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Neurosyphilis in the 21st century: a descriptive study in a tertiary hospital in Madrid

R.N. Villar-Quiles, J. Porta-Etessam [REV NEUROL 2016;63:393-402] PMID: 27779299 DOI: https://doi.org/10.33588/rn.6309.2016197

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Volumen 63 | Number 09 | Nº of views of the article 8.811 | Nº of PDF downloads 573 | Article publication date 01/11/2016

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ABSTRACT

INTRODUCTION Neurosyphilis can occur at any time following infection by Treponema pallidum and its incidence has increased over recent years. The epidemiological and clinical pattern has undergone a substantial change in the post-antibiotic era. AIMS. To describe and analyse the population of patients diagnosed with neurosyphilis at a tertiary hospital in Madrid from January to May 2015.

PATIENTS AND METHODS A retrospective analysis of the following data was performed: demographic, clinical, complementary tests –serology, cerebrospinal fluid (CSF), neuroimaging– and progression of 28 patients diagnosed between 2008 and 2015.

RESULTS Most of the patients were males (89.3%), Spanish (60.7%), with a mean age of 53 ± 16.4 years. The most frequent forms were asymptomatic (39.3%), followed by ocular syphilis (21%), non-classical forms (14.3%), cognitive deterioration and neuropsychiatric alterations (11%). Fifty per cent presented a concomitant infection by human immunodeficiency virus, most of them asymptomatic, with a significant correlation between CD4+ T-cells and asymptomatic neurosyphilis. Only 50% presented VDRL+ in CSF, the diagnosis being based on the clinical features, serology and alterations in CSF (cytobiochemical or serological). Neuroimages were unspecific in most cases. The early and ocular forms were associated to a better clinical course.

CONCLUSIONS With respect to the pre-antibiotic era, an important decrease can be observed in the late-onset forms, as well as the appearance of non-classical forms that can mimic other conditions such as viral encephalitis. Diagnosis is complex and based on the clinical features, the serology and study of CSF, often with a complex interpretation, and thus clinical suspicion plays a fundamental role in the diagnosis. KeywordsAsymptomatic neurosyphilis Atypical neurosyphilis HIV Meningovascular syphilis Ocular syphilis Progressive general paralysis Syphilitic meningitis Tabes dorsalis Treponema pallidum CategoriesInfecciones Nervios periféricos, unión neuromuscular y músculo Patología vascular

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Neurosyphilis in the 21st century: a descriptive study in a tertiary hospital in Madrid

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