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1.
PLoS One ; 15(10): e0238617, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33027255

RESUMO

BACKGROUND: Neurosyphilis (NS) presents with a variety of clinical syndromes that can be attributed to other aetiologies due to difficulties in its diagnosis. We reviewed all cases of NS from the "Top End" of the Australian Northern Territory over a ten-year period to assess incidence, clinical and laboratory manifestations. METHODS: Patient data (2007-2016) were extracted from hospital records, centralised laboratory data and Northern Territory Centre for Disease Control records. Clinical records of patients with clinically suspected NS were reviewed. A diagnosis of NS was made based on the 2014 US CDC criteria. Results were also recategorized based on the 2018 US CDC criteria. RESULTS: The population of the "Top End" is 185,570, of whom 26.2% are Indigenous. A positive TPPA was recorded in 3126 individuals. A total of 75 (2.4%) of TPPA positive patients had a lumbar puncture (LP), of whom 25 (35%) were diagnosed with NS (9 definite, 16 probable). Dementia was the most common manifestation (58.3%), followed by epilepsy (16.7%), psychosis (12.5%), tabes dorsalis (12.5%) and meningovascular syphilis (8.3%). 63% of probable NS cases were not treated appropriately due to a negative CSF VDRL. Despite increased specificity of the 2018 US CDC criteria, 70% of patient in the probable NS group were not treated appropriately. The overall annual incidence [95%CI] of NS was 2.47[1.28-4.31] per 100 000py in the Indigenous population and 0.95[0.50-1.62] in the non-Indigenous population (rate ratio = 2.60 [1.19-5.70];p = 0.017). CONCLUSION: Neurosyphilis is frequently reported in the NT, particularly in Indigenous populations. Disturbingly, 60% of probable neurosyphilis patients based on the 2014 criteria, and 70% based on the 2018 criteria with were not treated appropriately. It is critical that clinicians should be aware of the diagnosis of NS and treat patients appropriately.


Assuntos
Neurossífilis/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neurossífilis/diagnóstico , Neurossífilis/tratamento farmacológico , Northern Territory/epidemiologia , Penicilina G Benzatina/uso terapêutico , Prevalência , Estudos Prospectivos , Estudos Retrospectivos
2.
Cerebrovasc Dis ; 49(3): 301-306, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32570248

RESUMO

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.


Assuntos
Ataque Isquêmico Transitório/epidemiologia , Programas de Rastreamento , Neurossífilis/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Idoso , Brasil/epidemiologia , Feminino , Humanos , Ataque Isquêmico Transitório/líquido cefalorraquidiano , Ataque Isquêmico Transitório/diagnóstico , Masculino , Pessoa de Meia-Idade , Neurossífilis/líquido cefalorraquidiano , Neurossífilis/diagnóstico , Valor Preditivo dos Testes , Prevalência , Fatores de Risco , Acidente Vascular Cerebral/líquido cefalorraquidiano , Acidente Vascular Cerebral/diagnóstico , Sorodiagnóstico da Sífilis
5.
BMC Infect Dis ; 19(1): 1017, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791265

RESUMO

BACKGROUND: Early diagnosis and treatment of neurosyphilis is of great significance for regression. There is no gold standard for the diagnosis of neurosyphilis. We did this study to explore the factors associated with the clinical diagnosis of neurosyphilis and assess their accuracy for the diagnosis of neurosyphilis. METHODS: We retrospectively reviewed 100 cases of syphilis patients who underwent lumbar puncture at a major dermatology hospital in Guangzhou, China between April 2013 and November 2016. Fifty patients who were clinically diagnosed with neurosyphilis were selected as case group. Control group consisted of 50 general syphilis patients who were matched with age and gender. The records of patients were reviewed to collect data of socio-demographic information, clinical symptom, and laboratory indicators. Multivariable logistic regression was used to explore diagnostic indictors, and ROC analysis was used to assess diagnostic accuracy. RESULTS: Neurological symptoms (odds ratio (OR) = 59.281, 95% CI:5.215-662.910, P = 0.001), cerebrospinal fluid (CSF) Treponema pallidum particle agglutination (TPPA) titer (OR = 1.004, 95% CI:1.002-1.006, P < 0.001), CSF protein (OR = 1.005, 95% CI:1.000-1.009, P = 0.041), and CSF white blood cell (WBC) (OR = 1.120, 95% CI:1.017-1.233, P = 0.021) were found to be statistically associated with neurosyphilis. In ROC analysis, CSF TPPA titer had a sensitivity of 90%, a specificity of 84%, and an area under curve (AUC) of 0.941. CONCLUSION: CSF TPPA can potentially be considered as an alternative test for diagnosis of neurosyphilis. Combining with neurological symptoms, CSF protein, CSF WBC, the diagnosis would have a higher sensitivity.


