important for defense against Treponema pallidium, while the key importance in bacterial clearance is put on Th1. Evidence has shown that the level of cytokines which are secreted by Th1 (IL-2, interferon gamma and tumor necrosis factor) and Th2 (IL-6 and IL-10) — lymphocytes, correlates with syphilis progression. The role of IL-10 in immune response regulation in patients infected with syphilis has been examined: this cytokine can inhibit the activity of immunocompetent cells. Some data has been produced concerning intrathecal production of immunoglobulins in neurosyphilis patients’ cerebrospinal fluid. The research of immunological parameters and composition of liquor in the patients with syphilis has revealed, that lymphocytes of peripheral blood are sensitized to antigens of the brain. It indicates the violation of permeability of patients’ blood-brain barrier. Nervous system becomes involved into the pathological process during the first weeks or months after syphilis infection. Cerebrospinal fluid changes can be detected at seronegative stage of the primary infection. The most expressed changes were found in the cerebrospinal fluid of patients with secondary recurrent syphilis It was established that high titers of treponemas specific antibodies in the cerebrospinal fluid of patients are the consequence of inflammation of the central nervous system. According to our data, cytosis and protein levels in the cerebrospinal fluid of patients with meningovascular syphilis were significantly higher than these in individuals with a history of syphilis and negative serological results in the research of the cerebrospinal fluid. Thus, advances in the study of the immunological aspects of syphilis promote early diagnosis of neurosyphilis and development of vaccines against syphilis.

Analysis on the prevalence of neurosyphilis in patients with latent syphilis

Objective To compare the prevalence of neurosyphilis in untreated patients with latent syphilis (LS) versus serofast patients treated for LS in Guangzhou City. Methods A cross-sectional study was performed. Cerebrospinal fluid was obtained from 356 patients who were first diagnosed with LS, and venereal disease research laboratory (VDRL) test was conducted to screen neurosyphilis. Results Among 273 untreated patients with LS, 60 (21.98%) were diagnosed with neurosyphilis, and of the 60 patients, 30 were asymptomatic , and the other 30 were symptomatic. In 83 serofast patients treated for LS, only 1 ( 1.2% ) was diagnosed with neurosyphilis, while no symptom was observed in this patient. In untreated cases of LS, the mean age was significantly lower in patients without neurosyphilis than in those with neurosyphilis.Conclusions Patients with untreated LS are more likely to develop neurosyphilis compared with serofast patients treated for LS, and neurosyphilis mainly occurs in untreated patients with LS, suggesting that untreated latent syphilis is an important risk factor for the development of neurosyphilis. Key words: Syphilis; Neurosyphilis; Prevalence

Hirnstamm- und Kleinhirnatrophie bei Neurosyphilis

A 54-year-old man suffered from serologically proven neurosyphilis with tetraspastic syndrome and bladder dysfunction. He showed a pronounced psychopathy with cognitive decline and attention/concentration deficits. MRI showed slowly progressive cerebellar and brainstem atrophy, which has rarely been described over the past decades. During times of higher incidence and prevalence of neurosyphilis, infratentorial atrophy had been described occasionally, but today this clinical manifestation has been all but forgotten.

Prevalence of neurosyphilis at Government Rajaji Hospital, Madurai, India.

Forty patients (34 males and 6 females) with neurological complaints/manifestations and with a past history of multiple sexual partners attending the Government Rajaji Hospital, Madurai, India between April 1992 and October 1992 were investigated for neurosyphilis. Metabolic disorders, hypertension, ischaemic heart disease, arrhythmias and trauma were excluded. Seven males (17.5%) were found to have neurosyphilis. The youngest was 26 years old and the oldest was 47. All were married and of low socioeconomic background. Meningovascular syphilis was the predominant presentation (6:1). Associated cardiovascular involvement was noticed in one of the cases. There was no associated HIV infection in these cases. The incidence is higher than previous reports from this centre.

