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Fuertes de Vega L, de la Torre García JM, Suarez Farfante JM, Ceballos Rodríguez MC. [Translated article] AEDV Expert Consensus for the Management of Syphilis. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T896-T905. [PMID: 39111574 DOI: 10.1016/j.ad.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/28/2024] [Accepted: 03/16/2024] [Indexed: 09/01/2024] Open
Abstract
Syphilis -the "great simulator" for classical venereologists-is re-emerging in Western countries despite adequate treatment; several contributing factors have been identified, including changes in sexual behaviour, which won't be the topic of this article though. In 2021, a total of 6613 new cases of syphilis were reported in Spain, representing an incidence of 13.9×100 000 inhabitants (90.5%, men). Rates have increased progressively since 2000. The clinical presentation of syphilis is heterogeneous. Although chancroid, syphilitic roseola and syphilitic nails are typical lesions, other forms of the disease can be present such as non-ulcerative primary lesions like Follmann balanitis, chancres in the oral cavity, patchy secondary lingual lesions, or enanthema on the palate and uvula, among many others. Regarding diagnosis, molecular assays such as PCR have been replacing dark-field microscopy in ulcerative lesions while automated treponemal tests (EIA, CLIA) are being used in serological tests, along with classical tests (such as RPR and HAART) for confirmation and follow-up purposes. The interpretation of these tests should be assessed in the epidemiological and clinical context of the patient. HIV serology and STI screening should be requested for anyone with syphilis. Follow-up of patients under treatment is important to ensure healing and detect reinfection. Serological response to treatment should be assessed with the same non-treponemal test (RPR/VDRL); 3-, 6-, 12-, and 24-month follow-up is a common practice in people living with HIV (PLHIV). Sexual contacts should be assessed and treated as appropriate. Screening is advised for pregnant women within the first trimester of pregnancy. Pregnant women with an abortion after week 20 should all be tested for syphilis. The treatment of choice for all forms of syphilis, including pregnant women and PLHIV, is penicillin. Macrolides are ill-advised because of potential resistance.
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Affiliation(s)
- L Fuertes de Vega
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, España; Grupo investigación en ITS y VIH de la AEDV.
| | - J M de la Torre García
- Grupo investigación en ITS y VIH de la AEDV; Centro Diagnóstico y Prevención Enfermedades de Trasmisión Sexual, Servicio Dermatología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - J M Suarez Farfante
- Grupo investigación en ITS y VIH de la AEDV; Antigua Unidad ITS Campo Gibraltar, Algeciras, Cádiz, España
| | - M C Ceballos Rodríguez
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, España; Grupo investigación en ITS y VIH de la AEDV
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Ke W, Ao C, Wang L, Zhang X, Shui J, Zhao J, Huang L, Leng X, Zhu R, Wang H, Weng W, Zheng L, Ligang Yang, Tang S. Refining a non-invasive prediction model for neurosyphilis diagnosis by using immunoassay to detect serum anti-TP0435 (TP17) and TP0574 (TP47) IgG antibodies: two-centre cross-sectional retrospective study in China. Clin Microbiol Infect 2024; 30:1298-1304. [PMID: 38909686 DOI: 10.1016/j.cmi.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 06/12/2024] [Accepted: 06/16/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVES Invasive lumbar puncture is the conventional method for diagnosing neurosyphilis (NS). We investigated a non-invasive alternative method to detect serum Treponema pallidum-specific antibodies against highly immunogenic antigens TP0171 (TP15), TP0435 (TP17), and TP0574 (TP47) by using luciferase immunosorbent assay. METHODS A total of 816 HIV-negative patients suspected of NS from the Beijing and Guangzhou cohorts were retrospectively selected and tested for serum anti-TP15, TP17, and TP47 IgG antibodies. Two diagnostic prediction models were developed using stepwise logistic regression in the Beijing cohort, and evaluated in the Guangzhou cohort for external validation. RESULTS Serum antibodies against TP15, TP17, and TP47 showed moderate capability for NS diagnosis in the Beijing cohort and the corresponding area under the receiver operating characteristic curves (AUCs) were 0.722 [95% confidence interval (CI): 0.680-0.762)], 0.780 (95% CI: 0.741-0.817), and 0.774 (95% CI: 0.734-0.811), respectively. An expanded NS prediction model integrated with anti-TP17 and anti-TP47 antibodies showed better performance than the base NS diagnostic model without anti-TP17 and anti-TP47 antibodies with the AUC of 0.874 (95% CI: 0.841-0.906) vs. 0.845 (95% CI: 0.809-0.881) (p = 0.007) in the development cohort, and 0.934 (95% CI: 0.909-0.960) vs. 0.877 (95% CI: 0.840-0.914) (p < 0.001) in validation cohort, respectively. Decision curve analysis revealed that the net benefit of the expanded model exceeded that of the base model when the threshold probability was between 0.10 and 0.95 in both the development and external validation cohorts. DISCUSSION Serum antibodies against TP17 and TP47 exhibited promising diagnostic capability for NS and significantly enhanced the predictive accuracy of model for NS diagnosis. Our study highlights the potential of serum treponemal antibody detection as a non-invasive method for NS diagnosis to substitute invasive lumbar puncture in NS diagnosis.
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Affiliation(s)
- Wujian Ke
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China; Guangzhou Key Laboratory for Sexually Transmitted Diseases Control, Guangzhou, Guangdong, China
| | - Cailing Ao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China; Guangzhou Baiyun District Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Liuyuan Wang
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaohui Zhang
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Jingwei Shui
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Jianhui Zhao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Liping Huang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Xinying Leng
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Rui Zhu
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Haiying Wang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Wenjia Weng
- Department of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Lianhong Zheng
- Department of Neurology, Affiliated Hospital of Hebei University of Engineering, Handan, Hebei, China
| | - Ligang Yang
- Department of Sexually Transmitted Diseases, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Shixing Tang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China.
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Fuertes de Vega L, de la Torre García JM, Suarez Farfante JM, Ceballos Rodríguez MC. AEDV Expert Consensus for the Management of Syphilis. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:896-905. [PMID: 38663730 DOI: 10.1016/j.ad.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/28/2024] [Accepted: 03/16/2024] [Indexed: 05/26/2024] Open
Abstract
Syphilis -the "great simulator" for classical venereologists-is re-emerging in Western countries despite adequate treatment; several contributing factors have been identified, including changes in sexual behaviour, which won't be the topic of this article though. In 2021, a total of 6613 new cases of syphilis were reported in Spain, representing an incidence of 13.9×100 000 inhabitants (90.5%, men). Rates have increased progressively since 2000. The clinical presentation of syphilis is heterogeneous. Although chancroid, syphilitic roseola and syphilitic nails are typical lesions, other forms of the disease can be present such as non-ulcerative primary lesions like Follmann balanitis, chancres in the oral cavity, patchy secondary lingual lesions, or enanthema on the palate and uvula, among many others. Regarding diagnosis, molecular assays such as PCR have been replacing dark-field microscopy in ulcerative lesions while automated treponemal tests (EIA, CLIA) are being used in serological tests, along with classical tests (such as RPR and HAART) for confirmation and follow-up purposes. The interpretation of these tests should be assessed in the epidemiological and clinical context of the patient. HIV serology and STI screening should be requested for anyone with syphilis. Follow-up of patients under treatment is important to ensure healing and detect reinfection. Serological response to treatment should be assessed with the same non-treponemal test (RPR/VDRL); 3-, 6-, 12-, and 24-month follow-up is a common practice in people living with HIV (PLHIV). Sexual contacts should be assessed and treated as appropriate. Screening is advised for pregnant women within the first trimester of pregnancy. Pregnant women with an abortion after week 20 should all be tested for syphilis. The treatment of choice for all forms of syphilis, including pregnant women and PLHIV, is penicillin. Macrolides are ill-advised because of potential resistance.
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Affiliation(s)
- L Fuertes de Vega
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, España; Grupo investigación en ITS y VIH de la AEDV.
| | - J M de la Torre García
- Grupo investigación en ITS y VIH de la AEDV; Centro Diagnóstico y Prevención Enfermedades de Trasmisión Sexual, Servicio Dermatología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - J M Suarez Farfante
- Grupo investigación en ITS y VIH de la AEDV; Antigua Unidad ITS Campo Gibraltar, Algeciras, Cádiz, España
| | - M C Ceballos Rodríguez
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, España; Grupo investigación en ITS y VIH de la AEDV
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Li HY, Wang HY, Duan YF, Gou Y, Liu XQ, Gao ZX. Neurosyphilis Presenting as Psychiatric Symptoms at Younger Age: A Case Report. Int Med Case Rep J 2024; 17:647-650. [PMID: 38974881 PMCID: PMC11227323 DOI: 10.2147/imcrj.s477459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 06/23/2024] [Indexed: 07/09/2024] Open
Abstract
Neurosyphilis is a central nervous system infection caused by Treponema pallidum that imitates various neurological and mental disorders. Therefore, patients with this disease are prone to misdiagnoses. Here, we report a case of neurosyphilis with a psychotic disorder as the main manifestation. A young girl exhibited mental and behavioural abnormalities after a heartbreak, which manifested as alternating low mood, emotional irritability, and a lack of interest in social relations, followed by memory loss. The cerebrospinal fluid protein - Treponema pallidum particle agglutination test was positive, the toluidine red unheated serum test titre was 1:4, the white blood cell count was 5 × 10^6/L, the cerebrospinal fluid protein level was 0.97 g/L, and the brain CT was abnormal. After admission, the possibility of neurosyphilis was considered and the patient received intravenous penicillin G treatment. The patient's clinical symptom ms improved. This case emphasises that doctors should maintain clinical suspicion of Treponema pallidum infection in adolescent patients with mental abnormalities.
