Neurosyphilis in a suspected case of giant cell arteritis

A 67-year-old man had a few month history of deteriorating visual acuity. He had originally presented to ophthalmology with right-sided visual blurring. This subsequently progressed to involve the left eye. At this point, he was empirically treated with high-dose glucocorticoids, both orally and intravenously, with the suspicion that giant cell arteritis was causing acute visual deterioration of his left eye. Unfortunately, his symptoms did not improve. During an admission to hospital for a pneumonia, he underwent further investigations for this bilateral visual loss. He was diagnosed with left neuroretinitis and right vitritis. A thorough workup revealed positive syphilis serology and cerebrospinal fluid was positive on venereal disease research laboratory testing. He was diagnosed and treated for neurosyphilis with intravenous benzylpenicillin 4 million units 4 hourly for 14 days. His left-sided vision improved but he still suffers from severe visual impairment in his right eye.

Late neurosyphilis and VZV meningoencephalitis coinfection

The incidence of syphilis has increasing recently, largely attributable to improved screening that may result in the diagnosis of chronic untreated infections. These patients can develop severe or subtle neurologic symptoms that can be missed and, therefore, detected accidentally while a patient is evaluated for other mimicking neurological infections. A 58-year-old man with diabetes presented with 2 days of aphasia, headache, chills and confusion. He had an MRI brain with evidence of a prior cerebrovascular accident. Subsequently, he developed a fever and thoracic dermatomal rash consistent with herpes zoster. A lumbar puncture was performed, and cerebrospinal fluid analysis revealed a lymphocytic pleocytosis, a reactive Venereal Disease Research Laboratory test and positive varicella-zoster virus (VZV) PCR. He was suspected to have both late neurosyphilis and acute meningoencephalitis from VZV. This paper will discuss how to approach the diagnosis of late neurosyphilis and possible associations with herpesvirus central nervous system infections.

Soroprevalência de testes não-treponemicos em instituições públicas em Avaré-SP

A sífilis é uma infecção sexualmente transmissível (IST), causada pela bactéria Treponema pallidum, que acomete homens e mulheres. Apesar da relação sexual sem o uso de preservativos ser a principal forma de infecção, a transmissão congênita durante a gestação ou parto têm crescido nos últimos anos. O diagnóstico da sífilis pode ser realizado pelos testes treponêmicos e não-treponêmicos. O objetivo do presente estudo foi determinar a soroprevalência de testes não-treponêmicos, em duas Comunidades Terapêuticas de Avaré/SP, e aplicar um questionário social para avaliar o nível de conhecimento dos voluntários quanto as ISTs. O sangue foi coletado por venopunção, para realização da técnica de Venereal Disease Research Laboratory (VDRL) qualitativo e semi-quantitativo, além de teste rápido treponêmico específico para confirmação dos exames reagentes. Os resultados obtidos foram de 41 voluntários que estavam na faixa etária de 22 a 58 anos, onde 36,6% eram mulheres e 63,4% eram homens. As mulheres tinham mais conhecimento a respeito da sífilis do que os homens. Sobre os métodos de prevenção, 23,1% dos homens e 73,3% das mulheres disseram ter conhecimento sobre a forma correta de prevenção. Porém, aproximadamente metade deles afirmaram que não utilizavam preservativos durante o ato sexual. Dos testes realizados, 4,9% (2 voluntários) foram reagentes para sífilis. A maioria dos indivíduos não possuíam um conhecimento razoável sobre as ISTs, e, além disso, não utilizavam preservativos durante as relações sexuais, favorecendo, assim, a exposição e transmissão da sífilis.

