Clinical features associated with neurosyphilis in people living with HIV and late latent syphilis

Background The diagnosis of neurosyphilis is a challenge, and the criteria for deciding when to perform a lumbar puncture are still controversial, especially in people living with HIV with a late latent syphilis diagnosis. Methods Retrospective analysis of demographic, clinical, and laboratory data of people with HIV and documented late latent syphilis or syphilis of unknown duration with a cerebrospinal fluid VDRL test. Results 122 patients were evaluated, of whom 52 had the diagnosis of neurosyphilis. Patients with and without neurosyphilis presented a similar viral load and lymphocyte CD4+ T-cell count. Neurological symptoms (OR 6.4, 95% CI 2.1–22.4; p < 0.01), serum VDRL titers of 1:32 ( p<0.01), 1:64 ( p = 0.055), and ≥1:128 ( p < 0.001) were associated with neurosyphilis. Furthermore, serum VDRL ≥1:32 were associated with (OR 24.9, 95% CI 5.45–154.9; p < 0.001) or without (OR 6.5, 95% CI 2.0–29.2; p = 0.004) neurological symptoms with neurosyphilis; however, VDRL ≤1:16 with neurological symptoms can be associated with neurosyphilis (OR 7.6, 95% CI 1.03–64.3; p = 0.046). Conclusion Neurological symptoms, particularly headache, were predictors of neurosyphilis in people with HIV irrespective of their viral load and lymphocyte CD4+ T-cell count in late latent syphilis. A serum VDRL ≥1:32 increased the risk of neurosyphilis in patients with or without any symptoms.

Nonspecific protective factors in patients with early latent syphilis (report 1)

The objective of this work is to study nonspecific protective factors in patients with latent early syphilis. The results of the study are based on the data of a comprehensive examination before treatment of 142 patients with early latent syphilis and 20 patients of the comparison group. Methods of investigation: serological methods for the diagnosis of syphilis complex of serological reactions, enzyme-linked immunosorbent assay (IgM, IgG), Indirect immunofluorescence reaction (RIF) RIF-200, RIF-abs; determination of cytokines IL-2, IL-6, IL-10, TNFα and INFγ in blood serum by enzyme-linked immunosorbent assay; determination of the phenotype of lymphocytes (CD-receptors), the concentration of circulating immune complexes, phagocytic number, phagocytic index, Nitroblue tetrazolium test. In the blood serum of patients the concentration of IL-2, IL-6, IL-10 and TNFα, INFγ was significantly increased. The concentration of IL-10 and IL-6 was also significantly increased in patients with more than 1 year of infection. The most significant disorders of the parameters of the metabolic activity of neutrophils were found in patients with an infection of more than 1 year; an imbalance in the circulating immune complexes concentration was also established. Under the increasing duration of the infection, the concentration of CD16+ in the blood serum progressively decreases. The content of pro-inflammatory and anti-inflammatory cytokines in the blood serum of patients with early latent syphilis was significantly increased and depended on the timing of infection. This relationship was most pronounced for IL-6 and IL-10. In patients with early latent syphilis there is also an imbalance between CD25+ and late activation factor HLA-DR against the background of a progressive decrease in the number of CD16+ lymphocytes. A direct relationship was established between the time of infection and the number of NK-cells. The revealed disorders may be the consequence of significant disorders on the part of neutrophils and may be one of the factors of the latent course of syphilitic infection.

Features of biochemical indices and content of enzymes in the serum of syphilis patients with viral hepatites B and C in the course of treatment

Objective – before and after the treatment to determine the functional state of the liver, serum levels of enzymes and biochemical indices in syphilis patients with viral hepatites B and C. The results of the study are based on the data from a comprehensive examination of 35 patients with syphilis alone and 127 patients with syphilis co-infected with viral hepatites B and C before and after treatment. Test methods: hepatology, rheogeopathography, enzyme content and biochemical parameters determined in the serum. According to the results of radionuclide hepatology it has been established that disorders of the functional capacity of the liver already occur in the early stages of the disease. The most significant disorders have been in the patients with the prescription of infection for more than 12 months and in the patients co-infected with viral hepatites B and C. A disorder of pigment metabolism and increased activity of trans­aminases have been revealed in early latent syphilis. In co-infection with viral hepatites B and C an increase in total bilirubin, Lactate dehydrogenase, Alanine transaminase, Aspartate aminotransferase and albumin has been revealed. Dysproteinemia has been revealed in patients with early latent syphilis co-infected with hepatitis C. Patients with early latent syphilis treated with immunomodulators tend to normalize these indices. In patients with syphilis a disorder of the functional state of the liver have been revealed already at an early stage of the disease. The most pronounced disorder of biochemical parameters and activity of liver enzymes are observed in syphilis patients with viral hepatites B and C, as well as in patients with early latent syphilis only with the prescription of the infection for more than 12 months; in such a case it is advisable to use drugs affecting the immune system.

Treatment of dorsal tabes with salvarsan and latent lues "a. Pulay (Deut. med. Woch., 1922, Ж 7)

With the usual treatment of dorsal tabes with salvarsan, patients often experience strong reactionary phenomena, namely, stomach crises and severe pain, and with the same treatment of latent syphilis, easy fatigue, headaches, weight loss, etc.

