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Cited by 491Syphilis Diagnosis and TreatmentInfectious Diseases and TuberculosisBacterial Infections and Vaccines

Cerebrospinal fluid abnormalities in patients with syphilis: association with clinical and laboratory features.

Marra, Christina M., Maxwell, Clare L., Smith, Stacy L., Lukehart, Sheila A., Rompalo, Anne M., Eaton, Molly, Stoner, Bradley P., Augenbraun, Michael +7 more·2004·The Journal of Infectious Diseases
DOI 10.1086/381227
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Abstract

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. CONCLUSION: Serum RPR titer helps predict the likelihood of neurosyphilis. HIV-induced immune impairment may increase the risk of neurosyphilis.

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Crossref · 10.1086/381227

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  • Limited data indicate that changes in CSF parameters might occur more slowly among persons with HIV infection, especially those with more advanced immunosuppression.

    “Limited data indicate that changes in CSF parameters might occur more slowly among persons with HIV infection, especially those with more advanced immunosuppression (588,624).”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [588]

  • A serum RPR titre of 1:32 has been demonstrated to be associated with CSF abnormalities similar to those seen in neurosyphilis.

    “a serum RPR titre of 1:32 has been demonstrated to be associated with CSF abnormalities similar to those seen in neurosyphilis.63,65”

    From BASHH UK guidelines for the management of syphilis 2024 (2024) · cites this paper as [63]

  • CSF examination is rarely useful for ophthalmic or otological syphilis, irrespective of stage of disease.

    “CSF examination is indicated when there is clinical evidence of neurological involvement, except for ophthalmic or otological syphilis where it is rarely useful, irrespective of stage of disease62,63: 1C.”

    From BASHH UK guidelines for the management of syphilis 2024 (2024) · cites this paper as [63]

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Authors
Marra, C. M., Maxwell, C. L., Smith, S. L., Lukehart, S. A., Rompalo, A. M., Eaton, M., Stoner, B. P., Augenbraun, M., Barker, D. E., Corbett, J. J., Zajackowski, M., Raines, C., Nerad, J., Kee, R., & Barnett, S. H.
Affiliations
  • University of Washington (US)
  • Johns Hopkins University (US)
  • Emory University (US)
  • Washington University in St. Louis (US)
  • SUNY Downstate Health Sciences University (US)
  • John H. Stroger, Jr. Hospital of Cook County (US)
  • University of Mississippi (US)
  • Chicago Department of Public Health (US)
ORCID
Venue
The Journal of Infectious Diseases
Publisher
Oxford University Press (OUP)
Published
2004-02
Volume
189
Issue
3
Pages
369-376
ISSN
  • 0022-1899 (ISSN-L)
  • 1537-6613
DOI
10.1086/381227
OpenAlex
W2168374971
Cited by
491
References
27
Citations by year
2026: 13 · 2025: 13 · 2024: 21 · 2023: 24 · 2022: 18 · 2021: 31 · 2020: 29 · 2019: 20 · 2018: 19 · 2017: 21 · 2016: 18 · 2015: 29 · 2014: 29 · 2013: 25 · 2012: 26
FWCI
11.51
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Infectious Diseases (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • University of Washington
  • National Institutes of Health
  • National Institute of Neurological Disorders and Stroke (NS 34235, R01NS034235)
Topics
  • Health Sciences › Medicine › Physiology › Syphilis Diagnosis and Treatment
  • Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
  • Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
Keywords
neurosyphilis, cerebrospinal fluid abnormalities, syphilis, HIV infection, CD4 count, CSF white blood cell count, early syphilis, risk factors
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Neurosyphilis, Reagins, Risk Factors, Syphilis, Treponema pallidum, HIV Infections, Multivariate Analysis, CD4 Lymphocyte Count

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