Efektivitas Pemeriksaan Serologis Sifilis

High prevalence of syphilis can be reduced by doing screening. Tests used for screening and diagnosis of syphilis are serological tests of syphilis consisting of nontreponemal tests and treponemal tests. Nontreponemal tests consist of Rapid Plasma Reagin (RPR) and Venereal Disease Research Laboratory (VDRL) meanwhile Treponemal tests consist of Treponema Pallidum Haemagglutination Assay (TPHA) and Treponema Pallidum Rapid (TP Rapid). This study was aimed to determine the effectiveness of syphilis serological tests. This was a literature review study using the keywords namely serology OR serological OR serologic AND syphilis in PubMed and ClinicalKey. The literatures were written in English and/or Indonesian, published in the last 10 years (2011-2020), and can be accessed in full text. The results obtained 25 literatures. High sensitivity was found in RPR of 9.1%-100%, VDRL of 44.4% -100%, and TP Rapid of 50.0%-100%. High specificity was found in TPHA of 99.7% and TP Rapid of 85.3% -100%. In conclusion, effective syphilis screening is performed with RPR and VDRL, while effective syphilis diagnostic is performed with TP Rapid and TPHA.Keywords: syphilis, serology tests, effectiveness of tests Abstrak: Prevalensi kasus sifilis yang tinggi dapat diturunkan dengan adanya skrining. Pemeriksaan yang digunakan untuk skrining dan diagnosis sifilis ialah pemeriksaan serologis sifilis, terdiri atas pemeriksaan serologis non spesifik treponema dan pemeriksaan serologis spesifik treponema. Pemeriksaan serologis non spesifik treponema antara lain Rapid Plasma Reagin (RPR) dan Venereal Disease Research Laboratory (VDRL). Pemeriksaan serologis spesifik treponema antara lain Treponema Pallidum Haemagglutination Assay (TPHA) dan Treponema Pallidum Rapid (TP Rapid). Penelitian ini bertujuan untuk mengetahui efektivitas pemeriksaan serologis sifilis. Jenis penelitian ialah literature review menggunakan kata kunci serology OR serological OR serologic AND syphilis di PubMed dan ClinicalKey. Literatur yang digunakan memiliki bahasa Inggris dan/atau bahasa Indonesia, terbitan 10 tahun terakhir (2011-2020), dan dapat diakses teks lengkap. Sensitivitas tinggi ditemukan pada RPR sebesar 9,1%-100%, VDRL sebesar 44,4%-100%, dan TP Rapid sebesar 50,0%-100%. Spesifisitas tinggi ditemukan pada TPHA sebesar 99,7% dan TP Rapid sebesar 85,3%-100%. Simpulan penelitian ini ialah skrining sifilis efektif dilakukan dengan RPR dan VDRL, sedangkan diagnostik sifilis efektif dilakukan dengan TP Rapid dan TPHA.Kata kunci: sifilis, pmeriksaan serologis, efektivitas pemeriksaan

Frequency of reagent samples for syphilis in pregnant women treated at Distrital Leste Laboratory, Manaus, Amazonas, Brazil

Objective: Checking the frequency of reagent samples for syphilis in pregnant women treated at the Distrital Leste Laboratory in the city of Manaus from January 2016 to December 2018, comparing the positive VDRL (Venereal Disease Research Laboratory) cases with the confirmatory FTA-Abs (Fluorescent Treponemal Antibody Absorption Test). Methods: The study was cross-sectional and assessed the results of two syphilis diagnostic tests, VDRL and FTA-Abs. Data were obtained using the database of the electronic program SoftLab® and the Laboratory Environment Manager (GAL) and were quantitatively analyzed. Results: In 2016, 9,028 VDRL tests were performed on pregnant women, 8,562 tests in 2017 and 5,064 in 2018. From this total, 1020 tested positive for syphilis; 392 in 2016, 320 in 2017 and 308 in 2018, increasing from 4 to 6%. Comparison with the FTA-Abs was only made possible in 2016 when the diagnosis was confirmed in 82% of the tests. Conclusion: It was possible to check the frequency of pregnant women with positive and confirmatory results from 2016 to 2018, showing that although this pathology is easily preventable, it remains a challenging public health issue in pregnant women.

Dados alarmantes sobre a notificação de sífilis congênita em uma capital do Norte brasileiro: um estudo transversal

Modelo do estudo: Estudo de prevalência. Objetivo do estudo: Descrever o perfil clínico e epidemiológico dos portadores de Sífilis Congênita entre Janeiro de 2010 a Junho de 2016 em uma capital do Norte brasileiro. Metodologia: Foi realizado um levantamento das fichas de notificação para infecção por sífilis congênita da Vigilância Epidemiológica em Rio Branco-Acre no período de Janeiro 2010 a Junho de 2016. Os dados foram analisados por meio do Statistical Package for Social Sciences (SPSS). Resultados: Foram notificados 189 casos de sífilis congênita precoce. Apenas 36,51% (n=69) receberam diagnóstico de sífilis gestacional antes do parto. Os casos evoluíram com 74,6% de nascidos vivos, 15,3% de natimortos, 6,3% de abortos e 2,1% de óbitos por sífilis congênita. A relação entre o Venereal Disease Research Laboratory (VDRL) materno e o desfecho dos casos sugere que filhos provenientes de mães com títulos ≥1:16 representam 82,2% das evoluções deletérias associadas (p=0,045). Conclusão: A sífilis na gestação é uma patologia ainda subdiagnosticada durante a gravidez e, nesse estudo, foi mais frequente em filhos de mães no auge da menacme, de baixa escolaridade e moradoras da zona urbana. Apesar das medidas preventivas já implantadas, a sífilis congênita continua sendo um problema de saúde pública nesta capital do Norte brasileiro e deve continuar como alvo de estudos que gerem novas estratégias de prevenção.

