Cerebrospinal Fluid Abnormalities in Patients with Syphilis: Association with Clinical and Laboratory Features

• Published in: The Journal of infectious diseases 2004-02, Vol.189 (3), p.369-376
• Main Authors: Marra, Christina M., Maxwell, Clare L., Smith, Stacy L., Lukehart, Sheila A., Rompalo, Anne M., Eaton, Molly, Stoner, Bradley P., Augenbraun, Michael, Barker, David E., Corbett, James J., Zajackowski, Mark, Raines, Charles, Nerad, Judith, Kee, Romina, Barnett, Scott H.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Bacteria; Bacterial diseases; Bacterial diseases of the genital system; Biological and medical sciences; Blood; Blood plasma; CD4 Lymphocyte Count; Cerebrospinal fluid; Female; Fundamental and applied biological sciences. Psychology; HIV 1; HIV Infections - complications; Human bacterial diseases; Human immunodeficiency virus; Humans; Infectious diseases; Latent syphilis; Lumbar punctures; Male; Medical sciences; Microbiology; Middle Aged; Multivariate Analysis; Nervous system diseases; Neurosyphilis; Neurosyphilis - cerebrospinal fluid; Neurosyphilis - etiology; Neurosyphilis - immunology; Reagins - blood; Risk Factors; Syphilis - cerebrospinal fluid; Syphilis - etiology; Syphilis - immunology; T lymphocytes; Treponema pallidum; Treponema pallidum - isolation & purification; Wasserman test
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1086/381227

ObjectiveTo define clinical and laboratory features that identify patients with neurosyphilis MethodsSubjects (n=326) with syphilis but no previous neurosyphilis who met 1993 Centers for Disease Control and Prevention criteria for lumbar puncture underwent standardized history, neurological examination, venipuncture, and lumbar puncture. Neurosyphilis was defined as a cerebrospinal fluid (CSF) white blood cell count >20 cells/μL or reactive CSF Venereal Disease Research Laboratory (VDRL) test result ResultsSixty-five subjects (20.1%) had neurosyphilis. Early syphilis increased the odds of neurosyphilis in univariate but not multivariate analyses. In multivariate analyses, serum rapid plasma reagin (RPR) titer ⩾1:32 increased the odds of neurosyphilis 10.85-fold in human immunodeficiency virus (HIV)–uninfected subjects and 5.98-fold in HIV-infected subjects. A peripheral blood CD4+ T cell count ⩽350 cells/μL conferred 3.10-fold increased odds of neurosyphilis in HIV-infected subjects. Similar results were obtained when neurosyphilis was more stringently defined as a reactive CSF VDRL test result ConclusionSerum RPR titer helps predict the likelihood of neurosyphilis. HIV-induced immune impairment may increase the risk of neurosyphilis