Assuntos
Soronegatividade para HIV , Neurossífilis/diagnóstico , Adulto , Estudos de Casos e Controles , China/epidemiologia , Testes Diagnósticos de Rotina/métodos , Testes Diagnósticos de Rotina/normas , Feminino , Infecções por HIV/líquido cefalorraquidiano , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neurossífilis/líquido cefalorraquidiano , Neurossífilis/complicações , Neurossífilis/epidemiologia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Sífilis/líquido cefalorraquidiano , Sífilis/complicações , Sífilis/diagnóstico , Sífilis/epidemiologia , Treponema pallidum
6.
Pan Afr Med J ; 33: 252, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692814

RESUMO

Introduction: HIV and syphilis are major public health problems in Morocco. The region of Souss-Massa, south-west of the country, hold more than 24% of HIV seropositive cases registered in Morocco during 2009. The aim of this study is to evaluate the seroprevalence of syphilis among HIV seropositive patients in the region of Souss-Massa, south-west of Morocco. Methods: To evaluate the seroprevalence of syphilis and neurosyphilis among HIV seropositive patients, we retrospectively investigated the medical records of HIV-infected patients attending the regional hospital located in the city of Agadir, during the period comprised between 2011 and 2016. Results: The population studied involved 1381 males (49.18%) and 1427 females (50.82%) HIV seropositive patients. Among them, 481 patients were seropositive for syphilis and three cases were diagnosed with neurosyphilis. The sex ratio distribution was 243 male (52.71%) and 218 female (47.29%). The prevalence of syphilis among the studied population was estimated to 16.42% with a slight dominance in male (17.63%) compared to female (15.28%). By contrast, neurosyphilis was only detected in male patients, with a prevalence estimated to 0.11%. Conclusion: Even if the prevalence of HIV and syphilis is stable in the region of Souss-Massa, the prevalence of syphilis among HIV seropositive patients remained high and correlated positively with that of HIV infection. We did not find a significant difference between the genders, in relation to the prevalence of HIV and syphilis. We concluded that it was essential to continue monitoring the population, in order to improve the prevention and the access to the medical care in the south-west of Morocco.


Assuntos
Infecções por HIV/epidemiologia , Neurossífilis/epidemiologia , Sífilis/epidemiologia , Feminino , Humanos , Masculino , Marrocos/epidemiologia , Prevalência , Estudos Retrospectivos , Estudos Soroepidemiológicos , Distribuição por Sexo
7.
Artigo em Inglês | MEDLINE | ID: mdl-31632699

RESUMO

Study design: Retrospective case series. Objectives: To describe the epidemiological, clinical, MRI and therapeutic features and the outcomes of patients with syphilitic myelitis in a third-level hospital in Marrakesh in southern Morocco. Setting: The Neurology Department, University Hospital Mohamed VI Marrakesh, Morocco. Methods: Twelve charts of persons with syphilitic myelitis over a period of 17 years were reviewed to determine demographics, presenting symptoms, clinical and radiological findings, biological features, treatment received and outcomes. Results: There were 120 reports of neurosyphilis. Twelve patients (10%) had syphilitic myelitis. Eleven patients (92%) were male with mean age of 44 at presentation. Tabes dorsalis was the most common clinical form. Cerebrospinal fluid analysis showed lymphocytic meningitis in nine patients (75%). Spine MRI was abnormal in four patients (33%). All patients were treated with 30 million units of aqueous penicillin G IV per day for 10 days, every 3 months. In follow-up, two patients (17%) with clinical syphilitic meningomyelitis improved significantly, eight patients (66%) with tabes dorsalis and subacute transverse myelitis showed partial improvement but clinical status was stationary for two patients (17%) with Erb paraplegia. Conclusions: All patients with myelopathy should undergo syphilitic serology because of nonspecific manifestations and curability of this disease.


