T. pallidiumcan affect the central nervous system (CNS) during any stage of syphilis. Clinical manifestations of neurosyphilis (NS) are highly variable. The aim of this multicentre study was to describe clinical features, laboratuar findings and therapeatic regimen of 141 patients with NS.
This multicenter study was performed retrospectively by the Infectious Diseases International Research Initiative (ID-IRI) study group to analyze the patients with NS. The study included 22 centers from 4 countries hospitalizing patients between 2000 and 2015. NS was diagnosed at any stage of syphilis. Patients with positive CSF VDRL test, and positive serum treponemal or nontreponemal serologic tests for syphilis were included.
A total of 141 patients were included in this study. (123 males; mean age 48.09±12.32). Asymptomatic NS were detected in 22 (15%), symptomatic meningitis in 67 (47%), meningovascular in 13 (9%), tabes dorsalis in 10 (7%), general paresis 13 (9%) and taboparesis in 16 patients (11%). Forty-three patients (30%) were HIV positive. The symptoms of the patients with NS were headache (n=55, 39%), fatigue (n=52, 36%), altered consciousness (n=50, 35%), fever (n=33, 23%), nausea/vomiting (n=25, 17%), arthralgia (n=20, 14%) weight loss (n=17, 12%), and convulsions (n=7, 4%). Cranial nerve palsy (37 patients, 26%), signs of meningeal irritation (19 patients, 13%) and fever (17 patients, 12%) were also observed. Tabetic, paretic and vascular symptoms were detected in 28 (19%), 32 (22%), and in 39 patients (27%) respectively. Eye examination was performed in 76 patients. Ocular involvement caused by syphilis was detected in 19 patients (25%). 25 patients with NS underwent ear examination, and ear involvement was observed in the eight patients (32%). Crystallized penicillin, procaine penicillin, ceftriaxone, doxycycline were used in 109 (77%), seven (4%), 31 (21%), and in five patients (3%), respectively. The outcomes of 136 patients were known. Cure, neurological sequelae, relapse, mortality were detected in 64(47%), 56 (39%), one (0,7%), and in 6 patients (4%), respectively. Nine patients died due to other reasons.
A high suspicion of NS among patients with syphilis, and particularly in patients with HIV co-infection should be maintained for early diagnosis.
H. Tireli, None
R. Hasbun, bioMÃ©rieux: Consultant , Consulting fee
S. Senbayrak, None
U. Savascı, None