RSS-Feed abonnieren
PDF herunterladen
DOI: 10.1590/0004-282X20160016
Cerebrospinal fluid examination may be useful in diagnosing neurosyphilis in asymptomatic HIV+ patients with syphilis
El examen del líquido céfalo raquídeo puede ser útil en el diagnóstico de neurosífilis en pacientes VIH + asintomáticos con sífilis
ABSTRACT
Lumbar 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.
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 pacientes fueron seleccionados para este estudio, el VDRL fue positivo en 5. El diagnóstico se elevó a 14 cuando se sumaron el resto de las técnicas. No se evidenció que la celularidad y el aumento de proteínas fueran herramientas auxiliares para el diagnóstico. De acuerdo a nuestro trabajo el estudio del LCR con las técnicas señaladas puede ser de utilidad en el diagnóstico de NS en estos pacientes.
Publikationsverlauf
Eingereicht: 08. Juli 2015
Angenommen: 03. November 2015
Artikel online veröffentlicht:
06. September 2023
© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
-
References
- 1 Ghanem KG, Moore RD, Rompalo AM, Erbelding EJ, Zenilman JM, Gebo KA. Lumbar puncture in HIV infected patients with syphilis and no neurologic symptoms. Clin Infect Dis. 2009;48(6):816-21. doi:10.1086/597096
- 2 Libois A, De Wit S, Poll B, García F, Florence E, Del Río A et al. HIV and syphilis: when to perform a lumbar puncture. Sex Transm Dis. 2007;34(3):141-4. doi:10.1097/01.olq.0000230481.28936.e5
- 3 French P, Gomberg M, Janier M, Schmidt B, Voorst Vader P, Young H et al. IUSTI: 2008 European Guidelines on the Managements of Syphilis. Int J STD AIDS. 2009;20(5):300-9. doi:10.1258/ijsa.2008.008510
- 4 Tramont EC. Treponema pallidum (syphilis). In: Mandell, Douglas and Bennett’s Principles and practice of infectious diseases. 5th ed. New York: Elsevier; 2009. p. 2474-90.
- 5 Hart G. Syphilis tests in diagnostic and therapeutic decision making. Ann Intern Med. 1986;104(3):368-76. doi:10.7326/0003-4819-104-3-368
- 6 Marra CM, Maxwell CL, Collier AC, Robertson KR, Imrie A. Interpreting cerebrospinal fluid pleocytosis in HIV in the era of potent antiretroviral therapy. BMC Infect Dis. 2007;7:37. doi:10.1186/1471-2334-7-37
- 7 Marra CM, Maxwell CL, Smith SL, Lukehart SA, Rompalo AM, Eaton M et al. Cerebrospinal fluid abnormalities in patients with syphilis: association with clinical and laboratoryfeatures. J Infect Dis. 2004;189:369-76. doi:10.1086/381227
- 8 Marra CM. Neurosyphilis in infections of the central nervous system. In: Scheld WM, Whitley RJ, Marra CM, editors. Infections of the central nervous system. 4th ed. Philadelphia: Wolters Kluwer; 2014. p. 659-73.
- 9 Marra CM, Gary DW, Kuypers J, Jacobson MA. Diagnosis of Neurosyphilis in patients infected with Human Immunodeficiency Virus Type 1. J Infect Dis 1996;174(1):219-21. doi:10.1093/infdis/174.1.219
- 10 Machado L, Livramento JA, Vianna LS. Cerebrospinal fluid analysis in infectious diseases of the nervous system: when to ask, what to ask, what to expect. Arq Neuropsiquiatr. 2013;71(9B):693-8. doi:10.1590/0004-282X20130153
- 11 Turner TB, Hardy PH, Newman B. Infectivity tests in syphilis. Br J Vener Dis. 1969;49(3):183-96.
- 12 Luger AF, Schmidt BL, Steyer K, Schenwald E. Diagnosis of neurosyphilis by examination of the cerebrospinal fluid. Br J Vener Dis. 1981;57(4):232-7.
- 13 Müller F, Moskophidis M. Estimation of the local production of antibodies for Treponema Pallidum in the Central Nervous System of patients with Neurosyphilis. Br J Vener Dis. 1983;59:80-4.
- 14 Marra CM. Update on neurosyphilis. Curr Infect Dis Rep. 2009;11:127-34. doi:10.1007/s11908-009-0019-1
- 15 Ghanem KG, Moore RD, Rompalo AM, Erbelding EJ, Zenilman JM, Gebo KA. Neurosyphilis in a clinical cohort of HIV-1 infected patients. AIDS. 2008;22(10):1145-51. doi:10.1097/QAD.0b013e32830184df
- 16 Luger AF, Schmidt BL, Kaulich M. Significance of laboratory findings for the diagnosis of neurosyphilis. Int J of STD & AIDS. 2000;11(4):224-34. doi:10.1258/0956462001915750