Indication of lumbar puncture for neurosyphilis diagnosis

Abstract

Syphilis is an infect-contagious injury caused by Treponema pallidum, of predominantly sexual transmission, which affects 12 million people worldwide each year. If not cured in its early stages, predisposes to potentially serious complications. One of the complications is neurosyphilis, characterized by the invasion of the central nervous system by T. pallidum in any phase of the natural history of the disease, whose mortality exceeds 60%. In people with HIV, this complication may be more frequent, arising after a shorter period of latency and also be more aggressive. Most often, neurosyphilis is asymptomatic or presents itself by means of little specific clinical manifestations, which require high index of suspicion and invasive laboratory propaedeutics. The diagnosis is made by serological tests or molecular biology study on the cerebrospinal fluid. The controversy is about the indication of this diagnosis and respective treatment in asymptomatic cases, mainly in people living with HIV. This narrative review of the literature concluded that propaedeutic lumbar puncture of neurosyphilis is recommended for people who have serum-reactivity to the VDRL, associated with one or more of the following conditions: neurological manifestations on motor, sensory or cognitive sphere; syphilitic symptoms or VDRL greater than 1:8 post-treatment, discarded reinfection; persons with HIV at the presence of CD4 less than 351 cells/mm3 and VDRL greater than or equal to 1:32; and evidence of no neurological tertiary syphilitic disease in activity (gumma or aortitis). Made the diagnose from these criteria, specific treatment should be given even in asymptomatic cases.