Neurosífilis e Variantes Clínicas
DOI:
https://doi.org/10.4181/RNC.2012.20.617.6pPalavras-chave:
ífilis, Sistema Nervoso Central, NeurossífilisResumo
Introdução. A neurossífilis é uma manifestação pouco frequente da infecção do sistema nervoso central (SNC) pelo Treponema pallidum. Casos. Nós relatamos três casos de neurossífilis. O caso 1 apresentava-se com envolvimento ocular: atrofia ótica à direita e neurite ótica à esquerda; o caso 2 uma forma meningovascular com Acidente Vascular Cerebral isquêmico; e o caso 3, uma forma meníngea, tinha como queixa principal cefaléias. Discussão. Os casos relatados apresentavam distintas formas de neurossífilis. O diagnóstico sorológico depende da presença de anticorpos: Veneral Disease Research Laboratory (VDRL) – não específico – e/ou Fluorescent Treponemal Antibody Absorption (FTA-ABS) – específico. Conclusão. Nos casos acima o FTA-ABS no líquor foi uma ferramenta importante para o diagnóstico de neurossífilis, mesmo nos pacientes que apresentam VDRL sérico negativo.
Referências
Marra CM, Maxwell CL, Smith SL, Lukehart SA, Rompalo AM, Eaton M, et al. Cerebrospinal Fluid Abnormalities in Patients with Syphilis: Association with Clinical and Laboratory Features. JID 2004;189:369-76. http://dx.doi.org/10.1086/381227
Libois AS, Wit SP, Poll BND, Garcia F, Florence E, Del Rio A, et al. HIV and Syphilis: When to Perform a Lumbar Puncture. Sexually Transmitted Diseases 2007;34(3):141-44. http://dx.doi.org/10.1097/01.olq.0000230481.28936.e5
Sparling PF. Diagnosis of Neurosyphilis: New Tools. Sexually Transmitted Diseases 2010;37(5):288-9.
Smith GT, Goldmeier D, Migdal C. Neurosyphilis with optic neuritis: an update. Postgrad Med J 2006;82:36-9. http://dx.doi.org/10.1136/pgmj.2004.020875
Adams R, Victor M. Principles of neurology. 8 Ed. New York: McGraw-Hill; 2005, p.614-8.
Marra CM, Tantalo LC, Sahi SK, Maxwell CL, Lukehart SA. CXCL13 as a Cerebrospinal Fluid Marker for Neurosyphilis in HIV-Infected Patients With Syphilis. Sexually Transmitted Diseases 2010;37(5):283-7.
Katz DA, Berger JR, Duncam RC. Neurosyphilis: a comparative study of the effects of infection with human immunodeficiency virus. Arch Neurol 1993;50:243-249. http://dx.doi.org/10.1001/archneur.1993.00540030009006
Powell AL, Coyne AC, Jen L. A retrospective study of syphilis seropositivity in a cohort of demented patients. Alzheimer Dis Assoc Disord 1993;7:33-38. http://dx.doi.org/10.1097/00002093-199307010-00004
Holtom PD, Robert AL, Leal ME, Leedom JM. Prevalence of neurosyphilis in human immunodeficiency virus-infected patients with latent syphilis. Am J Med 1992;93:9-12. http://dx.doi.org/10.1016/0002-9343(92)90673-Y
Zetola NM, Engelman J, Jensen TP, Klausner JD. Syphilis in the United States: An Update for Clinicians With an Emphasis on HIV Coinfection. Mayo Clin Proc 2007;82(9):1091-1102. http://dx.doi.org/10.4065/82.9.1091
Madiedo G, Ho KC, Walsh P. False-Positive VDRL and FTA in Cerebrospinal Fluid. JAMA 1980;244(7):688-689. http://dx.doi.org/10.1001/jama.1980.03310070038026
Balba GP, Kumar PN, James AN, Malani A, Palestine AG, Welch JN, et al. Ocular syphilis in HIV-positive patients receiving highly active antiretroviral therapy. Am J Med 2006;119(5):448.e21-e25.
Holland BA, Perrett LV, Mills CM. Meningovascular syphilis: CT and MR findings. Radiology 1986;158:439-442.
Harriman DGF. Bacterial infections of nervous system. In Blackwood W, Dorselis JAN. (eds). Greenfield’s neuropathology. London: Edward Arnold; 1976, p.253-256.
Lambrecht F, Sá DS, Koerbel A, Tamanini A, Machareth SL, Scola RH, et al. Oclusão Bilateral das Artérias Carótidas Internas, Sífilis Meningovascular e Sida. Relato de Caso. Arq Neuropsiquiatr 1999;57(2-A):311-316.
http://dx.doi.org/10.1590/S0004-282X199900020002516.Sohler MP. Diagnóstico de Neuroinfecção. Rio de Janeiro: Editora Rubio; 2008 p.132.
Hook EW. Syphilis. In Scheld WM, Whitley RJ, Durak DT. Infections of central nervous system. 2Ed. Philadelphia: Lippicott Raven; 1997, p.669-684.
Uribe CS, Garcia FA. Neurosífilis y efecto prozona. Rev Neurol 1998;27:970-972.
Himmelmann A, Schaffner A, Greminger P. Dementielle Enticuicklung. Schw Rundsch Med Prax 1993; 82:1205-1208.
Bschor T, Nurbach-Roos B, Albrecht J. Organish Genese einer maniformen Psychose: ein Fallbeispiel von progressiver Paralyse. Nervenarzt 1995;66:54-56.
Workowski KA, Berman SM. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2006. Morbidity & Mortality Weekly Report 2006;55(RR-11):1-94.
Ghanem KG, Moore RD, Rompalo AM, Erbelding EJ, Zenilman JM, Gebo KA. Neurosyphilis in a clinical cohort of HIV-1-infected patients. AIDS. 2008;22(10):1145-51. http://dx.doi.org/10.1097/QAD.0b013e32830184df
Rupprecht TA, Kirschning CJ, Popp B, Kastenbauer S, Fingerle V, Pfister H, et al. Borrelia garinii induces CXCL13 production in human monocytes through Tolllike receptor 2. Infect Immun 2007;75:4351-56. http://dx.doi.org/10.1128/IAI.01642-06
