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Arquivos de Medicina

On-line version ISSN 2183-2447

Arq Med vol.19 no.3 Porto May 2005

 

Neurossífilis

Revisão Clínica e Laboratorial

Ana Margarida Barros*; Ana Paula Cunha*; Carmen Lisboa*; Maria José Sá†; Carlos Resende*

*Serviço de Dermatologia e Venereologia, Hospital de São João, Porto

†Serviço de Neurologia, Hospital de São João, Porto e Instituto de Anatomia, Faculdade de Medicina da Universidade do Porto.

 

Resumo

As manifestações neurológicas de sífilis tornaram-se raras após a introdução da penicilinoterapia. No entanto, a partir da década de 70, verificou-se um aumentou do número de casos, particularmente em associação com a infecção pelo vírus da imunodeficiência humana. Este aumento da incidência de sífilis, observável também na Europa e nos Estados Unidos da América, poderá traduzir-se num acréscimo do número de casos de neurossífilis observados na prática clínica. É importante conhecer o carácter polimórfico da neurossífilis, a qual pode mimetizar múltiplas afecções do sistema nervoso central. Importa ainda conhecer os diferentes perfis das reacções serológicas da sífilis, a bioquímica e os padrões electroforéticos de Imunoglobulina G no líquido cefalorraquidiano que, em conjugação com os achados clínicos, possibilitam um diagnóstico correcto. Nos doentes infectados com o vírus da imunodeficiência humana, o diagnóstico de neurossífilis assume algumas particularidades, nomeadamente a possibilidade de confusão das suas manifestações clínicas com outras infecções do sistema nervoso central como a infecção pelo próprio vírus da imunodeficiência humana ou infecções oportunistas, e a maior taxa de falsos negativos das reacções serológicas da sífilis. Pelas razões acima mencionadas, os autores fazem uma revisão dos aspectos clínicos e laboratoriais da doença e das recomendações terapêuticas mais recentes.

Palavras-chave: Neurossífilis; Sífilis; Líquido céfalo-raquidiano

 

Abstract

Neurosyphilis - Clinical and Laboratorial Review


Neurosyphilis became very rare since the introduction of penicillin. However, in the mid-1970s, it was reported an increasing number of cases in individuals likely to have concurrent human immunodeficiency virus infection. The rising in syphilis in recent years in Europe and United States of America, can also lead to an increase in the number of cases of neurosyphilis seen by practitioners. It is importante to know the polymorphic character of neurosyphilis, which can easily mimic many other neurologic and psychiatric diseases. Besides, one must know the range of the possible serologic reactions, biochemistry and Immunoglobulin G electrophoretic patterns in blood and cerebrospinal fluid. In human immunodeficiency virus infected patients clinical manifestations may be confused with other central nervous system diseases such as infection by human immunodeficiency virus or by other opportunistic agents and these patients also have a higher rate of negative serologic reactions in cerebrospinal fluid, which makes diagnosis more difficult. For the above mentioned reasons, the authors make a review of the clinical and laboratorial findings and of the more recent therapeutic guidelines of the disease.

Key-words: Neurosyphilis, Syphilis, Cerebrospinal fluid

 

Texto completo disponível apenas em PDF.

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Correspondência:

Dr.ª Ana Margarida Barros Serviço de Dermatologia e Venereologia Hospital São João Alameda Prof. Hernâni Monteiro 4202-451 Porto

e-mail: anambarros@clix.pt

 

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