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Affiliation(s)
- Hong-Yan Li
- West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People’s Republic of China
| | - Hao-Yu Wang
- Department of Radiology, The First People’s Hospital of Liangshan Yi Autonomous Prefecture, Xichang, Sichuan, People’s Republic of China
| | - Yi-Fei Duan
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People’s Republic of China
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yu Gou
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People’s Republic of China
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Xiao-Qin Liu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People’s Republic of China
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Zheng-Xiang Gao
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People’s Republic of China
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
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Yang Y, Gu X, Zhu L, Cheng Y, Lu H, Guan Z, Shi M, Ni L, Peng RR, Zhao W, Wu J, Qi T, Long F, Chai Z, Gong W, Ye M, Zhou P. Clinical spectrum of late symptomatic neurosyphilis in China: an 11-year retrospective study. Sex Transm Infect 2024:sextrans-2024-056117. [PMID: 38902025 DOI: 10.1136/sextrans-2024-056117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/26/2024] [Indexed: 06/22/2024] Open
Abstract
OBJECTIVES This study aimed to describe the clinical features of neurosyphilis in Chinese patients in an attempt to find clinical features that are helpful for the early identification of neurosyphilis. METHODS This retrospective study included people with syphilis who visited Shanghai Skin Disease Hospital between January 2010 and December 2020. Lumbar puncture was performed on those who met the inclusion and exclusion criteria. The diagnosis of neurosyphilis was based on clinical and laboratory findings. The parameters were analysed statistically. RESULTS Of the 3524 patients with neurosyphilis, 2111 (59.9%) and 1413 (40.1%) were asymptomatic and symptomatic neurosyphilis, respectively. General paresis was the most common type of symptomatic neurosyphilis (46.8%). The clinical manifestations of symptomatic neurosyphilis include psychiatric and neurotic symptoms, among which general paresis predominantly presented as psychiatric symptoms such as affective (66.7%) and memory disorder (72.9%). Tabes dorsalis is often presented as neurotic symptoms. One hundred fifty patients (10.6%) with symptomatic neurosyphilis presented candy signs, a rare and specific neurosyphilis symptom that is common in general paresis. Girdle sensation was presented in 13 patients, mainly with tabes dorsalis, which had not been reported in previous studies. CONCLUSIONS Notably, the candy sign is identified as a specific symptom of general paresis, while girdle sensations are highlighted as a particular symptom of tabes dorsalis. This is the largest study describing the clinical spectrum of neurosyphilis since the onset of the penicillin era and could help doctors learn more about the disease. A comprehensive description of the possible clinical manifestations of late symptomatic neurosyphilis, particularly highlighting rare symptoms, can identify suspicious patients and prevent diagnostic delays.
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Affiliation(s)
- Yilan Yang
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Xin Gu
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Lin Zhu
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Yuanyuan Cheng
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Haikong Lu
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Zhifang Guan
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Mei Shi
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Liyan Ni
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Rui-Rui Peng
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Wei Zhao
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Juan Wu
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Tengfei Qi
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Fuquan Long
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Zhe Chai
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Weiming Gong
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Meiping Ye
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
| | - Pingyu Zhou
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital,School of Medicine, Tongji University, Shanghai,200443, China
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Cheng Y, Qi T, Gu X. A Case of Perianal Annular Rash: Atypical Presentation of Recurrent Secondary Syphilis. Infect Drug Resist 2024; 17:2463-2466. [PMID: 38912217 PMCID: PMC11194011 DOI: 10.2147/idr.s470153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 06/14/2024] [Indexed: 06/25/2024] Open
Abstract
Syphilis is a complex, systemic infectious disease caused by Treponema pallidum subspecies pallidum. Secondary syphilitic lesions typically manifest within 3 months following initial exposure to T. pallidum. The predominant cutaneous manifestations of secondary syphilis are macula and papule. Certain individuals with syphilis may present with an atypical rash during the secondary stage owing to immunosuppression and other factors. Herein, we report a rare case of atypical recurrent secondary syphilis around the anus in a 65-year-old woman. Based on cerebrospinal fluid findings and skin biopsy results, the patient was ultimately diagnosed as neurosyphilis and recurrent secondary syphilis. Following intravenous antibiotic therapy, the patient's rash improved significantly. This case underscores the importance for physicians to remain vigilant regarding the possibility of syphilis when encountering cases exhibiting unusual clinical manifestations, as a definitive diagnosis necessitates a comprehensive evaluation.
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Affiliation(s)
- Yuanyuan Cheng
- Department of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Tengfei Qi
- Department of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Xin Gu
- Department of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
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Peng RR, Wu J, Zhao W, Zhu L, Guan Z, Gu X, Shi M, Yu J, Cheng Y, Zhou P. An observational prospective study based on a large cohort of HIV-negative neurosyphilis patients with particular reference to the Jarisch-Herxheimer reaction. Eur J Clin Microbiol Infect Dis 2024; 43:1073-1080. [PMID: 38557924 PMCID: PMC11178573 DOI: 10.1007/s10096-024-04810-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE The purpose of this study is to outline a complete picture of Jarisch-Herxheimer reaction (JHR) in the central nervous system among HIV-negative neurosyphilis patients. METHODS A prospective study cohort of 772 cases with almost all stages of neurosyphilis depicted the features of JHR including occurrence rate, risk profiles, clinical manifestations, medical management and prognosis. RESULTS The total occurrence rate of JHR was 9.3% (95% CI, 7.3-11.4%), including 4.1% (95% CI, 2.7-5.6%) with severe JHR. The reaction started 5 h after treatment initiation, peaked after 8 h, and subsided after 18 h. Patients with severe JHR experienced a longer recovery time (26 h). Patients with general paresis (OR = 6.825), ocular syphilis (OR = 3.974), pleocytosis (OR = 2.426), or a high CSF-VDRL titre (per log2 titre increase, OR = 2.235) were more likely to experience JHR. Patients with general paresis had an 11.759-fold increased risk of severe JHR. Worsening symptoms included cognitive impairment, mania, nonsense speech, and dysphoria, while symptoms of hallucination, urination disorder, seizures, myoclonus, or aphasia appeared as new-onset symptoms. Neurosyphilis treatment did not need to be interrupted in most patients with JHR and could be reinstated in patients with seizures under supportive medication when JHR subsided. CONCLUSION Severe JHR displayed a 4.1% occurrence rate and clinicians should pay particular attention to patients at a higher risk of JHR. The neurosyphilis treatment regime can be restarted under intensive observation for patients with severe JHR and, if necessary, supportive medication should be initiated and continued until the end of therapy.
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Affiliation(s)
- Rui-Rui Peng
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Shanghai, 200443, China
| | - Juan Wu
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Shanghai, 200443, China
| | - Wei Zhao
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Shanghai, 200443, China
| | - Lin Zhu
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Shanghai, 200443, China
| | - Zhifang Guan
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Shanghai, 200443, China
| | - Xin Gu
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Shanghai, 200443, China
| | - Mei Shi
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Shanghai, 200443, China
| | - Junjun Yu
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Shanghai, 200443, China
| | - Yanchun Cheng
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Shanghai, 200443, China
| | - Pingyu Zhou
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Shanghai, 200443, China.
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Tang Y, Shen L, Yang D, Zhang J, Xie Q, Sun F, Luo Q. Neutrophil CD64 index as a potential blood biomarker for the diagnosis of neurosyphilis in secondary and tertiary syphilis: A retrospective study. Heliyon 2024; 10:e29027. [PMID: 38596103 PMCID: PMC11002674 DOI: 10.1016/j.heliyon.2024.e29027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/11/2024] Open
Abstract
Objective To examine the correlation of neutrophil CD64 (nCD64) index with neurosyphilis (NS) across different stages of syphilis. Methods A total of 1243 syphilis patients at different stages (344 of primary, 385 of secondary, and 514 of tertiary) included in this study were divided into NS and non-NS (NNS). Correlations of nCD64 index with currently used syphilis biomarkers were explored using Spearman correlation test. Relationships between nCD64 index and NS at different stages were investigated by stratified analysis and restricted cubic spline model. The diagnostic performance of nCD64 index for NS was assessed by receiver operating characteristic (ROC) curve. Results Significant statistical correlations of nCD64 index with cerebrospinal fluid (CSF) NS indicators were found in secondary and tertiary syphilis. Increased nCD64 index was associated with increased risk of NS in secondary and tertiary syphilis. ROC analysis values further confirmed the diagnostic potential of nCD64 index for NS. Marked decrease of nCD64 index was observed in NS patients after effective antisyphilitic treatments. Conclusions The nCD64 index may help to the diagnosis of NS in secondary and tertiary syphilis.
