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
Autor para correspondencia
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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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 6 | 13 | 19 |
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| 2023 Febrero | 26 | 31 | 57 |
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| 2021 Diciembre | 31 | 44 | 75 |
| 2021 Noviembre | 34 | 48 | 82 |
| 2021 Octubre | 24 | 50 | 74 |
| 2021 Septiembre | 26 | 32 | 58 |
| 2021 Agosto | 27 | 41 | 68 |
| 2021 Julio | 29 | 36 | 65 |
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| 2021 Abril | 72 | 84 | 156 |
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| 2021 Enero | 46 | 21 | 67 |
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| 2020 Noviembre | 26 | 17 | 43 |
| 2020 Octubre | 34 | 23 | 57 |
| 2020 Septiembre | 27 | 18 | 45 |
| 2020 Agosto | 25 | 33 | 58 |
| 2020 Julio | 17 | 19 | 36 |
| 2020 Junio | 18 | 24 | 42 |
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| 2020 Marzo | 18 | 27 | 45 |
| 2020 Febrero | 2 | 4 | 6 |
| 2020 Enero | 0 | 8 | 8 |
| 2019 Diciembre | 0 | 5 | 5 |
| 2019 Noviembre | 0 | 8 | 8 |
| 2019 Octubre | 0 | 2 | 2 |
| 2019 Septiembre | 0 | 1 | 1 |
| 2019 Agosto | 0 | 2 | 2 |
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| 2019 Mayo | 0 | 53 | 53 |
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| 2019 Marzo | 0 | 5 | 5 |
| 2019 Febrero | 0 | 1 | 1 |
| 2018 Diciembre | 1 | 2 | 3 |
| 2018 Noviembre | 0 | 2 | 2 |
| 2018 Octubre | 0 | 3 | 3 |
| 2018 Septiembre | 1 | 0 | 1 |
| 2018 Marzo | 0 | 2 | 2 |
| 2018 Febrero | 11 | 30 | 41 |
| 2018 Enero | 14 | 28 | 42 |
| 2017 Diciembre | 17 | 25 | 42 |
| 2017 Noviembre | 13 | 29 | 42 |
| 2017 Octubre | 15 | 21 | 36 |
| 2017 Septiembre | 15 | 24 | 39 |
| 2017 Agosto | 23 | 29 | 52 |
| 2017 Julio | 22 | 26 | 48 |
| 2017 Junio | 21 | 32 | 53 |
| 2017 Mayo | 31 | 18 | 49 |
| 2017 Abril | 28 | 14 | 42 |
| 2017 Marzo | 21 | 38 | 59 |
| 2017 Febrero | 16 | 28 | 44 |
| 2017 Enero | 9 | 24 | 33 |
| 2016 Diciembre | 27 | 13 | 40 |
| 2016 Noviembre | 17 | 27 | 44 |
| 2016 Octubre | 27 | 27 | 54 |
| 2016 Septiembre | 28 | 34 | 62 |
| 2016 Agosto | 35 | 17 | 52 |
| 2016 Julio | 30 | 13 | 43 |
| 2016 Junio | 12 | 12 | 24 |
| 2016 Mayo | 8 | 16 | 24 |
| 2016 Abril | 7 | 12 | 19 |
| 2016 Marzo | 7 | 14 | 21 |
| 2016 Febrero | 3 | 12 | 15 |
| 2016 Enero | 8 | 12 | 20 |
| 2015 Diciembre | 11 | 8 | 19 |
| 2015 Noviembre | 8 | 2 | 10 |
| 2015 Octubre | 8 | 23 | 31 |
| 2015 Septiembre | 5 | 6 | 11 |
| 2015 Agosto | 9 | 2 | 11 |
| 2015 Julio | 29 | 29 | 58 |
| 2015 Junio | 23 | 22 | 45 |
| 2015 Mayo | 74 | 31 | 105 |
| 2015 Abril | 36 | 27 | 63 |
| 2015 Marzo | 36 | 36 | 72 |
| 2015 Febrero | 33 | 21 | 54 |
| 2015 Enero | 23 | 38 | 61 |
| 2014 Diciembre | 21 | 25 | 46 |
| 2014 Noviembre | 24 | 30 | 54 |
| 2014 Octubre | 23 | 27 | 50 |
| 2014 Septiembre | 29 | 24 | 53 |
| 2014 Agosto | 38 | 21 | 59 |
| 2014 Julio | 41 | 33 | 74 |
| 2014 Junio | 31 | 16 | 47 |
| 2014 Mayo | 49 | 17 | 66 |
| 2014 Abril | 33 | 7 | 40 |
| 2014 Marzo | 47 | 22 | 69 |
| 2014 Febrero | 24 | 30 | 54 |
| 2014 Enero | 35 | 27 | 62 |
| 2013 Diciembre | 32 | 18 | 50 |
| 2013 Noviembre | 38 | 32 | 70 |
| 2013 Octubre | 35 | 28 | 63 |
| 2013 Septiembre | 33 | 30 | 63 |
| 2013 Agosto | 28 | 57 | 85 |
| 2013 Julio | 26 | 37 | 63 |
| 2013 Junio | 29 | 46 | 75 |
| 2013 Mayo | 39 | 38 | 77 |
| 2013 Abril | 29 | 49 | 78 |
| 2013 Marzo | 27 | 40 | 67 |
| 2013 Febrero | 33 | 19 | 52 |
| 2013 Enero | 15 | 8 | 23 |
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