Methods: We identified patients with suspected NS from the King County Public Health STD and Harborview Infectious Disease clinics from 10/2016 to 2/2018. Demographics, clinical symptoms, diagnostics, treatment and outcomes were collected by chart review. Successful NS treatment was defined as resolution of cerebrospinal fluid (CSF) pleocytosis or elevated protein, improvement in neurologic symptoms or appropriate decrease in serum rapid plasma reagin (RPR) or CSF Venereal Disease Research Laboratory (VDRL) titers.
|Table 1: Demographic and socioeconomic characteristics|
|Total = 43|
|Insurance status ❖|
|Substance use disorder||15 (35)|
|HIV Positive||22 (51)|
|Viral load suppressed (< 200 copies/mL)||13 (59)|
|❖ Represents > 1 payer per patient|
Results: We identified 43 cases of suspected NS. The most common symptoms were blurred vision, headache and tinnitus. All had a lumbar puncture (LP). Median days from LP to treatment initiation was 6 - many starting on day of diagnosis. Fourteen patients (33%) required admission for treatment. Two patients declined therapy. IV PCN G was used in 93% of cases; 1 received IM ceftriaxone. Treatment was successful in 32 of 41 (78%) cases, with 23 of these (72%) managed as outpatients. Three cases were treatment failures for incomplete therapy adherence or equivocal response and uncertain diagnosis.
Conclusion: Without available IM procaine PCN, neurosyphilis is challenging to manage in vulnerable populations or those wishing to avoid inpatient admission. Employing a multidisciplinary, coordinated care approach can lead to successful treatment of NS using IV PCN in the outpatient setting.
M. Ramchandani, None
R. Kerani, None
S. Dhanireddy, None