Central nervous system infection in congenital syphilis.
Central nervous system infection in congenital syphilis.
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DOI：
10.1056/nejmoa012684
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发表时间：
2002-06-06
影响因子：
158.5
通讯作者：
Sánchez, PJ
中科院分区：
文献类型：
--
作者：
Michelow, IC;Wendel, GD;Sánchez, PJ
背景资料：中枢神经系统梅毒螺旋体感染婴儿的鉴定仍然具有挑战性。梅毒母亲所生婴儿中枢神经系统的梅毒感染。结果进行了比较，与临床，放射学，和传统的实验室评价; IgM免疫印迹的血清和脑脊液;聚合酶链反应（PCR）检测血清或血液和脑脊液;和兔感染性测试的血清或blood.Results：148名婴儿的脑脊液中检测到19只兔感染性测试。在获得脑脊液进行家兔感染性试验之前，婴儿暴露于抗生素与阴性试验结果相关（P=0.001）。76名婴儿中有17名（22%）在脑脊液中检测到螺旋体，这些婴儿以前没有接触过抗生素。这17名婴儿中有41%（39例中的16例）在临床、实验室或放射学评估中有一些异常; 60%（15/25）体格检查异常结果符合先天性梅毒; 41%（41例中的17例）血清、血液或脑脊液IgM免疫印迹或PCR检测结果阳性，或对家兔血清或血液进行感染性检测的阳性结果。只有一个婴儿谁有正常的临床评价结果有阳性脑脊液兔感染性试验。总的来说，血清IgM免疫印迹法或血清或血液PCR检测是预测中枢神经系统感染的最佳方法。中枢神经系统的苍白球感染可通过体格检查、常规实验室检查和放射学研究来确定。然而，识别所有此类婴儿需要使用额外的测试，包括IgM免疫印迹和PCR检测。
Background: Identification of infants with Treponema pallidum infection of the central nervous system remains challenging.Methods: We used rabbit-infectivity testing of the cerebrospinal fluid to detect T. pallidum infection of the central nervous system in infants born to mothers with syphilis. The results were compared with those of clinical, radiographic, and conventional laboratory evaluations; IgM immunoblotting of serum and cerebrospinal fluid; polymerase-chain-reaction (PCR) assay testing of serum or blood and cerebrospinal fluid; and rabbit-infectivity testing of serum or blood.Results: Spirochetes were detected in the cerebrospinal fluid of 19 of 148 infants by rabbit-infectivity testing. Exposure of the infant to antibiotics before cerebrospinal fluid was obtained for rabbit-infectivity testing was associated with a negative test result (P=0.001). Spirochetes were detected in the cerebrospinal fluid in 17 of 76 infants (22 percent) who had no prior antibiotic exposure. These 17 infants included 41 percent (16 of 39) of those with some abnormality on clinical, laboratory, or radiographic evaluation; 60 percent (15 of 25) of those with abnormal findings on physical examination that were consistent with congenital syphilis; and 41 percent (17 of 41) of those with a positive result on IgM immunoblotting or PCR testing of serum, blood, or cerebrospinal fluid, or a positive result on rabbit-infectivity testing of serum or blood. Only one infant who had normal findings on clinical evaluation had a positive cerebrospinal fluid rabbit-infectivity test. Overall, central nervous system infection was best predicted by IgM immunoblotting of serum or PCR assay of serum or blood.Conclusions: Most infants with T. pallidum infection of the central nervous system can be identified by physical examination, conventional laboratory tests, and radiographic studies. However, the identification of all such infants requires the use of additional tests, including IgM immunoblotting and PCR assay.