Sífilis na gestação: barreiras na assistência pré-natal para o controle da transmissão vertical

Resumo Introdução A sífilis gestacional é uma doença de transmissão vertical, da mãe para o feto, que se não tratada, pode resultar em inúmeros desfechos negativos para a saúde materna e infantil. Objetivo Avaliar as barreiras na assistência pré-natal para o controle da transmissão vertical da sífilis em gestantes segundo o perfil sociodemográfico, reprodutivo e assistencial em uma metrópole do Nordeste brasileiro. Método Estudo descritivo, conduzido a partir de banco de dados de um estudo caso-controle para sífilis gestacional em maternidades públicas no Nordeste do Brasil, entre 2013 e 2014. As informações do acompanhamento e tratamento foram obtidas pelos registros do cartão do pré-natal e entrevistas. O diagnóstico de sífilis considerou os registros do cartão, anotações em prontuário e resultados do Venereal Disease Research Laboratory (VDRL). Resultados Foram incluídas 1.206 mulheres, 91,7% realizaram pré-natal e se declararam, em maior proporção, como casadas, menor número de filhos e maior escolaridade. O resultado do VDRL do pré-natal foi anotado em 23,9%. Entre as 838 mulheres que receberam o VDRL no pré-natal, 21% eram reagentes e 70,5% trataram a infecção. Destas, 69,4% utilizaram o esquema para sífilis terciária e 8,1% trataram com outras medicações. Conclusão O pré-natal não alcançou a efetividade na prevenção e rastreio da sífilis, uma vez que ocorreram mulheres reagentes para a infecção na admissão à maternidade, ainda que em menor proporção, sendo perdida a oportunidade de alcançar o controle da doença.

339. Assessing Utilization of the Venereal Disease Research Laboratory Test in Cerebrospinal Fluid for the Diagnosis of Neurosyphilis: A Cohort Study

Background The Venereal Disease Research Laboratory (VDRL) test performed in cerebrospinal fluid (CSF) is considered highly specific for the diagnosis of neurosyphilis, but algorithms to diagnose neurosyphilis require positive syphilis serologic testing prior to obtaining CSF-VDRL. Inappropriate use of diagnostic tests depletes healthcare resources, and contributes to rising healthcare expenditures. CSF-VDRL has historically been improperly utilized; however there is no recent evaluation of its use in clinical practice. We aimed to quantify rates of appropriate CSF-VDRL testing, determine the CSF-VDRL false-positivity rate and describe causes of false-positive CSF-VDRL reactivity. Methods In this retrospective cohort study of three Mayo Clinic sites (Rochester, MN, Jacksonville, FL, and Scottsdale, AZ), we measured the rate of appropriate CSF-VDRL test utilization in patients with negative testing from January 1, 2011 to December 31, 2017. We then identified all patients with positive CSF-VDRL testing from January 1, 1994 to February 28, 2018, characterized true- and false-positive rates and described causes of CSF-VDRL false-positivity. Results Among 8,553 persons with negative CSF-VDRL results, testing was unnecessarily ordered in 8,399 (98.2%). The word “syphilis” or “neurosyphilis” appeared in the notes of only 1,184 (13.8%) individuals with a negative CSF-VDRL result. From January 1994 through February 2018, 33,933 CSF-VDRL tests were performed on 32,626 individual patients. Among 60 positive CSF-VDRL results, 41 (68.3%) were true-positives, 2 (3.3%) were indeterminate, and 17 (28.3%) were false-positives. Every patient with true-positive CSF-VDRL had positive serologic syphilis testing prior to CSF testing. All patients with false-positive CSF-VDRL results were inappropriately tested. Neoplastic meningitis was a common cause of false-positive CSF-VDRL results. Conclusion This is the first study in decades to review CSF-VDRL utilization for the diagnosis of neurosyphilis. Inappropriate use of CSF-VDRL testing for diagnosis of neurosyphilis remains problematic in clinical practice. Following recommended testing algorithms would prevent unnecessary testing, preserve resources, and minimize false-positive results. Disclosures All Authors: No reported disclosures