Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 81
Filtrar
1.
Zhonghua Nan Ke Xue ; 26(4): 335-340, 2020 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-33351301

RESUMO

Objective: To investigate the levels of chemokines 8 and 10 (CXCL8 and CXCL10), Th1 cytokines (IL-2, IL-12 and IFN-γ) and Th2 cytokines (IL-6 and IL-10) in the serum and cerebrospinal fluid of patients with neurosyphilis and elucidate their roles in the immune response and pathogenesis of neurosyphilis. METHODS: Using ELISA, we detected the expressions of CXCL8, CXCL10, IL2, IL-2, IFN-γ, IL-6 and IL-10 in the serum and cerebrospinal fluid of 42 cases of neurosyphilis, 44 cases of syphilis and 40 cases of non-inflammatory diseases of the nervous system (the control group). RESULTS: The serum levels of CXCL8, CXCL10, IL-2, IL-12, IFN-γ, IL-6 and IL-10 were significantly lower in the neurosyphilis group than in the syphilis and control groups (P < 0.05), and so were they in the male than in the female neurosyphilis patients (P < 0.05). However, the expressions of CXCL8, CXCL10, IL-2, IL-12, IFN-γ, IL-6 and IL-10 in the cerebrospinal fluid were remarkably higher in the neurosyphilis group than in the syphilis and control groups (P < 0.05), and so were they in the male than in the female neurosyphilis patients (P < 0.05). CONCLUSIONS: Patients with neurosyphilis have cellular immune dysfunction, and their immune response involves CXCL8, CXCL10 and Th1 / Th2 cytokines.


Assuntos
Quimiocina CXCL10/sangue , Quimiocina CXCL10/líquido cefalorraquidiano , Interleucina-8/sangue , Interleucina-8/líquido cefalorraquidiano , Neurossífilis/sangue , Neurossífilis/líquido cefalorraquidiano , Citocinas/sangue , Citocinas/líquido cefalorraquidiano , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino
2.
Biomed Res Int ; 2019: 2426313, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31198783

RESUMO

A retrospective study was performed to compare the differences in clinical and laboratory features of asymptomatic neurosyphilis (ANS) and symptomatic neurosyphilis (SNS). A total of 264 HIV-negative inpatients with neurosyphilis were enrolled from Beijing Ditan Hospital and Beijing Tiantan Hospital between January 2014 and May 2018, including 110 SNS and 154 ANS. The SNS group had more patients in males, older median age and without antisyphilis treatment than ANS group (P<0.001, P<0.001, and P<0.001, respectively). The laboratory findings showed that the SNS group had higher pretreatment serum rapid plasma regain (RPR) titer, current serum RPR titer, cerebrospinal fluid (CSF) white blood cell (WBC) counts, CSF protein concentrations, and higher positive CSF RPR rate than those in the ANS group (P=0.011, P<0.001, P<0.001, P<0.001, and P<0.001, respectively). The multivariate logistic regression analysis revealed that male (OR=2.833, P=0.009), age≥45 years (OR=3.611, P=0.001), without antisyphilis treatment (OR=0.247, P<0.001), higher current serum RPR titer (OR=1.373, P=0.022), positive CSF RPR (OR=4.616, P<0.001), and higher CSF protein concentration (OR=1.017, P=0.026) were independent risk predictors for SNS. Therefore, clinical and laboratory features between SNS and ANS are quietly different. Male gender, age≥45 years, and lack of antisyphilis treatment are risk factors for SNS. The elevated level of serum RPR titer, CSF protein concentration, and CSF RPR titer may indicate the development of neurosyphilis and the aggravation of neurological symptoms.


Assuntos
Neurossífilis , Adulto , Fatores Etários , Feminino , Infecções por HIV , HIV-1 , Humanos , Masculino , Pessoa de Meia-Idade , Neurossífilis/sangue , Neurossífilis/líquido cefalorraquidiano , Neurossífilis/diagnóstico , Neurossífilis/patologia , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais
3.
Sex Transm Infect ; 95(4): 246-250, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30926713

RESUMO

OBJECTIVE: Changes in microRNAs (miRNAs) in the cerebrospinal fluid (CSF) are associated with different neurological diseases. Since alternations of miRNAs in neurosyphilis are insufficiently investigated, we analysed miRNAs in the CSF of patients suffering from neurosyphilis. METHODS: Exosomes were isolated from serum and CSF. Levels of 44 miRNAs were determined using quantitative real-time PCR-based miRNA array. RESULTS: In patients with neurosyphilis (NSP), miR-590-5p, miR-570-3p and miR-570-5p were upregulated in the CSF and serum, when compared with patients with syphilis without neurosyphilis (SP). miR-590-5p and miR-570-3p were significantly upregulated (p<0.001). The expression of miR-21-5p was upregulated only in the CSF of NSP. Significant downregulation was observed for miR-93-3p in the CSF and serum of NSP. No statistical difference was found in the expression of miR-7-5p, miR-1307-5p, miR-203a-3p, miR-16, miR-23b-3p and miR-27b-5p in the CSF and serum of NSP and SP. CONCLUSION: For the first time, regulation profiles in miRNA in the CSF and serum were analysed in NSP. We found significant differences in upregulation and downregulation. Therefore, miRNAs may be potential biomarkers for the presence of neurosyphilis.