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Affiliation(s)
- Yijie Tang
- Department of Clinical Laboratory Medicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lingyun Shen
- Department of Clinical Laboratory Medicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Dandan Yang
- Department of Clinical Laboratory Medicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jiaqin Zhang
- Department of Clinical Laboratory Medicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qinghui Xie
- Department of Clinical Laboratory Medicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fenyong Sun
- Department of Clinical Laboratory Medicine, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qingqiong Luo
- Department of Clinical Laboratory Medicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
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Li W, Sun J, Wang T, Liu Y, Zhou W, Man X. Clinical and laboratory features of neurosyphilis: A single-center, retrospective study of 402 patients. Heliyon 2024; 10:e28011. [PMID: 38524602 PMCID: PMC10958422 DOI: 10.1016/j.heliyon.2024.e28011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 03/26/2024] Open
Abstract
Neurosyphilis is a serious global health issue and a big challenge in developing countries, related risk factors should be taken seriously. Although there are a certain number of studies describing the clinical and laboratory features and risk factors for symptomatic neurosyphilis (SNS), but some risk factors are still controversial. The aim of this research is to investigate the association between asymptomatic neurosyphilis (ANS) and symptomatic neurosyphilis (SNS) and identify risk factors for SNS. This was a single-center retrospective study in a tertiary hospital in Hangzhou, China. The clinical and laboratory features of neurosyphilis patients from January 1, 2011 to July 31, 2020 were retrospectively reviewed. After detailed assessments based on diagnostic criteria, 402 patients with neurosyphilis were enrolled in this study. There were 299 male and 103 female patients. The median age was 53.5 (45, 61) years. Multivariable logistic regression displayed that SNS were correlated with the following factors: male, without anti-syphilis treatment, high pretreatment serum RPR titer and positive CSF RPR. Our findings suggest a potential association between SNS and specific factors, including male gender, elevated pretreatment serum and CSF RPR titers. Moreover, our observations indicate that individuals without anti-syphilis treatment may be at a higher likelihood of manifesting the symptomatic form. This underscores the importance of considering gender, RPR titers, and treatment status as significant contributors to the risk profile for SNS.
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Affiliation(s)
- Wei Li
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Jinfang Sun
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, 210009, China
| | - Tingting Wang
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Yiyuan Liu
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Weifang Zhou
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Xiaoyong Man
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
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Yang Y, Gu X, Zhu L, Cheng Y, Lu H, Guan Z, Shi M, Ni L, Peng R, Zhao W, Wu J, Qi T, Long F, Chai Z, Gong W, Ye M, Zhou P. Clinical parameter-based prediction model for neurosyphilis risk stratification. Epidemiol Infect 2024; 152:e21. [PMID: 38224151 PMCID: PMC10894895 DOI: 10.1017/s0950268824000074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 01/16/2024] Open
Abstract
Accurately predicting neurosyphilis prior to a lumbar puncture (LP) is critical for the prompt management of neurosyphilis. However, a valid and reliable model for this purpose is still lacking. This study aimed to develop a nomogram for the accurate identification of neurosyphilis in patients with syphilis. The training cohort included 9,504 syphilis patients who underwent initial neurosyphilis evaluation between 2009 and 2020, while the validation cohort comprised 526 patients whose data were prospectively collected from January 2021 to September 2021. Neurosyphilis was observed in 35.8% (3,400/9,504) of the training cohort and 37.6% (198/526) of the validation cohort. The nomogram incorporated factors such as age, male gender, neurological and psychiatric symptoms, serum RPR, a mucous plaque of the larynx and nose, a history of other STD infections, and co-diabetes. The model exhibited good performance with concordance indexes of 0.84 (95% CI, 0.83-0.85) and 0.82 (95% CI, 0.78-0.86) in the training and validation cohorts, respectively, along with well-fitted calibration curves. This study developed a precise nomogram to predict neurosyphilis risk in syphilis patients, with potential implications for early detection prior to an LP.
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Affiliation(s)
- Yilan Yang
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xin Gu
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lin Zhu
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yuanyuan Cheng
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Haikong Lu
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhifang Guan
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Mei Shi
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Liyan Ni
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ruirui Peng
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wei Zhao
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Juan Wu
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Tengfei Qi
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fuquan Long
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhe Chai
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Weiming Gong
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Meiping Ye
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Pingyu Zhou
- Institute of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
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11
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Wu S, Ye F, Wang Y, Li D. Neurosyphilis: insights into its pathogenesis, susceptibility, diagnosis, treatment, and prevention. Front Neurol 2024; 14:1340321. [PMID: 38274871 PMCID: PMC10808744 DOI: 10.3389/fneur.2023.1340321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/27/2023] [Indexed: 01/27/2024] Open
Abstract
Background and aim Invasion of the central nervous system by Treponema pallidum can occur at any stage of syphilis. In the event that T. pallidum is not cleared promptly, certain individuals may experience progression to neurosyphilis, which manifests as cognitive and behavioral abnormalities, limb paralysis, and potentially fatal outcomes. Early identification or prevention of neurosyphilis is therefore crucial. The aim of this paper is to conduct a critical and narrative review of the latest information focusing exclusively to the pathogenesis and clinical management of neurosyphilis. Methodology To compile this review, we have conducted electronic literature searches from the PubMed database relating to neurosyphilis. Priority was given to studies published from the past 10 years (from 2013 to 2023) and other studies if they were of significant importance (from 1985 to 2012), including whole genome sequencing results, cell structure of T. pallidum, history of genotyping, and other related topics. These studies are classic or reflect a developmental process. Results Neurosyphilis has garnered global attention, yet susceptibility to and the pathogenesis of this condition remain under investigation. Cerebrospinal fluid examination plays an important role in the diagnosis of neurosyphilis, but lacks the gold standard. Intravenous aqueous crystalline penicillin G continues to be the recommended therapeutic approach for neurosyphilis. Considering its sustained prominence, it is imperative to develop novel public health tactics in order to manage the resurgence of neurosyphilis. Conclusion This review gives an updated narrative description of neurosyphilis with special emphasis on its pathogenesis, susceptibility, diagnosis, treatment, and prevention.
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Affiliation(s)
| | | | | | - Dongdong Li
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
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12
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Fu Y, Yang L, Du J, Khan R, Liu D. Establishment of HIV-negative neurosyphilis risk score model based on logistic regression. Eur J Med Res 2023; 28:200. [PMID: 37381052 DOI: 10.1186/s40001-023-01177-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 06/20/2023] [Indexed: 06/30/2023] Open
Abstract
OBJECTIVE To establish the risk scoring model for HIV-negative neurosyphilis (NS) patients and to optimize the lumbar puncture strategy. METHODS From 2016 to 2021, clinical information on 319 syphilis patients was gathered. Multivariate logistic regression was used to examine the independent risk factors in NS patients who tested negative for human immunodeficiency virus (HIV). Receiver operating characteristic curves (ROC) were used to assess the risk scoring model's capacity for identification. According to scoring model, the timing of lumbar puncture was suggested. RESULTS There were statistically significant differences between HIV-negative NS and non-neurosyphilis (NNS) patients in the following factors. These included age, gender, neuropsychiatric symptoms (including visual abnormalities, hearing abnormalities, memory abnormalities, mental abnormalities, paresthesia, seizures, headache, dizziness), serum toluidine red unheated serum test (TRUST), cerebrospinal fluid Treponema pallidum particle agglutination test (CSF-TPPA), cerebrospinal fluid white blood cell count (CSF-WBC), and cerebrospinal fluid protein quantification (CSF-Pro) (P < 0.05). Logistic regression analysis of HIV-negative NS patients risk factors showed that age, gender, and serum TRUST were independent risk factors for HIV-negative NS (P = 0.000). The total risk score (- 1 ~ 11 points) was obtained by adding the weight scores of each risk factor. And the predicted probability of NS in HIV-negative syphilis patients (1.6 ~ 86.6%) was calculated under the corresponding rating. ROC calculation results showed that the score had good discrimination value for HIV-negative NS and NNS: area under the curve (AUC) was 0.80, the standard error was 0.026 and 95% CI was 74.9-85.1% (P = 0.000). CONCLUSION The risk scoring model in this study can classify the risk of neurosyphilis in syphilis patients, optimize the lumbar puncture strategy to a certain extent, and provide ideas for the clinical diagnosis and treatment of HIV-negative neurosyphilis.
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Affiliation(s)
- Yu Fu
- Department of Dermatology and Venereology, First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, China
| | - Ling Yang
- Department of Dermatology and Venereology, First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, China
| | - Jie Du
- Department of Biostatistics, School of Public Health, Guangxi Medical University, Nanning, China
| | - Raqib Khan
- Department of Dermatology and Venereology, First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, China
| | - Donghua Liu
- Department of Dermatology and Venereology, First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, China.