Assuntos
Meningites Bacterianas , Mielite , Neurossífilis , Adulto , Feminino , Humanos , Masculino , Meningites Bacterianas/líquido cefalorraquidiano , Meningites Bacterianas/diagnóstico por imagem , Meningites Bacterianas/epidemiologia , Meningites Bacterianas/terapia , Pessoa de Meia-Idade , Marrocos/epidemiologia , Mielite/líquido cefalorraquidiano , Mielite/diagnóstico por imagem , Mielite/epidemiologia , Mielite/terapia , Neurossífilis/líquido cefalorraquidiano , Neurossífilis/diagnóstico por imagem , Neurossífilis/epidemiologia , Neurossífilis/terapia , Estudos Retrospectivos , Tabes Dorsal/líquido cefalorraquidiano , Tabes Dorsal/diagnóstico por imagem , Tabes Dorsal/epidemiologia , Tabes Dorsal/terapia
8.
Rev Neurol ; 69(2): 53-58, 2019 Jul 16.
Artigo em Espanhol | MEDLINE | ID: mdl-31287148

RESUMO

INTRODUCTION: Neurosyphilis is the Treponema pallidum infection of the central nervous system and can occur at any time after the initial infection. In the 21st century, the incidence of neurosyphilis has increased in the post-antibiotic era. The highest rates of neurosyphilis are from low-income countries and the published studies are limited. AIM: To determine the clinical and sociodemographic characteristics of neurosyphilis patients in a tertiary care center in Pereira, Colombia. PATIENTS AND METHODS: Retrospective study of diagnosed neurosyphilis patients in a tertiary care center in Pereira, Colombia, between 2012 to 2017. The diagnosis was established based on serologic treponemal tests, VDRL in CSF, and CSF analysis. Sociodemographic, clinical, and laboratory parameters variables were obtained. RESULTS: Sixteen patients were included, 11 with definitive neurosyphilis and 5 with probable neurosyphilis. The median age was 59.50 ± 13.78 years. Men accounted for 75% (n = 12) of the patients. Four patients were (25%) HIV-infected. All the patients had positive peripheral FTA-ABS and 11 had reactive VDRL in CSF. The most frequent form was late neurosyphilis (62.5%), being general paralysis the most common. The most frequently clinical manifestations were neuropsychiatric alterations (46.9%), predominantly disorientation, behavioral changes, and cognitive impairment, followed by motor changes (36.7%). CONCLUSIONS: Late neurosyphilis was the most prevalent form, predominantly neuropsychiatric alterations. Only a quarter of patients presented HIV coinfection.


Assuntos
Neurossífilis/epidemiologia , Idoso , Colômbia/epidemiologia , Demografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sociológicos
9.
Rev. neurol. (Ed. impr.) ; 69(2): 53-58, 16 jul., 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184015

RESUMO

Introducción. La neurosífilis es causada por Treponema pallidum y puede afectar al sistema nervioso central en cualquier momento de la infección. Desde inicios de este siglo, su incidencia ha ido en aumento, aun en la era postantibiótica. En países en vías de desarrollo, el problema tiene mayor magnitud y los estudios son escasos. Objetivo. Describir las características de la población con neurosífilis en un hospital de tercer nivel de Pereira, Colombia. Pacientes y métodos. Estudio descriptivo de corte transversal de pacientes con neurosífilis que acudieron a un centro de tercer nivel de Pereira, Colombia, entre 2012 y 2017. Los criterios diagnósticos se basaron en las siguientes variables: prueba treponémica en sangre, VDRL y análisis citoquímico del líquido cefalorraquídeo. Se consideraron variables sociodemográficas, clínicas y de laboratorio. Resultados. Se incluyó a 16 pacientes, 11 con neurosífilis definitiva y cinco con neurosífilis probable, con una edad media de 59,5 ± 13,78 años. El 75% (n = 12) de los casos eran hombres. La coinfección por virus de la inmunodeficiencia humana fue del 25%. Todos los pacientes tenían FTA-ABS positivo en sangre y 11 presentaron VDRL reactiva en el líquido cefalorraquídeo. La forma más frecuente de neurosífilis fue la tardía (62,5%), y predominó la parálisis general. Las manifestaciones clínicas más frecuentes fueron las alteraciones neuropsiquiátricas (46,9%), con predominio de la desorientación, los cambios en el comportamiento y el deterioro cognitivo, seguidos de las alteraciones motoras (36,7%). Conclusiones. La neurosífilis tardía fue la presentación más prevalente, caracterizada por manifestaciones neuropsiquiátricas. Una cuarta parte de los pacientes presentaba infección por virus de la inmunodeficiencia humana


