Cerebrospinal Fluid Abnormalities in Patients with Syphilis: Association with Clinical and Laboratory Features

Marra, Christina M.; Maxwell, Clare; Smith, Stacy L.; Lukehart, Sheila A.; Rompalo, Anne; Eaton, Molly; Stoner, Bradley P.; Augenbraun, Michael; Barker, David E.; Corbett, James J.; Zajackowski, Mark; Raines, Charles; Nerad, Judith L.; Kee, Romina; Barnett, Scott H.

doi:10.1086/381227

Cited by 419 publications

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“…12 There is also evidence that HIV infection may lead to more rapid progression to neurosyphilis. 13 It is therefore important to exclude HIV and syphilis in a patient presenting with neuropsychiatric disease and it is recommended that all patients diagnosed with syphilis be tested for HIV, and vice versa. 11,14,15 The National HIV Counselling and Testing Policy guidelines for diagnostic HIV testing support a sequential testing strategy, whereby HIV testing is initiated with a rapid screening test (finger prick).…”

Section: Introductionmentioning

confidence: 99%

HIV sero-positivity in recently admitted and long-term psychiatric in-patients: prevalence and diagnostic profile

Henning¹,

Krüger²,

Fletcher³

2012

Afr. J. Psych

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Objective: Research on HIV in South Africa has not reflected the impact of the disease on psychiatric patients. The aims of the study were: to compare the HIV prevalence among patient groups in Weskoppies Hospital; to compare psychiatric diagnoses of infected and non-infected patients; to assess intravenous drug use and high-risk sexual behaviour; to establish HIV-syphilis association; and to investigate the rapid test performance for screening, compared to the confirmatory ELISA test. Method: Onehundred-and-ninety-five patients were grouped into four categories according to their duration of admission and gender. HIV rapid testing, HIV ELISA, syphilis-RPR and TPHA testing were performed. Results: The HIV prevalence of 11% in the sample was significantly associated with 'gender-and-duration-of-admission' categories (p=0.003). No significant association between HIV infection and psychiatric diagnoses or intravenous drug use was found, but a significant association existed between HIV infection and high-risk sexual behaviour (p=0.002), and between HIV and syphilis (p=0.012). The HIV rapid screening test had a sensitivity of 91.7% and a specificity of 98.2%. Conclusion: The overall HIV prevalence at Weskoppies Hospital remains lower than the national average, but has increased since a previous local study. The rapid test for HIV had a lower sensitivity than was expected, and it is recommended that HIV ELISA testing be performed as a first line test in the setting of hospitalised patients. Due to the high prevalence of HIV and syphilis in the psychiatric population it is recommended that all patients be tested for both of these diseases.

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Section: Introductionmentioning

confidence: 99%

HIV sero-positivity in recently admitted and long-term psychiatric in-patients: prevalence and diagnostic profile

Henning¹,

Krüger²,

Fletcher³

2012

Afr. J. Psych

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“…Its moderate sensitivity (30-70%) in immunocompetent patients 4 and its significantly decreased sensitivity in patients who are immunosuppressed due to HIV, makes it necessary to use other techniques for diagnosing this condition. These may include cellularity and CSF protein levels, in those cases that cannot be detected through VDRL 5,6,7 . High cellularity and CSF protein levels are indicative criteria of neurosyphilis in the absence of other diseases.…”

mentioning

confidence: 99%

Cerebrospinal fluid examination may be useful in diagnosing neurosyphilis in asymptomatic HIV+ patients with syphilis

Salamano

Ballesté

Perna

et al. 2016

Arq. Neuro-Psiquiatr.

