Original articles
Indications for Lumbar Puncture in Patients With Early Active Syphilis and Human Immunodeficiency Virus Coinfection: Experience in a Tertiary Level Hospital in La Coruña, Spain, 2003-2006
Indicaciones de la Punción Lumbar en Pacientes con Sífilis Precoz Activa Coinfectados por el VIH. Casuística en un Hospital Terciario de la Coruña (España) 2003-2006
M. Mazaira
, M. Almagro, E. Fonseca
Corresponding author
martamazaira@hotmail.com
Correspondence: Servicio de Dermatología, Hospital Juan Canalejo, Xubias de Arriba, 84, 15006 La Coruña, Spain.
Correspondence: Servicio de Dermatología, Hospital Juan Canalejo, Xubias de Arriba, 84, 15006 La Coruña, Spain.
Servicio de Dermatología, Complejo Hospitalario Universitario Juan Canalejo, La Coruña, Spain
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"apellidos" => "Mazaira" "email" => array:1 [ 0 => "martamazaira@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Almagro" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Fonseca" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario Universitario Juan Canalejo, La Coruña, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Correspondence: Servicio de Dermatología, Hospital Juan Canalejo, Xubias de Arriba, 84, 15006 La Coruña, Spain." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Indicaciones de la Punción Lumbar en Pacientes con Sífilis Precoz Activa Coinfectados por el VIH. Casuística en un Hospital Terciario de la Coruña (España) 2003-2006" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaAceptado" => "2008-03-05" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec84321" "palabras" => array:6 [ 0 => "syphilis" 1 => "human immunodeficiency virus" 2 => "lumbar puncture" 3 => "neurosyphilis" 4 => "venereal disease research laboratory test" 5 => "rapid plasma reagin test" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec84322" "palabras" => array:6 [ 0 => "sífilis" 1 => "VIH" 2 => "punción lumbar" 3 => "neurosífilis" 4 => "VDRL" 5 => "RPR" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p class="elsevierStyleSimplePara elsevierViewall">In the last years, the incidence of syphilis has incremented in Spain and coinfection with HIV occurs in a high percentage. In HIV-infected patients with syphilis, neurological complications, treatment failure and relapse appear to be slightly raised. Therefore, careful follow-up must be carried out because of the risk of developing neurosyphilis. According to the guidelines, lumbar puncture (LP) is indicated in HIV-infected patients with late latent syphilis or syphilis of unknown duration, but it is discussed in HIV-infected patients with early active syphilis. Recent research has been developed in order to determine clinical and analytical findings for identification of patients with high neurosyphilis risk. We review different opinions about this topic and report our experience.</p> <span class="elsevierStyleSectionTitle">Methods</span><p class="elsevierStyleSimplePara elsevierViewall">We have performed LP in all HIV-infected patients with early active syphilis during 2003-2006.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Of the eight studied patients, none met criteria for neurosyphilis. Three of eight (38%) had a peripheral blood CD4 cell count CD4 + ≤ 350 cells/μL. Seven of eight (87’5%) had RPR ≥ 1:32.