ABSTRACT
INTRODUCTION: Neurosyphilis is the Treponema pallidum infection of the central nervous system and can occur at any time after the initial infection. In the 21st century, the incidence of neurosyphilis has increased in the post-antibiotic era. The highest rates of neurosyphilis are from low-income countries and the published studies are limited. AIM: To determine the clinical and sociodemographic characteristics of neurosyphilis patients in a tertiary care center in Pereira, Colombia. PATIENTS AND METHODS: Retrospective study of diagnosed neurosyphilis patients in a tertiary care center in Pereira, Colombia, between 2012 to 2017. The diagnosis was established based on serologic treponemal tests, VDRL in CSF, and CSF analysis. Sociodemographic, clinical, and laboratory parameters variables were obtained. RESULTS: Sixteen patients were included, 11 with definitive neurosyphilis and 5 with probable neurosyphilis. The median age was 59.50 ± 13.78 years. Men accounted for 75% (n = 12) of the patients. Four patients were (25%) HIV-infected. All the patients had positive peripheral FTA-ABS and 11 had reactive VDRL in CSF. The most frequent form was late neurosyphilis (62.5%), being general paralysis the most common. The most frequently clinical manifestations were neuropsychiatric alterations (46.9%), predominantly disorientation, behavioral changes, and cognitive impairment, followed by motor changes (36.7%). CONCLUSIONS: Late neurosyphilis was the most prevalent form, predominantly neuropsychiatric alterations. Only a quarter of patients presented HIV coinfection.
TITLE: Perfil clinico y sociodemografico de la neurosifilis: estudio retrospectivo en un centro de referencia de Colombia.Introduccion. La neurosifilis es causada por Treponema pallidum y puede afectar al sistema nervioso central en cualquier momento de la infeccion. Desde inicios de este siglo, su incidencia ha ido en aumento, aun en la era postantibiotica. En paises en vias de desarrollo, el problema tiene mayor magnitud y los estudios son escasos. Objetivo. Describir las caracteristicas de la poblacion con neurosifilis en un hospital de tercer nivel de Pereira, Colombia. Pacientes y metodos. Estudio descriptivo de corte transversal de pacientes con neurosifilis que acudieron a un centro de tercer nivel de Pereira, Colombia, entre 2012 y 2017. Los criterios diagnosticos se basaron en las siguientes variables: prueba treponemica en sangre, VDRL y analisis citoquimico del liquido cefalorraquideo. Se consideraron variables sociodemograficas, clinicas y de laboratorio. Resultados. Se incluyo a 16 pacientes, 11 con neurosifilis definitiva y cinco con neurosifilis probable, con una edad media de 59,5 ± 13,78 años. El 75% (n = 12) de los casos eran hombres. La coinfeccion por virus de la inmunodeficiencia humana fue del 25%. Todos los pacientes tenian FTA-ABS positivo en sangre y 11 presentaron VDRL reactiva en el liquido cefalorraquideo. La forma mas frecuente de neurosifilis fue la tardia (62,5%), y predomino la paralisis general. Las manifestaciones clinicas mas frecuentes fueron las alteraciones neuropsiquiatricas (46,9%), con predominio de la desorientacion, los cambios en el comportamiento y el deterioro cognitivo, seguidos de las alteraciones motoras (36,7%). Conclusiones. La neurosifilis tardia fue la presentacion mas prevalente, caracterizada por manifestaciones neuropsiquiatricas. Una cuarta parte de los pacientes presentaba infeccion por virus de la inmunodeficiencia humana.
