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Volume 47, Number 6, December 2015

Elevated cerebrospinal fluid nitrite level in human immunodeficiency virus-infected patients with neurosyphilis

Yu-Jung Cheng, Hung-Chin Tsai, Shin-Yu Y, Cheng-Len Sy, Kuan-Sheng Wu, Jui-Kuang Chen, Susan Shin-Jung Lee, Yao-Shen Chen

Received: February 27, 2013    Revised: June 11, 2013    Accepted: July 15, 2013   


Corresponding author:

Corresponding author. Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, 386 Ta-Chung First
Road, Kaohsiung 813, Taiwan.
E-mail address: (Y.-S. Chen). e Y.-J. Cheng and H.-C. Tsai contributed equally to this study. 


Background and purpose: 

Human immunodeficiency virus (HIV) and syphilis coinfection is a common phenomenon. A percentage of neurosyphilis cases is asymptomatic in HIV-infected patients. The diagnosis of neurosyphilis is more difficult because of the alteration of cerebrospinal fluid (CSF) presentation by the HIV itself. The CSF levels of the degradation products of nitric oxide (NO; e.g., nitrate and nitrite) are reportedly elevated in animals and patients with bacterial meningitis. We hypothesized that an elevated CSF nitrite concentration may be present in patients coinfected with HIV and neurosyphilis. 



This cohort study was conducted from January 2007 to June 2008. Forty patients were enrolled and included seven patients in the control group and 33 HIV-infected patients with or without syphilis. Nitrite levels in the serum and the CSF were measured by using the Griess assay.



The CSF nitrite levels were significantly higher in HIV-infected patients with neurosyphilis, compared to the control group or patients with HIV infection only or patients with HIV and syphilis coinfection (p = 0.026). The CSF nitrite levels were correlated with the CSF white blood cell counts (Spearman correlation test, r2 = 0.324; p < 0.001). There was no significant difference between different groups in serum nitrite levels. 



Marked elevation of CSF nitrite level was observed in HIV-infected patients with neurosyphilis. 


Key words:

Cerebrospinal fluid, Human immunodeficiency virus, Neurosyphilis, Nitrite