Combination of the neutrophil to lymphocyte ratio and serum toluidine red unheated serum test titer as a predictor of neurosyphilis in HIV-negative patients

Serum homocysteine levels as a predictor of neurosyphilis among HIV-negative syphilis patients: A single-center retrospective study

This study investigates the differences in peripheral blood parameters between patients with non-neurosyphilis and neurosyphilis, aiming to identify potential serum biomarkers to predict the occurrence of neurosyphilis and avoid unnecessary lumbar punctures. A retrospective analysis was conducted on 110 HIV-negative syphilis patients in this study. We found that the serum homocysteine (Hcy) levels in the non-neurosyphilis group, asymptomatic neurosyphilis group, and symptomatic neurosyphilis group were 12.30 (10.45, 13.25), 17.50 (12.03, 26.28), and 15.70 (13.70, 20.20), respectively. The serum Hcy levels in the asymptomatic neurosyphilis group and symptomatic neurosyphilis group were significantly higher than those in the non-neurosyphilis group (P<0.05). The AUC for serum Hcy in diagnosing neurosyphilis was 0.861 (95% CI: 0.715-0.950), with a sensitivity and specificity of 98.47% and 71.43% respectively. The study indicated that serum Hcy levels serve as a potential biomarker to differentiate neurosyphilis from non-neurosyphilis.

Symptomatic neurosyphilis in HIV-negative patients: a retrospective cohort study

Introduction

Neurosyphilis does not necessarily involve progressive invasion from interstitial to parenchymal nerve tissue. Few studies have focused on human immunodeficiency virus (HIV)-negative patients with symptomatic neurosyphilis, and the clinical outcomes and factors influencing the outcomes are unclear. Therefore, in this study, we aimed to compare the characteristics and clinical outcomes of interstitial and parenchymal neurosyphilis following treatment in HIV-negative patients with symptomatic neurosyphilis.

Methods

We conducted a retrospective analysis of the clinical characteristics, laboratory results, neuroimaging findings, treatment regimens, and outcomes at discharge of HIV-negative patients admitted to our hospital with symptomatic neurosyphilis between May 2013 and May 2023.

Results

Of the 142 patients, the mean age was 56.6 ± 11.4 years, with 111 (78.2%) being men. The predominant clinical manifestations included psychological disorders, cognitive decline, and cranial nerve disorders. Overall, 134 (94.4%) patients had elevated cerebrospinal fluid (CSF) cell counts, 113 (79.6%) had elevated protein levels, and 22/133 (16.5%) had elevated intracranial pressure. During hospitalization 113 patients (87.6%) were treated with intravenous penicillin and 13 (10.1%) were treated with ceftriaxone. Furthermore, 62 (43.7%) and 80 (56.3%) patients had interstitial and parenchymal types of neurosyphilis, respectively. Patients with the parenchymal type were younger and had higher platelet-to-lymphocyte ratio (PLR) and lower lymphocyte-to-monocyte ratio (LMR). Overall, 126 (88.7%) patients completed anti-syphilitic treatment prior to discharge, with 111 (88.1%) showing poor outcomes.

Discussion

An elevated CSF protein level and the parenchymal type were associated with poor outcome. This study revealed that clinical manifestations of neurosyphilis vary, and that the majority of patients had elevated CSF cell and protein levels and a normal intracranial pressure. The PLR was higher and the LMR was lower in the parenchymal type than in the interstitial type. Only a small proportion of patients had favorable outcomes. CSF protein level and parenchymal type may be risk factors for poor prognosis.

Selective attention function impairment in HIV-negative patients with early forms of neurosyphilis

BACKGROUND

The attentional network test (ANT) is widely used to evaluate the performance of three attentional networks: alerting, orienting and executive attention networks. This study aimed to investigate the characteristics of attention functions in HIV-negative patients with early forms of neurosyphilis (NS) and their correlation with abnormalities in brain magnetic resonance imaging (MRI).

METHODS

Thirty patients with early forms of NS, 31 patients with syphilis but without NS (Non-NS) and 35 healthy controls were recruited from an HIV-negative cohort between September 2020 and November 2022. The participants were evaluated with the ANT and the Mini-Mental State Examination (MMSE). Brain MRI was performed in NS and Non-NS patients.

RESULTS

No significant differences were observed in the MMSE scores among the three groups. However, patients with early forms of NS showed poorer performance in orienting and alerting functions than Non-NS group (F = 6.952, P = 0.011 and F = 8.794, P = 0.004, respectively); No significant difference was observed in executive function between the two groups (F = 0.001, P = 0.980). Multivariate analysis of variance using the Bonferroni post hoc test indicated that patients with NS exhibited less efficient orienting function (P = 0.023), and alerting function (P = 0.003) but not executive function (P = 0.99), compared to Non-NS patients. Additionally, a significant difference was found in orienting function between patients with NS and healthy controls (P < 0.001) compared to healthy controls. MRI scans revealed that the NS group had a higher prevalence of abnormalities in the frontal lobes and/or the temporoparietal junction compared to the Non-NS group (24/25 vs. 13/19, P = 0.032).