Introduction. Neurosyphilis is the Treponema pallidum infection of the central nervous system and can occur at any time after the initial infection. In the 21st century, the incidence of neurosyphilis has increased in the post-antibiotic era. The highest rates of neurosyphilis are from low-income countries and the published studies are limited. Aim. To determine the clinical and sociodemographic characteristics of neurosyphilis patients in a tertiary care center in Pereira, Colombia. Patients and methods. Retrospective study of diagnosed neurosyphilis patients in a tertiary care center in Pereira, Colombia, between 2012 to 2017. The diagnosis was established based on serologic treponemal tests, VDRL in CSF, and CSF analysis. Sociodemographic, clinical, and laboratory parameters variables were obtained. Results. Sixteen patients were included, 11 with definitive neurosyphilis and 5 with probable neurosyphilis. The median age was 59.50 ± 13.78 years. Men accounted for 75% (n = 12) of the patients. Four patients were (25%) HIV-infected. All the patients had positive peripheral FTA-ABS and 11 had reactive VDRL in CSF. The most frequent form was late neurosyphilis (62.5%), being general paralysis the most common. The most frequently clinical manifestations were neuropsychiatric alterations (46.9%), predominantly disorientation, behavioral changes, and cognitive impairment, followed by motor changes (36.7%). Conclusions. Late neurosyphilis was the most prevalent form, predominantly neuropsychiatric alterations. only a quarter of patients presented HIV coinfection


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Neurossífilis/epidemiologia , Fatores Socioeconômicos , Colômbia/epidemiologia , Estudos Retrospectivos , Estudos Transversais
10.
BMJ Open ; 9(6): e025995, 2019 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-31230001

RESUMO

OBJECTIVES: To review the notification rate and characteristics of tertiary and neurosyphilis cases in Alberta, Canada in the postantibiotic era. METHODS: A retrospective review of all neurosyphilis and tertiary syphilis cases reported in Alberta from 1973 to March 2017 was undertaken and cases classified into early neurosyphilis, late neurosyphilis and cardiovascular (CV) syphilis. Variables collected included demographics, sexual partners, HIV status, clinical parameters, symptoms and treatment and distributions were compared between early versus late neurosyphilis and asymptomatic versus symptomatic cases (stratified by early versus late stage). Data were analysed using IBM SPSS Statistics V.19.0. RESULTS: 254 cases were identified; 251 were neurosyphilis and 3 were CV. No cases of gummatous syphilis were reported. Early neurosyphilis accounted for 52.4% (n=133) and 46.1% (n=117) were late neurosyphilis cases; one (0.4%) case with unknown duration. Three outbreaks of infectious syphilis were identified during the study period and a concurrent rise in both early and late neurosyphilis was observed during the outbreak periods. The most common manifestation of symptomatic neurosyphilis was ocular involvement which was more likely in early neurosyphilis. Relative to late neurosyphilis cases, early neurosyphilis cases were more likely to be younger, Caucasian, born in Canada, HIV positive and reporting same sex partners. CONCLUSIONS: Our review of tertiary and neurosyphilis cases found that early and late neurosyphilis cases continue to occur in the context of cycling syphilis outbreaks. CV syphilis cases were extremely rare. Ongoing identification of new cases of syphilis and clinical evaluation of cases for complications continues to be important in the context of global resurgence of syphilis.


