ALTERATION IN THE NATURAL-HISTORY OF NEUROSYPHILIS BY CONCURRENT INFECTION WITH THE HUMAN-IMMUNODEFICIENCY-VIRUS
ALTERATION IN THE NATURAL-HISTORY OF NEUROSYPHILIS BY CONCURRENT INFECTION WITH THE HUMAN-IMMUNODEFICIENCY-VIRUS
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DOI：
10.1056/nejm198706183162503
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发表时间：
1987-06-18
影响因子：
158.5
通讯作者：
FELSENSTEIN, D
中科院分区：
文献类型：
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作者：
JOHNS, DR;TIERNEY, M;FELSENSTEIN, D
在过去的18个月里，我们在我们的机构中看到了四例神经梅毒病例(两例脑膜血管梅毒，一例急性梅毒脑膜炎，一例无症状神经梅毒)，这些病例的血清学证据表明他们接触了人类免疫缺陷病毒(HIV)。这四名患者中有两名患有神经梅毒，尽管之前曾用苄星青霉素对早期梅毒进行过适当的治疗。1例患者在初次感染后4个月内出现脑膜血管梅毒，与梅毒感染的加速病程相一致。这些发现表明，艾滋病毒感染可能会改变梅毒的自然进程，因为它导致了细胞介导的免疫系统的严重缺陷。HIV对梅毒螺旋体感染的可能增强作用表明，在评估HIV血清阳性的梅毒患者时，有必要进行腰椎穿刺术，并修改目前推荐的针对这些患者群体中的一期、二期和潜伏梅毒和神经梅毒的治疗方案。神经梅毒可能应该被添加到获得性免疫缺陷综合征(AIDS)不断增长的感染性并发症名单中，并可能是第一个出现的此类并发症。
Within the past 18 months, we have seen four cases of neurosyphilis at our institution (two of meningovascular syphilis, one of acute syphilitic meningitis, and one of asymptomatic neurosyphilis) in young homosexual men with serologic evidence of exposure to human immunodeficiency virus (HIV). Two of the four patients had neurosyphilis despite previous adequate therapy for early syphilis with benzathine penicillin. Meningovascular syphilis developed in one patient within four months after a primary infection, in a manner consistent with an accelerated course of syphilitic infection. These findings suggest the possibility that HIV infection may alter the natural course of syphilis because of the profound defects in cell-mediated immunity it causes. The possible potentiating effects of HIV on Treponema pallidum infection suggest the need for lumbar puncture in the evaluation of HIV-seropositive patients with syphilis, as well as modifications of the currently recommended treatment regimens for primary, secondary, and latent syphilis and neurosyphilis in this patient population. Neurosyphilis should probably be added to the growing list of infectious complications of the acquired immunodeficiency syndrome (AIDS) and may be the first such complication to appear.