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2017 ; 11
(8
): e0005880
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Neurosyphilis in Africa: A systematic review
#MMPMID28859081
Marks M
; Jarvis JN
; Howlett W
; Mabey DCW
PLoS Negl Trop Dis
2017[Aug]; 11
(8
): e0005880
PMID28859081
show ga
INTRODUCTION: Neurological involvement is one of the most important clinical
manifestations of syphilis and neurological disease occurs in both early and late
syphilis. The impact of HIV co-infection on clinical neurosyphilis remains
unclear. The highest prevalence of both syphilis and HIV is in Africa. Therefore
it might be expected that neurosyphilis would be an important and not uncommon
manifestation of syphilis in Africa and frequently occur in association with HIV
co-infection; yet few data are available on neurosyphilis in Africa. The aim of
this study is to review data on neurosyphilis in Africa since the onset of the
HIV epidemic. METHODS: We searched the literature for references on neurosyphilis
in Africa for studies published between the 1st of January 1990 and 15th February
2017. We included case reports, case series, and retrospective and prospective
cohort and case-control studies. We did not limit inclusion based on the
diagnostic criteria used for neurosyphilis. For retrospective and prospective
cohorts, we calculated the proportion of study participants who were diagnosed
with neurosyphilis according to the individual study criteria. Depending on the
study, we assessed the proportion of patients with syphilis found to have
neurosyphilis, and the proportion of patients with neurological syndromes who had
neurosyphilis. Due to heterogeneity of data no formal pooling of the data or
meta-analysis was undertaken. RESULTS: Amongst patients presenting with a
neurological syndrome, three studies of patients with meningitis were identified;
neurosyphilis was consistently reported to cause approximately 3% of all cases.
Three studies on stroke reported mixed findings but were limited due to the small
number of patients undergoing CSF examination, whilst neurosyphilis continued to
be reported as a common cause of dementia in studies from North Africa. Ten
studies reported on cases of neurosyphilis amongst patients known to have
syphilis. Studies from both North and Southern Africa continue to report cases of
late stage syphilis, including tabes dorsalis and neurosyphilis, in association
with ocular disease. DISCUSSION: This is the first systematic review of the
literature on neurosyphilis in Africa since the beginning of the HIV epidemic.
Neurosyphilis continues to be reported as a manifestation of both early and late
syphilis, but the methodological quality of the majority of the included studies
was poor. Future well-designed prospective studies are needed to better delineate
the incidence and clinical spectrum of neurosyphilis in Africa and to better
define interactions with HIV in this setting.
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