Neurosyphilis in a clinical cohort of HIV-1-infected patients

Ghanem, Khalil G.; Moore, Richard D.; Rompalo, Anne; Erbelding, Emily J.; Zenilman, Jonathan M.; Gebo, Kelly A.

doi:10.1097/qad.0b013e32830184df

Cited by 173 publications

(169 citation statements)

References 17 publications

(19 reference statements)

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“…It was not surprising that this patient did not show much improvement in symptoms following treatment. Findings from a previous study (Ghanem KG et al, 2008) showed that in 38% of patients, the major symptom persisted after 1 year and 29% needed retreatment. However, some cases had documented improvement of psychotic symptoms after penicillin therapy (e.g.…”

Section: Discussionmentioning

confidence: 90%

Neurosyphilis and psychosis

Wahab

Rani

2013

Asia-Pacific Psychiatry

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Neurosyphilis may presents with a range of psychiatric symptoms. This report illustrates a case of neurosyphilis in a man who presented with psychosis and cognitive dysfunction. Clinical findings and investigations done in the present case showed positive results for syphilis. Reduction of symptoms was noted after treatment with antibiotic. This case further highlights the importance of having high index of suspicion for neurosyphilis in patients presenting with psychiatric symptoms.

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Section: Discussionmentioning

confidence: 90%

Neurosyphilis and psychosis

Wahab

Rani

2013

Asia-Pacific Psychiatry

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“…On Reibergrams, this can be seen to be connected with intrathecal production of specific antibodies (IgG quotient), which would indicate local activity, while the IgG index itself might have less sensitivity in this regard 12,13,14,15,16 . These diagnostic alternatives have made it possible to obtain information in cases of symptomatic HIV-negative patients.…”

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%

“…15,16,33 The rates of syphilis reported by Marra et al, Leber et al and Ghanem et al in individuals undergoing lumbar puncture based on these criteria ranged from 20 to 27%. 24,30,32,34 Importantly, HIV-infected patients with syphilis who are virally suppressed on combination ART may be at lower risk of neurosyphilis compared with those not taking combination ART. 32 Two retrospective studies have suggested that uncontrolled plasma HIV RNA (>50 copies mL ) increased the risk of neurosyphilis.…”

Section: Laboratory Definitions Of Neurosyphilismentioning

confidence: 99%

“…24,30,32,34 Importantly, HIV-infected patients with syphilis who are virally suppressed on combination ART may be at lower risk of neurosyphilis compared with those not taking combination ART. 32 Two retrospective studies have suggested that uncontrolled plasma HIV RNA (>50 copies mL ) increased the risk of neurosyphilis. 30,35 In HIV-infected individuals with detectable plasma HIV RNA, those who have neurosyphilis have higher CSF HIV RNA concentrations compared with those who have uncomplicated syphilis, suggesting there may be an interaction between syphilis and HIV in the CNS.…”

Section: Laboratory Definitions Of Neurosyphilismentioning

confidence: 99%

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