Subject(s)
Neurosyphilis/epidemiology , Aged , Colombia/epidemiology , Demography , Female , Humans , Male , Middle Aged , Retrospective Studies , Sociological FactorsABSTRACT
OBJECTIVES: To describe the sociodemographic and clinical characteristics of a cohort of patients with epilepsy from a reference centre in Colombia. METHODS: Cross-sectional study including patients diagnosed with epilepsy who attended our epilepsy centre (Neurocentro) between 2013 and 2016. Data were gathered from patients' medical histories. RESULTS: We gathered data from a total of 354 patients diagnosed with epilepsy. Median age was 37 years; 52% were men. Seizures were focal in 57% of the patients and generalised in 38%; seizure type was not determined in 6% of the sample. The most frequent aetiology was cryptogenic (21%), followed by traumatic (14%). Median time of disease progression and age at onset were 23 and 11 years, respectively. Psychiatric comorbidities were found in 18% of the patients and 40% had some degree of cognitive impairment. Around 40% of our sample reported adverse reactions to antiepileptic drugs at some point during treatment. Antiepileptic drugs were administered in monotherapy in 36% of the patients. Around 37% had drug-resistant epilepsy and 14% underwent surgery. CONCLUSIONS: Psychiatric comorbidities, cognitive impairment, adverse drug reactions, and drug-resistant epilepsy are common among epileptic patients in Colombia. Knowledge of the factors with an impact on epilepsy may lay the foundations for improving management of these patients on the administrative level and improving quality of life.
Subject(s)
Epilepsy , Adult , Colombia , Cross-Sectional Studies , Demography , Epilepsy/complications , Epilepsy/diagnosis , Epilepsy/drug therapy , Female , Humans , Male , Middle Aged , Sociological FactorsABSTRACT
AIM: To identify predictors of seizure related injuries in adult patients with epilepsy in Colombia. SUBJECTS AND METHODS: Case-control study. Patients with a diagnosis of epilepsy aged 16 years and older who attended the Neurocentro epilepsy center between 2013-2016 and were attended by a specialist in epilepsy were included. Patients with seizure related injuries were defined as the case. The control group was conformed by those without seizure related injuries. Odds ratios and 95% confidence intervals were calculated. A logistic regression was performed. RESULTS: A total of 101 (28.5%) patients were cases and 253 (71.5%) were controls. Patients with seizure related injuries were significantly younger than controls at the age of onset of epilepsy (9 vs 12 years; p = 0.017). The significant variables in the bivariate analysis were: some degree of cognitive impairment, drug resistant epilepsy, abnormal neurological examination, and seizures related with changes in the lunar phases. No protective factors were identified. In the multivariate analysis, two variables remained significant: drug resistant epilepsy and some degree of cognitive impairment. CONCLUSION: Drug-resistant epilepsy and cognitive impairment were predictors of seizure related injuries in adult patients with epilepsy. Adequate pharmacological control of epileptic seizures and prevention recommendations may reduce the risk of seizure related injuries in these patients.
TITLE: Predictores de lesiones asociadas a crisis epilepticas en pacientes adultos con epilepsia en Colombia: estudio de casos y controles.Objetivo. Identificar los predictores de lesiones asociadas con crisis epilepticas en adultos con epilepsia en Colombia. Sujetos y metodos. Estudio de casos y controles. Se incluyo a los pacientes con diagnostico de epilepsia mayores de 16 anos que fueron atendidos por una especialista en epilepsia que acudieron a Neurocentro en el periodo comprendido entre 2013 y 2016. Se definio como caso a los pacientes que habian presentado lesiones asociadas con crisis epilepticas, y como grupo control, a los que no las habian presentado. Se calcularon odds ratios e intervalos de confianza al 95%. Se realizo una regresion logistica. Resultados. Se identificaron 101 (28,5%) casos y 253 (71,5%) controles. Los pacientes con lesiones asociadas con crisis epilepticas fueron significativamente mas jovenes que los controles a la edad de inicio de la epilepsia (9 frente a 12 anos; p = 0,017). Las variables significativas en el analisis bivariado fueron: algun grado de deterioro cognitivo, epilepsia resistente a medicamentos, examen neurologico anormal y crisis asociadas a cambios en las fases lunares. No se identificaron factores protectores. En el analisis multivariado, dos variables permanecieron significativas: epilepsia resistente a medicamentos y algun grado de deterioro cognitivo. Conclusion. Se observo que la epilepsia resistente a medicamentos y el deterioro cognitivo son predictores de lesiones asociadas con crisis epilepticas en pacientes adultos con epilepsia. Un adecuado control farmacologico de las crisis epilepticas y unas recomendaciones de prevencion pueden disminuir el riesgo de dichas lesiones en estos pacientes.