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13
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Codreanu Balaban RA, Axelerad A, Musat D, Cioabla AC, Stuparu AZ, Axelerad SD, Muja LF. Three cases of neurosyphilis diagnosed in the 21st century: A case report. Exp Ther Med 2023; 25:201. [PMID: 37090068 PMCID: PMC10119846 DOI: 10.3892/etm.2023.11900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/20/2023] [Indexed: 04/25/2023] Open
Abstract
In the last decades, it has been considered that syphilis and its complications, including neurological damage, are able to be kept under control with proper epidemiological management. However, socio-economic changes and the problem of antibiotic resistance have brought it back into the focus of clinicians. The present study reports on the cases of three male patients of different ages (28, 76 and 51 years) from different social backgrounds and occupations were provided (first patient, nurse; second patient, pensioner; third patient, navigator); they were confirmed to have neurosyphilis, clinically, paraclinically and by imaging. The complications that may occur in the evolution of the disease but also the beneficial effects of targeted, antisyphilitic and symptomatic therapy were outlined. The purpose of the present study was to highlight issues of major importance regarding neurosyphilis, particularly for neurologists, for whom diagnosis may be challenging. It is key for the neurologist to understand the clinical manifestations and limitations of current diagnostic tests. It is important to consider that a positive rapid plasma reagin test result without confirmation of the presence of Treponema pallidum antibodies in the cerebrospinal fluid may represent a false-positive screening test.
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Affiliation(s)
| | - Any Axelerad
- Department of Neurology, ‘Sf. Ap Andrei’ Emergency County Clinical Hospital, 900591 Constanta, Romania
- Department of Neurology, General Medicine Faculty, ‘Ovidius’ University, 900470 Constanta, Romania
- Correspondence to: Dr Any Axelerad, Department of Neurology, ‘Sf. Ap Andrei’ Emergency County Clinical Hospital, 145 Tomis Bd, 900591 Constanta, Romania
| | - Daniela Musat
- Department of Neurology, ‘Sf. Ap Andrei’ Emergency County Clinical Hospital, 900591 Constanta, Romania
| | - Anabella Cristiana Cioabla
- Department of Neurology, ‘Sf. Ap Andrei’ Emergency County Clinical Hospital, 900591 Constanta, Romania
- Department of Neurology, General Medicine Faculty, ‘Ovidius’ University, 900470 Constanta, Romania
| | - Alina Zorina Stuparu
- Department of Neurology, ‘Sf. Ap Andrei’ Emergency County Clinical Hospital, 900591 Constanta, Romania
- Department of Neurology, General Medicine Faculty, ‘Ovidius’ University, 900470 Constanta, Romania
| | | | - Lavinia Florenta Muja
- Department of Neurology, ‘Sf. Ap Andrei’ Emergency County Clinical Hospital, 900591 Constanta, Romania
- Department of Neurology, General Medicine Faculty, ‘Ovidius’ University, 900470 Constanta, Romania
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14
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Du FZ, Zhang X, Zhang RL, Wang QQ. CARE-NS, a research strategy for neurosyphilis. Front Med (Lausanne) 2023; 9:1040133. [PMID: 36687428 PMCID: PMC9852909 DOI: 10.3389/fmed.2022.1040133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/16/2022] [Indexed: 01/07/2023] Open
Abstract
Neurosyphilis is a major clinical manifestation of syphilis. In recent years, an increase in neurosyphilis cases has been reported in many countries. The overall incidence of neurosyphilis remains unknown, and there is a lack of understanding of the disease pathogenesis, which hampers clinical management, development of prevention strategies, and control. This article proposes the CARE-NS research strategy to enhance the clinical management of neurosyphilis, which consists of six key features: comprehensive management including multidisciplinary treatment (C), alleviating neurological impairment and sequelae (A), risk factors and clinical epidemiology (R), etiology and pathogenesis (E), new diagnostic indicators and strategies (N), and social impact and cost-effectiveness analysis (S).
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Affiliation(s)
- Fang-Zhi Du
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing, China
| | - Xu Zhang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing, China
| | - Rui-Li Zhang
- Department of Dermatology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China,*Correspondence: Rui-Li Zhang,
| | - Qian-Qiu Wang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing, China,Qian-Qiu Wang,
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15
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Jackson DA, McDonald R, Quilter LAS, Weinstock H, Torrone EA. Reported Neurologic, Ocular, and Otic Manifestations Among Syphilis Cases-16 States, 2019. Sex Transm Dis 2022; 49:726-732. [PMID: 35819903 PMCID: PMC9481702 DOI: 10.1097/olq.0000000000001673] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Syphilis can cause neurologic, ocular, or otic manifestations, possibly resulting in permanent disability or death. In 2018, the Centers for Disease Control and Prevention began collecting syphilis clinical manifestation data via the National Notifiable Diseases Surveillance System. We present the first reported US syphilis neurologic, ocular, and otic manifestation prevalence estimates. METHODS We reviewed 2019 National Notifiable Diseases Surveillance System data to identify jurisdictions reporting 70% or greater of syphilis cases 15 years or older with clinical manifestation data (considered "complete reporting"). Among these jurisdictions, we determined reported neurologic, ocular, and otic manifestation prevalence, stratified by demographic, behavioral, and clinical characteristics. RESULTS Among 41,187 syphilis cases in 16 jurisdictions with complete reporting, clinical manifestations were infrequently reported overall: neurologic (n = 445, 1.1%), ocular (n = 461, 1.1%), otic (n = 166, 0.4%), any (n = 807, 2.0%). Reported clinical manifestation prevalence was highest among cases 65 years or older (neurologic, 5.1%; ocular, 3.5%; otic, 1.2%) and those reporting injection drug use (neurologic: 2.8%; ocular: 3.4%; otic: 1.6%). Although reported neurologic and ocular manifestation prevalence was slightly higher among human immunodeficiency virus (HIV)-infected versus HIV-negative persons, approximately 40% of cases with manifestations were HIV-negative. Reported otic manifestation prevalence was similar regardless of HIV status. When stratifying by HIV status and syphilis stage, reported prevalence was highest among HIV-infected persons with unknown duration/late syphilis (neurologic, 3.0%; ocular, 2.3%; otic, 0.7%). CONCLUSIONS Reported neurologic, ocular, and otic manifestation prevalence was low among syphilis cases, but these data are likely an underestimate given potential underreporting. Reported clinical manifestation frequency, including among HIV-negative persons, emphasizes the importance of evaluating all syphilis cases for signs/symptoms of neurosyphilis, ocular syphilis, and otosyphilis.
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Affiliation(s)
- David A Jackson
- From the Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Jankowska M, Mross K, Pałczyński M, Machowska-Sempruch K, Bajer-Czajkowska A, Parczewski M, Masztalewicz M. When modern diagnostics is challenged by a historical disease: A case report. Medicine (Baltimore) 2022; 101:e30586. [PMID: 36123886 PMCID: PMC9478244 DOI: 10.1097/md.0000000000030586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/15/2022] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Syphilis is a bacterial, systemic infectious disease caused by Treponema pallidum spirochetes, which spread rapidly through the body affecting various organs. The term neurosyphilis (NS) refers to a CNS infection that can occur at any stage of the disease. The lack of a gold standard for the diagnosis of NS greatly hinders diagnosis, which must be based mainly on clinical assessment. PATIENT CONCERNS A 58-year-old man reported dizziness and headache for a week and right-sided hearing impairment, with suspected transient cerebral ischemic attack. A month later he experience transient speech disturbance and suspected cerebral ischemic stroke. DIAGNOSIS MRI showed fresh ischemic lesions with a diameter up to 10 mm in the deep brain structures on the left side and foci of subacute ischemia also in the deep structures and the brain stem. Cerebrospinal fluid examination showed positive Pandy's reaction, doubtful Noone-Apelt reaction, increased protein level and decreased glucose level. The reactive result of the USR test performed (VDRL) finally allowed the diagnosis of symptomatic CNS syphilis. INTERVENTIONS Empiric treatment for bacterial meningitis was administered. The patient was transferred to the Department of Infectious Diseases for further treatment. OUTCOMES The diagnosis has been confirmed at the Department of Infectious Diseases after repeating CSF analysis including VDRL and FTA-ABS. LESSON Symptoms of NS are nonspecific, hence the diagnostic process is not straightforward. Despite the availability of modern diagnostic techniques, establishing a final diagnosis was challenging, but the patient ultimately received appropriate treatment. It is important to remember that syphilis is not only a disease known from history lessons but is still present in modern times and its incidence is increasing.
