Indication of lumbar puncture for neurosyphilis diagnosis

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Filipe Augusto Gava Martins
Bernardino Geraldo Alves Souto

Abstract

Syphilis is an infect-contagious injury caused by Treponema pallidum, of predominantly sexual transmission, which affects 12 million people worldwide each year. If not cured in its early stages, predisposes to potentially serious complications. One of the complications is neurosyphilis, characterized by the invasion of the central nervous system by T. pallidum in any phase of the natural history of the disease, whose mortality exceeds 60%. In people with HIV, this complication may be more frequent, arising after a shorter period of latency and also be more aggressive. Most often, neurosyphilis is asymptomatic or presents itself by means of little specific clinical manifestations, which require high index of suspicion and invasive laboratory propaedeutics. The diagnosis is made by serological tests or molecular biology study on the cerebrospinal fluid. The controversy is about the indication of this diagnosis and respective treatment in asymptomatic cases, mainly in people living with HIV. This narrative review of the literature concluded that propaedeutic lumbar puncture of neurosyphilis is recommended for people who have serum-reactivity to the VDRL, associated with one or more of the following conditions: neurological manifestations on motor, sensory or cognitive sphere; syphilitic symptoms or VDRL greater than 1:8 post-treatment, discarded reinfection; persons with HIV at the presence of CD4 less than 351 cells/mm3 and VDRL greater than or equal to 1:32; and evidence of no neurological tertiary syphilitic disease in activity (gumma or aortitis). Made the diagnose from these criteria, specific treatment should be given even in asymptomatic cases.

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How to Cite
Martins, F. A. G., & Souto, B. G. A. (2015). Indication of lumbar puncture for neurosyphilis diagnosis. ABCS Health Sciences, 40(2). https://doi.org/10.7322/abcshs.v40i2.737
Section
Review Articles

References

1. Fraga DD. Detecção de Treponema pallidum em líquido cefalorraquidinao (LCR) por reação em cadeia da polimerase (PCR) em pacientes HIV positivos assintomáticos com diagnóstico de sífilis latente. Dissertação (Mestrado) - Universidade Federal do Rio Grande do Sul. Porto Alegre: 2013.

2. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância Epidemiológica. Doenças infecciosas e parasitárias: guia de bolso. Ministério da Saúde. 8 ed. rev. Brasília: Ministério da Saúde, 2010. p. 373-86.

3. Silva Neto RP. Erros diagnóstico e terapêutico em neurossífilis: uma análise de dez anos. Rev Bras Neurol. 2008;44(2):35-40.

4. Ghanem KG. Review: neurosyphilis: a historical perspective and review. CNS Neurosc Ther. 2010;16(5):e157-68. http://dx.doi.org/10.1111/j.1755-5949.2010.00183.x

5. Madhusudhan M. Neurosyphilis. Neurol India; J Neurol Soc India. 2009;57(3):233-4. http://dx.doi.org/10.4103/0028-3886.53259

6. De Almeida SM, Bhatt A, Riggs PK, Durelle J, Lazzaretto D, Marquie-Beck J, et al. Cerebrospinal fluid human immunodeficiency vírus viral load in patients with neurosyphilis. J Neurovirol. 2010;16(1):6-12. http://dx.doi.org/10.3109/13550280903514776

7. Proudfoot M, McLean B. Old adversaries, modern mistakes: neurosyphilis. Pract Neurol. 2013;13(3):174-7. http://dx.doi.org/10.1136/practneurol-2012-000314

8. Cleinman IB, May SB. Diretrizes de Atendimento de Sífilis em Adultos. Serviço de Doenças Infecciosas e Parasitárias do Hospital Universitário Clementino Fraga Filho. Universidade Federal do Rio de Janeiro. Disponível em: http://www.hucff.ufrj.br/download-de-arquivos/category/26-dip?download=338:rotinas. Acesso em: 13 mar. 2015.

9. Chahine LM, Khoriaty RN, Tomford WJ, Hussain MS. The changing face of neurosyphilis. Int J Stroke. 2011;6(2):136-43. http://dx.doi.org/10.1111/j.1747-4949.2010.00568.x

10. Almeida Filho N, Rouquayrol, MZ. Introdução à Epidemiologia. 4. ed. Rio de Janeiro: MESI; 2006.

11. Barros AM, Cunha AP, Lisboa C, Sá MJ, Resende C. Neurossífilis revisão clínica e laboratorial. Arq Med. 2005;19(3):121-9.

12. Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. 2006;55(RR11):1-94.

13.Workowski KA, Berman S. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010;59(RR12):1-110.

14. Avelleira JCR, Bottino G. Sífilis: diagnóstico, tratamento e controle. An Bras Dermatol. 2006;81(2):111-26. http://dx.doi.org/10.1590/S0365-05962006000200002

15. Machado LR, Livramento JA, Vianna LS. O exame do liquido cefalorraquidiano em doenças infecciosas do sistema nervoso: quando pedir, o que pedir, o que esperar. Arq Neuropsiquiatr. 2013;71(9B):693-98. http://dx.doi.org/10.1590/0004-282X20130153

16. Ho EL, Marra CM. Treponemal tests for neurosyphilis - less accurate than what we thought? Sex Transm Dis. 2012;39(4):298-9. http://dx.doi.org/10.1097/OLQ.0b013e31824ee574

17. Salazar JC, Cruz AR, Pope CD, Valderrama L, Trujillo R, Saravia NG, et al. Treponema pallidum elicits innate and adaptive cellular immuneresponses in skin and blood during secondary syphilis: a flow-cytometric analysis. J Infect Dis. 2007;195(6): 879-87. http://dx.doi.org/10.1086/511822

18. Nadal LRM, Nadal SR. Indicações da punção liquórica nos portadores de sífilis. Rev Bras Colo-proctol. 2006;26(4):459-62. http://dx.doi.org/10.1590/S0101-98802006000400015

19. Ghanem KG, Moore RD, Rompalo AM, Erbelding EJ, Zenilman JM, Gebo KA. Lumbar puncture in HIV-infected patients with syphilis and no neurologic symptoms. Clin Infect Dis. 2009;48(6):816-21. http://dx.doi.org/10.1086/597096

20. Dumaresq J, Langevin S, Gagnon S, Serhir B, Deligne B, Tremblay C, et al. Clinical prediction and diagnosis of neurosyphilis in HIV-infected patients with early Syphilis. J Clin Microbiol. 2013;51(12):4060-6. http://dx.doi.org/10.1128/JCM.01989-13

21. Martinelli P, Rizzo G, Scaglione C, Capellari S. Neurosyphilis orofacial dyskinesia: the candy sign. Mov Disord. 2013;28(2):246-7. http://dx.doi.org/10.1002/mds.25281

22. Choe PG, Song JS, Song KH, Jeon JH, Park WB, Park KU, et al. Usefulness of routine lumbar puncture in non-HIV patients with latent syphilis of unknown duration. Sex Transm Infect. 2010;86(1):39-40. http://dx.doi.org/10.1136/sti.2009.037267