</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p class="elsevierStyleSimplePara elsevierViewall">In these patients, performance of LP could be over indicated because of lack of well-established criterion. Our results are in agreement over to recent studies which restrict indication of LP to specific groups.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p class="elsevierStyleSimplePara elsevierViewall">En los últimos años se ha incrementado la incidencia de sífilis en España. En un porcentaje importante existe coinfección con el virus de la inmunodeficiencia humana (VIH). Dado que estos pacientes tienen mayor riesgo de complicaciones neurológicas y de fracaso del tratamiento, hay que seguirlos cuidadosamente por el riesgo de desarrollar neurosífilis. En los pacientes coinfectados por el VIH –si bien las guías coinciden en realizar punción lumbar en aquellos con sífilis latente tardía o de duración incierta– la indicación en pacientes con sífilis precoz activa es controvertida. Recientemente se han realizado estudios para determinar parámetros clínicos o analíticos que identifiquen a aquellos pacientes que se beneficiarían de la punción lumbar. Exponemos las diversas opiniones y aportamos la experiencia en nuestro servicio.</p> <span class="elsevierStyleSectionTitle">Material y método</span><p class="elsevierStyleSimplePara elsevierViewall">Hemos realizado punción lumbar de forma sistemática a todos los pacientes con sífilis precoz activa coinfectados por el VIH en el periodo 2003-2006.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">En el 100% no se objetivó neurosífilis en LCR, y los parámetros entraban dentro de la normalidad o eran compatibles con la infección por el VIH. Un 38% presentó un recuento de linfocitos CD4 + ≤ 350 y un 87,5% tenía una titulación en suero RPR ≥ 1:32.</p> <span class="elsevierStyleSectionTitle">Conclusión</span><p class="elsevierStyleSimplePara elsevierViewall">Es posible que en la práctica clínica se abuse de la realización de PL en estos pacientes, debido a la ausencia de criterios bien definidos. Nuestros datos están en correlación con los criterios actuales que apoyan la idea de restringir la realización de PL a determinados grupos.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increasing rates of sexually transmitted diseases in homosexual men in Western Europe and the United States: why?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K.A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 13 | 17 |
| 2024 October | 74 | 53 | 127 |
| 2024 September | 57 | 58 | 115 |
| 2024 August | 86 | 82 | 168 |
| 2024 July | 60 | 66 | 126 |
| 2024 June | 73 | 81 | 154 |
| 2024 May | 61 | 82 | 143 |
| 2024 April | 64 | 50 | 114 |
| 2024 March | 69 | 68 | 137 |
| 2024 February | 43 | 59 | 102 |
| 2024 January | 47 | 81 | 128 |
| 2023 December | 44 | 83 | 127 |
| 2023 November | 42 | 73 | 115 |
| 2023 October | 34 | 37 | 71 |
| 2023 September | 32 | 43 | 75 |
| 2023 August | 27 | 33 | 60 |
| 2023 July | 28 | 42 | 70 |
| 2023 June | 46 | 36 | 82 |
| 2023 May | 41 | 42 | 83 |
| 2023 April | 27 | 33 | 60 |
| 2023 March | 23 | 40 | 63 |
| 2023 February | 26 | 31 | 57 |
| 2023 January | 27 | 36 | 63 |
| 2022 December | 31 | 52 | 83 |
| 2022 November | 14 | 36 | 50 |
| 2022 October | 10 | 22 | 32 |
| 2022 September | 10 | 56 | 66 |
| 2022 August | 13 | 39 | 52 |
| 2022 July | 14 | 50 | 64 |
