Neurosyphilis in Africa: A systematic review

Abstract

IntroductionNeurological 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.MethodsWe 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.ResultsAmongst 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.DiscussionThis 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.

Prevalence Of Syphilis, Neurosyphilis And Associated Factors In a Cross-Sectional Analysis Of HIV Infected Patients Attending Bugando Medical Centre Mwanza Tanzania

“…This low prevalence may be due either to ART use in most patients, or possibly having been previously treated with antibiotics, for a different indication, that have activity against Treponema pallidum. Our findings on neurosyphilis fit with a systemic review of neurosyphilis in Africa by Mark et al (52), which found only two patients with meningitis (3.3%).Another study done in Brazil by Jacquelline et al had showed to be 1% among HIV positive patient with neurologic features (53). In contrast, a study by Borden et al showed that 23.5% seropositive for T.pallidum patients who were not on ART had neurosyphilis.…”

Prevalence Of Syphilis, Neurosyphilis And Associated Factors In a Cross-Sectional Analysis Of HIV Infected Patients Attending Bugando Medical Centre Mwanza Tanzania

“…This low prevalence may be due either to ART use in most patients, or possibly to having been previously treated with antibiotics, for a different indication, that have activity against Treponema pallidum. Our findings on neurosyphilis fit with a systemic review of neurosyphilis in Africa (22), which found only two patients with meningitis (3.3%).Another study done in Brazil had shown the prevalence of neurosyphilis to be 1% among HIV positive patients with neurologic features (23). In contrast, a study by Alverez et al showed that 23.5%…”

Neurological Disease Surveillance in Cameroon, a Rural and Urban-Based Inout Patient Population Study

“…Traditionally, the neurological complications of infectious diseases (HIV infection, tuberculosis and malaria) have been considered to account for a significant portion of the neurological diseases found in the countries of Sub Saharan Africa. [17][18][19] Contrary to this belief, cerebrovascular disease accounted for 51.0% of neurological admissions in this urban sample, 55.3% of the neurological mortality and 79.7% of the neurological disability among the survivors. Other studies in Sub-Saharan Africa have reported crude yearly stroke incidence rates of 94.5-107.9/100,000, associated with high mortality rates.…”