CONCLUSIONS

The orienting and alerting functions but not executive function were significantly less efficient in early forms of NS group than in the Non-NS group (P < 0.01). This indicates deficits in selective attention in patients with early forms of NS. Brain MRI scans revealed abnormalities in the frontal and/or parietal lobes, as well as the temporoparietal junction, suggesting potential neuropathological correlates of these attentional deficits.

Neurosyphilis: insights into its pathogenesis, susceptibility, diagnosis, treatment, and prevention

Background and aim

Invasion of the central nervous system by Treponema pallidum can occur at any stage of syphilis. In the event that T. pallidum is not cleared promptly, certain individuals may experience progression to neurosyphilis, which manifests as cognitive and behavioral abnormalities, limb paralysis, and potentially fatal outcomes. Early identification or prevention of neurosyphilis is therefore crucial. The aim of this paper is to conduct a critical and narrative review of the latest information focusing exclusively to the pathogenesis and clinical management of neurosyphilis.

Methodology

To compile this review, we have conducted electronic literature searches from the PubMed database relating to neurosyphilis. Priority was given to studies published from the past 10 years (from 2013 to 2023) and other studies if they were of significant importance (from 1985 to 2012), including whole genome sequencing results, cell structure of T. pallidum, history of genotyping, and other related topics. These studies are classic or reflect a developmental process.

Results

Neurosyphilis has garnered global attention, yet susceptibility to and the pathogenesis of this condition remain under investigation. Cerebrospinal fluid examination plays an important role in the diagnosis of neurosyphilis, but lacks the gold standard. Intravenous aqueous crystalline penicillin G continues to be the recommended therapeutic approach for neurosyphilis. Considering its sustained prominence, it is imperative to develop novel public health tactics in order to manage the resurgence of neurosyphilis.

Conclusion

This review gives an updated narrative description of neurosyphilis with special emphasis on its pathogenesis, susceptibility, diagnosis, treatment, and prevention.

CARE-NS, a research strategy for neurosyphilis

Neurosyphilis is a major clinical manifestation of syphilis. In recent years, an increase in neurosyphilis cases has been reported in many countries. The overall incidence of neurosyphilis remains unknown, and there is a lack of understanding of the disease pathogenesis, which hampers clinical management, development of prevention strategies, and control. This article proposes the CARE-NS research strategy to enhance the clinical management of neurosyphilis, which consists of six key features: comprehensive management including multidisciplinary treatment (C), alleviating neurological impairment and sequelae (A), risk factors and clinical epidemiology (R), etiology and pathogenesis (E), new diagnostic indicators and strategies (N), and social impact and cost-effectiveness analysis (S).

Comparing Noninvasive Predictors of Neurosyphilis Among Syphilis Patients With and Without HIV Co-Infection Based on the Real-World Diagnostic Criteria: A Single-Center, Retrospective Cohort Study in China

Diagnosis of neurosyphilis is currently based on the cerebrospinal fluid (CSF) assessments and CSF-Venereal Disease Research Laboratory (CSF-VDRL) is the traditional "gold standard." In the real world, CSF assessments and CSF-VDRL are not always available. This study aimed to identify noninvasive predictors of neurosyphilis based on real-world clinical parameters and diagnostic criteria in populations with different HIV status. In this retrospective cohort study, syphilis patients with different HIV statuses hospitalized for neurosyphilis screening were retrospectively recruited at an infectious disease hospital. Neurosyphilis was defined by real-world diagnostic criteria. Logistic regression and receiver operating characteristic curve analysis were used to investigate and evaluate predictors of neurosyphilis. In total, 528 patients were enrolled, including 143 syphilis patients without HIV infection and 385 HIV/syphilis-co-infected patients. One hundred twelve and 304 neurosyphilis patients were identified in the HIV-negative and HIV-positive groups, respectively. A high serum toluidine red unheated serum test (TRUST) titer was a robust predictor of neurosyphilis in all participants. An age ≥50 years old [adjusted odds ratio (aOR) = 5.062, 95% confidence interval (CI), 1.449-17.680] in the HIV-negative group and CD4⁺ T cell count <330/μL (<300 as reference, aOR = 0.552, 95% CI, 0.315-0.966) in the HIV-positive group were predictors of asymptomatic neurosyphilis. In real-world situations, for asymptomatic syphilis patients, relatively old age and a high serum TRUST titer in HIV-negative populations, and CD4⁺ T cells <330/μL and/or serum TRUST titer >1:64 in HIV-positive populations might predict neurosyphilis.