Assuntos
Exossomos/metabolismo , MicroRNAs/sangue , Neurossífilis/diagnóstico , Adulto , Idoso , Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , Feminino , Perfilação da Expressão Gênica , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Masculino , MicroRNAs/líquido cefalorraquidiano , Pessoa de Meia-Idade , Neurossífilis/sangue , Neurossífilis/líquido cefalorraquidiano , Reação em Cadeia da Polimerase , Análise de Sequência de RNA
4.
Arq Neuropsiquiatr ; 77(2): 91-95, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30810592

RESUMO

BACKGROUND: Syphilis is a re-emerging sexually-transmitted infection, caused by the spirochete Treponema pallidum, that may penetrate early into the central nervous system. The venereal disease research laboratory test (VDRL) on the cerebrospinal fluid (CSF) is the most widely used for neurosyphilis diagnosis. We evaluated the performance of two other nontreponemal tests (rapid plasma reagin [RPR] and unheated serum reagin [USR] tests) in comparison with the VDRL in CSF. METHODS: We analyzed CSF samples from 120 individuals based on VDRL reactivity in the CSF and the clinical picture of neurosyphilis. RESULTS: High inter-rater reliability was found among all three tests, with equivalent sensitivity and specificity. Intraclass correlation coefficient for absolute agreement was 1 for VDRL versus USR, 0.99 for VDRL versus RPR, and 0.99 for RPR versus USR. CONCLUSIONS: Rapid plasma reagin and unheated serum reagin tests were identified as excellent alternatives for neurosyphilis diagnosis.


Assuntos
Anticorpos Antibacterianos/líquido cefalorraquidiano , Neurossífilis/líquido cefalorraquidiano , Neurossífilis/diagnóstico , Sorodiagnóstico da Sífilis/métodos , Adulto , Análise de Variância , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurossífilis/sangue , Neurossífilis/imunologia , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Estatísticas não Paramétricas
5.
Eur Neurol ; 80(1-2): 82-86, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30343296

RESUMO

BACKGROUND: The differential diagnosis of general paresis (GP) and non-neurosyphilis (NS) dementia is not clearly defined. The present study examined the differences in clinical and laboratory features of GP and non-NS dementia. MATERIALS AND METHODS: We retrospectively examined clinical and laboratory features of 85 GP patients and 196 non-NS dementia patients. Data were collected from Zhongshan Hospital between June 2005 and June 2014. RESULTS: The GP group had a higher percentage of males (83.53%, 71/85) and younger median age ([52 [interquartile range 47.0-61.0] vs. 76 [68.3-82.0] years) than the non-NS dementia group. GP have higher Mini-Mental State Examination (MMSE; Z = -5.809; p = 0.000) than non-NS dementia. Distribution of CDR scores were significantly higher in the non-NS group than GP group (χ2 = 29.153; p = 0.000). The laboratory findings showed significantly different total cholesterol (CH), low-density lipoprotein CH and homocysteine levels between the 2 groups. Serologic testing for syphilis revealed that the GP group had higher seropositive rapid plasma reagin (RPR) and Treponema pallidum particle agglutination (TPPA) rates than the non-NS dementia group (96.47% [82/85] vs. 0.51% [1/196], Z = -2.663, p = 0.008; 100% [85/85] vs. 1.02% [2/196], Z = -2.663, p = 0.008). Interestingly, cerebrospinal fluid (CSF) biochemical indices, including pleocytosis rates, increased protein levels, and positive RPR and TPPA rates in the GP group were higher than that in the non-NS dementia group. CONCLUSIONS: Based on these preliminary data, patients with clinically evident symptoms of dementia, especially middle-aged males, should undergo blood tests for syphilis. All patients with positive serology results should undergo CSF examinations to diagnose GP dementia before further pharmaceutical and behavioral interventions.


