gms | German Medical Science

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010)

Deutsche Gesellschaft für Infektiologie,
Deutsche AIDS-Gesellschaft,
Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit,
Paul-Ehrlich-Gesellschaft für Chemotherapie

23.06. - 26.06.2010, Köln

Prevalence of early Neurosyphilis (NSI) diagnosed by Cerebrospinal Fluid (CSF) in HIV-infected patients

Prävalenz der frühen Neurosyphilis bei HIV-infizierten Patienten

Meeting Abstract

  • S. Esser - Universitätsklinikum Essen, Klinik für Dermatologie und Venerologie, Essen, Germany
  • R. Jablonka - Universitätsklinikum Essen, Klinik für Dermatologie und Venerologie, Essen, Germany
  • B. Ross - Universitätsklinikum Essen, Klinik für Dermatologie und Venerologie, Essen, Germany
  • P. Schenk-Westkamp - Universitätsklinikum Essen, Klinik für Dermatologie und Venerologie, Essen, Germany
  • A. C. Riehemann - Universitätsklinikum Essen, Klinik für Dermatologie und Venerologie, Essen, Germany
  • D. Schadendorf - Universitätsklinikum Essen, Klinik für Dermatologie und Venerologie, Essen, Germany

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010). Köln, 23.-26.06.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocHIV 06-2

DOI: 10.3205/10kit002, URN: urn:nbn:de:0183-10kit0025

Published: June 2, 2010

© 2010 Esser et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Background: Since 2000 prevalence of SI increased in Germany. SI cases showed rapid progression of SI to NSI and therapy failure in HIV-infected patients. The aim of the study is to evaluate signs for NSI in CSF in patients with co-infection of SI and HIV from January 2000 till February 2005.

Methods: This prospective ongoing study included HIV-positive Patients with serological (TPHA, VDRL, IgM Western Blot) and clinical diagnosed primary or secondary SI. Neurological examinations and CSF puncture were performed and repuncture 12 months after treatment (TPHA, TPHA- ratio, FTA-ABS-19s-IgM, blood-CSF-barrier).

Results: 94% of the 47 male patients (CDC WHO stage A 17%, B 68%, C 15%; mean age 37 yrs) were described as men who have sex with men, three were heterosexual. Mean CD4-cell count was 469/µl (range 81–1164) and mean HIV-RNA 48497 copies/ml (range 50–500.000). 31 (66%) patients were treated with antiretroviral therapy. Nine patients (19%) showed infectious seropositive SI without dermatological symptoms and 35 (74%) showed makulo-papular exanthema. All IgM-Western Blots were positive. Mean TPHA was 1:1.299.885 (range 1:1.280–1:41.943.040), mean VDRL 1:634 (1–1:8.192). Mean CSF-TPHA was 1:387 (range 1:2–1:8.192), in repuncture of actual 11 patients 1:32 (range 0–1:128). Nine (19%) patients had a positive FTA-ABS-19s-IgM in CSF. Neurological symptoms were verified by a neurologist in three patients. At least a neurological attendance of SI was diagnosed in seven cases (15%) followed by intravenous Penicillin G therapy for 21 days. The others got intramuscularly treatment with Benzathinpenicillin for 14 days. In repuncture one year after treatment neither treatment failure nor positive CSF-FTA-ABS-19s-IgM titer was observed after therapy.

Conclusions: 15% of the HIV-positive patients with infectious SI had signs of early NSI. No treatment failure was observed in repuncture. This survey shows increased risk of NSI in HIV-Infected patients but obviously no treatment failure after sufficient therapy.