Prevalence of neurosyphilis in human immunodeficiency virus-infected patients with latent syphilis

purpose: A prospective study was done to determine the prevalence of confirmed neurosyphilis (cerebrospinal fluid [CSF] Venereal Disease Research Laboratory [VDRL]-reactive) in human immunodeficiency virus (HIV)-infected patients with latent syphilis (reactive serum rapid plasma reagin [RPR] and microhemagglutination- Treponema pallidum [MHA-TP]). patients and methods: All HIV-infected patients seen for their first visit at the Los Angeles County/University of Southern California Medical Center AIDS Clinic from June through December 1990 were screened for latent syphilis. Those with reactive serum RPRs and MHA-TPs who had not received recent (within 6 months) therapy for syphilis were offered diagnostic CSF sampling. results: A total of 312 patients were screened, of whom 71 (22.8%) had reactive serum RPRs and MHA-TPs. Thirty-three of these patients (47%) had diagnostic CSF sampling (26 refused lumbar puncture or were lost to follow-up; 12 had had recent therapy for syphilis and thus did not have CSF sampling). Among the 33 patients who had CSF sampling, 20 (60.6%) had normal CSF profiles (white blood cell count less than 8/mm 3, protein less than 0.60 g/L; glucose greater than 2.8 mmol/L) and nonreactive CSF VDRIs. Ten of the 33 patients (303%) had abnormal CSF profiles and nonreactive CSF VDRLs, and three of 33 (9.1%) had reactive CSF VDRLs. conclusions: Asymptomatic neurosyphilis was found in 9.1% of our patient population undergoing CSF sampling, giving a 1.0% prevalence of CSF VDRL-reactive neurosyphilis in the population we screened. The abnormal CSF findings may have been due to either nonreactive CSF VDRL neurosyphilis, central nervous system infection with HIV, or infection with some unrecognized agent.

Neurosyphilis and Human Immunodeficiency Virus Type 2 Infection

To the Editor. —In a recent study designed to know the prevalence of neurosyphilis in immunodeficiency virus type 1 infection (HIV-1)—seropositive persons, Berger1found a significant rate of unexpected neurosyphilis compared with HIV-1-negative patients. He also detected a high association (46%) of reactive serum syphilitic test results and HIV-positive patients. In our Dermatology Department in a General Hospital in Barcelona, Spain, from January 1, 1990, through October 1, 1991, we observed that 14 (40%) of 35 patients with syphilis also had HIV infection. Nine of them were seropositive to HIV-1, and the remaining five were seropositive to HIV-2. Ten patients were black West African immigrants, and four were white local residents. All but three were men, aged from 20 to 36 years. The average time living in Spain in the immigrant group was 4.6 years. The only risk factor for HIV infection among African patients was heterosexual intercourse with

Neurosyphilis in Human Immunodeficiency Virus Type 1-Seropositive Individuals

The prevalence of neurosyphilis in human immunodeficiency virus type 1 (HIV-1)-seropositive (HIV+) persons was assessed during the course of a study of the neurological complications of HIV-1 infection. One hundred sixty-six asymptomatic HIV+ subjects, 63 neurologically symptomatic HIV+ subjects, and six at-risk HIV-1-seronegative (HIV-) control subjects underwent cerebrospinal fluid (CSF) analysis on entry into this longitudinal study. Three (1.8%) of the asymptomatic HIV+ subjects had both a reactive CSF VDRL test and a reactive CSF fluorescent treponemal antibody-absorption (FTA-ABS) test. Two of these three subjects had a history of appropriately treated early syphilis, and all had a reactive serum rapid plasma reagin test. Of the 63 neurologically symptomatic HIV+ subjects, one patient with dementia had both a reactive CSF VDRL test and a fluorescent treponemal antibody-absorption test. Subjective improvement in cognitive skills followed high-dose, intravenous penicillin therapy. Another subject had a penicillin-responsive myelopathy accompanied by a reactive CSF fluorescent treponemal antibody-absorption test result, but a nonreactive CSF VDRL. Unsuspected neurosyphilis is relatively common in our population of asymptomatic HIV+ subjects and may be responsible for neurological disease in a significant minority of neurologically symptomatic HIV+ persons. Cerebrospinal fluid examination should be performed in all HIV+ persons with a history of syphilis or serological evidence of syphilis, regardless of prior treatment. Additionally, neurosyphilis should be considered in the differential diagnosis of neurological disease in any HIV+ person.

Short Notices

THE first edition of Dr. Bayly's “Venereal Disease” appeared in 1919. This is the fifth edition, and it is an improvement on the other editions. The author very wisely, we think, points out that a number of competent judges consider that there is a definite increase in the prevalence of neurosyphilis, and not a reduction, as so many hoped there would be. Probably the wish was father to the thought. It is probable that the ideal treatment for general paralysis is tryparsamide followed by malaria or some other pyrexial treatment and then tryparsamide again. The last word on the various fever and arsenical treatments of general paralysis has by no means been said, and in twenty years' time we may find all these present treatments scrapped. From the descriptions given, it is rather difficult to see how a differential diagnosis between cerebral syphilis and general paralysis can be made.