Department of Infectious Diseases, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal.
Department of Medicine III, Centro Hospitalar Lisboa Norte, Hospital Pulido Valente, Lisbon, Portugal.
Aging Clin Exp Res. 2019 Aug;31(8):1155-1161. doi: 10.1007/s40520-018-1052-4. Epub 2018 Oct 20.
Syphilis is a systemic human disease which is caused by infection with the spirochete Treponema pallidum. It is spread worldwide, and there has recently been an increase in its incidence. Neurosyphilis (NS) can have a variety of presentations; meningovascular NS is a specific affection of the Treponema which occurs in an early stage after the primary infection, causing an inflammatory arteriopathy which may result in an ischemic stroke. As a rare manifestation of syphilis, there are few prevalence and epidemiological studies, and data are almost non-existent. The objective of this study is to analyse the prevalence of meningovascular NS in a stroke unit in a tertiary hospital.
A descriptive retrospective study was carried out over a period of 44 months in a stroke unit. All patients admitted had neurological symptoms compatible with a vascular event, and routine blood tests including infectious screening were performed. Those with positive test results for syphilis were identified and proceeded to lumbar puncture to CSF cytochemical analysis and VDRL. NS was categorized as confirmed or probable (using CDC criteria).
A total of 525 patients were admitted, and 62.53% were submitted to a routine screening for syphilis. A total of 309 patients (95.67%) revealed a negative screening; 12 patients (3.72%) had a positive syphilis serology. Among the 12 patients with positive screening, a single case of NS (0.31%) was identified.
We observed a low prevalence of NS (0.31%), but this result was surprisingly higher than what was expected in an elderly population.
梅毒是一种由苍白密螺旋体感染引起的系统性人类疾病。它在全球范围内传播，最近其发病率有所上升。神经梅毒（NS）可能有多种表现形式；脑膜血管性 NS 是原发性感染后早期特有的苍白密螺旋体感染，引起炎症性动脉病，可能导致缺血性中风。作为梅毒的一种罕见表现，其患病率和流行病学研究较少，几乎没有数据。本研究旨在分析三级医院卒中单元中脑膜血管性 NS 的患病率。
在一个卒中单元进行了为期 44 个月的描述性回顾性研究。所有入院的患者均有与血管事件相符的神经系统症状，并进行了包括传染病筛查在内的常规血液检查。对梅毒检测结果阳性的患者进行识别，并进行腰椎穿刺以进行 CSF 细胞学分析和 VDRL。NS 分为确诊或可能（使用 CDC 标准）。
共收治 525 例患者，62.53%接受了梅毒常规筛查。309 例患者（95.67%）筛查结果阴性；12 例患者（3.72%）梅毒血清学阳性。在 12 例筛查阳性的患者中，发现 1 例 NS（0.31%）。
我们观察到 NS 的患病率较低（0.31%），但这一结果出人意料地高于老年人群的预期。