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ARTICLE Cerebrospinal fluid examination may be useful in diagnosing neurosyphilis in asymptomatic HIV+ patients with syphilisEl examen del líquido céfalo raquídeo puede ser útil en el diagnóstico de neurosífilis en pacientes VIH + asintomáticos con sífilis Whether lumbar puncture should be indicated for diagnosing neurosyphilis in patients who are coinfected with the human immunodeficiency virus (HIV) and Treponema pallidum (T. pallidum) but do not have any symptoms or neurological signs is a matter for discussion 1,2 . The European guidelines recommend lumbar puncture in cases of symptomatic patients (neurological, ophthalmological or otological symptoms) and asymptomatic HIV-positive patients with Venereal Disease Research Laboratory (VDRL) test results greater than or equal to 1/32 in serum and CD4 less than or equal to 350. These guidelines suggest that lumbar puncture should not be compulsory but that it could be indicated in cases of late latent syphilis or syphilis of undetermined duration 3 . In 2002, the Centers for Disease Control and Prevention (CDC) recommended lumbar puncture for patients with late latent syphilis or syphilis of undetermined duration. This recommendation was later revised to include reactive VDRL ≥ 1/32 in serum and CD4 cell counts ≤ 350 cells/ml. Since 2010, CDC has not been recommending lumbar puncture for asymptomatic patients. AbstrACtLumbar puncture in neurologically asymptomatic HIV+ patients is still under debate. There are different criteria for detecting neurosyphilis through cerebrospinal fluid (CSF), especially in cases that are negative through the Venereal Disease Research Laboratory (VDRL), regarding cellularity and protein content. However, a diagnosis of neurosyphilis can still exist despite negative VDRL. Treponema pallidum hemagglutination assay (TPHA) titers and application of the TPHA index in albumin and IgG improve the sensitivity, with a high degree of specificity. Thirty-two patients were selected for this study. VDRL was positive in five of them. The number of diagnoses reached 14 when the other techniques were added. It was not determined whether cellularity and increased protein levels were auxiliary tools in the diagnosis. According to our investigation, CSF analysis using the abovementioned techniques may be useful in diagnosing neurosyphilis in these patients.Keywords: neurosyphilis, HIV positive, VDRL, TPHA in CSF, TPHA indexes. resumo La punción lumbar (PL) en pacientes VIH+ neurológicamente asintomáticos es controversial. Existen diferentes criterios para detectar en el líquido cefalorraquídeo (LCR) neurosífilis (NS): el examen Venereal Disease Research Laboratory (VDRL) en primer lugar, en caso de negatividad: la celularidad y el tenor de proteinas. Sin embargo el diagnóstico de NS puede ser sostenido a pesar de la negatividad de las técnicas mencionadas. La titulación del Treponema pallidum hemagglutination assay (TPHA) y la aplicación del índice de TPHA en Albúmina e Ig G mejoran la sensibilidad asociando elevado grado de especificidad. 32 pacien...

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“…Numerous prior studies have shown that the risk of neurosyphilis in HIV-infected patients with systemic syphilis is significantly higher in the setting of neurological symptoms such as headache or ocular symptoms. 24,30,31 Additionally, reduced peripheral blood CD4+ T-cell count has been associated with the risk of neurosyphilis: CD4 T-cell counts of 350 uL -1 in several studies 24,31,32 and 500 uL -1 in a more recent study 30 have been clearly associated with an increased probability of neurosyphilis in HIV-infected persons, as defined by CSF criteria. Some controversy remains as to whether high serum rapid plasma reagin (RPR) titres also predict neurosyphilis.…”

Section: Laboratory Definitions Of Neurosyphilismentioning

confidence: 99%

“…Given this, most recent definitions have used a cut-off of >20 WBCs/uL as diagnostic of neurosyphilis in HIV-infected individuals who have a positive blood syphilis titre but a non-reactive CSF-VDRL, as employed in a large prospective study of syphilis in HIV-infected patients. 24 Others have used a lower cut-off, 25 which may be most appropriate in HIV patients with a low peripheral blood CD4+ T-cell concentration, who are taking combination ART or who have undetectable plasma HIV RNA, because these lower the risk of HIV-related CSF pleocytosis. 23,26 Other tests not currently used clinically that may contribute to the diagnosis of asymptomatic neurosyphilis include: (i) the proportion of CSF lymphocytes that are B-cells; 27 and (ii) the CSF concentration of the chemokine C-X-C motif ligand 13 (CXCL-13), a B-cell chemoattractant.…”

Section: Laboratory Definitions Of Neurosyphilismentioning

confidence: 99%

Neurosyphilis and the impact of HIV infection

Spudich

2015

Sex. Health

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Cerebrospinal Fluid Abnormalities in Patients with Syphilis: Association with Clinical and Laboratory Features

Abstract: Serum RPR titer helps predict the likelihood of neurosyphilis. HIV-induced immune impairment may increase the risk of neurosyphilis.

Cited by 419 publications

References 23 publications

HIV sero-positivity in recently admitted and long-term psychiatric in-patients: prevalence and diagnostic profile

HIV sero-positivity in recently admitted and long-term psychiatric in-patients: prevalence and diagnostic profile

Cerebrospinal fluid examination may be useful in diagnosing neurosyphilis in asymptomatic HIV+ patients with syphilis

Neurosyphilis and the impact of HIV infection

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