       Document 0705
 DOCN  M95A0705
 TI    Lumbar puncture for evaluation of latent syphilis in hospitalized
       patients. High prevalence of cerebrospinal fluid abnormalities unrelated
       to syphilis.
 DT    9510
 AU    Carey LA; Glesby MJ; Mundy LM; Janis EM; Hook EW 3rd; Department of
       Oncology, Johns Hopkins University School of; Medicine, Baltimore, MD,
       USA.
 SO    Arch Intern Med. 1995 Aug 7-21;155(15):1657-62. Unique Identifier :
       AIDSLINE MED/95344299
 AB    OBJECTIVE: To determine the prevalence of abnormal neurologic findings
       and cerebrospinal fluid abnormalities in hospitalized patients with
       serologic evidence of latent syphilis. DESIGN: Cross-sectional survey.
       METHODS: Consecutively admitted hospital inpatients from an inner-city
       population were screened for serologic evidence of syphilis with
       reactive plasma reagin and confirmatory fluorescent treponemal antibody
       absorption assays. In those with reactive tests, such clinical findings
       as a history of treatment for syphilis, neurologic abnormalities,
       presence of human immunodeficiency virus infection, and rapid plasma
       reagin titer were correlated with cerebrospinal fluid white blood cell
       count, protein level, and VDRL result. RESULTS: Of 490 consecutive
       patients, 52 (11%) had serologic evidence of syphilis. Forty-three (83%)
       of these underwent lumbar puncture. Of the 43, 31 (72%) were
       seronegative for human immunodeficiency virus and 12 (28%) were
       seropositive. No patient had a reactive cerebrospinal fluid VDRL test.
       Cerebrospinal fluid abnormalities were seen in 32% of human
       immunodeficiency virus-seronegative patients and in 67% of human
       immunodeficiency virus-seropositive patients. Cerebrospinal fluid
       abnormalities were not predicted by history of treatment for syphilis,
       abnormal neurologic findings, or an elevated rapid plasma reagin titer.
       Cerebrospinal fluid IgG indexes in patients with elevated cerebrospinal
       fluid protein levels suggested that the protein abnormalities were not
       caused by local antibody production. Nonreactive cerebrospinal fluid
       fluorescent treponemal antibody absorption tests suggest that the
       cerebrospinal fluid abnormalities were not the result of neurosyphilis.
       CONCLUSIONS: There was a high prevalence of cerebrospinal fluid
       abnormalities in hospitalized patients with latent syphilis detected by
       routine screening. Because of the nonspecificity of the cerebrospinal
       fluid findings, routine lumbar puncture for such patients appears to
       contribute little to the treatment of latent syphilis.
 DE    Adolescence  Adult  Aged  Aged, 80 and over  Cerebrospinal Fluid
       Proteins/*CEREBROSPINAL FLUID  Cross-Sectional Studies  Female
       Hospitalization  Human  HIV Seropositivity/COMPLICATIONS  Male  Middle
       Age  Neurosyphilis/*CEREBROSPINAL FLUID/COMPLICATIONS/IMMUNOLOGY
       Prevalence  *Spinal Puncture  Support, Non-U.S. Gov't  Syphilis,
       Latent/*CEREBROSPINAL FLUID/COMPLICATIONS/IMMUNOLOGY  Urban Health
       JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