Assuntos
Neurossífilis/epidemiologia , Sífilis Cardiovascular/epidemiologia , Sífilis/epidemiologia , Adulto , Idoso , Alberta/epidemiologia , Feminino , Soropositividade para HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
12.
Int J STD AIDS ; 30(5): 440-446, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30999830

RESUMO

We evaluated associations between history of syphilis infection and both cognitive function and depressive symptoms in people living with HIV (PLHIV) and comparable HIV-negative controls. Syphilis serological tests, cognitive function and depression were assessed in PLHIV and controls participating in the Pharmacokinetic and Clinical Observations in People Over Fifty study. Cognitive test scores were converted to demographically adjusted T-scores (mean = 50, SD = 10) and then averaged to obtain a global T-score. Severity of depressive symptoms was assessed via the Patient Health Questionnaire-9. Associations of syphilis with global T-scores and depression were assessed using median regression. The 623 PLHIV and 246 HIV-negative controls were predominantly male (89.3% and 66.5%) with median age (interquartile range [IQR]) of 57 (53-63) and 58 (53-63) years, respectively. PLHIV had lower global cognitive T-scores (median [IQR] 48.7 [45.1, 52.1] versus 50.5 [47.0, 53.9], p < 0.001), more severe depressive symptoms (median [IQR] 4 [1, 10] versus 1 [0, 3], p < 0.001) and were more likely to report history of syphilis infection (22.0% versus 8.1%) than controls. There was no significant association between history of syphilis and global cognitive function in either PLHIV (p = 0.69) or controls (p = 0.10). Participants with a history of syphilis had more severe depressive symptoms (median [IQR] 4 [1, 9] versus 2 [0, 8], p = 0.03); however, the association became non-significant (p = 0.62) after adjusting for HIV status and potential confounders. Despite the higher prevalence of syphilis infection in PLHIV, there was no evidence of an association between history of syphilis infection and impaired cognitive function nor depressive symptoms after accounting for potential confounders.


Assuntos
Cognição/fisiologia , Depressão/diagnóstico , Infecções por HIV/epidemiologia , Sífilis/diagnóstico , Estudos de Casos e Controles , Depressão/epidemiologia , Depressão/psicologia , Feminino , Infecções por HIV/psicologia , Soronegatividade para HIV , Humanos , Masculino , Pessoa de Meia-Idade , Neurossífilis/diagnóstico , Neurossífilis/epidemiologia , Prevalência , Sífilis/epidemiologia , Sorodiagnóstico da Sífilis
13.
Sex Transm Infect ; 95(6): 416-418, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30923165

RESUMO

OBJECTIVE: Syphilis is an STI that potentially affects any organ. Syphilitic hepatitis and neurosyphilis have been reported in both HIV-uninfected and HIV-infected individuals. The aim of this study was to investigate syphilitic hepatitis and neurosyphilis among HIV-infected individuals during a 13-year period. METHODS: This retrospective study included all HIV-infected individuals ≥18 years diagnosed with syphilis between 1 May 2004 and 31 December 2016 in Copenhagen, Denmark. We used the unique 10-digit personal identification number assigned to all individuals in Denmark to link data from two nationwide registers to identify the patients. Patient files were revised to obtain clinical and laboratory data. RESULTS: A total of 509 episodes of syphilis were diagnosed in 427 HIV-infected individuals attending three hospitals in Copenhagen, Denmark. The majority of the patients were men (99.5%), and the majority of men were men who have sex with men (96%). Twenty-seven patients (6%) met the criteria for neurosyphilis, and the neurological symptoms included ocular and auditory abnormalities, headache, paraesthesia, vertigo, facial paresis, motor weakness and unexplained pain in the legs. The patients with neurosyphilis were diagnosed in the secondary stage (84%) and in the early latent (8%) or late latent (8%) stage. Among the patients tested for liver affection, 41% met the criteria for syphilitic hepatitis. The patients with syphilitic hepatitis were diagnosed in the secondary stage (82%), primary stage (10%), and in the early latent (5%) or late latent (3%) stage. CONCLUSIONS: The study emphasises that patients with syphilis, also those seen at STI clinics, should undergo a thorough clinical examination and questioning to reveal neurological symptoms. Identification of patients with neurosyphilis is crucial since these patients undergo a different treatment. The study also emphasises that syphilis should be considered as a diagnosis in sexually active patients with liver .


