Neurosyphilis

Katz, Debra A.; Berger, Joseph; Duncan, Robert C.

doi:10.1001/archneur.1993.00540030009006

Cited by 121 publications

(11 citation statements)

References 45 publications

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“…In table 8, the different clinical forms in several historical series are compared [5, 9, 14, 15, 16, 17]. In order to overcome differences in classification criteria, we have made some corrections, specified in the table.…”

Section: Discussionmentioning

confidence: 99%

“…We found a proportion of patients with GP similar to that in series previous to the HIV pandemia. Two contemporary series [9, 17]including HIV patients report a lower prevalence of GP, suggesting a negative effect of HIV on GP incidence; however, both series included cases with positive CSF VDRL only, a fact that could explain this difference. We observed that among patients with positive CSF VDRL, those with early NS had significantly higher titers; thus, if we take this as the only criterion, a number of cases of NS could be missed, mostly later forms.…”

Section: Discussionmentioning

confidence: 99%

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Current Clinical Spectrum of Neurosyphilis in Immunocompetent Patients

et al. 2004

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Background: Neurosyphilis (NS) is nowadays a less frequent disease. Its incidence and clinical spectrum have changed over time. Objective: To estimate the incidence of NS and describe the clinical spectrum of NS in immunocompetent patients in the last decade. Methods: Demographic and clinical features, cerebrospinal fluid (CSF) changes, neuroimaging findings and outcome were retrospectively analyzed. Results: Forty-three patients met NS criteria. The yearly incidence was 0.2– 2.1 cases per 100,000 inhabitants. The mean age was 48.1 years, males being more frequently involved. The most frequent clinical patterns were meningovascular (30.2%), meningeal (25.6%) and general paresis (25.6%). Compared to prepenicillin series, we observed a decrease in late forms, mainly tabes dorsalis. CSF titers studied by the Venereal Disease Research Laboratory were higher in early NS. Neuroimaging findings were nonspecific. Outcome was better for early forms. Conclusions: Compared to the preantibiotic era, a lower frequency of late NS was observed, similar to that reported in other modern series which include patients with HIV infection. Therefore, this trend seems to be due to the impact of antibiotics rather than to HIV infection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Current Clinical Spectrum of Neurosyphilis in Immunocompetent Patients

et al. 2004

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“…Ocular inflammation was observed up to one third of all neurosyphilis patients [ 10 ]. Although numerous studies on ocular syphilis have been reported, there are limited data about HIV-related risk factors such as HIV viral load or CD4+ cell count as they relate to syphilis serology and CSF laboratory findings.…”

Section: Introductionmentioning

confidence: 99%

Clinical and laboratory characteristics of ocular syphilis: a new face in the era of HIV co-infection

Lee

Cheng

Rodger

et al. 2015

J Ophthal Inflamm Infect

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BackgroundOcular syphilis is reemerging as an important cause of uveitis in the new era of common co-infection with HIV. This study will reveal the clinical and laboratory characteristics in the group of individuals co-infected with ocular syphilis and HIV compared with HIV-negative individuals. In this retrospective observational case series, medical records of patients diagnosed with ocular syphilis with serologic support from 2008 to 2014 were reviewed. Ocular and systemic manifestation and laboratory profiles were reviewed.ResultsTwenty-nine eyes of 16 consecutive patients (10 HIV-positive and 6 HIV-negative) were included. All patients were males, and mean age of onset for ocular syphilis was 43 (mean 42.65 ± 13.13). In both HIV-positive and HIV-negative groups, ocular manifestations of syphilis were variable including anterior uveitis (4 eyes), posterior uveitis (8 eyes), panuveitis (13 eyes), and isolated papillitis (4 eyes). In HIV-positive patients, panuveitis was the most common feature (12/18 eyes, 67 %) and serum rapid plasma reagin (RPR) titers were significantly higher (range 1:64–1:16,348; mean 1:768; p = 0.018) than in HIV-negative patients. Upon the diagnosis of ocular syphilis in HIV-positive patients, HIV-1 viral load was high (median 206,887 copies/ml) and CD4 cell count ranged from 127 to 535 cells/ml (mean 237 ± 142; median 137). Regardless of HIV status, cerebrospinal fluid (CSF) exam was frequently abnormal: positive CSF fluorescent treponemal antibody absorption (FTA-ABS) or Venereal Disease Research Laboratory (VDRL) test results in seven patients or either elevated CSF WBC count or elevated CSF protein in six patients.ConclusionsOur results reveal that the patients with ocular syphilis with high serum RPR titers may have concomitant HIV infection requiring further testing for HIV status and ocular syphilis is likely associated with the central nervous system involvement and therefore needs to be managed according to the treatment recommendations for neurosyphilis.

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“…An increased frequency of ocular disease, multiple and slower resolving primary chancres, and a higher titer RPR have been reported (1–6). In addition, delay or failure of titer decline after treatment, predilection for developing the Jarisch-Herxheimer reaction, and clinical relapse have also been described in HIV infection (1,4,7,8). …”

Section: Discussionmentioning

confidence: 99%