Clinical and laboratory characteristics of patients with symptomatic neurosyphilis before and after intensive anti-syphilis treatment

doi:10.3877/cma.j.issn.1674-1358.2019.02.009

Abstract

Abstract:

Objective

To analyze the clinical characterisitcs and laboratory indexes of patients with symptomatic neurosyphilis before and after intensive anti-syphilis therapy, and its significance for curative effect evaluation.

Methods

Data of 29 patients with HIV-negative symptomatic neurosyphilis in Beijing Ditan Hospital, Capital Medical University were analyzed, retrospectively. Serum and cerebrospinal fluid (CSF) were detected by toluidine red unheated serum test (TRUST) and treponema pallidum particle agglutination test (TPPA) before treatment and 6 months after treatment. The levels of serum TRUST (serum-TRUST), white blood cell count in CSF (CSF-WBC) (× 10⁶/L), cerebrospinal fluid protein level in CSF (CSF-PRO) (mg/dl) and dynamic changes of CSF-TRUST were detected, respectively. The clinical significance and evaluation value of curative effect of the above indicators were analyzed.

Results

There were 8 cases (27.58%) with serum-TRUST decreased more than 4 times after 6 months intensive anti-syphilis treatment, which were 15 cases (51.72%) 2 years after treatment. Before treatment, 6 months after treatment and 2 years after treatment, the median (quartile) of log₂serum-TRUST countdown were 1.81 (1.20, 2.11), 1.51 (1.20, 1.81) and 1.20 (0.90, 1.51), respectively, the differences between every two groups were significant (all P < 0.001). There were 17 patients (62.97%) with CSF-TRUST titers decreased more than 4 times or negative at the end of 6 months after treatment. Before treatment and 6 months after treatment, the median (quartile) of log₂serum-TRUST countdown were 0.60 (0.30, 0.90) and 0.30 (0.00, 0.60), respectively, with significant difference (Z = -3.012, P = 0.003). Before treatment and 6 months after treatment, the median (quartile) of CSF-PRO were 64.50 (52.05, 88.55) and 50.85 (37.28, 65.25), respectively, with significant difference (Z =-3.238, P = 0.001).

Conclusions

Titers of CSF-PRO and CSF-TRUST before and after treatment could be used to evaluate the curative effect of patients with neurosyphilis, and the decrease of serum-TRUST titer ≥ 4 times could predict the curative effect of patients with neurosyphilis.

Key words: Symptomatic neurosyphilis, Intensive anti-syphilis therapy, Clinical and laboratory characteristics

Fang Qian, Aibin Wang, Di Tian, Yanli Xu, Rui Song, Rongmeng Jiang, Zhihai Chen. Clinical and laboratory characteristics of patients with symptomatic neurosyphilis before and after intensive anti-syphilis treatment[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2019, 13(02): 134-139.

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References 22

[1]	龚向东，岳晓丽，滕菲, 等. 2000-2013年中国梅毒流行特征与趋势分析[J]. 中华皮肤科杂志,2014,47(5):310-315.
[2]	Forest A, Barrou Z, VernYM. Neurosyphilis and cognitive disorders[J]. Geriatr Psychol Neuropsychiatr vieil,2013,11(4):423-431.
[3]	Choe PG, Song JS, Song KH, et al. Usefulness of routine Lumbar puncture in non-HIV patients with latent syphilis of unknown duration[J]. Sex Transm Infect,2010,86(1):39-40.
[4]	Faden J, O’Reardon J. Misdiagnosed neurosyphilis associated with prolonged psychosis[J]. Acta neuropsychiatr,2016,28(6):362-364.
[5]	Ahbeddou N, El Alaoui Taoussi K, Ibrahimi A, et al. Stroke and syphilis: A retrospective study of 53 patients[J]. Rev neurol(Paris), 2018,174(5):313-318.
[6]	中国疾病预防控制中心性病控制中心，中华医学会皮肤性病学分会性病学组，中国医师协会皮肤科医师分会性病亚专业委员会. 梅毒,淋病,生殖器疱疹,生殖道沙眼衣原体感染诊疗指南(2014)[J]. 中华皮肤科杂志,2014,47(5):365-372.
[7]	Workowski KA, Bolan GA. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015[J]. MMWR Recomm Rep,2015,64(RR-03):1-137.
[8]	何明峰. 神经梅毒的近期研究综述[J]. 实用医药杂志,2011,28(6):551-554.
[9]	Larsen SA, Steiner BM, Rudolph AH. Laboratory diagnosis and interpretation of tests for syphilis[J]. Clin Microbiol Rev,1995,8(1):1-21.
[10]	Lukehart SA, Hook EW 3rd, Baker-Zander SA, et al. Invasion of the central nervous system by Treponema pallidum: implications for diagnosis and treatment [J]. Ann Intern Med,1988,109(11):855-862.
[11]	Garcia P, Grassi B, Fich F, et al. Laboratory diagnosis of Treponema pallidum infection in patients with early syphilis and neurosyphilisthrough a PCR-based test[J]. Rev Chilena Infectol, 2011,28(4):310-315.
[12]	Molepo J, Pillay A, Weber B, et al. Molecular typing of Treponema pallidum strains from patients with neurosyphilis in Pretoria, South Africa[J]. Sex Transm Infect,2007,83(3):189-192.
[13]	Chung KY, Lee MG, Lee JB. Detection of Treponema pallidum by polymerase chain reaction in the cerebrospinal fluid of syphilis patients[J]. Yonsei Med J,1994,35(2):190-197.
[14]	Gayet-Ageron A, Ninet B, Toutous-Trellu L, et al. Assessment of a real-time PCR test to diagnose syphilis from diverse biological samples[J]. Sex Transm Infect,2009,85(4):264-269.
[15]	Marra CM. Neurosyphilis [J]. Continuum(Minneap Minn), 2015,12(21):1714-1728.
[16]	Gu W, Yang Y, Lei W, et al. Comparing the performance characteristics of CSF-TRUST and CSF-VDRL for syphilis: A cross-sectional study[J]. BMJ,2013,3(2):1-5.
[17]	Zhu L, Gu X, Peng RR, et al. Comparison of the cerebrospinal fluid (CSF) toluidine red unheated serum test and the CSF rapid plasma reagin test with the CSF venereal disease research laboratory test for diagnosis of neurosyphilis among HIV-negative syphilis patients in China[J]. J Clin Microbiol,2014,52(3):736-740.
[18]	谭燕，王丽娟，张玉虎, 等. 神经梅毒脑脊液蛋白含量与3年远期预后相关研究[J]. 中华神经医学杂志,2013,12(2):212-213.
[19]	Thurnheer MC, Weber R, Toutous-Trellu L, et al. Occurrence, risk factors, diagnosis and treatment of syphilis in the prospective observational Swiss HIV cohort study[J]. AIDS,2010,24(12):1907-1916.
[20]	Sena AC, Wolff M, Martin DH, et al. Predictors of serological cure and serofast state after treatment in HIV-negative persons with early syphilis[J]. Clin Infect Dis,2011,53(11):1092-1099.
[21]	Marra CM, Maxwell CL, Tantalo LC, et al. Normalization of serum rapid plasma reagin titer predicts normalization of cerebrospinal fluid and clinical abnormalities after treatment of neurosyphilis[J]. Clin Infect Dis,2008,47(7):893-899.
[22]	陈勇，段毓姣，杨思园, 等. 神经梅毒实验室诊断研究进展[J]. 传染病信息,2016,29(1):60-64.