Assuntos
Infecções por HIV/complicações , Hepatite/epidemiologia , Neurossífilis/epidemiologia , Adulto , Dinamarca/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Hepatite/complicações , Hepatite/diagnóstico , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Neurossífilis/complicações , Neurossífilis/diagnóstico , Estudos Retrospectivos , Adulto Jovem
14.
Spinal Cord Ser Cases ; 5(1): 38, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32350239

RESUMO

STUDY DESIGN: Retrospective case series. OBJECTIVES: To describe the epidemiological, clinical, MRI and therapeutic features and the outcomes of patients with syphilitic myelitis in a third-level hospital in Marrakesh in southern Morocco. SETTING: The Neurology Department, University Hospital Mohamed VI Marrakesh, Morocco. METHODS: Twelve charts of persons with syphilitic myelitis over a period of 17 years were reviewed to determine demographics, presenting symptoms, clinical and radiological findings, biological features, treatment received and outcomes. RESULTS: There were 120 reports of neurosyphilis. Twelve patients (10%) had syphilitic myelitis. Eleven patients (92%) were male with mean age of 44 at presentation. Tabes dorsalis was the most common clinical form. Cerebrospinal fluid analysis showed lymphocytic meningitis in nine patients (75%). Spine MRI was abnormal in four patients (33%). All patients were treated with 30 million units of aqueous penicillin G IV per day for 10 days, every 3 months. In follow-up, two patients (17%) with clinical syphilitic meningomyelitis improved significantly, eight patients (66%) with tabes dorsalis and subacute transverse myelitis showed partial improvement but clinical status was stationary for two patients (17%) with Erb paraplegia. CONCLUSIONS: All patients with myelopathy should undergo syphilitic serology because of nonspecific manifestations and curability of this disease.


Assuntos
Mielite/epidemiologia , Neurossífilis/epidemiologia , Adulto , Medula Cervical/diagnóstico por imagem , Medula Cervical/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Marrocos , Mielite/complicações , Mielite/diagnóstico por imagem , Mielite/patologia , Neurossífilis/complicações , Neurossífilis/diagnóstico por imagem , Neurossífilis/patologia , Estudos Retrospectivos , Tabes Dorsal/complicações , Tabes Dorsal/diagnóstico por imagem , Tabes Dorsal/epidemiologia , Tabes Dorsal/patologia
15.
Eur J Clin Microbiol Infect Dis ; 38(1): 125-134, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30368740

RESUMO

Neurosyphilis (NS) has different clinical manifestations and can appear during any stage of syphilis. We aimed to identify the factors affecting poor outcome in NS patients. Patients with positive cerebrospinal fluid Venereal Disease Research Laboratory test, and positive serological serum treponemal or nontreponemal tests were classified as definite NS. The data of 141 patients with definite NS were submitted from 22 referral centers. Asymptomatic NS, syphilitic meningitis, meningovascular syphilis, tabes dorsalis, general paresis, and taboparesis were detected in 22 (15.6%), 67 (47.5%), 13 (9.2%), 10 (7%), 13 (9.2%), and 16 patients (11.3%), respectively. The number of HIV-positive patients was 43 (30.4%). The most common symptoms were headache (n = 55, 39%), fatigue (n = 52, 36.8%), and altered consciousness (50, 35.4%). Tabetic symptoms were detected in 28 (19.8%), paretic symptoms in 32 (22.6%), and vascular symptoms in 39 patients (27.6%). Eye involvement was detected in 19 of 80 patients (23.7%) who underwent eye examination and ear involvement was detected in eight of 25 patients (32%) who underwent ear examination. Crystallized penicillin was used in 109 (77.3%), procaine penicillin in seven (4.9%), ceftriaxone in 31 (21.9%), and doxycycline in five patients (3.5%). According to multivariate regression analysis, while headache was a protective factor in NS patients, double vision was significantly associated to poor outcome. We concluded that double vision indicated unfavorable outcome among NS patients. A high clinical suspicion is needed for the diagnosis NS. As determined in our study, the presence of headache in syphilitic patients can help in early diagnosis of central nervous system disease.