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Affiliation(s)
- Marta Jankowska
- Department of Neurology, Pomeranian Medical University, Szczecin, Poland
| | - Krystian Mross
- Department of Neurology, Pomeranian Medical University, Szczecin, Poland
| | - Marcin Pałczyński
- Department of Neurology, Pomeranian Medical University, Szczecin, Poland
| | | | | | - Miłosz Parczewski
- Department of Infectious, Tropical Diseases and Acquired Immunodeficiency Pomeranian Medical University, Szczecin, Poland
| | - Marta Masztalewicz
- Department of Neurology, Pomeranian Medical University, Szczecin, Poland
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Du FZ, Zhang HN, Li JJ, Zheng ZJ, Zhang X, Zhang RL, Wang QQ. Neurosyphilis in China: A Systematic Review of Cases From 2009-2021. Front Med (Lausanne) 2022; 9:894841. [PMID: 35646949 PMCID: PMC9136070 DOI: 10.3389/fmed.2022.894841] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Considered the increased threaten of neurosyphilis in China, a review on cases reported in the literature to describe the clinical epidemiological characteristics of neurosyphilis cases, may be beneficial to the early detection and management strategies of neurosyphilis for clinicians. We searched the literature on Chinese neurosyphilis cases published from January 1, 2009 to December 31, 2021, described their clinical epidemiological characteristics and calculated the prevalence of neurosyphilis amongst other associated diseases, according to the individual study criteria. A total of 284 studies including 7,486 neurosyphilis cases were included. No meta-analysis was performed due to the heterogeneity of the data. Among 149 case reports and 93 retrospective case series studies, the main clinical manifestation of 3,507 neurosyphilis cases was cerebral parenchymal syphilis (57.3%), followed by asymptomatic neurosyphilis (16.7%), meningovascular syphilis (13.6%), meningitis syphilis (7.7%) and ocular syphilis (2.8%), etc. In addition, the initial diagnosis was incorrect in 53.2% patients, and the most frequent misdiagnoses were mental disorders (31.0%), stroke (15.9%), cognitive impairment (9.0%), etc. The positive or abnormal rates of cerebrospinal fluid non-treponemal and treponemal tests, white blood cell counts and protein concentrations were 74.2%, 96.2%, 61.5%, and 60.9%, respectively. Aqueous penicillin was the first choice for treatment in 88.3% cases, and 81.7% and 50.0% patients had response in the improvement of symptoms and serological effective in CSF, respectively. Among 26 studies on neurosyphilis patients amongst other associated diseases, the prevalence of neurosyphilis amongst central nervous system infectious diseases, syphilis-associated neurological symptoms, serofast status, coinfected with human immunodeficiency virus were 10.6%-30.1%, 23.2%-35.5%, 9.8%-56.1%, and 8.9%, respectively. In summary, the lack of early detection of neurosyphilis cases remains a clinical challenge. The high rate of misdiagnosis and high prevalence of neurosyphilis amongst associated diseases strongly remind clinicians to focus on the early detection among suspected cases. Besides, the standard treatment regimen and long-term follow-up, which complied with guideline should be provided. Further prospective studies are urgent to better delineate the clinical epidemiological characteristics of neurosyphilis in China.
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Affiliation(s)
- Fang-Zhi Du
- Department of Clinical Prevention and Control of STD, Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing, China
| | - Hai-Ni Zhang
- Department of Clinical Prevention and Control of STD, Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing, China
| | - Jing-Jing Li
- Department of Dermatology, The Fifth People's Hospital of Suzhou, Suzhou, China
| | - Zhi-Ju Zheng
- Department of Clinical Prevention and Control of STD, Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing, China
| | - Xu Zhang
- Department of Clinical Prevention and Control of STD, Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing, China
| | - Rui-Li Zhang
- Department of Dermatology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qian-Qiu Wang
- Department of Clinical Prevention and Control of STD, Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing, China
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18
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Yan J, Luo L, Han J, Yan D, Zhang B, Zhang Z, Shi J, Zhu M, Yu J, Liu S, Qi J, Yang Z. Comparing Noninvasive Predictors of Neurosyphilis Among Syphilis Patients With and Without HIV Co-Infection Based on the Real-World Diagnostic Criteria: A Single-Center, Retrospective Cohort Study in China. AIDS Res Hum Retroviruses 2022; 38:406-414. [PMID: 34314231 DOI: 10.1089/aid.2021.0085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Diagnosis of neurosyphilis is currently based on the cerebrospinal fluid (CSF) assessments and CSF-Venereal Disease Research Laboratory (CSF-VDRL) is the traditional "gold standard." In the real world, CSF assessments and CSF-VDRL are not always available. This study aimed to identify noninvasive predictors of neurosyphilis based on real-world clinical parameters and diagnostic criteria in populations with different HIV status. In this retrospective cohort study, syphilis patients with different HIV statuses hospitalized for neurosyphilis screening were retrospectively recruited at an infectious disease hospital. Neurosyphilis was defined by real-world diagnostic criteria. Logistic regression and receiver operating characteristic curve analysis were used to investigate and evaluate predictors of neurosyphilis. In total, 528 patients were enrolled, including 143 syphilis patients without HIV infection and 385 HIV/syphilis-co-infected patients. One hundred twelve and 304 neurosyphilis patients were identified in the HIV-negative and HIV-positive groups, respectively. A high serum toluidine red unheated serum test (TRUST) titer was a robust predictor of neurosyphilis in all participants. An age ≥50 years old [adjusted odds ratio (aOR) = 5.062, 95% confidence interval (CI), 1.449-17.680] in the HIV-negative group and CD4+ T cell count <330/μL (<300 as reference, aOR = 0.552, 95% CI, 0.315-0.966) in the HIV-positive group were predictors of asymptomatic neurosyphilis. In real-world situations, for asymptomatic syphilis patients, relatively old age and a high serum TRUST titer in HIV-negative populations, and CD4+ T cells <330/μL and/or serum TRUST titer >1:64 in HIV-positive populations might predict neurosyphilis.
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Affiliation(s)
- Jun Yan
- Xixi Hospital of Hangzhou, Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Lian Luo
- Xixi Hospital of Hangzhou, Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Jie Han
- Xixi Hospital of Hangzhou, Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Dingyan Yan
- Xixi Hospital of Hangzhou, Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Binhai Zhang
- Xixi Hospital of Hangzhou, Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Zhongdong Zhang
- Xixi Hospital of Hangzhou, Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Jinchuan Shi
- Xixi Hospital of Hangzhou, Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Mingli Zhu
- Xixi Hospital of Hangzhou, Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Jianhua Yu
- Xixi Hospital of Hangzhou, Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Shourong Liu
- Xixi Hospital of Hangzhou, Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Jianjiang Qi
- Hangzhou Seventh People's Hospital, Affiliated Mental Center, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Zongxing Yang
- Xixi Hospital of Hangzhou, Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
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19
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Tuddenham S, Ghanem KG. Management of Adult Syphilis: Key Questions to Inform the 2021 Centers for Disease Control and Prevention Sexually Transmitted Infections Treatment Guidelines. Clin Infect Dis 2022; 74:S127-S133. [PMID: 35416969 PMCID: PMC9006973 DOI: 10.1093/cid/ciac060] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A panel of experts generated 5 "key questions" in the management of adult syphilis. A systematic literature review was conducted and tables of evidence were constructed to answer these questions. Available data suggest no clinical benefit to >1 dose of benzathine penicillin G for early syphilis in human immunodeficiency virus (HIV)-infected patients. While penicillin remains the drug of choice to treat syphilis, doxycycline to treat early and late latent syphilis is an acceptable alternate option if penicillin cannot be used. There are very limited data regarding the impact of additional antibiotic doses on serologic responses in serofast patients and no data on the impact of additional antibiotic courses on long-term clinical outcomes. In patients with isolated ocular or otic signs and symptoms, reactive syphilis serologic results, and confirmed ocular/otic abnormalities at examination, a diagnostic cerebrospinal fluid (CSF) examination is not necessary, because up to 40% and 90% of patients, respectively, would have no CSF abnormalities. Based on the results of 2 studies, repeated CSF examinations are not necessary for HIV-uninfected patients or HIV-infected patients on antiretroviral therapy who exhibit appropriate serologic and clinical responses after treatment for neurosyphilis. Finally, several important gaps were identified and should be a priority for future research.
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Affiliation(s)
- Susan Tuddenham
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Khalil G Ghanem
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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20
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Liu WN, Wu KX, Wang XT, Lin LR, Tong ML, Liu LL. LncRNA- ENST00000421645 promotes T cells to secrete IFN-γ by sponging PCM1 in neurosyphilis. Epigenomics 2021; 13:1187-1203. [PMID: 34382410 DOI: 10.2217/epi-2021-0163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Aim: Neurosyphilis patients exhibited significant expression of long noncoding RNA (lncRNA) in peripheral blood T lymphocytes. In this study, we further clarified the role of lncRNA-ENST00000421645 in the pathogenic mechanism of neurosyphilis. Methods: lncRNA-ENST00000421645 was transfected into Jurkat-E6-1 cells, namely lentivirus (Lv)-1645 cells. RNA pull-down assay, flow cytometry, RT-qPCR, ELISA (Neobioscience Technology Co Ltd, Shenzhen, China) and RNA immunoprecipitation chip assay were used to analyze the function of lncRNA-ENST00000421645. Results: The expression of IFN-γ in Lv-1645 cells was significantly increased compared to that in Jurkat-E6-1 cells stimulated by phorbol-12-myristate-13-acetate (PMA). Then, it was suggested that lncRNA-ENST00000421645 interacts with PCM1 protein. Silencing PCM1 significantly increased the level of IFN-γ in Lv-1645 cells stimulated by PMA. Conclusion: This study revealed that lncRNA-ENST00000421645 mediates the production of IFN-γ by sponging PCM1 protein after PMA stimulation.
