在HIV感染个体中出现脑脊液性病研究实验室玻片试验（CSF-VDRL）假阴性的轻症神经梅毒？

Oligosymptomatic neurosyphilis with false negative CSF-VDRL in HIV-infected individuals?

作者信息

Malessa R, Agelink M W, Hengge U, Mertins L, Gastpar M, Brockmeyer N H

机构信息

Department of Neurology, University of Essen, Hufelandstr. 55, Essen D-45147, Germany.

出版信息

Eur J Med Res. 1996 Mar 19;1(6):299-302.

PMID:9367943

Abstract

The true prevalence of neurosyphilis in HIV-infection is unknown, since a sufficiently sensitive and specific test is lacking. In a prospective study we found reactive serum TPHA and FTA-ABS IgG tests in 95 (31%) of 307 HIV-infected patients. Three of 11 patients with latent syphilis revealed reactive CSF-VDRL tests, six others only demonstrated CSF abnormalities. Resolution of CSF abnormalities during a six month follow up after high dose antibiotic therapy led to the diagnosis of oligosymptomatic or asymptomatic neurosyphilis in all nine patients. Thus, the specificity of the CSF-VDRL was 100%, but the sensitivity was only 33%. The overall prevalence of neurosyphilis was 2.9%, increasing to 9.5% in patients with a reactive serum TPHA. Our study emphasizes the importance of antibiotic therapy for presumptive neurosyphilis in HIV-infected patients with latent syphilis and CSF abnormalities but nonreactive CSF-VDRL tests, even if they are neurologically asymptomatic or present with complaints inconclusive of neurosyphilis.

摘要

由于缺乏足够敏感和特异的检测方法，HIV感染中神经梅毒的真实患病率尚不清楚。在一项前瞻性研究中，我们在307例HIV感染患者中的95例（31%）发现血清梅毒螺旋体血凝试验（TPHA）和荧光螺旋体抗体吸收试验（FTA-ABS）IgG检测呈阳性。11例潜伏梅毒患者中有3例脑脊液性病研究实验室玻片试验（CSF-VDRL）呈阳性，另外6例仅显示脑脊液异常。在大剂量抗生素治疗后的6个月随访期间，脑脊液异常消失，这9例患者均被诊断为轻症或无症状神经梅毒。因此，CSF-VDRL的特异性为100%，但敏感性仅为33%。神经梅毒的总体患病率为2.9%，血清TPHA呈阳性的患者中升至9.5%。我们的研究强调了对潜伏梅毒且脑脊液异常但CSF-VDRL检测阴性的HIV感染患者进行推定神经梅毒抗生素治疗的重要性，即使他们没有神经症状或仅有不能确诊神经梅毒的主诉。