Assuntos
Neurossífilis/epidemiologia , Neurossífilis/fisiopatologia , Adulto , Antibacterianos/uso terapêutico , Estudos de Coortes , Diplopia , Feminino , Cefaleia , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Neurossífilis/diagnóstico , Neurossífilis/tratamento farmacológico , Resultado do Tratamento
16.
Aging Clin Exp Res ; 31(8): 1155-1161, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30343380

RESUMO

INTRODUCTION: Syphilis is a systemic human disease which is caused by infection with the spirochete Treponema pallidum. It is spread worldwide, and there has recently been an increase in its incidence. Neurosyphilis (NS) can have a variety of presentations; meningovascular NS is a specific affection of the Treponema which occurs in an early stage after the primary infection, causing an inflammatory arteriopathy which may result in an ischemic stroke. As a rare manifestation of syphilis, there are few prevalence and epidemiological studies, and data are almost non-existent. The objective of this study is to analyse the prevalence of meningovascular NS in a stroke unit in a tertiary hospital. METHODS: A descriptive retrospective study was carried out over a period of 44 months in a stroke unit. All patients admitted had neurological symptoms compatible with a vascular event, and routine blood tests including infectious screening were performed. Those with positive test results for syphilis were identified and proceeded to lumbar puncture to CSF cytochemical analysis and VDRL. NS was categorized as confirmed or probable (using CDC criteria). RESULTS: A total of 525 patients were admitted, and 62.53% were submitted to a routine screening for syphilis. A total of 309 patients (95.67%) revealed a negative screening; 12 patients (3.72%) had a positive syphilis serology. Among the 12 patients with positive screening, a single case of NS (0.31%) was identified. CONCLUSION: We observed a low prevalence of NS (0.31%), but this result was surprisingly higher than what was expected in an elderly population.


Assuntos
Neurossífilis/epidemiologia , Acidente Vascular Cerebral/complicações , Idoso , Feminino , Humanos , Masculino , Neurossífilis/etiologia , Portugal , Prevalência , Estudos Retrospectivos , Medula Espinal , Sorodiagnóstico da Sífilis , Treponema pallidum
17.
Sex Transm Dis ; 45(9S Suppl 1): S10-S12, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30102680

RESUMO

Despite over a century of clinical experience in diagnosing and managing patients with syphilis, many thorny clinical questions remain unanswered. We focus on several areas of uncertainty for the clinician: the role of serologic tests in diagnosing syphilis and assessing syphilis treatment responses, and the risk of neurosyphilis and ocular syphilis in patients with syphilis. We also address whether clinical approaches should differ in patients who are, and are not, infected with HIV. The current increases in syphilis rates in the United States and elsewhere underscore our urgent need to definitively address these issues.


Assuntos
Infecções Oculares Bacterianas/prevenção & controle , Infecções por HIV/complicações , Sorodiagnóstico da Sífilis/métodos , Sífilis/prevenção & controle , Centers for Disease Control and Prevention, U.S. , Infecções Oculares Bacterianas/complicações , Infecções Oculares Bacterianas/diagnóstico , Humanos , Neurossífilis/complicações , Neurossífilis/diagnóstico , Neurossífilis/epidemiologia , Neurossífilis/prevenção & controle , Sífilis/complicações , Sífilis/diagnóstico , Sífilis/epidemiologia , Estados Unidos/epidemiologia
18.
Rev Neurol (Paris) ; 174(5): 313-318, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29631855