Assuntos
Demência/diagnóstico , Neurossífilis/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Demência/sangue , Demência/líquido cefalorraquidiano , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Neurossífilis/sangue , Neurossífilis/líquido cefalorraquidiano , Estudos Retrospectivos , Testes Sorológicos , Treponema pallidum
6.
BMC Infect Dis ; 18(1): 144, 2018 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-29606102

RESUMO

BACKGROUND: Repeated nontreponemal serologic test for syphilis titers is recommended to evaluate treatment response. However, it is unknown whether serum rapid plasma reagin (RPR) titer can serve as a surrogate for determining the efficacy of treatment in general paresis (GP) remains unknown. METHODS: We retrospectively reviewed data from 105 GP patients, who were divided into two groups (62 CSF RPR+ patients and 43 CSF RPR- patients) according to reactive RPR test status in CSF. Clinical assessment included the Mini-Mental State Examination (MMSE) scores, CSF examinations (WBC count, protein concentration and RPR titer), and serum tests (RPR titer and TPPA). Among the 105 GP patients, 13 CSF RPR+ patients and 6 CSF RPR- patients had a 12 months follow-up of CSF, serum measures and MMSE. RESULTS: The median serum RPR titer was significantly higher in CSF RPR+ patients than that in CSF RPR- GP patients, 1:8 [IQR 1:4-1:32] vs. 1:4 [IQR 1:4-1:8] (P < 0.001). The number of CSF RPR+ patients with serum RPR titer≥1:32 was significantly higher when compared with CSF RPR- patients (P = 0.001). For CSF RPR+ patients, the MMSE scores improved or remained constantly after penicillin treatment. For CSF RPR+ patients, the CSF RPR titer declined four-fold in 85% (11/13) of the patients, whereas the serum RPR titer declined four-fold in only 46% (6/13) of the patients, the odds ratio is 6.4 (95% confidence interval 1.0-41.2). CONCLUSIONS: A four-fold decline in CSF RPR titer is a good predictor for treatment efficacy in CSF RPR+ GP patients within 12 months after the completion of therapy.


Assuntos
Soronegatividade para HIV , Neurossífilis/sangue , Neurossífilis/terapia , Reaginas/sangue , Sorodiagnóstico da Sífilis , Adulto , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurossífilis/diagnóstico , Valor Preditivo dos Testes , Prognóstico , Reaginas/análise , Estudos Retrospectivos , Testes Sorológicos , Resultado do Tratamento
7.
Sci Rep ; 7(1): 15456, 2017 11 13.
Artigo em Inglês | MEDLINE | ID: mdl-29133821

RESUMO

More new diagnosed syphilis cases were reported in china, the incidence and relevant factors of asymptomatic neurosyphilis (ANS) in serofast syphilis patients were unclear. Clinical and laboratory data of 402 Human Immunodeficiency Virus (HIV) negative, serofast syphilis patients, who underwent lumbar puncture at the Peking University Ditan Teaching Hospital between September 2008 and August 2016, were collected. Incidence of ANS was verified and the relevant factors were further analyzed. According to the ANS criteria, 139 (34.6%) patients had ANS. Of these, 40 (28.8%) had reactive cerebrospinal fluid (CSF), rapid plasma reagin (RPR) positive, 115 (82.7%) had CSF white blood cell (WBC) count > 5 × 106/L, 28 (20.1%) had CSF protein concentration > 45 mg/dL (without other neurological diseases). Patients aged 51-60 years, of non-Han ethnicity, with serum RPR titer 1:32 and ≥ 1:64 were 2.28-fold, 9.11-fold, 5.12-fold and 5.69-fold, respectively, more likely to have ANS. The incidence of ANS was 34.6% among Chinese serofast syphilis patients. Age, ethnicity and serum RPR titer were associated with high risk of ANS.


Assuntos
Infecções Assintomáticas/epidemiologia , Líquido Cefalorraquidiano/microbiologia , Neurossífilis/epidemiologia , Treponema pallidum/isolamento & purificação , Adolescente , Adulto , Fatores Etários , Idoso , China/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neurossífilis/sangue , Neurossífilis/líquido cefalorraquidiano , Neurossífilis/microbiologia , Fatores de Risco , Punção Espinal , Adulto Jovem
8.
Sci Rep ; 7(1): 9911, 2017 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-28855625

