Poliseli Rodolfo, Vidal Jose E, Penalva De Oliveira Augusto C, Hernandez Adrian V
Department of Infectious Diseases, Emílio Ribas Institute of Infectious Diseases, Sao Paulo, Brazil.
Sex Transm Dis. 2008 May;35(5):425-9. doi: 10.1097/OLQ.0b013e3181623853.
To describe clinical and laboratory features of human immunodeficiency infection (HIV)-infected patients with neurosyphilis.
Retrospective study of 27 consecutive cases of HIV-infected patients with a positive Venereal Disease Research Laboratory (VDRL) in cerebrospinal fluid (CSF).
Median of age was 36 years and 89% were men. Ten (37%) patients had previous nonneurologic syphilis treatment. At the time of neurosyphilis diagnosis, 10 (37%) patients had early syphilis, and 6 of them were neurologically asymptomatic. Nine (33%) patients had symptomatic neurosyphilis. Twenty-six (96%) patients were classified with early neurosyphilis. The medians of serum VDRL and CD4 T cell counts were 1:128 and 182 cell/muL, respectively. Twenty five (93%) patients presented serum VDRL titers > or =1:16. Five of 6 patients with early syphilis and asymptomatic neurosyphilis, presented serum VDRL > or =1:16. Symptomatic patients showed lower CD4 T cell counts (59 cell/muL vs. 208 cell/muL, P = 0.03) and higher protein concentration on CSF (118 mg/dL vs. 39 mg/dL, P <0.001) than asymptomatic patients.
Most patients had early and asymptomatic neurosyphilis, and more than one third had early syphilis. Patients with symptomatic neurosyphilis showed lower CD4 T cell counts and higher protein concentration on CSF than those asymptomatic. Most patients had serum VDRL titers > or =1:16, regardless of syphilis stage.
描述感染人类免疫缺陷病毒(HIV)且患有神经梅毒患者的临床和实验室特征。
对27例脑脊液(CSF)性病研究实验室(VDRL)检测呈阳性的HIV感染患者进行回顾性研究。
患者年龄中位数为36岁,89%为男性。10例(37%)患者曾接受过非神经梅毒治疗。在神经梅毒诊断时,10例(37%)患者患有早期梅毒,其中6例无神经症状。9例(33%)患者患有症状性神经梅毒。26例(96%)患者被归类为早期神经梅毒。血清VDRL和CD4 T细胞计数的中位数分别为1:128和182个细胞/微升。25例(93%)患者血清VDRL滴度≥1:16。6例早期梅毒且无症状性神经梅毒患者中有5例血清VDRL≥1:16。有症状的患者CD4 T细胞计数较低(59个细胞/微升对208个细胞/微升,P = 0.03),脑脊液中的蛋白质浓度较高(118毫克/分升对39毫克/分升,P <0.001),高于无症状患者。
大多数患者患有早期无症状性神经梅毒,超过三分之一患有早期梅毒。有症状性神经梅毒的患者与无症状患者相比,CD4 T细胞计数较低,脑脊液中的蛋白质浓度较高。大多数患者血清VDRL滴度≥1:16,无论梅毒处于何阶段。