Risk profiles of neurosyphilis in HIV-negative patients with primary, secondary and latent syphilis: implications for clinical intervention.

BACKGROUND: Neurosyphilis is one of the most feared complications of syphilis. The question of how to identify patients at higher risk in order for timely intervention whilst avoiding unnecessary lumbar puncture remains. METHODS: Between August 2009 and March 2013, a total of 834 HIV-negative patients with primary, secondary or latent syphilis were recruited. Venous blood and cerebrospinal fluid specimens were collected for diagnoses of syphilis and/or neurosyphilis and information of socio-demographic and behavioral characteristics was collected by interviewing with a questionnaire. RESULTS: The prevalence of neurosyphilis differed among patients with primary (7.1%), secondary (23.8%) and latent (26.6%) syphilis. Neurosyphilis was more likely in male patients (1.52-fold). Compared with patients aged <30 years, those aged 45-59 years and ≥60 years old had a 2.51-fold and 4.98-fold risk of neurosyphilis respectively. Male gender and age ≥45 years were consistently associated with neurosyphilis both in secondary and latent stage. There was a 2.68-fold, 2.55-fold and 3.67-fold increased risk of neurosyphilis when the serum RPR titer was 1:32, 1:64 and ≥1:128 compared to that of ≤1:16. ). CONCLUSIONS: Male gender and age 45years are both correlated risk factors for neurosyphilis in HIV-negative patients with primary, secondary and latent syphilis.

[Brain and spine cord lesions caused by syphilis].

OBJECTIVE: To analyze clinical features of the nervous system damage in syphilis taking into account the changes in the content of cerebrospinal fluid and clinical/anatomical brain damages of the brain. METHODS: The study was based on the analysis of 47 case histories of patients hospitalized in 1995-2001. The group included 47 patients, aged from 17 to 60 years. RESULTS: Syphilitic meningitis, syphilitic meningoneuritis, syphilitic menongoencephalitis, syphilitic meningovasculitis, cerebral gummas, syphilitic meningomyelitis and mental changes caused by syphilis are reviewed. CONCLUSIONS: The pathogenesis of different clinical forms of syphilitic damages of the brain and terminological issues are discussed.

[Syphilis--diagnosis, treatment and characteristics in HIV-infected patients]. / Syphilis und HIV-Infektion. Dem Duo möglichst fruh den Kampf ansagen.

Venereal syphilis is a chronic cyclic infectious disease that, if untreated, runs a decades-long course. The responsible pathogen is Treponema pallidum. Clinically, a differentiation is made into early (primary) syphilis (up to 1 year following infection, syphilis I), during which disease manifestations are localized, secondary syphilis (syphilis II) with generalized manifestations, and late, or tertiary syphilis (syphilis III). Clinical manifestations that have been observed in HIV patients are syphilis maligna and neurosyphilis. Treatment of choice continues to be penicillin. Instead of only a single injection of penicillin, HIV infected patients with early syphilis should be given three injections, with an interval of 1 week between them, to prevent the development of neurosyphilis.

Neurossífilis: revisão de literatura e relato de casos do Hospital Universitário da Universidade Federal de Juiz de Fora / Neurosyphilis: review of literature and report of cases of the University Hospital of the Universidade Federal de Juiz de Fora

A sífilis é uma doença infecciosa, sexualmente transmissível, que cursa com diversas manifestações clínicas, decorrentes de lesões de vários órgãos e sistemas causados pelo Treponema pallidum. Este microorganismo pode invadir o sistema nervoso central, determinando quadros clínicos variados, desde alterações liquóricas em indivíduos assintomáticos até quadros mais graves como a paralisia geral progressiva. A todas as formas de comprometimento do sistema nervoso central (SNC) denominamos genericamente de neurossífilis. Este trabalho tem como objetivo destacar os aspectos relevantes das manifestações clínicas, métodos diagnósticos, características epidemiológicas e recursos terapêuticos desta enfermidade, cuja a ocorrência diminuiu muito nas últimas décadas. Nos dias atuais, entretanto, existe uma tendência a nova elevação de seu aparecimento, pois a sífilis primária tem aumentado em decorrência de mudanças comportamentais e sócio-econômicas vivenciadas pela sociedade. Os clínicos, diante do número reduzido de casos, tornaram-se desinteressados e, por conseguinte, desinformados acerca do assunto. Com este trabalho, os autores retomam a discussão do tema. São relatados cinco casos de neurossífilis, sendo feito estudo comparativo entre eles, bem como uma atualização da literatura pertinente.

