Katz D A, Berger J R, Duncan R C
Department of Neurology, University of Miami (Fla) School of Medicine 33151.
Arch Neurol. 1993 Mar;50(3):243-9. doi: 10.1001/archneur.1993.00540030009006.
The course of neurosyphilis has been reported to be altered by human immunodeficiency virus (HIV) infection. Prior reports of neurosyphilis occurring in association with HIV infection have been largely anecdotal and have failed to compare neurosyphilis in patients with HIV infection with an uninfected control group. This study was performed to determine if the clinical presentation encountered is different in the presence of HIV infection.
A retrospective, hospital-based, case series study based on chart review encompassing a 64-month period.
The study was performed in a large, university-affiliated, public health trust hospital in south Florida.
Forty-six hospitalized patients with neurosyphilis were identified; 13 patients fulfilled Centers for Disease Control and Prevention (Atlanta, Ga) criteria for acquired immunodeficiency syndrome (AIDS), 11 were HIV seropositive only, and 22 were HIV uninfected. Neurosyphilis was determined by a reactive cerebrospinal fluid VDRL slide test.
The HIV-infected patients (both AIDS and HIV-seropositive groups) were younger and more frequently had features of secondary syphilis, such as rash, fever, adenopathy, headache, or meningismus. Significant differences were observed in cerebrospinal fluid measurements when the HIV-infected group was compared with the HIV-uninfected group, including a higher mean white blood cell count in patients with AIDS and a higher mean protein level and a lower mean glucose level in the HIV-infected group. Syphilitic meningitis was more common in HIV-seropositive patients, although the HIV-uninfected patients presented with a greater variety of types of neurosyphilis. Ophthalmic syphilis was observed more frequently in the HIV-infected group.
Significant differences exist between neurosyphilis occurring in the presence and absence of HIV infection.
据报道，人类免疫缺陷病毒（HIV）感染会改变神经梅毒的病程。先前关于与HIV感染相关的神经梅毒的报道大多是轶事性的，且未能将HIV感染患者的神经梅毒与未感染的对照组进行比较。本研究旨在确定在存在HIV感染的情况下所遇到的临床表现是否有所不同。
一项基于图表回顾的回顾性、医院病例系列研究，涵盖64个月的时间段。
该研究在佛罗里达州南部一家大型的、大学附属的公共卫生信托医院进行。
确定了46例住院的神经梅毒患者；13例患者符合美国疾病控制与预防中心（佐治亚州亚特兰大）获得性免疫缺陷综合征（AIDS）的标准，11例仅HIV血清学呈阳性，22例未感染HIV。神经梅毒通过脑脊液VDRL玻片试验呈反应性来确定。
HIV感染患者（AIDS组和HIV血清学阳性组）更年轻，更频繁地出现二期梅毒的特征，如皮疹、发热、淋巴结病、头痛或颈项强直。将HIV感染组与未感染HIV组进行比较时，在脑脊液测量方面观察到显著差异，包括AIDS患者的平均白细胞计数较高，HIV感染组的平均蛋白水平较高且平均葡萄糖水平较低。梅毒脑膜炎在HIV血清学阳性患者中更常见，尽管未感染HIV的患者表现出更多种类的神经梅毒。眼科梅毒在HIV感染组中更频繁地被观察到。
存在HIV感染和不存在HIV感染时发生的神经梅毒之间存在显著差异。
