HIV and syphilis: when to perform a lumbar puncture
AÈ Libois, SÉ De Wit, BÉÉ Poll, F Garcia… - Sexually transmitted …, 2007 - journals.lww.com
Sexually transmitted diseases, 2007•journals.lww.com
Objectives: The objectives of this study were to determine predictive factors for neurosyphilis
in HIV-infected patients with syphilis and optimize the use of lumbar puncture. Study Design:
The authors reviewed 112 cases of HIV-infected patients with syphilis who underwent a
lumbar puncture. Diagnosis of neurosyphilis was based on a cerebrospinal fluid white blood
cells count≥ 20/μL, and/or a reactive cerebrospinal fluid–Venereal Disease Research
Laboratory, and/or a positive intrathecal T. pallidum antibody (ITPA) index. Results: Twenty …
in HIV-infected patients with syphilis and optimize the use of lumbar puncture. Study Design:
The authors reviewed 112 cases of HIV-infected patients with syphilis who underwent a
lumbar puncture. Diagnosis of neurosyphilis was based on a cerebrospinal fluid white blood
cells count≥ 20/μL, and/or a reactive cerebrospinal fluid–Venereal Disease Research
Laboratory, and/or a positive intrathecal T. pallidum antibody (ITPA) index. Results: Twenty …
Objectives:
The objectives of this study were to determine predictive factors for neurosyphilis in HIV-infected patients with syphilis and optimize the use of lumbar puncture.
Study Design:
The authors reviewed 112 cases of HIV-infected patients with syphilis who underwent a lumbar puncture. Diagnosis of neurosyphilis was based on a cerebrospinal fluid white blood cells count≥ 20/μL, and/or a reactive cerebrospinal fluid–Venereal Disease Research Laboratory, and/or a positive intrathecal T. pallidum antibody (ITPA) index.
Results:
Twenty-six of 112 had neurosyphilis. Neurologic manifestations and serum rapid plasma reagin (RPR) were associated with neurosyphilis (P= 0.036, P= 0.018, respectively). In multivariate analysis, log 2 RPR was still associated with neurosyphilis (P= 0.005). In patients without neurologic manifestations, the risk of neurosyphilis increases gradually with log 2 RPR. A serum RPR of 1/32 seems to be the best cutoff point to decide the performance or not of a lumbar puncture (sensitivity 100%, specificity 40%).
Conclusion:
In HIV-infected patients with syphilis, lumbar puncture could be restricted to those with neurologic manifestations or a serum RPR≥ 1/32.
Lippincott Williams & Wilkins