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Neurosyphilis in a Non-HIV Patient: Case series in a hospital Tertiary of Portugal

Author: 
Gonçalo Sarmento, Fátima Leal-Seabra and Agripino Oliveira
Subject Area: 
Health Sciences
Abstract: 

Background: The clinical spectrum of neurosyphilis (NS) has changed over time. The majority of cases are reported in HIV-infected patients, but the epidemiology of modern NS is not well defined because of the paucity of population-based data. Objective: To describe the clinical spectrum and characteristics of NS in HIV-negative patients. Materials and Methods: Diagnosticated cases of NS by diagnosis-related group presenting at Centro Hospitalar Gaia-Espinho a period of 6 years were identified. Diagnosis of NS was based on clinical presentation, routine CSF biochemistry (protein and leukocytes) and serological evidence serum and CSF Venereal disease research laboratory (VDRL) and Treponema pallidum haemagglutination assay (TPHA) tests. Results: We identified 47 clinical records and excluded 7 HIV positive cases, 1 case diagnosed in 2001 and 6 cases of unlikely diagnosis. In the other, the median age was 61 years with a male predominance (79.79%). We not identify asymptomatic patients and later forms were the most representative (57.58%) with a predominance of general paralysis (54.55%). All patients had serum and cerebrospinal fluid TPHA positive titers. VDRL performed in CSF was positive in 12 (36.36%). In 13 patients (39.39%) showed CSF pleocytosis and 27 (81.82%) elevated CSF protein were found. In the study by neuroimaging in 25 patients (75.76%) showed abnormalities. Conclusions: Neurosyphilis has various clinical manifestations, laboratory, and neuroimaging findings, but all studies lack specificity. Every patient with neurological or psychiatric symptoms that are without unambiguous causes should have blood tests for syphilis. When serology proves positive, patients should undergo CSF examination.

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