RESUMO

This study aimed to determine whether a serological response could predict the normalization of cerebrospinal fluid (CSF) abnormalities at 6 months after treatment in human immunodeficiency virus (HIV)-negative neurosyphilis patients. A total of 123 neurosyphilis patients were recruited at baseline, 58 of these patients undergoing treatment, repeated CSF examinations and serological tests for syphilis at 6 months after treatment were included in the follow-up study. Before treatment, the CSF rapid plasma reagin (RPR) titer, CSF Treponema pallidum particle agglutination (TPPA) titer, CSF leukocyte count, and CSF protein concentration were correlated with both serum RPR and TPPA titers. At 6 months after treatment, 28 and nine patients achieved serological responses of RPR and TPPA tests, respectively. The sensitivities of the serological response of RPR and TPPA tests for identifying the normalization of CSF abnormalities were 60.0∼83.3% and 17.1~22.2%, respectively; and 75.0∼91.3% of patients showing serological response of RPR test also achieved CSF normalization, suggesting that the serological response could predict CSF normalization to some degree. Particularly, in patients with ≥8-fold decreases in the serum RPR titer, the CSF RPR, CSF leukocyte count, and CSF protein concentration had normalized, and follow-up lumbar puncture could be reduced considering the resolution of neurological symptoms.


Assuntos
Neurossífilis/sangue , Neurossífilis/líquido cefalorraquidiano , Penicilinas/uso terapêutico , Treponema pallidum/efeitos dos fármacos , Adulto , Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Doxiciclina/uso terapêutico , Feminino , Humanos , Corpos de Inclusão/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Neurossífilis/tratamento farmacológico , Testes Sorológicos/métodos , Sorodiagnóstico da Sífilis/métodos , Fatores de Tempo , Resultado do Tratamento , Treponema pallidum/fisiologia
9.
Clin Infect Dis ; 65(6): 943-948, 2017 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-28525592

RESUMO

Background: Individuals infected with human immunodeficiency virus (HIV) who have previously had syphilis may have cognitive impairment. We tested the hypothesis that neurosyphilis causes cognitive impairment in HIV by amplifying HIV-related central nervous system (CNS) inflammation. Methods: HIV-infected participants enrolled in a study of cerebrospinal fluid (CSF) abnormalities in syphilis underwent the mental alternation test (MAT), venipuncture, and lumbar puncture. CSF concentrations of chemokine (C-X-C motif) ligand 10 (CXCL10), chemokine (C-C motif) ligand 2 (CCL2), and neurofilament light (NFL) were determined by commercial assays. The proportion of peripheral blood mononuclear cells (PBMCs) and of CSF white blood cells (WBCs) that were activated monocytes (CD14+CD16+) was determined by flow cytometry. Neurosyphilis was defined as detection of Treponema pallidum 16S RNA in CSF or CSF white blood cells (WBCs) >20/uL or a reactive CSF-Venereal Disease Research Laboratory (VDRL) test; uncomplicated syphilis was defined as undetectable CSF T. pallidum, CSF WBCs ≤5/uL and nonreactive CSF-VDRL. MAT <18 was considered low. Results: Median proportion of PBMCs that were activated monocytes (16.6 vs. 5.3), and median CSF CXCL10 (10658 vs. 2530 units), CCL2 (519 vs. 337 units) and HIV RNA (727 vs. 50 c/mL) were higher in neurosyphilis than in uncomplicated syphilis (P ≤ .001 for all comparisons). Neurosyphilis was not related to low MAT scores. Participants with low MAT scores had higher median CSF CXCL10 (10299 vs. 3650 units, P = .008) and CCL2 (519 vs. 365 units, P = .04) concentrations than those with high MAT scores. Conclusions: Neurosyphilis may augment HIV-associated CNS inflammation, but it does not explain cognitive impairment in HIV-infected individuals with syphilis.


Assuntos
Disfunção Cognitiva/microbiologia , Coinfecção/complicações , Infecções por HIV/complicações , Inflamação/virologia , Neurossífilis/complicações , RNA Viral/líquido cefalorraquidiano , Adulto , Quimiocina CCL2/líquido cefalorraquidiano , Quimiocina CXCL10/líquido cefalorraquidiano , Disfunção Cognitiva/sangue , Disfunção Cognitiva/líquido cefalorraquidiano , Coinfecção/sangue , Coinfecção/líquido cefalorraquidiano , Feminino , HIV/genética , Infecções por HIV/sangue , Infecções por HIV/líquido cefalorraquidiano , Humanos , Inflamação/sangue , Inflamação/líquido cefalorraquidiano , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Monócitos Matadores Ativados , Proteínas de Neurofilamentos/líquido cefalorraquidiano , Neurossífilis/sangue , Neurossífilis/líquido cefalorraquidiano , RNA Viral/sangue
10.
Medicine (Baltimore) ; 96(47): e8850, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29381995