指标	治疗前	治疗结束6个月	Z值	P值
CSF-WBC^a,b	10.00（6.00，45.00）	5.50（3.00，10.00）	－0.318	0.751
CSF-PRO^a,b	64.50（52.05，88.55）	50.85（37.28，65.25）	－3.238	0.001
log₂CSF-TRUST^a,c	0.60（0.30，0.90）	0.30（0.00，0.60）	－3.012	0.003

指标	治疗前	治疗结束6个月	Z值	P值
CSF-WBC^a,b	10.00（6.00，45.00）	5.50（3.00，10.00）	－0.318	0.751
CSF-PRO^a,b	64.50（52.05，88.55）	50.85（37.28，65.25）	－3.238	0.001
log₂CSF-TRUST^a,c	0.60（0.30，0.90）	0.30（0.00，0.60）	－3.012	0.003

临床表现	治疗前（29例）	治疗后症状减轻（16例）
脑脊膜梅毒	4（13.8）	3（18.8）
头痛	4（13.8）	3（18.8）
头晕	3（10.3）	1（6.3）
脑膜刺激征	1（3.4）	1（6.3）
眼梅毒	2（6.9）	2（12.5）
视物模糊	2（6.9）	2（12.5）
复视	1（3.4）	1（6.3）
麻痹性痴呆	19（65.5）	10（63.0）
反应迟钝	11（37.9）	9（31.3）
言语障碍	6（20.7）	5（26.3）
记忆障碍	7（24.1）	2（12.5）
精神行为异常	7（24.1）	2（12.5）
脊髓痨	9（31.0）^a	1（6.3）
大小便失禁	1（3.4）	1（6.3）
下肢感觉异常	4（13.8）	1（6.3）
步态蹒跚	5（17.2）	0（0.0）

临床表现	治疗前（29例）	治疗后症状减轻（16例）
脑脊膜梅毒	4（13.8）	3（18.8）
头痛	4（13.8）	3（18.8）
头晕	3（10.3）	1（6.3）
脑膜刺激征	1（3.4）	1（6.3）
眼梅毒	2（6.9）	2（12.5）
视物模糊	2（6.9）	2（12.5）
复视	1（3.4）	1（6.3）
麻痹性痴呆	19（65.5）	10（63.0）
反应迟钝	11（37.9）	9（31.3）
言语障碍	6（20.7）	5（26.3）
记忆障碍	7（24.1）	2（12.5）
精神行为异常	7（24.1）	2（12.5）
脊髓痨	9（31.0）^a	1（6.3）
大小便失禁	1（3.4）	1（6.3）
下肢感觉异常	4（13.8）	1（6.3）
步态蹒跚	5（17.2）	0（0.0）

患者编号	CSF-WBC（/μl）^a		CSF-PRO（mg/dl）^b		CSF-TRUST倒数		serum-TRUST倒数
患者编号	治疗前	治疗后6个月	治疗前	治疗后6个月	治疗前	治疗后6个月	治疗前	治疗后6个月	治疗后2年
1	2	4	58.4	64.5	1	2	16	8	8
2	50	6	52.6	20.7	8	8	32	16	4
3	6	4	52.7	39.4	2	1	16	16	16
4	8	10	87.6	50.6	16	16	256	128	128
5	20	4	64.5	85.7	2	4	128	128	128
6	0	5	46.5	9.9	2	2	64	64	16
7	11	12	64.1	66.0	4	4	64	16	16

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