[Syphilis. Clinical aspects of Treponema pallidum infection]. / Syphilis. Klinik der Treponema-pallidum-Infektion.

Syphilis is a sexually transmitted infection by Treponema pallidum. Without antibiotic treatment syphilis lasts for several decades and may develop up to 4 different clinical stages. Usually, the disease begins with a distinct painless and indurated ulcer at the contact site: the primary chancre. An indolent regional lymph node swelling is usually associated with the syphilitic chancre. After spontaneous healing of the primary lesion and several weeks of latency, the clinical symptoms of secondary syphilis occur. Treponema pallidum bacteremia leads to common symptoms like fever and malaise, but also to a generalized lymphadenopathy, and a broad variety of lesions of the skin and mucosal membranes. Non-pruritic transient exanthems often involving palms and soles, condylomata lata, and a specific angina with mucous patches of the oral cavity are prominent signs. After several relapses, which are characterized by a decreasing intensity of clinical symptoms, secondary syphilis then resolves spontaneously. A second period of latency follows, lasting 3-12 years. Then the outcome of untreated syphilis becomes apparent: spontaneous healing by elimination/inactivation of the spirochetes (75%) or transition to tertiary syphilis (25%). Two kinds of granulomatous skin reactions are typical for tertiary syphilis: superficial nodular syphilids and gummas. The bones, as well as the cardiovascular and central nervous system, may also be involved. Finally, metasyphilis with severe and sometimes lethal neurological symptoms (tabes dorsalis, progressive paralysis) occurs 10 to 30 years after primary infection. Except for irreversible tissue destruction which occurs prior to therapy, all stages of syphilis can be cured completely.

La introducción del concepto de "parálisis general progresiva" en la psiquiatría decimonónica española

Se analizan los primeros datos sobre la incidencia de la Parálisis General Progresiva en los manicomios españoles durante el siglo XIX, las referencias decimonónicas a dicha entidad morbosa en la literatura médica y la introducción del concepto en nuestros textos psiquiátricos. El retraso en la recepción del concepto de PGP traduce un elevado grado de desinformación de los profesionales médicos y una lenta asimilación del proceso de somatización de la enfermedad mental en nuestro país (AU)

Neurosyphilis. A comparative study of the effects of infection with human immunodeficiency virus.

BACKGROUND: The course of neurosyphilis has been reported to be altered by human immunodeficiency virus (HIV) infection. Prior reports of neurosyphilis occurring in association with HIV infection have been largely anecdotal and have failed to compare neurosyphilis in patients with HIV infection with an uninfected control group. This study was performed to determine if the clinical presentation encountered is different in the presence of HIV infection. DESIGN: A retrospective, hospital-based, case series study based on chart review encompassing a 64-month period. SETTING: The study was performed in a large, university-affiliated, public health trust hospital in south Florida. PATIENTS: Forty-six hospitalized patients with neurosyphilis were identified; 13 patients fulfilled Centers for Disease Control and Prevention (Atlanta, Ga) criteria for acquired immunodeficiency syndrome (AIDS), 11 were HIV seropositive only, and 22 were HIV uninfected. Neurosyphilis was determined by a reactive cerebrospinal fluid VDRL slide test. RESULTS: The HIV-infected patients (both AIDS and HIV-seropositive groups) were younger and more frequently had features of secondary syphilis, such as rash, fever, adenopathy, headache, or meningismus. Significant differences were observed in cerebrospinal fluid measurements when the HIV-infected group was compared with the HIV-uninfected group, including a higher mean white blood cell count in patients with AIDS and a higher mean protein level and a lower mean glucose level in the HIV-infected group. Syphilitic meningitis was more common in HIV-seropositive patients, although the HIV-uninfected patients presented with a greater variety of types of neurosyphilis. Ophthalmic syphilis was observed more frequently in the HIV-infected group. CONCLUSIONS: Significant differences exist between neurosyphilis occurring in the presence and absence of HIV infection.

Neurossífilis: atualizaçäo e descriçäo de um caso / Neurosiphilis: an up date and report of one case

Os autores, através da revisäo da literatura, destacam os aspectos importantes para o diagnóstico, tratamento e avaliaçäo da resposta terapêutica da neurossífilis (NS). As dificuldades, muitas vezes presentes, em relacionar a sintomatologia com achados sorológicos säo enfatizadas pelo relato de um caso clínico.