Our findings have shown that all the examined criteria for the diagnosis of neurosyphilis in CSF are different assessment tools of intrathecal humoral immune activity and support the hypothesis that high CSF treponemal-specific antibody titers are a consequence of inflammatory pathology of the central nervous system.
Neurosyphilis can occur at any stage of syphilis infection, even in patients who have received timely and proper treatment (1,2). The choice of which syphilitic patients should undergo examination of the cerebrospinal fluid (CSF) to diagnose neurosyphilis is difficult. The use of selective lumbar puncture criteria, based on serum titres of non-treponemal tests, have been considered (3)(4)(5)(6)(7)(8). We hypothesized that Treponema pallidum haemagglutination assay (TPHA) serum titres may also be useful in evaluating the probability of neurosyphilis. In this study we explored the ability of the TPHA to predict basic CSF abnormalities consistent with neurosyphilis (9-12). MATERIALS AND METHODSA total of 151 HIV-non-infected patients with serological evidence of syphilis, who had undergone lumbar puncture in the Urals Institute of Dermatovenereology and Immunopathology in Yekaterinburg, Russia, from May 2006 through December 2012, were reviewed.The patients were part of a consecutive, prospectively collected cohort, and were referred from outpatient clinics for sexually transmitted diseases, neurology units of in-patient hospitals and in-patient psychiatric hospitals. The patients had neurological manifestations consistent with neurosyphilis, late-stage syphilis or a reactive non-treponemal test more than 2 years after treatment for non-neurological syphilis, combined with a low probability of re-infection.The extensive list of laboratory tests, database maintenance and its use for analysis were approved by the local ethics committee. Written informed consent was provided by all patients. Lumbar puncture was performed in all patients for the first time. Follow-up cases were not included in the study.Both CSF and blood samples were collected within the same day. CSF samples contaminated with blood were excluded from the study. CSF abnormalities considered consistent with neurosyphilis were: a reactive CSF Venereal Disease Research Laboratory (VDRL) test; CSF white blood cell (WBC) count > 5/μl; CSF-TPHA titre ≥ 1:640; TPHA index > 70; intrathecally produced T. pallidum antibody (ITpA) index > 3; minimally detectable level of Reiber intrathecal fraction of any immunoglobulin class; and a reactive CSF-FTA-Abs test. Serum TPHA titres were compared across groups with normal and abnormal CSF parameters, and each parameter was tested separately.A 2-sample Kolmogorov-Smirnov test procedure was used to assess the significance of differences in distributions and to establish a cut-off point. A χ 2 test was used to compare proportions, and Mann-Whitney U test to compare continuous and categorical variables. Logistic regression was used to calculate univariate and adjusted odds ratios. All analyses were performed using MedCalc for Windows, version 12.2 (MedCalc Software, Belgium) and Microsoft Excel, version 11.0 (Excel Software, USA). RESULTSA total of 151 patients (88 males, 63 females, age range 17-64 years, mean age 40.4 ± 10.5 years) were included in the study. All patients were reactive in more than 2 serum treponemal tes...
The epidemiological role of migrants in the propagation of syphilis in the territory of Urals, Siberia and Far East has been studied. The syphilis incidence rate (per 100,000 of people under examination) among legal migrants was 5-30 times as high as among the autochthonic population. Latent forms (80.0%) prevailed in the clinical structure of migrants suffering from syphilis, and the percentage of contagious forms was high (62.7%). The share of migrants suffering from syphilis who withdrew from dermatovenerological observation after the diagnosis was made turned out to be high (37.5%). The authors also revealed risk factors affecting the growth in the syphilis incidence rate among labor migrants. The article discusses issues related to organizing reasonable anti-epidemic measures for the epidemiological group.
Выявление сифилиса у детей представляет сложную задачу, что обусловлено многообразием клинических проявлений, их схожестью с другими инфекциями и заболеваниями, отсутствием настороженности у врачей. Материал и методы. Проведен ретроспективный анализ клинических проявлений манифестных форм сифилиса у детей различных возрастных групп (0-3 года, 4-7, 8-14 и 15-17 лет) и у взрослых на основании данных первичной медицинской документации (151 история болезни детей и 109 историй болезни взрослых 18-59 лет). Изучены давность заболевания, полиморфизм, распространенность, характер, локализация высыпаний, изменение роста волос, реакция лимфатической системы, результаты серологических тестов. Результаты. Клинические проявления сифилиса у детей зависят от возраста, что наиболее выражено при вторичном периоде сифилиса и у детей младшего возраста до 7 лет. При вторичном сифилисе по мере увеличения возраста больных клинический процесс приобретает более распространенный характер, появляется истинный полиморфизм высыпаний и увеличивается их количество. Заключение. Выявленные возрастные особенности клиники манифестных форм сифилиса необходимо учитывать при обследовании ребенка. Такой подход позволит улучшить качество и своевременность диагностики сифилитической инфекции у детей.
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