RESUMO

Neurosyphilis is a chronic infectious disease with involvement of central nervous system infection by Treponema pallidum. This study was to investigate the contents of B lymphocyte chemokine 1 (BLC-1/chemokine [C-X-C motif] ligand 13), Th1 cytokines (Interleukin [IL]-2, IL-12, and Interferon [IFN]-γ), and Th2 cytokines (IL-6 and IL-10) in serum and cerebrospinal fluid (CSF) of HIV-negative patients with neurosyphilis before and after treatment, aiming to elucidate roles of CXCL13 and Th1/Th2 cytokines in immune response to and pathogenesis of neurosyphilis.Enzyme-linked immunosorbent assay was employed to detect the contents of CXCL13, IL-2, IL-12, IFN-γ, IL-6, and IL-10 in serum and CSF of 47 HIV-negative patients with neurosyphilis, 36 syphilis patients without neurological involvement and 23 controls (noninfectious intracranial disease) before, 3 and 12 months after treatment with high dose penicillin.Results showed that there was no significant difference in blood CXCL13 content among 3 groups (P > .05); CSF CXCL13 content in neurosyphilis patients was significantly higher than in other 2 groups (P < .001), and positively related to leucocyte count, protein concentration, and IgG index. IL-6 and IL-10 contents of the serum and CSF in neurosyphilis patients were markedly higher than in other 2 groups (P < .05 or .01), but IL-2, IL-12, and IFN-γ of the serum and CSF were significantly lower than in other 2 groups (P < .05 or .01). The IL-6, IL-10, IL-2, IL-12, and IFN-γ contents of the serum and CSF were comparable between control group and syphilis group (P > .05). CSF CXCL13 content was positively related with IL-6 and IL-10 content, while negatively related to IL-12 content in neurosyphilis patients. CSF IL-6 content was negatively related with IL-12 content. In neurosyphilis patients, the CSF CXCL13 content reduced significantly at 3 and 12 months (P < .001), the CSF IL-2 and IL-12 contents increased significantly at 12 months, and CSF IL-6 contents reduced significantly at 12 months after treatment (P < .05 or .01).It is concluded that neurosyphilis patients did not have normal immune function. CXCL13 and Th1/Th2 cytokines are involved in the immune response of neurosyphilis patients. CSF CXCL13 and Th1/Th2 cytokines contents may be used for the diagnosis and evaluation of therapeutic efficacy of neurosyphilis.


Assuntos
Quimiocina CXCL13/análise , Citocinas/análise , Neurossífilis/sangue , Neurossífilis/líquido cefalorraquidiano , Adulto , Idoso , Antibacterianos/uso terapêutico , Estudos de Casos e Controles , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Interferon gama/análise , Interleucina-10/análise , Interleucina-12/análise , Interleucina-2/análise , Interleucina-6/análise , Masculino , Pessoa de Meia-Idade , Neurossífilis/tratamento farmacológico , Penicilinas/uso terapêutico , Sífilis/sangue , Sífilis/líquido cefalorraquidiano , Sífilis/tratamento farmacológico , Equilíbrio Th1-Th2/efeitos dos fármacos , Adulto Jovem
11.
Sci Rep ; 6: 33569, 2016 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-27650493

RESUMO

At present, diagnosis for neurosyphilis remains a major clinical challenge. Venereal Disease Research Laboratory (VDRL) titer of the cerebrospinal fluid (CSF) is suboptimally sensitive to diagnose neurosyphilis, which can be negative in neurosyphilis patients, especially in asymptomatic neurosyphilis patients. In the search for biomarkers of neurosyphilis, we investigated the chemokine profile in CSF of neurosyphilis patients and found that the concentrations of CXCL13, CXCL10 and CXCL8 were selectively elevated in neurosyphilis patients and correlated with CSF protein concentration and CSF-VDRL titer. After antibiotic treatment, the concentration of these chemokines was dramatically reduced. The area under the ROC curve (AUC) of CSF CXCL13, CXCL8,CXCL10 and the CSF/serum ratio of CXCL13, CXCL8,CXCL10 in the diagnosis of neurosyphilis were 0.940, 0.899, 0.915, 0.963, 0.846 and 0.926, respectively. The corresponding sensitivities/specificities of CSF CXCL13, CXCL8,CXCL10 and the CSF/serum ratio of CXCL13, CXCL8,CXCL10 in diagnosis of neurosyphilis were 85.4%/89.1%, 79%/90.1% and 79.6%/91.1%, 86.6%/99%, 79%/73.3% and 86%/92.1%, respectively. Our results suggest that the elevated concentrations of CXCL13, CXCL8, and CXCL10 or their increasing CSF/serum ratios may be potential biomarkers of neurosyphilis, particularly for asymptomatic neurosyphilis. Reduced concentration of these chemokines may indicate the prognosis of antibiotic therapy.


