Cerebrospinal fluid abnormalities in patients with syphilis: association with clinical and laboratory features.
OBJECTIVE
To define clinical and laboratory features that identify patients with neurosyphilis.


METHODS
Subjects (n=326) with syphilis but no previous neurosyphilis who met 1993 Centers for Disease Control and Prevention criteria for lumbar puncture underwent standardized history, neurological examination, venipuncture, and lumbar puncture. Neurosyphilis was defined as a cerebrospinal fluid (CSF) white blood cell count >20 cells/ microL or reactive CSF Venereal Disease Research Laboratory (VDRL) test result.


RESULTS
Sixty-five subjects (20.1%) had neurosyphilis. Early syphilis increased the odds of neurosyphilis in univariate but not multivariate analyses. In multivariate analyses, serum rapid plasma reagin (RPR) titer > or =1 : 32 increased the odds of neurosyphilis 10.85-fold in human immunodeficiency virus (HIV)-uninfected subjects and 5.98-fold in HIV-infected subjects. A peripheral blood CD4+ T cell count < or =350 cells/ microL conferred 3.10-fold increased odds of neurosyphilis in HIV-infected subjects. Similar results were obtained when neurosyphilis was more stringently defined as a reactive CSF VDRL test result.


CONCLUSIONS
Serum RPR titer helps predict the likelihood of neurosyphilis. HIV-induced immune impairment may increase the risk of neurosyphilis.
Marra
Christina M
CM
Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA. cmarra@u.washington.edu
Maxwell
Clare L
CL
Smith
Stacy L
SL
Lukehart
Sheila A
SA
Rompalo
Anne M
AM
Eaton
Molly
M
Stoner
Bradley P
BP
Augenbraun
Michael
M
Barker
David E
DE
Corbett
James J
JJ
Zajackowski
Mark
M
Raines
Charles
C
Nerad
Judith
J
Kee
Romina
R
Barnett
Scott H
SH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009494:Neurosyphilis / Q000134:cerebrospinal fluid / Q000209:etiology / Q000276:immunology; D011935:Reagins / Q000097:blood; D012307:Risk Factors; D013587:Syphilis / Q000134:cerebrospinal fluid / Q000209:etiology* / Q000276:immunology; D014210:Treponema pallidum / Q000302:isolation & purification*
D011935:Reagins