CHU Charles Nicolle, Service des Maladies infectieuses et Tropicales, 1, rue de Germont, 76000 Rouen, France.
CHU Charles Nicolle, Service d'ophtalmologie, 1, rue de Germont, 76000 Rouen, France.
Infect Dis Now. 2021 Jun;51(4):351-356. doi: 10.1016/j.medmal.2020.10.016. Epub 2020 Oct 22.
Since the 2000s, there has been an increase in prevalence of neurosyphilis (NS) and ocular syphilis (OS). As data about symptomatic NS/OS is limited, this study aims to assess the characteristics of symptomatic NS/OS, according to HIV status.
We compared the clinical and biological presentation of early symptomatic NS/OS and its outcome in HIV-positive and HIV-negative patients.
Ninety-six patients (93% men, 49% HIV-positive) were included from 2000 to 2016 in two centers, with 67 (69%) having OS, 15 (16%) NS, and 14 (14%) both. HIV-positive patients were younger (P=0.006) and more likely to be males having sex with males (P=0.00048) or to have a history of syphilis (P=0.01). Among 81 OS, there were 43 posterior uveitis (57%), and bilateral involvement was more common in HIV-positive patients (62% versus 38%, P=0.045). Among 29 NS there were 21 cases of cranial nerve involvement (72%), seven meningitis (24%) and 11 paresthesia (38%). Involvement of the VIII cranial nerve was the most common (16 cases). Treponemal tests were more commonly found positive in cerebrospinal fluid in HIV-positive patients (88% versus 76%, P=0.04). Visual acuity (VA) always improved after treatment (initial VA logMAR 0.8±0.8 versus 0.1±0.1 at 3 months), but 32% and 18% of the patients still had neurological or ocular impairment respectively six and 12 months after treatment. Non-treponemal serological reversion was observed in 43/50 patients (88%) at six months.
HIV infection has no consequence on the outcome of NS and OS. Sequelae are common, emphasizing the importance of prevention, and screening, and questioning enhanced treatment.
自 21 世纪初以来，神经梅毒（NS）和眼部梅毒（OS）的发病率有所增加。由于有关症状性 NS/OS 的数据有限，本研究旨在根据 HIV 状况评估症状性 NS/OS 的特征。
我们比较了来自两个中心的 2000 年至 2016 年期间的 96 例（93%为男性，49%为 HIV 阳性）早期症状性 NS/OS 患者的临床和生物学表现及其结局。
96 例患者中，67 例（69%）为 OS，15 例（16%）为 NS，14 例（14%）为 NS 和 OS 均有。HIV 阳性患者更年轻（P=0.006），更有可能为男男性行为者（P=0.00048）或有梅毒史（P=0.01）。在 81 例 OS 中，有 43 例为后葡萄膜炎（57%），HIV 阳性患者更常见双侧受累（62%对 38%，P=0.045）。在 29 例 NS 中，有 21 例颅神经受累（72%），7 例脑膜炎（24%）和 11 例感觉异常（38%）。第 VIII 颅神经受累最常见（16 例）。在 HIV 阳性患者中，脑脊液中的梅毒螺旋体检查更常为阳性（88%对 76%，P=0.04）。治疗后视力（VA）始终改善（初始 VA logMAR 0.8±0.8 与 3 个月时的 0.1±0.1），但治疗后 6 个月和 12 个月时，仍分别有 32%和 18%的患者存在神经或眼部损害。6 个月时，50 例患者中有 43 例（88%）非梅毒螺旋体血清学反应恢复。
HIV 感染对 NS 和 OS 的结局无影响。后遗症常见，强调预防、筛查和强化治疗的重要性。