Assuntos
Quimiocina CXCL10/líquido cefalorraquidiano , Quimiocina CXCL13/líquido cefalorraquidiano , Interleucina-8/líquido cefalorraquidiano , Neurossífilis/líquido cefalorraquidiano , Neurossífilis/diagnóstico , Adulto , Antibacterianos/uso terapêutico , Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , Estudos de Casos e Controles , Quimiocina CXCL10/sangue , Quimiocina CXCL13/sangue , Feminino , Humanos , Interleucina-8/sangue , Masculino , Pessoa de Meia-Idade , Neurossífilis/sangue , Neurossífilis/tratamento farmacológico , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Regulação para Cima
12.
BMC Psychiatry ; 16: 230, 2016 07 11.
Artigo em Inglês | MEDLINE | ID: mdl-27400713

RESUMO

BACKGROUND: Neurosyphilis is caused by the invasion of Treponema pallidum into the central nervous system. General paresis (GP) is a type of neurosyphilis. The main manifestation of general paresis is dementia; however, this is different from the other types of dementia, which can be cured by adequate doses of penicillin in the early stage. Neurosyphilis is the "great imitator" because it can mimic many types of medical disorders. In addition, the manifestations of neurosyphilis are not typical. Psychiatric disorders as a cause of general paresis have become more common due to the use of antibiotics. Patients with a psychiatric manifestation are often misdiagnosed. The purpose of this study was to explore the differences in the clinical and neuropsychological characteristics of general paresis between patients misdiagnosed as having a primary psychiatric disease and patients diagnosed correctly upon seeing a doctor. The results may assist clinicians in the early identification of neurosyphilis with a mental disorder. METHOD: The demographic and clinical manifestations, laboratory tests, and neuroimaging and neuropsychological characteristics were analysed in 55 general paresis patients with psychiatric disorders, including 29 patients misdiagnosed as primary psychiatric disease and 26 patients diagnosed as having general paresis after being seen once by a doctor. RESULT: All of the patients had positive assay results for cerebral spinal fluid (CSF) Treponema pallidum hemagglutination (TPHA). Only 43.3 % of misdiagnosed patients and 30.8 % of general paresis patients had positive results for the CSF rapid plasma reagin (RPR) test; 96.4 % patients had abnormal neuroimaging. Mood disturbances were the most common psychiatric disorder in the general paresis patients, especially agitation, between the two groups (patients with general paresis who were misdiagnosed as having primary psychiatric disease and patients who had never been misdiagnosed) (p = 0.011). CONCLUSION: Our findings reinforce the importance of performing serologic testing for syphilis. This should be a part of the evaluation of patients with psychiatric disorders, especially patients with cognitive impairment. When the syphilis serology is positive, the patient should be examined thoroughly for neurosyphilis by lumbar puncture. Brain imaging could also aid the physician in discriminating these patients from those with a functional mental disorder.


Assuntos
Neurossífilis/diagnóstico , Neurossífilis/fisiopatologia , Treponema pallidum/isolamento & purificação , Adolescente , Adulto , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Demência/diagnóstico , Demência/etiologia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Neuroimagem , Neurossífilis/sangue , Reaginas , Testes Sorológicos
13.
Eur J Neurol ; 23(10): 1541-7, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27415600

RESUMO

BACKGROUND AND PURPOSE: Chronic syphilitic infection may lead to dementia. It is in general paresis (GP), which is the major late form of neurosyphilis, that cognitive impairment frequently occurs. The association between lipid metabolism and GP is unclear. METHODS: In this study, serum lipids were studied in 188 GP patients, in 241 syphilitic patients without neurosyphilis and in 539 healthy controls. The Mini-Mental State Examination (MMSE) was tested in all GP patients. Thirty-five GP patients had a follow-up evaluation 3 months after penicillin treatment. RESULTS: Significantly lower apolipoprotein A-I (apoA-I) levels were found in GP and in syphilitic patients without neurosyphilis compared to controls. In the 25-44-year-old groups, the male syphilitic patients without neurosyphilis had lower serum apoA-I levels and higher apolipoprotein B (apoB)/apoA-I ratios compared with female patients. A follow-up evaluation of 35 GP patients 3 months after penicillin treatment showed a significant positive correlation between increased apoA-I levels and MMSE scores. CONCLUSION: Abnormal apoA-I metabolism may be associated with the decline of cognitive performance. Long-term decrease of apoA-I level and higher apoB/apoA-I ratio may be contributing factors in syphilitic dementia. These results suggest a similar overlap between syphilitic dementia and lipid metabolism to that occurring in Alzheimer's disease.