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Affiliation(s)
- Wen-Na Liu
- Center of Clinical Laboratory, Zhongshan Hospital, School of Medical, Xiamen University, Xiamen, Fujian Province, China.,Department of Laboratory Medicine, Sichuan Provincial People's Hospital, University of Electronic Science & Technology of China, Chengdu, China
| | - Kai-Xuan Wu
- Center of Clinical Laboratory, Zhongshan Hospital, School of Medical, Xiamen University, Xiamen, Fujian Province, China
| | - Xiao-Tong Wang
- Center of Clinical Laboratory, Zhongshan Hospital, School of Medical, Xiamen University, Xiamen, Fujian Province, China
| | - Li-Rong Lin
- Center of Clinical Laboratory, Zhongshan Hospital, School of Medical, Xiamen University, Xiamen, Fujian Province, China
| | - Man-Li Tong
- Center of Clinical Laboratory, Zhongshan Hospital, School of Medical, Xiamen University, Xiamen, Fujian Province, China
| | - Li-Li Liu
- Center of Clinical Laboratory, Zhongshan Hospital, School of Medical, Xiamen University, Xiamen, Fujian Province, China
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21
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He C, Kong Q, Shang X, Duan Y, Cui Y, Wang J, Ci C, Sang H. Clinical, laboratory and brain Magnetic Resonance Imaging (MRI) characteristics of asymptomatic and symptomatic HIV-negative neurosyphilis patients. J Infect Chemother 2021; 27:1596-1601. [PMID: 34330638 DOI: 10.1016/j.jiac.2021.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 05/12/2021] [Accepted: 07/05/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There are few studies concerning the differences between asymptomatic neurosyphilis (ANS) and symptomatic neurosyphilis (SNS). This study aimed to summarize clinical, laboratory and brain Magnetic Resonance Imaging (MRI) characteristics of HIV-negative patients with ANS and SNS. METHODS Data from 43 HIV-negative patients with ANS and 59 HIV-negative patients with SNS were retrospectively collected from our hospital between December 2012 and December 2018. RESULTS Compared with the ANS group, SNS group had more patients that were male, age≥45 years, had brain MRI abnormalities, and exhibited higher serum/cerebrospinal fluid (CSF) TRUST titer, CSF WBC count, CSF protein concentration (P < 0.05). Multivariate regression analysis revealed that male sex, age ≥45 years and CSF TRUST titer were risk factors for SNS [odds ratio (OR) = 7.946,P = 0.001;OR = 3.757, P = 0.041; OR = 2.713, P = 0.002; respectively]. The brain MRI findings of 78 patients without comorbidities showed that ischemic infarct lesions presented in 17/37 (45.95%) of patients with ANS; infarct ischemic stroke (73.17%) especially multiple cerebral infractions (46.34%), cerebral atrophy (48.78%) were also common presentations in the SNS group. CONCLUSIONS Patients with HIV-negative ANS and SNS presented different clinical, laboratory and brain MRI features. Male sex, age ≥45 years and elevated CSF TRUST titer may have an increased risk of developing neurological symptoms. Brain MRI abnormalities may present prior to clinical symptoms. Multiple cerebral infarctions without explained reasons or cerebral atrophy should alert clinicians the possibility of SNS.
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Affiliation(s)
- Caifeng He
- Department of Dermatology,Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210002, China; Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, 241000, China
| | - Qingtao Kong
- Department of Dermatology,Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210002, China
| | - Xianjin Shang
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, 241000, China
| | - Yuanyuan Duan
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Yong Cui
- Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, 241000, China; Department of Dermatology, China-Japan Friendship Hospital, Beijing, China
| | - Jun Wang
- Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, 241000, China
| | - Chao Ci
- Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, 241000, China.
| | - Hong Sang
- Department of Dermatology,Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210002, China.
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22
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Circulating MicroRNAs as Potential Biomarkers in the Diagnosis of Neurosyphilis: A Case Control Study. INTERNATIONAL JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2021. [DOI: 10.1097/jd9.0000000000000127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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He C, Shang X, Liu W, Hang S, Chen J, Ci C. Combination of the neutrophil to lymphocyte ratio and serum toluidine red unheated serum test titer as a predictor of neurosyphilis in HIV-negative patients. Exp Ther Med 2021; 21:185. [PMID: 33488794 PMCID: PMC7812589 DOI: 10.3892/etm.2021.9616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 11/20/2020] [Indexed: 12/24/2022] Open
Abstract
The present study explored the associations of the neutrophil to lymphocyte ratio (NLR) and the serum toluidine red unheated serum test (TRUST) titer with neurosyphilis (NS). The present retrospective study examined 87 NS patients and 80 Non-NS patients from an HIV-negative cohort and 1:1 age- and gender-matched healthy controls. The results demonstrated that the NLR was increased in both NS and Non-NS groups compared with that in the healthy controls (P<0.001 and P=0.01, respectively). The NLR and serum TRUST titer in the NS group were significantly higher than those in the Non-NS group (P=0.004 and P<0.001, respectively). The NLR was positively correlated with the serum TRUST titer (r=0.298, P<0.001). Age, elevated NLR and serum TRUST titer were distinctly associated with NS by binomial logistic regression analysis [odds ratio (OR)=1.10, P<0.001; OR=1.36, P=0.028; OR=3.07, P<0.001; respectively]. The cut-off values for the NLR and serum TRUST titer were 1.97 and 1:8, respectively. A significantly higher sensitivity of 90.8% was obtained for screening out NS with a combination of the NLR and serum TRUST titer compared with each test alone. Age, elevated NLR and serum TRUST titer were associated with NS. The combination of NLR and serum TRUST titer is a potential predictor for NS, and the reduced NLR and serum TRUST titer at the 6-month follow up suggested that the NLR and serum TRUST titer were biomarkers for monitoring the disease course.
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Affiliation(s)
- Caifeng He
- Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Xianjin Shang
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Wenbei Liu
- Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Shouyun Hang
- Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Jingtao Chen
- Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Chao Ci
- Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China
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24
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Weng W, Hou J, Song B, Zhang M, Zhang T, Gao Y. Identification of the factors associated with post-treatment asymptomatic neurosyphilis in HIV-negative patients with serological non-response syphilis: a retrospective study. Int J STD AIDS 2020; 32:331-335. [PMID: 33345747 DOI: 10.1177/0956462420965850] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Some syphilis patients do not exhibit an appropriate serological response after treatment despite the absence of any clinical evidence of treatment failure or reinfection. This condition is called "serofast syphilis" or "serological non-response syphilis." This study explored the incidence of asymptomatic neurosyphilis (ANS) and related factors in 324 asymptomatic patients with serological non-response syphilis. We analyzed descriptive statistics stratified by the presence of asymptomatic neurosyphilis for the basic characteristics of samples. Bivariate analysis was conducted to assess correlations between outcomes and potential predictors. Variables significant in the bivariate analysis (p<0.1) were entered into multivariable logistic regression models. All p-values were two-sided with a significance threshold of p<0.05. The results indicated that 89 of 324 patients had ANS (incidence of 27.5%), and the greatest risk factors were a < fourfold decrease in serum rapid plasma reagin (RPR) titers after treatment and current serum RPR titers >1:32. Our findings suggest that ANS is common among syphilis patients, and patients with a fourfold decrease in serum RPR titers after treatment and current serum RPR titers >1:32 are more likely to develop ANS.
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Affiliation(s)
- Wenjia Weng
- Department of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Jiahua Hou
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Bingbing Song
- Department of Dermatology, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Ming Zhang
- Department of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Tong Zhang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Yanqing Gao
- Department of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
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25
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Janier M, Unemo M, Dupin N, Tiplica GS, Potočnik M, Patel R. 2020 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol 2020; 35:574-588. [PMID: 33094521 DOI: 10.1111/jdv.16946] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/04/2020] [Indexed: 12/22/2022]
Abstract
The 2020 edition of the European guideline on the management of syphilis is an update of the 2014 edition. Main modifications and updates include: -The ongoing epidemics of early syphilis in Europe, particularly in men who have sex with men (MSM) -The development of dual treponemal and non-treponemal point-of-care (POC) tests -The progress in non-treponemal test (NTT) automatization -The regular episodic shortage of benzathine penicillin G (BPG) in some European countries -The exclusion of azithromycin as an alternative treatment at any stage of syphilis -The pre-exposure or immediate post-exposure prophylaxis with doxycycline in populations at high risk of acquiring syphilis.
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Affiliation(s)
- M Janier
- STD Clinic, Hôpital Saint-Louis AP-HP and Hôpital Saint-Joseph, Paris, France
| | - M Unemo
- WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, Department of Laboratory Medicine, Microbiology, Örebro University Hospital and Örebro University, Örebro, Sweden
| | - N Dupin
- Syphilis National Reference Center, Hôpital Tarnier-Cochin, AP-HP, Paris, France
| | - G S Tiplica
- 2nd Dermatological Clinic, Carol Davila University, Colentina Clinical Hospital, Bucharest, Romania
| | - M Potočnik
- Department of Dermatovenereology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - R Patel
- Department of Genitourinary Medicine, the Royal South Hants Hospital, Southampton, UK
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26
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Shannon CL, Keizur EM, Fehrenbacher A, Wood-Palmer D, Ramos W, Koussa M, Fournier J, Lee SJ, Patel D, Akabike WN, Abdalian SE, Rotheram-Borus MJ, Klausner JD. Sexually Transmitted Infection Positivity Among Adolescents With or at High-Risk for Human Immunodeficiency Virus Infection in Los Angeles and New Orleans. Sex Transm Dis 2019; 46:737-742. [PMID: 31453926 PMCID: PMC6812613 DOI: 10.1097/olq.0000000000001056] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Gay, bisexual, and transgender youth and homeless youth are at high risk for sexually transmitted infections (STIs). However, little recent data exist describing STI positivity by anatomical site among those groups. We determined the positivity of Chlamydia trachomatis (CT) infection, Neisseria gonorrhoeae (NG) infection, and syphilis antibody reactivity among lesbian, gay, bisexual, transgender, and homeless youth. METHODS We recruited 1,264 adolescents with high risk behavior aged 12 to 24 years from homeless shelters, lesbian, gay, bisexual, and transgender organizations, community health centers, and using social media and online dating apps in Los Angeles, California and New Orleans, Louisiana from May 2017 to February 2019. Participants received point-of-care pharyngeal, rectal, and urethral/vaginal CT and NG testing and syphilis antibody testing. We calculated STI positivity by anatomical site and compared positivity by participant subgroups based on human immunodeficiency virus (HIV) status, sex assigned at birth, and gender identity. RESULTS CT and NG positivity and syphilis antibody reactivity was higher among HIV-infected adolescent men who have sex with men (MSM) than HIV-uninfected adolescent MSM (40.2% vs. 19%, P < 0.05), particularly CT or NG rectal infection (28% vs. 12.3%, P < 0.05). Of participants with positive CT or NG infections, 65% had extragenital-only infections, 20% had both extragenital and urogenital infections, and 15% had urogenital-only infections. CONCLUSIONS Sexually transmitted infection positivity was high, particularly among transgender women and MSM. The high proportion of rectal and pharyngeal infections highlights the importance of both urogenital and extragenital STI screening. More accessible STI testing is necessary for high-risk adolescent populations.
