Merins V, Hahn K
Group Practice Family Physicians, Alt-Buckow 9-11, 12349, Berlin, Germany.
Department of Neurology, Universitätsmedizin Charité, Charitéplatz 1, 10117, Berlin, Germany.
Eur J Med Res. 2015 Oct 7;20:81. doi: 10.1186/s40001-015-0175-8.
Neurosyphilis might be difficult to diagnose particularly in asymptomatic patients and patients with HIV-coinfection. The objective of this study was to evaluate current diagnostic standards for neurosyphilis in HIV-positive and -negative patients.
We studied retrospectively patients with an active syphilis infection who had additionally undergone lumbar puncture. Patients where the criteria for the diagnosis of a definite or probable neurosyphilis were applicable were further analyzed for clinical symptoms, CSF, HIV-status as well as Treponema pallidum testing in serum and CSF. Correlation analysis of categorical variables was done by using the Chi-square test or in cases of small sample sizes the exact test of Fisher. p values ≤0.05 were considered significant.
Eighty-nine patients were diagnosed with syphilis. All necessary criteria for the diagnosis of a neurosyphilis were available in 67 of them including 35 HIV-positive and 32 HIV-negative patients. A definite neurosyphilis could be retrospectively diagnosed in 13 and a probable in another 25 cases. Normal CSF results were more likely in HIV-negatives (p = 0.016). A neurosyphilis was correlated to a CSF pleocytosis > 5 cells/µl and to an albumin quotient >7.8 mg/dl regardless of a parallel HIV infection. HIV-positives had more frequently a CSF-RPR titre >1:4 than HIV-negatives (p = 0.031). However, the RPR test in CSF in definite or probable neurosyphilis had a sensitivity of only 21 %.
Our data show that a pleocytosis and an elevated albumin quotient correlate with neurosyphilis. However, the CSF-RPR test as gold standard in neurosyphilis diagnostics has a very low sensitivity.
神经梅毒可能难以诊断，尤其是在无症状患者和合并感染艾滋病毒的患者中。本研究的目的是评估艾滋病毒阳性和阴性患者中神经梅毒的当前诊断标准。
我们回顾性研究了患有活动性梅毒感染且额外接受了腰椎穿刺的患者。对适用明确或疑似神经梅毒诊断标准的患者，进一步分析其临床症状、脑脊液、艾滋病毒状态以及血清和脑脊液中的梅毒螺旋体检测情况。分类变量的相关性分析采用卡方检验，样本量较小时采用Fisher精确检验。p值≤0.05被认为具有统计学意义。
89例患者被诊断为梅毒。其中67例具备神经梅毒诊断的所有必要标准，包括35例艾滋病毒阳性患者和32例艾滋病毒阴性患者。回顾性诊断明确神经梅毒13例，疑似25例。艾滋病毒阴性患者脑脊液结果正常的可能性更高（p = 0.016）。无论是否合并艾滋病毒感染，神经梅毒均与脑脊液细胞增多>5个/微升以及白蛋白商>7.8毫克/分升相关。艾滋病毒阳性患者脑脊液快速血浆反应素环状卡片试验（RPR）滴度>1:4的情况比艾滋病毒阴性患者更常见（p = 0.031）。然而，在明确或疑似神经梅毒中，脑脊液RPR试验的敏感性仅为21%。
我们的数据表明，细胞增多和白蛋白商升高与神经梅毒相关。然而，脑脊液RPR试验作为神经梅毒诊断的金标准，敏感性非常低。