Assuntos
Demência/sangue , Demência/etiologia , Metabolismo dos Lipídeos , Neurossífilis/sangue , Neurossífilis/complicações , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
BMJ Case Rep ; 20152015 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-25716037

RESUMO

A 66-year-old Caucasian man was admitted to an acute psychiatric ward under section 2 of the Mental Health Act after presenting with auditory hallucinations and partition delusions. He had been known to mental health services since 2005 but had never been treated with psychotropic medication or given a formal psychiatric diagnosis. He was also diagnosed with hypopituitarism of unknown aetiology in 2002. In light of this presentation, his medical history was reviewed in full, hormone levels and a full delirium screen including blood borne virus and syphilis serology was completed to ensure no organic cause had been missed. The treponemal antibody was positive, and he reported no previous syphilis treatment, as such a diagnosis of neurosyphilis was performed. This case demonstrates a patient presenting with two potential complications of syphilis; psychosis and hypopituitarism where screening for this infection had not been previously considered.


Assuntos
Hipopituitarismo/diagnóstico , Neurossífilis/complicações , Neurossífilis/diagnóstico , Sorodiagnóstico da Sífilis , Treponema pallidum/isolamento & purificação , Idoso , Androgênios/uso terapêutico , Antibacterianos/uso terapêutico , Antipsicóticos/uso terapêutico , Delusões/microbiologia , Quimioterapia Combinada , Alucinações/microbiologia , Humanos , Hipopituitarismo/tratamento farmacológico , Hipopituitarismo/microbiologia , Masculino , Neurossífilis/sangue , Neurossífilis/tratamento farmacológico , Unidade Hospitalar de Psiquiatria , Transtornos Psicóticos/microbiologia , Sorodiagnóstico da Sífilis/métodos , Resultado do Tratamento , Treponema pallidum/imunologia
17.
J Neurol Sci ; 350(1-2): 79-83, 2015 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-25703276

RESUMO

BACKGROUND: No gold standard currently exists for the diagnosis of general paresis (GP), thus often resulting in unnecessarily delayed therapeutic decision. METHODS: A retrospective chart review was performed for 85 inpatients with GP in Zhongshan Hospital, Medical College of Xiamen University, and the characteristics of their clinical profiles, serum and cerebrospinal fluid (CSF) examinations, neuroimaging examination, and electroencephalogram (EEG) data were analyzed. RESULTS: Among the 85 GP patients, the clinical symptoms that were frequently observed upon admission included a variety of psychiatric-behavioral symptoms and varying degrees of cognitive impairment. All of the patients had positive serum Treponema pallidum particle agglutination (TPPA) assays, 96.47% of the patients had positive CSF TPPA assays, and 41.18% of the patients had both CSF pleocytosis and elevated CSF protein levels. Focal atrophy in one cerebral region or in multiple regions was evident in neuroimages. The EEG data primarily showed slightly abnormal EEG activity. CONCLUSION: These results demonstrate the complexity of the clinical characteristics of GP and highlight the importance of early diagnosis.


Assuntos
Neurossífilis/sangue , Neurossífilis/diagnóstico , Treponema pallidum/isolamento & purificação , Adulto , Idoso , Eletroencefalografia/tendências , Feminino , Humanos , Imagem por Ressonância Magnética/tendências , Masculino , Pessoa de Meia-Idade , Neurossífilis/fisiopatologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/tendências
18.
J Stroke Cerebrovasc Dis ; 24(1): e1-3, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25282187

RESUMO

Cerebral ischemia due to meningovascular syphilis is rare and more frequently affects the anterior circulation than the posterior circulation. We describe clinical features and imaging studies of a 50-year-old patient with Parinaud syndrome and a syphilitic dorsal midbrain infarction. Brain magnetic resonance imaging indicated vasculitis of the posterior circulation. The diagnosis of meningovascular syphilis was established by serum and cerebrospinal fluid examinations. Although rare, because of the high impact on treatment, clinicians should always be aware of meningovascular syphilis in the differential diagnosis of stroke, particularly in young and male patients with cryptogenic stroke.