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Affiliation(s)
| | | | - Anne Fehrenbacher
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA
| | | | - Wilson Ramos
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Maryann Koussa
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Jasmine Fournier
- Department of Pediatrics/Adolescent Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Sung-Jae Lee
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA
| | | | - Whitney N Akabike
- Department of Community Health Sciences, University of California, Los Angeles, CA, USA
| | - Sue Ellen Abdalian
- Department of Pediatrics/Adolescent Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Mary Jane Rotheram-Borus
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA
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27
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Zhu L, Shi M, Peng RR, Gu X, Guan Z, Xu H, Zhou P. Neurosyphilis is more common in malignant syphilis: A case series and review of the literature. Int J STD AIDS 2019; 30:779-785. [PMID: 31142223 DOI: 10.1177/0956462419826710] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Malignant syphilis is a rare skin manifestation of secondary syphilis, which has been reported primarily in the HIV-infected population. This study aimed to investigate the relationship between HIV infection, malignant syphilis, and neurosyphilis through a systematic chart review of 26 malignant syphilis patients seen at our hospital. We also performed a literature review of 83 reported malignant syphilis cases since 1987, when the first case of malignant syphilis co-infected with HIV was reported. We found there was no direct association between HIV infection and malignant syphilis or neurosyphilis. In contrast, we found that much higher proportion (30%) of malignant syphilis patients develop concurrent neurosyphilis compared to those with the common type of secondary syphilis (13.1%). Physicians should be aware of the fact that neurosyphilis is more common among patients with malignant syphilis and the importance of investigating for neurosyphilis in such patients.
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Affiliation(s)
- Lin Zhu
- Department of Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, China
| | - Mei Shi
- Department of Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, China
| | - Rui-Rui Peng
- Department of Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, China
| | - Xin Gu
- Department of Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, China
| | - Zhifang Guan
- Department of Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, China
| | - Huanbin Xu
- Department of Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, China
| | - Pingyu Zhou
- Department of Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, China
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28
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Clinical and Laboratory Characteristics of Symptomatic and Asymptomatic Neurosyphilis in HIV-Negative Patients: A Retrospective Study of 264 Cases. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2426313. [PMID: 31198783 PMCID: PMC6526518 DOI: 10.1155/2019/2426313] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/21/2019] [Accepted: 04/16/2019] [Indexed: 12/27/2022]
Abstract
A retrospective study was performed to compare the differences in clinical and laboratory features of asymptomatic neurosyphilis (ANS) and symptomatic neurosyphilis (SNS). A total of 264 HIV-negative inpatients with neurosyphilis were enrolled from Beijing Ditan Hospital and Beijing Tiantan Hospital between January 2014 and May 2018, including 110 SNS and 154 ANS. The SNS group had more patients in males, older median age and without antisyphilis treatment than ANS group (P<0.001, P<0.001, and P<0.001, respectively). The laboratory findings showed that the SNS group had higher pretreatment serum rapid plasma regain (RPR) titer, current serum RPR titer, cerebrospinal fluid (CSF) white blood cell (WBC) counts, CSF protein concentrations, and higher positive CSF RPR rate than those in the ANS group (P=0.011, P<0.001, P<0.001, P<0.001, and P<0.001, respectively). The multivariate logistic regression analysis revealed that male (OR=2.833, P=0.009), age≥45 years (OR=3.611, P=0.001), without antisyphilis treatment (OR=0.247, P<0.001), higher current serum RPR titer (OR=1.373, P=0.022), positive CSF RPR (OR=4.616, P<0.001), and higher CSF protein concentration (OR=1.017, P=0.026) were independent risk predictors for SNS. Therefore, clinical and laboratory features between SNS and ANS are quietly different. Male gender, age≥45 years, and lack of antisyphilis treatment are risk factors for SNS. The elevated level of serum RPR titer, CSF protein concentration, and CSF RPR titer may indicate the development of neurosyphilis and the aggravation of neurological symptoms.
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29
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Rubin AN, Espiridion ED, Truong NH, Lofgren DH. Neurosyphilis Presenting with Anxiety: A Case Report. Cureus 2018; 10:e3020. [PMID: 30254809 PMCID: PMC6150767 DOI: 10.7759/cureus.3020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 07/22/2018] [Indexed: 11/09/2022] Open
Abstract
The number of cases of late and late latent syphilis in the United States is on the rise. This diagnosis is often forgotten when an elderly patient is being worked up for altered mental status. Rarely does a 70-year-old male with neurosyphilis present simply with anxiety. Due to the decreased severity of the presentation, this patient was sent home from the emergency department multiple times until the anxiety progressed to psychosis. He was finally admitted with delirium, suicidal ideation, and paranoia. A routine Treponema pallidum antibody test returned positive and a further workup of confirmatory lab work, a thorough neurological exam, and magnetic resonance imaging (MRI) revealed a chronic syphilis infection. This case study explores signs in the history and physical examination that should quickly prompt a provider to consider neurosyphilis in their differential. This patient presented with Argyll-Robertson pupils and significant risk factors. The goal of this discussion is to bring awareness to this infrequent presentation and share simple examination techniques that could have been used to diagnose and treat this patient's symptoms more promptly. In doing so, the hope is to raise awareness for the diagnosis of neurosyphilis, especially in the elderly patient presenting with psychiatric symptoms.
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Affiliation(s)
- Ashley N Rubin
- Family Medicine, West Virginia School of Osteopathic Medicine, Lewisburg, USA
| | | | - Nhu-Hac Truong
- Family Medicine, West Virginia School of Osteopathic Medicine, Silver Spring, USA
| | - Daniel H Lofgren
- Surgery Student, West Virginia School of Osteopathic Medicine, Lewisburg , USA
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30
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Incidence of asymptomatic neurosyphilis in serofast Chinese syphilis patients. Sci Rep 2017; 7:15456. [PMID: 29133821 PMCID: PMC5684362 DOI: 10.1038/s41598-017-15641-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/31/2017] [Indexed: 11/20/2022] Open
Abstract
More new diagnosed syphilis cases were reported in china, the incidence and relevant factors of asymptomatic neurosyphilis (ANS) in serofast syphilis patients were unclear. Clinical and laboratory data of 402 Human Immunodeficiency Virus (HIV) negative, serofast syphilis patients, who underwent lumbar puncture at the Peking University Ditan Teaching Hospital between September 2008 and August 2016, were collected. Incidence of ANS was verified and the relevant factors were further analyzed. According to the ANS criteria, 139 (34.6%) patients had ANS. Of these, 40 (28.8%) had reactive cerebrospinal fluid (CSF), rapid plasma reagin (RPR) positive, 115 (82.7%) had CSF white blood cell (WBC) count > 5 × 106/L, 28 (20.1%) had CSF protein concentration > 45 mg/dL (without other neurological diseases). Patients aged 51–60 years, of non-Han ethnicity, with serum RPR titer 1:32 and ≥ 1:64 were 2.28-fold, 9.11-fold, 5.12-fold and 5.69-fold, respectively, more likely to have ANS. The incidence of ANS was 34.6% among Chinese serofast syphilis patients. Age, ethnicity and serum RPR titer were associated with high risk of ANS.
