Shorer E F, Zauchenberger C Z, Govender S, Shorer G E, Geragotellis A A, Centner C M, Marais S
Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA.
Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa.
J Neurol Sci. 2023 Dec 15;455:122798. doi: 10.1016/j.jns.2023.122798. Epub 2023 Nov 14.
Syphilis and HIV coinfection is highly prevalent in South Africa, and both can cause neurological complications. We describe the clinical presentation and outcome of neurosyphilis in patients with and without HIV coinfection diagnosed at a tertiary facility, Groote Schuur Hospital (GSH), in South Africa.
We retrospectively analyzed folders of adults with positive cerebrospinal fluid (CSF) fluorescent treponemal antibody absorption test in 2018 and 2019, with follow-up data collected until 2022.
HIV-coinfection was identified in 35% of the 69 included patients. Patients with HIV-coinfection were more likely to be female (58% vs 25% female, p < 0.01), and present earlier (median age = 31 years vs. 40 years, p < 0.001). Neuropsychiatric manifestations (confusion, dementia, psychosis), and strokes were the commonest clinical presentations in both groups. Those with HIV-coinfection were significantly less likely to be diagnosed with neurosyphilis by the treating clinician (71% vs. 91%, p < 0.05), as were those with a negative CSF Venereal Disease Research Laboratory (74% vs. 94%, p < 0.05). Accurate diagnosis of neurosyphilis was associated with an increased 12-month survival (alive: N = 36 [63%]) relative to those who did not receive an accurate diagnosis (alive: N = 2 [17%], p < 0.05). Those who were optimally treated with antibiotics had significantly higher 12-month survival (alive: N = 33, 63%) compared to those with suboptimal treatment (alive: N = 5, 29%), p < 0.01.
Neurosyphilis presented similarly in those with and without HIV-coinfection. Accurate identification and optimal antibiotic treatment of neurosyphilis, particularly in CSF VDRL negative patients and those with HIV-coinfection, is necessary to improve patient survival.
梅毒和艾滋病毒合并感染在南非极为普遍，二者均可引发神经并发症。我们描述了在南非一家三级医疗机构——格罗特舒尔医院（GSH）诊断出的合并或未合并艾滋病毒感染的梅毒患者的临床表现及预后情况。
我们回顾性分析了2018年和2019年脑脊液（CSF）梅毒螺旋体荧光抗体吸收试验呈阳性的成年患者病历，并收集随访数据直至2022年。
69例纳入患者中，35%被确定合并艾滋病毒感染。合并艾滋病毒感染的患者更可能为女性（女性占比58% vs 25%，p < 0.01），且发病更早（中位年龄 = 31岁 vs 40岁，p < 0.001）。神经精神症状（意识模糊、痴呆、精神病）和中风是两组最常见的临床表现。合并艾滋病毒感染的患者被主治医生诊断为梅毒的可能性显著更低（71% vs 91%，p < 0.05），脑脊液性病研究实验室检查结果为阴性的患者也是如此（74% vs 94%，p < 0.05）。与未得到准确诊断的患者相比，梅毒的准确诊断与12个月生存率的提高相关（存活：N = 36 [63%]）（存活：N = 2 [17%]，p < 0.05）。与治疗不充分的患者相比，接受最佳抗生素治疗的患者12个月生存率显著更高（存活：N = 33，63%）（存活：N = 5，29%），p < 0.01。
合并或未合并艾滋病毒感染的患者中，梅毒的表现相似。准确识别并对梅毒进行最佳抗生素治疗，尤其是对脑脊液性病研究实验室检查结果为阴性的患者以及合并艾滋病毒感染的患者，对于提高患者生存率至关重要。
