CCS01.1 Neurosyphilis is more common among malignant syphilis: based on case series evidence. (14th July 2019) - Zhou, Pingyu
Abstract : Background: Malignant syphilis and neurosyphilis were believed more likely to exist in the HIV positive population. However China's huge and active epidemics of syphilis were much more seen in HIV negative population, thus a considerable amount of the malignant syphilis patients with HIV-uninfected patients might be under the shadow of lower evaluate of neurosyphilis. Methods: This study aimed to investigate the relationship between HIV infection, malignant syphilis and neurosyphilis through a systematic analysis. Results: Clinical characteristics of the malignant syphilis: 26 patients were diagnosed with malignant syphilis and eighteen out of them were HIV negative. They presented different symptoms, and had a more aggressive disease progression with skin rashes. Laboratory findings: 1) A strongly high titre of serum RPR and a sub-acute inflammation of the histopathological finds; The RPR titers of all patients were strongly positive with a range from 1:32 to 1:256. Histopathological examination demonstrated a sub-acute inflammation rich with dermal perivascular plasma cell and neutrophils infiltrate. Numerous spirochetes will be found by immunohistochemistry. 2) WBC, protein and VDRL index in CSF. CSF test revealed the increased WBC count (>10 cells/μL) in eleven patients, of which five were with HIV positive. Increased total protein (>0.5 g/L) were found in eight patients, and four of them showed HIV positive. A positive CSF-VDRL test was shown in seven patients, three had HIV positive. 3) Peripheral blood CD4 + T cell count The peripheral blood CD4 + T cell count was low (<550 cells/µL) in fifteen out of 26 malignant syphilis, of those seven cases were HIV seropositive. Six out of 26 patients suffered from both malignant syphilis and neurosyphilis but without HIV infection. Conclusion: There is no direct association between HIV infection and malignant syphilis or neurosyphilis. Additionally, we found a new unusual combination of malignant syphilis and neurosyphillis in the absence of HIV infection. Disclosure: No significant relationships.