金庆文中枢神经系统螺旋体病诊疗进展_培训课件.pptx

中枢神经系统螺旋体病诊疗进展-----------脑脊液检查在合并感染HIV的神经梅毒患者诊断中的应用江苏省人民医院神经内科—金庆文梅毒梅毒是由苍白（梅毒）螺旋体引起的慢性、系统性性传播疾病。主要通过性途径传播，临床上可表现为一期梅毒、二期梅毒、三期梅毒、潜伏梅毒和先天梅毒（胎传梅毒）等。与结核、麻风并称世界三大慢性传染病。是《中华人民共和国传染病防治法》中，列为乙类防治管理的病种。神经梅毒神经梅毒(neurosyphilis) 是由苍白密螺旋体侵犯神经系统出现脑膜、大脑、血管或脊髓等损害的一组临床综合征，可发生于梅毒病程的各个阶段，往往是因为早期梅毒未经彻底治疗，常为晚期（Ⅲ期）梅毒全身性损害的重要表现。The term “neurosyphilis” is frequently misunderstood to be synonymous with “tertiary syphilis” by health care personnel. Neurosyphilis is simply involvement of the central nervous system (CNS) with syphilis infection. The manifestations vary, though, and are usually divided into early neurosyphilis and late neurosyphilis. The late neurosyphilis manifestations usually manifest during the tertiary stage of syphilis and classically include dementia, general paresis, and tabes dorsalis, and are a result of extensive damage to the parynchema in the spinal cord or the cortical regions of the brain.流行病学梅毒在全世界流行，据WHO估计，全球每年约有1200万新发病例，主要集中在南亚、东南亚和次撒哈拉非洲。近年来梅毒在我国增长迅速，已成为报告病例数最多的性病。所报告的梅毒中，潜伏梅毒占多数，一、二期梅毒也较为常见，先天梅毒报告病例数也在增加。流行病学10-50% of syphilis patients are HIV+ – 15-20% of HIV+ syphilis patients have symptomatic neurosyphilis。 – 180,000-1.2 million cases of symptomatic neurosyphilis per year in HIV+ individuals。The United States Centers for Disease Control and Prevention (CDC) reported that the incidence rate of syphilis in HIV-infected persons was 77-fold greater than that in the general population.Syphilis is a common co-morbidity with HIV, especially in the MSM (men who have sex with men) community. MSM make up approximately 2/3 of cases of syphilis nationwide and HIV co-infection rates range from 34% in Houston to 51% in Chicago to 60% in Los Angeles and San Francisco.Flood et al. JID 1998;177 (April)神经梅毒的疾病进程Christina M. Marra University of Washington，Seattle, Washington, USA临床症状(梅毒)1.获得性显性梅毒（1）一期梅毒 （2）二期梅毒 （3）三期梅毒 2.获得性隐性梅毒3.妊娠梅毒4.先天性显性梅毒（1）早期先天梅毒（2）晚期先天梅毒 5.先天潜伏梅毒临床症状(梅毒) 初次性接触感染后的3天到3个月是一期梅毒，称为“硬下疳”，经过一段时间后会自愈；再经过4到10个星期发展为二期梅毒，症状多样，在躯干和四肢出现对称而不瘙痒的粉红色皮疹，随后演变成斑丘疹乃至溃