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31
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Xiao Y, Tong ML, Lin LR, Liu LL, Gao K, Chen MJ, Zhang HL, Zheng WH, Li SL, Lin HL, Lin ZF, Yang TC, Niu JJ. Serological Response Predicts Normalization of Cerebrospinal Fluid Abnormalities at Six Months after Treatment in HIV-Negative Neurosyphilis Patients. Sci Rep 2017; 7:9911. [PMID: 28855625 PMCID: PMC5577126 DOI: 10.1038/s41598-017-10387-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 08/07/2017] [Indexed: 12/09/2022] Open
Abstract
This study aimed to determine whether a serological response could predict the normalization of cerebrospinal fluid (CSF) abnormalities at 6 months after treatment in human immunodeficiency virus (HIV)-negative neurosyphilis patients. A total of 123 neurosyphilis patients were recruited at baseline, 58 of these patients undergoing treatment, repeated CSF examinations and serological tests for syphilis at 6 months after treatment were included in the follow-up study. Before treatment, the CSF rapid plasma reagin (RPR) titer, CSF Treponema pallidum particle agglutination (TPPA) titer, CSF leukocyte count, and CSF protein concentration were correlated with both serum RPR and TPPA titers. At 6 months after treatment, 28 and nine patients achieved serological responses of RPR and TPPA tests, respectively. The sensitivities of the serological response of RPR and TPPA tests for identifying the normalization of CSF abnormalities were 60.0∼83.3% and 17.1~22.2%, respectively; and 75.0∼91.3% of patients showing serological response of RPR test also achieved CSF normalization, suggesting that the serological response could predict CSF normalization to some degree. Particularly, in patients with ≥8-fold decreases in the serum RPR titer, the CSF RPR, CSF leukocyte count, and CSF protein concentration had normalized, and follow-up lumbar puncture could be reduced considering the resolution of neurological symptoms.
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Affiliation(s)
- Yao Xiao
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, Fujian Province, China.,Xiamen Hospital of Traditional Chinese Medicine, Xiamen, Fujian Province, China.,Xiamen Zhongshan Hospital, Fujian Medical University, Xiamen, Fujian Province, China
| | - Man-Li Tong
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, Fujian Province, China.,Institute of Infectious Disease, Medical College of Xiamen University, Xiamen, Fujian Province, China
| | - Li-Rong Lin
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, Fujian Province, China.,Institute of Infectious Disease, Medical College of Xiamen University, Xiamen, Fujian Province, China
| | - Li-Li Liu
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, Fujian Province, China.,Institute of Infectious Disease, Medical College of Xiamen University, Xiamen, Fujian Province, China
| | - Kun Gao
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, Fujian Province, China
| | - Mei-Jun Chen
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, Fujian Province, China
| | - Hui-Lin Zhang
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, Fujian Province, China
| | - Wei-Hong Zheng
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, Fujian Province, China
| | - Shu-Lian Li
- Xiamen Huli District Maternity and Child Care Hospital, Xiamen, Fujian Province, China
| | - Hui-Ling Lin
- Xiamen Huli District Maternity and Child Care Hospital, Xiamen, Fujian Province, China
| | - Zhi-Feng Lin
- Xiamen Huli District Maternity and Child Care Hospital, Xiamen, Fujian Province, China
| | - Tian-Ci Yang
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, Fujian Province, China. .,Institute of Infectious Disease, Medical College of Xiamen University, Xiamen, Fujian Province, China.
| | - Jian-Jun Niu
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, Fujian Province, China. .,Institute of Infectious Disease, Medical College of Xiamen University, Xiamen, Fujian Province, China. .,Xiamen Zhongshan Hospital, Fujian Medical University, Xiamen, Fujian Province, China.
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Xiao Y, Tong ML, Liu LL, Lin LR, Chen MJ, Zhang HL, Zheng WH, Li SL, Lin HL, Lin ZF, Xing HQ, Niu JJ, Yang TC. Novel predictors of neurosyphilis among HIV-negative syphilis patients with neurological symptoms: an observational study. BMC Infect Dis 2017; 17:310. [PMID: 28446129 PMCID: PMC5406894 DOI: 10.1186/s12879-017-2339-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/24/2017] [Indexed: 11/24/2022] Open
Abstract
Background Known predictors of neurosyphilis were mainly drawn from human immunodeficiency virus (HIV)-infected syphilis patients, which may not be applicable to HIV-negative populations as they have different characteristics, particularly those with neurological symptoms. This study aimed to identify novel predictors of HIV-negative symptomatic neurosyphilis (S-NS). Methods From June 2005 to June 2015, 370 HIV-negative syphilis patients with neurological symptoms were recruited, consisting of 191 S-NS patients (including 123 confirmed neurosyphilis and 68 probable neurosyphilis patients) and 179 syphilis/non-neurosyphilis (N-NS) patients. Clinical and laboratory characteristics of S-NS were compared with N-NS to identify factors predictive of S-NS. Serum rapid plasma reagin (RPR), Treponema pallidum particle agglutination (TPPA), and their parallel testing format for screening S-NS were evaluated. Results The likelihood of S-NS was positively associated with the serum RPR and TPPA titers. The serum TPPA titers performed better than the serum RPR titers in screening S-NS. The optimal cut-off points to recognize S-NS were serum RPR titer ≥1:4 and serum TPPA titer ≥1:2560 respectively. A parallel testing format of a serum RPR titer ≥1:2 and serum TPPA titer ≥1:1280 screened out 95.8% of S-NS and all confirmed cases of neurosyphilis. S-NS was independently associated with male sex, serum RPR titer ≥1:4, serum TPPA titer ≥1:2560, and elevated serum creatine kinase. Concurrence of these factors increased the likelihood of S-NS. Conclusions Quantitation of serum TPPA is worthwhile and performs better than serum RPR in screening S-NS. Serum RPR, serum TPPA, male sex, and serum creatine kinase can predict S-NS. Moreover, patients with both a serum RPR titer <1:2 and a serum TPPA titer <1:1280 have a low probability of S-NS, suggesting that it is reasonable to reduce lumbar punctures in such individuals.
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Affiliation(s)
- Yao Xiao
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, 361004, China.,Xiamen Hospital of Traditional Chinese Medicine, Xiamen, 361009, China.,Xiamen Zhongshan Hospital, Fujian Medical University, Xiamen, 361004, China
| | - Man-Li Tong
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, 361004, China
| | - Li-Li Liu
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, 361004, China
| | - Li-Rong Lin
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, 361004, China
| | - Mei-Jun Chen
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, 361004, China
| | - Hui-Lin Zhang
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, 361004, China
| | - Wei-Hong Zheng
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, 361004, China
| | - Shu-Lian Li
- Xiamen Huli District Maternity and Child Care Hospital, Xiamen, 361009, China
| | - Hui-Ling Lin
- Xiamen Huli District Maternity and Child Care Hospital, Xiamen, 361009, China
| | - Zhi-Feng Lin
- Xiamen Huli District Maternity and Child Care Hospital, Xiamen, 361009, China
| | - Hui-Qin Xing
- Institute of Neuroscience, Medical College of Xiamen University, Xiamen, 361005, China
| | - Jian-Jun Niu
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, 361004, China. .,Xiamen Zhongshan Hospital, Fujian Medical University, Xiamen, 361004, China.
| | - Tian-Ci Yang
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, 361004, China.
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Peng RR, Wu J, Zhao W, Qi T, Shi M, Guan Z, Lu H, Long F, Gao Z, Zhang S, Zhou P. Neutropenia induced by high-dose intravenous benzylpenicillin in treating neurosyphilis: Does it really matter? PLoS Negl Trop Dis 2017; 11:e0005456. [PMID: 28288165 PMCID: PMC5363990 DOI: 10.1371/journal.pntd.0005456] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 03/23/2017] [Accepted: 03/03/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Prompt therapy with high-dose intravenous benzylpenicillin for a prolonged period is critical for neurosyphilis patients to avoid irreversible sequelae. However, life-threatening neutropenia has been reported as a complication of prolonged therapy with high doses of benzylpenicillin when treating other diseases. This study aimed to investigate the incidence, presentation, management and prognosis of benzylpenicillin-induced neutropenia in treating neurosyphilis based on a large sample of syphilis patients in Shanghai. METHODOLOGY/PRINCIPAL FINDINGS Between 1st January 2013 and 31st December 2015, 1367 patients with neurosyphilis were treated with benzylpenicillin, 578 of whom were eligible for recruitment to this study. Among patients without medical co-morbidities, the total incidence of benzylpenicillin-induced neutropenia and severe neutropenia was 2.42% (95% CI: 1.38-4.13%) and 0.35% (95% CI: 0.06-1.39%), respectively. The treatment duration before onset of neutropenia ranged from 10 to 14 days, with a total cumulative dose of between 240 and 324 megaunits of benzylpenicillin. Neutropenia was accompanied by symptoms of chills and fever (5 patients), fatigue (2 patients), cough (1 patient), sore throat (1 patient), diarrhea (1 patient) and erythematous rash (1 patient). The severity of neutropenia was not associated with age, gender or type of neurosyphilis (p>0.05). Neutropenia, even when severe, was often tolerated and normalized within one week. A more serious neutropenia did not occur when reinstituting benzylpenicillin in patients with mild or moderate neutropenia nor when ceftriaxone was used three months after patients had previously experienced severe neutropenia. CONCLUSIONS/SIGNIFICANCE Benzylpenicillin-induced neutropenia was uncommon in our cohort of patients. Continuation of therapy was possible with intensive surveillance for those with mild or moderate neutropenia. For severe neutropenia, it is not essential to aggressively use hematopoietic growth factors or broad-spectrum antibiotics for patients in good physical condition after withdrawing anti-neurosyphilis regimen. We did not see an exacerbation of neutropenia in patients with the readministration of benzylpenicillin.
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Affiliation(s)
- Rui-Rui Peng
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Juan Wu
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Wei Zhao
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Tengfei Qi
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Mei Shi
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Zhifang Guan
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Haikong Lu
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Fuquan Long
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Zixiao Gao
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Sufang Zhang
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
| | - Pingyu Zhou
- Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, People's Republic of China
- * E-mail:
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