Development and research of a model for differential diagnosis of latent late syphilis and false-positive serological reactions on immunochips with a panel of 12 Treponema pallidum antigens

The aim - to find the optimal attributing rules to distinguish groups of latent stages of syphilis and false positive serological tests of using multivariate discriminant analysis Material and methods. The objects of the study were serum samples from patients with late latent (N=34) syphilis and false positive serological tests (N=31). The samples were studied to determine IgG and IgM levels using indirect immunofluorescent reaction with immunochip containing recombinant antigens T. pallidum Results The mathematical model allows to differentiate with a high degree of confidence patients with late latent syphilis and with false-positive serological reactions to syphilis. Conclusions. . Multivariate discriminant analysis makes possible to create reliable mathematical models to classify patients with late latent syphilis and with false-positive serological reactions to syphilis.

Análise da sífilis em gestantes nos anos de 2010 a 2019 em Joinville - SC

Syphilis is a common sexually transmitted infection worldwide. Objective: to analyze notified/ confirmed cases of gestational syphilis in Joinville/SC. Method: Descriptive study performed through the retrospective analysis of secondary data, from years 2010 to 2019. One thousand thirty-nine (1039) pregnant women with syphilis were investigated, based on data extracted from the DATASUS Data Processing System. Results: Most of the pregnant women were 29 years old or younger, had no paid job and low-income. Most of these women were diagnosed with syphilis and notified in the 3rd trimester of pregnancy. The predominant clinical classification of syphilis was latent syphilis. Ninety two percent (92%) of pregnant women and fifty two percent (52%) of their partners were treated. Conclusions: It was observed that young women, with no paid employment and low income are more susceptible to Sexually Transmitted Infections. Other findings were the late diagnosis of syphilis among pregnant women, and the condition of untreated partners.

Clinical efficacy and tolerability of 1.5 g/day oral amoxicillin therapy without probenecid for the treatment of syphilis

ObjectivesIntramuscular benzathine penicillin G is not available in certain countries. In a previous report, 3 g/day amoxicillin with probenecid was shown to be effective in treating syphilis in patients with HIV; however, 7.3% of patients changed their therapy owing to adverse events. The objective of this study was to assess the clinical efficacy and tolerability of 1.5 g/day amoxicillin without probenecid for the treatment of syphilis.MethodsThe routine clinical records of patients diagnosed with syphilis and treated with 1.5 g/day amoxicillin at a tertiary care hospital between 2006 and 2018 were retrospectively analysed. Syphilis was diagnosed if serum rapid plasma reagin (RPR) titres were ≥8 RU and the Treponema pallidum latex-agglutination test was positive. Serological cure was defined as a ≥fourfold decrease in the RPR titre within 12 months in symptomatic early syphilis and within 24 months in latent syphilis.ResultsOverall, 138 patients (112 with HIV) were analysed. The percentages of primary, secondary, early latent, late latent and latent syphilis of unknown duration were 8.0%, 50.0%, 25.4%, 5.8% and 10.9%, respectively. The median treatment duration was 4.5 weeks (IQR 4–8 weeks), which was not related to the stage of syphilis. Two patients (1.5%) changed treatment due to skin rash. The rate of serological cure was 94.9% (131/138; 95% CI 89.8% to 97.9%) overall; 93.8% (105/112; 95% CI 87.5% to 97.5%) in patients with HIV and 100% (26/26; 95% CI 86.8% to 100%) in patients without HIV. Treatment duration was not related to the treatment efficacy.ConclusionThe regimen of 1.5 g/day amoxicillin without probenecid is highly effective with a low switch rate in patients with and without HIV.

Metabolomic Analysis of the Cerebrospinal Fluid in Latent Syphilis and Neurosyphilis Patients

Purpose: The infection rate of syphilis continues to rise, and the difficulty in detecting and treating neurosyphilis promptly needs to be resolved. The metabolic profiles of cerebrospinal fluid (CSF) of different patients were analyzed to understand the pathogenesis of syphilis better. Method: The metabolic profiles of 88 CSF samples from patients were analyzed by UPLC-Q Exactive-MS. The experimental process was evaluated by PCA, PLS-DA, and HCA. T-test statistics were used to compare levels of metabolites to determine significant differences between groups. Pathway analysis was based on the KEGG database.Result: In total, 272 metabolites based on 3937 features obtained in ESI- mode and 252 metabolites based on 3799 features in ESI+ mode were identified. A clear separation between latent syphilis and neurosyphilis was found. Levels of lipid and linoleic acid metabolites, such as 9-OxoODE and 9,10,13-TriHOME, were increased in syphilis patients. In patients with neurosyphilis, significant changes in levels of 5-hydroxy-L-tryptophan (5-HTP) and acetyl-N-formyl-5-methoxykynurenamine (AFMK) in the tryptophan-kynurenine pathway were also detected. Only one metabolite, theophylline, differed significantly between symptomatic and asymptomatic neurosyphilis patients. Additionally, KEGG analysis revealed significant enrichment of tryptophan metabolism pathways, indicating a high correlation between tryptophan metabolism and syphilis symptoms. Conclusions: Levels of linoleic acid metabolites, 5-HTP, AFMK and theophylline were significantly altered in different patients. The role of these differential metabolites in the development of syphilis is worthy of further exploration, probably improving the treatment and diagnosis of neurosyphilis and occult syphilis in the future.