Assuntos
Infartos do Tronco Encefálico/diagnóstico , Mesencéfalo/patologia , Neurossífilis/diagnóstico , Transtornos da Motilidade Ocular/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Infartos do Tronco Encefálico/patologia , Diagnóstico Diferencial , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neurossífilis/sangue , Neurossífilis/líquido cefalorraquidiano , Neurossífilis/patologia , Transtornos da Motilidade Ocular/patologia , Acidente Vascular Cerebral/patologia
19.
Sex Transm Dis ; 42(1): 48-52, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25504301

RESUMO

BACKGROUND: The laboratory diagnosis of neurosyphilis rests upon identifying cerebrospinal fluid (CSF) abnormalities, including CSF-Venereal Disease Research Laboratory (VDRL) reactivity. The CSF-VDRL may not be available in the parts of the world where neurosyphilis is most common. Treponemal immunochromatographic strip tests (ICSTs) have been developed as point-of-care tests on blood for syphilis diagnosis in resource-limited settings. METHODS: We optimized 3 commercial ICSTs for performance on CSF and tested CSF samples from 217 patients with syphilis. The Syphicheck-WB test (Qualpro Diagnostics, Goa, India; "Syphicheck") was chosen for further study based on agreement with CSF-VDRL test results. We determined CSF-Syphicheck titers for 152 samples. We modified the CSF-Syphicheck for point-of-care testing in a US sexually transmitted diseases clinic and compared results on 102 paired centrifuged and uncentrifuged CSF samples obtained in the laboratory to the results obtained at point of care; results of samples diluted 1:4 were compared in a subset. RESULTS: The diagnostic sensitivity of a reactive CSF-Syphicheck (62%-64%) and the diagnostic specificity of a CSF-Syphicheck titer at or above 1:4 (79%-81%) were equivalent to the CSF-VDRL (54%-69% sensitivity, 73%-75% specificity) for laboratory and clinical neurosyphilis diagnoses. The CSF-Syphicheck normalized after neurosyphilis therapy similarly to the CSF-VDRL. The modified CSF-Syphicheck performed well at the point of care, albeit with better performance on cell-free compared with uncentrifuged CSF. CONCLUSIONS: Cerebrospinal fluid treponemal ICSTs hold promise for point-of-care neurosyphilis diagnosis in regions where the CSF-VDRL is not available. Further study should address the performance of CSF ICSTs in resource-limited settings.


Assuntos
Neurossífilis/líquido cefalorraquidiano , Neurossífilis/diagnóstico , Sistemas Automatizados de Assistência Junto ao Leito , Sorodiagnóstico da Sífilis/métodos , Treponema pallidum/isolamento & purificação , Cromatografia de Afinidade , Técnicas de Laboratório Clínico , Feminino , Humanos , Masculino , Neurossífilis/sangue , Sensibilidade e Especificidade
20.
Inflammation ; 37(3): 950-5, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24419746

RESUMO

The potential mechanisms for blood-brain barrier damage and the diagnosis of neurosyphilis in HIV patients co-infected with syphilis (HIV-S) are unclear. The aim of the study was to determine the expression of CXCL2 in the serum and cerebrospinal fluid (CSF) of HIV-S patients. A total of 34 HIV patients and 7 controls were enrolled in a HIV clinical cohort for diagnosis of neurosyphilis in Taiwan. Serum and CSF concentrations of CXCL2 were determined by ELISA. Neurosyphilis was defined as a CSF white blood cell count of ≧20 cells/µl or a reactive CSF Venereal Disease Research Laboratory (VDRL). Demographics and medical histories were collected. All the patients with HIV-S were males. Most (80%) had sex with men (MSM) and serum rapid plasma reagin (RPR) titers of ≧1:32. The medium age was 37 (range 21-68) years. The medium CD4 T cell counts at the time of the diagnosis of syphilis were 299 (range 92-434) cells/µl. Eight patients (24%) had neurosyphilis based on a reactive CSF VDRL test (n = 5) or increased CSF white blood cell counts of ≧20 cells/µl (n = 3). The concentrations of CSF CXCL2 were significantly higher in patients with HIV and neurosyphilis as compared to HIV with syphilis, HIV, and controls (p = 0.012). There were no significant differences in serum concentrations between the four groups. There was a correlation between CSF CXCL2 concentrations with neurosyphilis (p = 0.017), CSF white blood cell count (p = 0.001), and CSF protein levels (p = 0.005). The CSF level of CXCL2 can be used to distinguish those with or without neurosyphilis in HIV infected patients.


Assuntos
Quimiocina CXCL2/sangue , Quimiocina CXCL2/líquido cefalorraquidiano , Infecções por HIV/líquido cefalorraquidiano , Neurossífilis/líquido cefalorraquidiano , Sífilis/líquido cefalorraquidiano , Adulto , Idoso , Barreira Hematoencefálica/microbiologia , Barreira Hematoencefálica/patologia , Barreira Hematoencefálica/virologia , Cardiolipinas/líquido cefalorraquidiano , Colesterol/líquido cefalorraquidiano , Coinfecção , Feminino , Infecções por HIV/sangue , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Neurossífilis/sangue , Fosfatidilcolinas/líquido cefalorraquidiano , Sífilis/sangue , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...