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1.
Med ; 5(4): 321-334.e3, 2024 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-38513660

RESUMO

BACKGROUND: Neurosyphilis is increasing in prevalence but its pathophysiology remains incompletely understood. This study assessed for CNS-specific immune responses during neurosyphilis compared to syphilis without neurosyphilis and compared these immune profiles to those observed in other neuroinflammatory diseases. METHODS: Participants with syphilis were categorized as having neurosyphilis if their cerebrospinal fluid (CSF)-venereal disease research laboratory (VDRL) test was reactive and as having syphilis without neurosyphilis if they had a non-reactive CSF-VDRL test and a white blood cell count <5/µL. Neurosyphilis and syphilis without neurosyphilis participants were matched by rapid plasma reagin titer and HIV status. CSF and plasma were assayed for markers of neuronal injury and glial and immune cell activation. Bulk RNA sequencing was performed on CSF cells, with results stratified by the presence of neurological symptoms. FINDINGS: CSF neopterin and five CSF chemokines had levels significantly higher in individuals with neurosyphilis compared to those with syphilis without neurosyphilis, but no markers of neuronal injury or astrocyte activation were significantly elevated. The CSF transcriptome in neurosyphilis was characterized by genes involved in microglial activation and lipid metabolism and did not differ in asymptomatic versus symptomatic neurosyphilis cases. CONCLUSIONS: The CNS immune response observed in neurosyphilis was comparable to other neuroinflammatory diseases and was present in individuals with neurosyphilis regardless of neurological symptoms, yet there was minimal evidence for neuronal or astrocyte injury. These findings support the need for larger studies of the CSF inflammatory response in asymptomatic neurosyphilis. FUNDING: This work was funded by the National Institutes of Health, grants K23MH118999 (S.F.F.) and R01NS082120 (C.M.M.).


Assuntos
Neurossífilis , Sífilis , Estados Unidos , Humanos , Sífilis/líquido cefalorraquidiano , Doenças Neuroinflamatórias , Neurossífilis/diagnóstico , Neurossífilis/líquido cefalorraquidiano , Sorodiagnóstico da Sífilis/métodos , Reaginas
2.
Salus militiae ; 17(1/2): 62-6, ene.-dic. 1992. tab
Artigo em Espanhol | LILACS | ID: lil-157207

RESUMO

Se realizó un estudio prospectivo para evaluar el comportamiento de la sífilis en individuos con infección por el virus de inmunodeficiencia humana (VIH). Entre enero de 1990 y enero de 1994 se estudiaron 12 pacientes: 10 con sífilis primaria y 2 con sífilis secundaria. A todos previo al tratamiento, se les realizó evaluación neurológica y estudio de liquido cefalorraquideo (LCR). Resultados: un individuo (sífilis primaria y portador de hapatitis B) con síndrome vertiginoso y VDRL positivo, recibe penicilina cristalina 20 millones de Uds x 20 días con falla al mismo; con desaparición de síntomas y normalización del LCR con el uso de cloramfenicol (4 grs. diarios por 14 días); mantiene dilusiones ascendentes sanguíneas del VDLR sin evidencias de reinfección, comportándose como "resistente al tratamiento". Otro paciente (sífilis primaria tratada) con pleocitosis e hiperproteinorraquía con VDRL no reactivo en el LCR, se indicó tratamiento con penicilina cristalina; el control posterior del LCR fue normal. un tercer paciente (sífilis primaria tratada) con cuadro clínico comicial focal; un estudio cerebral con resonancia magnética nuclear (RMN), demostró: lesiones múltiples corticales bilaterales y subagudas; LCR: pleocitosis y VDRL positivo; recibe tratamiento con cloramfenicol (alérgico a penicilina) con desaparición en la RMN de las imágenes cerebrales patológicos. El resto de lospacientes se encontraban asintomáticos y con LCR normal. Se les realizó controles trimestrales serológicos y licuóricos cada seis meses, luego del tratamiento convencional. Consideramos que todo individuo con infección por VIH y sífilis se le debe descartar precozmente invasión por treponema pallidum del sitema nervioso central(SNC)


Assuntos
Humanos , Masculino , Feminino , Infecções por HIV/complicações , Neurossífilis/líquido cefalorraquidiano , Neurossífilis/terapia , Sífilis/líquido cefalorraquidiano
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