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The clinical and laboratory features of neurosyphilis in HIV-infected patients: A retrospective study in 92 patients

Neurosyphilis (NS) is an important component of central nervous system diseases among HIV-infected patients. However, its characteristics are not very clear. A retrospective analysis of clinical and laboratory findings was performed in 92 NS patients with HIV infection from a tertiary hospital in Sh...

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Autores principales: Wang, Zhenyan, Liu, Li, Shen, Yin-Zhong, Zhang, Ren-Fang, Qi, Tang-Kai, Tang, Yang, Song, Wei, Chen, Jun, Lu, Hongzhou
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5851754/
https://www.ncbi.nlm.nih.gov/pubmed/29489672
http://dx.doi.org/10.1097/MD.0000000000010078
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author Wang, Zhenyan
Liu, Li
Shen, Yin-Zhong
Zhang, Ren-Fang
Qi, Tang-Kai
Tang, Yang
Song, Wei
Chen, Jun
Lu, Hongzhou
author_facet Wang, Zhenyan
Liu, Li
Shen, Yin-Zhong
Zhang, Ren-Fang
Qi, Tang-Kai
Tang, Yang
Song, Wei
Chen, Jun
Lu, Hongzhou
author_sort Wang, Zhenyan
collection PubMed
description Neurosyphilis (NS) is an important component of central nervous system diseases among HIV-infected patients. However, its characteristics are not very clear. A retrospective analysis of clinical and laboratory findings was performed in 92 NS patients with HIV infection from a tertiary hospital in Shanghai, China. The patients had a median age of 38 years and a median CD4 count of 198 cells/μL. In all, 44.6% (41/92) were diagnosed as asymptomatic NS (ANS), 23.9% (22/92) as syphilitic meningitis, 17.4% (16/92) as cerebrovascular NS, and 14.1% (13/92) as parenchymal syphilis. A quarter of patients (23/92) complicated with ocular syphilis (OS), 60.9% (14/23) of which were ANS. The serum tolulized red unheated serum test (TRUST) titers were ≤1:8 in 15 patients (16.3%), 1:16–1:128 in 51 patients (55.4%), and ≥1:256 in 26 patients (28.3%). Sixty-nine patients (75.0%) had both cerebrospinal fluid (CSF) TRUST and Treponema pallidum particle assay reactive. CSF pleocytosis and protein elevation were found in 58.7% and 53.3% of patients, respectively. Syphilitic meningitis was more likely to present with CSF pleocytosis than ANS (P = .001), cerebrovascular NS (P < .001), and parenchymal NS (P < .001). The proportion of patients with CSF elevated protein was lower in ANS group than that in syphilitic meningitis (P = .003), cerebrovascular NS (P = .001), and parenchymal NS groups (P = .025), and was higher in sero-TRUST titers ≤1:8 group than that in 1:16–1:128 (P = .01) and 1:256–1:1024 groups (P = .005). This study revealed that ANS was the most common clinical type of NS in HIV-infected patients, which should be considered in HIV and syphilis co-infection patients without neurologic symptoms, especially in those with OS. Different patterns of NS might have different CSF features which may also vary with sero-TRUST titers.
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spelling pubmed-58517542018-03-21 The clinical and laboratory features of neurosyphilis in HIV-infected patients: A retrospective study in 92 patients Wang, Zhenyan Liu, Li Shen, Yin-Zhong Zhang, Ren-Fang Qi, Tang-Kai Tang, Yang Song, Wei Chen, Jun Lu, Hongzhou Medicine (Baltimore) 4850 Neurosyphilis (NS) is an important component of central nervous system diseases among HIV-infected patients. However, its characteristics are not very clear. A retrospective analysis of clinical and laboratory findings was performed in 92 NS patients with HIV infection from a tertiary hospital in Shanghai, China. The patients had a median age of 38 years and a median CD4 count of 198 cells/μL. In all, 44.6% (41/92) were diagnosed as asymptomatic NS (ANS), 23.9% (22/92) as syphilitic meningitis, 17.4% (16/92) as cerebrovascular NS, and 14.1% (13/92) as parenchymal syphilis. A quarter of patients (23/92) complicated with ocular syphilis (OS), 60.9% (14/23) of which were ANS. The serum tolulized red unheated serum test (TRUST) titers were ≤1:8 in 15 patients (16.3%), 1:16–1:128 in 51 patients (55.4%), and ≥1:256 in 26 patients (28.3%). Sixty-nine patients (75.0%) had both cerebrospinal fluid (CSF) TRUST and Treponema pallidum particle assay reactive. CSF pleocytosis and protein elevation were found in 58.7% and 53.3% of patients, respectively. Syphilitic meningitis was more likely to present with CSF pleocytosis than ANS (P = .001), cerebrovascular NS (P < .001), and parenchymal NS (P < .001). The proportion of patients with CSF elevated protein was lower in ANS group than that in syphilitic meningitis (P = .003), cerebrovascular NS (P = .001), and parenchymal NS groups (P = .025), and was higher in sero-TRUST titers ≤1:8 group than that in 1:16–1:128 (P = .01) and 1:256–1:1024 groups (P = .005). This study revealed that ANS was the most common clinical type of NS in HIV-infected patients, which should be considered in HIV and syphilis co-infection patients without neurologic symptoms, especially in those with OS. Different patterns of NS might have different CSF features which may also vary with sero-TRUST titers. Wolters Kluwer Health 2018-03-02 /pmc/articles/PMC5851754/ /pubmed/29489672 http://dx.doi.org/10.1097/MD.0000000000010078 Text en Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0
spellingShingle 4850
Wang, Zhenyan
Liu, Li
Shen, Yin-Zhong
Zhang, Ren-Fang
Qi, Tang-Kai
Tang, Yang
Song, Wei
Chen, Jun
Lu, Hongzhou
The clinical and laboratory features of neurosyphilis in HIV-infected patients: A retrospective study in 92 patients
title The clinical and laboratory features of neurosyphilis in HIV-infected patients: A retrospective study in 92 patients
title_full The clinical and laboratory features of neurosyphilis in HIV-infected patients: A retrospective study in 92 patients
title_fullStr The clinical and laboratory features of neurosyphilis in HIV-infected patients: A retrospective study in 92 patients
title_full_unstemmed The clinical and laboratory features of neurosyphilis in HIV-infected patients: A retrospective study in 92 patients
title_short The clinical and laboratory features of neurosyphilis in HIV-infected patients: A retrospective study in 92 patients
title_sort clinical and laboratory features of neurosyphilis in hiv-infected patients: a retrospective study in 92 patients
topic 4850
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5851754/
https://www.ncbi.nlm.nih.gov/pubmed/29489672
http://dx.doi.org/10.1097/MD.0000000000010078
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