RESUMO

OBJECTIVE: The aim of this study was to describe the clinical, biological and radiological characteristics of patients with syphilitic vasculitis, and to assess the outcome after treatment. METHODOLOGY: A retrospective review was carried out based on the records of patients with ischemic stroke, and reactive CSF TPHA and VDRL results. None of these patients showed symptoms of any other diseases or had received high doses of penicillin. RESULTS: A total of 53 patients with stroke met the diagnostic criteria for syphilitic arteritis. Their average age was 41±12 years. Nine patients had a history of genital ulcer (17%), and the median duration of illness after presenting a chancre was 8 [range: 1-14] years. A prodromal syndrome was seen in 27 patients (50.9%) and included changes in mental status in 14 patients (26.4%), seizures in 10 cases (18.9%), headache in eight (15.1%) and memory loss in seven (13.2%). Neurological events included focal motor deficits in 29 cases (54.7%), ataxia in 11 (20.8%) and movement disorders in 15 (28.3%). HIV serology was performed in 31 patients and proved negative in every case. Disease evolution was generally favorable: 12 patients (22.6%) were autonomous at the time of hospital discharge; 29 (54.7%) had partially recovered; and only seven (13.2%) still had signs of severe sequelae. CONCLUSION: A diagnosis of syphilitic stroke should be suspected in young patients as a manifestation of syphilis, and tests for neurosyphilis should be routine in neurology departments to make a prompt diagnosis, thereby preventing psychological sequelae.


Assuntos
Acidente Vascular Cerebral/etiologia , Sífilis/complicações , Adulto , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/etiologia , Estudos Transversais , Progressão da Doença , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/psicologia , Neurossífilis/complicações , Neurossífilis/epidemiologia , Neurossífilis/psicologia , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/psicologia , Sífilis/epidemiologia , Sífilis/psicologia , Tomografia Computadorizada por Raios X , Vasculite do Sistema Nervoso Central/etiologia
19.
Handb Clin Neurol ; 152: 151-166, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29604973

RESUMO

Human immunodeficiency virus (HIV)-infected individuals are particularly susceptible to several central nervous system infections: human cytomegalovirus, which may cause encephalitis, ventriculitis, polyradiculitis, or polyradiculomyelitis; Mycobacterium tuberculosis, which can cause meningitis or space-occupying lesions; and Treponema pallidum subspecies pallidum (T. pallidum), which affects the meninges, cerebrospinal fluid, cranial nerves, and vasculature in early neurosyphilis, and additionally the brain and spinal cord parenchyma in late neurosyphilis. Central nervous system cytomegalovirus infection is seen in HIV-infected individuals with very advanced immunosuppression. Its prognosis is poor and optimal therapy has not been determined. Tuberculous meningitis has a high mortality in those also infected with HIV, especially in the developing world, and better therapies are urgently needed. As the rates of syphilis increase in the developed world, neurosyphilis and in particular ocular syphilis are increasingly reported. The likelihood of all three of these central nervous system infections is decreased in individuals who receive potent antiretroviral therapy.


Assuntos
Infecções por Citomegalovirus/epidemiologia , Citomegalovirus , Mycobacterium tuberculosis , Neurossífilis/epidemiologia , Treponema pallidum , Tuberculose Meníngea/epidemiologia , Animais , Encéfalo/patologia , Encéfalo/virologia , Infecções do Sistema Nervoso Central/diagnóstico , Infecções do Sistema Nervoso Central/epidemiologia , Infecções do Sistema Nervoso Central/terapia , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/terapia , Encefalite/diagnóstico , Encefalite/epidemiologia , Encefalite/terapia , Humanos , Mycobacterium tuberculosis/isolamento & purificação , Neurossífilis/diagnóstico , Neurossífilis/terapia , Treponema pallidum/isolamento & purificação , Tuberculose Meníngea/diagnóstico , Tuberculose Meníngea/terapia
20.
Intern Med J ; 48(2): 204-206, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29415349

RESUMO

Given the long term sequelae of untreated neurosyphilis and insensitive tests to detect treponemes in the cerebrospinal fluid, questions regarding the utility of a lumbar puncture and cerebrospinal fluid analysis either to confirm or exclude neurosyphilis are raised.


Assuntos
Gerenciamento Clínico , Neurossífilis/diagnóstico , Neurossífilis/terapia , Treponema pallidum/isolamento & purificação , Australásia/epidemiologia , Testes Diagnósticos de Rotina/métodos , Humanos , Neurossífilis/epidemiologia , Sorodiagnóstico da Sífilis/métodos , Fatores de Tempo
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