| 2022 June | 17 | 37 | 54 |
| 2022 May | 28 | 48 | 76 |
| 2022 April | 40 | 54 | 94 |
| 2022 March | 36 | 72 | 108 |
| 2022 February | 23 | 27 | 50 |
| 2022 January | 26 | 41 | 67 |
| 2021 December | 31 | 44 | 75 |
| 2021 November | 34 | 48 | 82 |
| 2021 October | 24 | 50 | 74 |
| 2021 September | 26 | 32 | 58 |
| 2021 August | 27 | 41 | 68 |
| 2021 July | 29 | 36 | 65 |
| 2021 June | 28 | 46 | 74 |
| 2021 May | 28 | 30 | 58 |
| 2021 April | 72 | 84 | 156 |
| 2021 March | 70 | 48 | 118 |
| 2021 February | 76 | 28 | 104 |
| 2021 January | 46 | 21 | 67 |
| 2020 December | 21 | 18 | 39 |
| 2020 November | 26 | 17 | 43 |
| 2020 October | 34 | 23 | 57 |
| 2020 September | 27 | 18 | 45 |
| 2020 August | 25 | 33 | 58 |
| 2020 July | 17 | 19 | 36 |
| 2020 June | 18 | 24 | 42 |
| 2020 May | 23 | 24 | 47 |
| 2020 April | 12 | 22 | 34 |
| 2020 March | 18 | 27 | 45 |
| 2020 February | 2 | 4 | 6 |
| 2020 January | 0 | 8 | 8 |
| 2019 December | 0 | 5 | 5 |
| 2019 November | 0 | 8 | 8 |
| 2019 October | 0 | 2 | 2 |
| 2019 September | 0 | 1 | 1 |
| 2019 August | 0 | 2 | 2 |
| 2019 July | 0 | 5 | 5 |
| 2019 June | 0 | 5 | 5 |
| 2019 May | 0 | 53 | 53 |
| 2019 April | 0 | 2 | 2 |
| 2019 March | 0 | 5 | 5 |
| 2019 February | 0 | 1 | 1 |
| 2018 December | 1 | 2 | 3 |
| 2018 November | 0 | 2 | 2 |
| 2018 October | 0 | 3 | 3 |
| 2018 September | 1 | 0 | 1 |
| 2018 March | 0 | 2 | 2 |
| 2018 February | 11 | 30 | 41 |
| 2018 January | 14 | 28 | 42 |
| 2017 December | 17 | 25 | 42 |
| 2017 November | 13 | 29 | 42 |
| 2017 October | 15 | 21 | 36 |
| 2017 September | 15 | 24 | 39 |
| 2017 August | 23 | 29 | 52 |
| 2017 July | 22 | 26 | 48 |
| 2017 June | 21 | 32 | 53 |
| 2017 May | 31 | 18 | 49 |
| 2017 April | 28 | 14 | 42 |
| 2017 March | 21 | 38 | 59 |
| 2017 February | 16 | 28 | 44 |
| 2017 January | 9 | 24 | 33 |
| 2016 December | 27 | 13 | 40 |
| 2016 November | 17 | 27 | 44 |
| 2016 October | 27 | 27 | 54 |
| 2016 September | 28 | 34 | 62 |
| 2016 August | 35 | 17 | 52 |
| 2016 July | 30 | 13 | 43 |
| 2016 June | 12 | 12 | 24 |
| 2016 May | 8 | 16 | 24 |
| 2016 April | 7 | 12 | 19 |
| 2016 March | 7 | 14 | 21 |
| 2016 February | 3 | 12 | 15 |
| 2016 January | 8 | 12 | 20 |
| 2015 December | 11 | 8 | 19 |
| 2015 November | 8 | 2 | 10 |
| 2015 October | 8 | 23 | 31 |
| 2015 September | 5 | 6 | 11 |
| 2015 August | 9 | 2 | 11 |
| 2015 July | 29 | 29 | 58 |
| 2015 June | 23 | 22 | 45 |
| 2015 May | 74 | 31 | 105 |
| 2015 April | 36 | 27 | 63 |
| 2015 March | 36 | 36 | 72 |
| 2015 February | 33 | 21 | 54 |
| 2015 January | 23 | 38 | 61 |
| 2014 December | 21 | 25 | 46 |
| 2014 November | 24 | 30 | 54 |
| 2014 October | 23 | 27 | 50 |
| 2014 September | 29 | 24 | 53 |
| 2014 August | 38 | 21 | 59 |
| 2014 July | 41 | 33 | 74 |
| 2014 June | 31 | 16 | 47 |
| 2014 May | 49 | 17 | 66 |
| 2014 April | 33 | 7 | 40 |
| 2014 March | 47 | 22 | 69 |
| 2014 February | 24 | 30 | 54 |
| 2014 January | 35 | 27 | 62 |
| 2013 December | 32 | 18 | 50 |
| 2013 November | 38 | 32 | 70 |
| 2013 October | 35 | 28 | 63 |
| 2013 September | 33 | 30 | 63 |
| 2013 August | 28 | 57 | 85 |
| 2013 July | 26 | 37 | 63 |
| 2013 June | 29 | 46 | 75 |
| 2013 May | 39 | 38 | 77 |
| 2013 April | 29 | 49 | 78 |
| 2013 March | 27 | 40 | 67 |
| 2013 February | 33 | 19 | 52 |
| 2013 January | 15 | 8 | 23 |
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