Tabla I. Criterios diagnósticos de neurosífilis. |
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Probable |
Definitiva |
|||
Sin VIH |
Con VIH |
Sin VIH |
Con VIH |
|
Sangre |
Prueba treponémica |
Prueba treponémica |
||
Líquido cefalorraquídeo |
Leucocitos > 5/mm3 |
Leucocitos > 20/mm3 |
VDRL reactiva |
|
FTA-ABS: fuorescent treponemal antibody absorption; TPHA: Treponema pallidum hemagglutination assay; VDRL: venereal disease research laboratory; VIH: virus de la inmunodeficiencia humana. |
Tabla II. Principales comorbilidades presentes. |
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n |
% |
|||
Infecciosas |
VIH |
4 |
25,00 |
|
Citomegalovirus |
3 |
18,75 |
||
Toxoplasmosis |
3 |
18,75 |
||
Tuberculosis |
3 |
18,75 |
||
Histoplasmosis |
1 |
6,25 |
||
Sida |
1 |
6,25 |
||
Neurológicas |
Demencia |
5 |
31,25 |
|
Delirium |
2 |
12,50 |
||
Enfermedad cerebrovascular |
1 |
6,25 |
||
Hidrocefalia |
1 |
6,25 |
||
Otras |
Hipertensión arterial |
3 |
18,75 |
|
Hipotiroidismo |
3 |
18,75 |
||
Dislipidemia |
1 |
6,25 |
||
Sarcoma de Kaposi |
1 |
6,25 |
||
VIH: virus de la inmunodeficiencia humana. |
Tabla III. Presentación clínica inicial. |
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n |
% |
||
Manifestaciones neuropsiquiátricas |
Desorientación |
5 |
21,7 |
Cambios en el comportamiento |
4 |
17,4 |
|
Deterioro cognitivo |
4 |
17,4 |
|
Alteración del estado de conciencia |
3 |
13,0 |
|
Lenguaje incoherente |
3 |
13,0 |
|
Alteración de la memoria |
2 |
8,7 |
|
Alucinaciones |
1 |
4,3 |
|
Neologismos |
1 |
4,3 |
|
Manifestaciones motoras |
Alteraciones de la marcha |
4 |
22,2 |
Signo de Babinski |
3 |
16,7 |
|
Afasia |
2 |
11,1 |
|
Hemiparesia |
2 |
11,1 |
|
Pupila de Argyll-Robinson |
2 |
11,1 |
|
Afectación de pares craneales |
1 |
5,6 |
|
Disartria |
1 |
5,6 |
|
Dislalia |
1 |
5,6 |
|
Reflejos de regresión |
1 |
5,6 |
|
Signo de Romberg |
1 |
5,6 |
|
Otros síntomas |
5 |
10,2 |
|
Asintomático |
3 |
6,1 |
Tabla IV. Características de las pruebas diagnósticas de la totalidad de pacientes. |
||||||
FTA-ABS |
VIH |
Conteo CD4+ |
VDRL |
Leucocitos en |
Proteínas en |
|
Paciente 1 |
+ |
– |
+ |
7 |
45 |
|
Paciente 2 |
+ |
– |
+ |
1 |
31 |
|
Paciente 3 |
+ |
– |
1 |
67 |
||
Paciente 4 |
+ |
+ |
297 |
+ |
110 |
244 |
Paciente 5 |
+ |
– |
– |
1 |
46 |
|
Paciente 6 |
+ |
– |
+ |
50 |
77 |
|
Paciente 7 |
+ |
– |
+ |
23 |
79 |
|
Paciente 8 |
+ |
– |
+ |
1 |
57 |
|
Paciente 9 |
+ |
+ |
196 |
+ |
2 |
180 |
Paciente 10 |
+ |
– |
– |
3 |
89 |
|
Paciente 11 |
+ |
+ |
135 |
13 |
131 |
|
Paciente 12 |
+ |
– |
+ |
71 |
235 |
|
Paciente 13 |
+ |
+ |
42 |
– |
1 |
70 |
Paciente 14 |
+ |
– |
+ |
210 |
109 |
|
Paciente 15 |
+ |
– |
+ |
18 |
108 |
|
Paciente 16 |
+ |
– |
+ |
30 |
108 |
|
FTA-ABS: fuorescent treponemal antibody absorption; LCR: líquido cefalorraquídeo; VDRL: venereal disease research laboratory; VIH: virus de la inmunodeficiencia humana. |
Clinical and socio-demographic profile of neurosyphilis: a retrospective study in a reference centre in Colombia Introduction. Neurosyphilis is the Treponema pallidum infection of the central nervous system and can occur at any time after the initial infection. In the 21st century, the incidence of neurosyphilis has increased in the post-antibiotic era. The highest rates of neurosyphilis are from low-income countries and the published studies are limited. Aim. To determine the clinical and sociodemographic characteristics of neurosyphilis patients in a tertiary care center in Pereira, Colombia. Patients and methods. Retrospective study of diagnosed neurosyphilis patients in a tertiary care center in Pereira, Colombia, between 2012 to 2017. The diagnosis was established based on serologic treponemal tests, VDRL in CSF, and CSF analysis. Sociodemographic, clinical, and laboratory parameters variables were obtained. Results. Sixteen patients were included, 11 with definitive neurosyphilis and 5 with probable neurosyphilis. The median age was 59.50 ± 13.78 years. Men accounted for 75% (n = 12) of the patients. Four patients were (25%) HIV-infected. All the patients had positive peripheral FTA-ABS and 11 had reactive VDRL in CSF. The most frequent form was late neurosyphilis (62.5%), being general paralysis the most common. The most frequently clinical manifestations were neuropsychiatric alterations (46.9%), predominantly disorientation, behavioral changes, and cognitive impairment, followed by motor changes (36.7%). Conclusions. Late neurosyphilis was the most prevalent form, predominantly neuropsychiatric alterations. Only a quarter of patients presented HIV coinfection. Key words. Asymptomatic neurosyphilis. Colombia. HIV. Meningovascular neurosyphilis. Progressive general paralysis. Syphilitic meningitis. Tabes dorsalis. Treponema pallidum. |