Sífilis em pacientes acompanhados pelo Serviço de Transplante Renal do Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP
Data
2019-07-30
Autores
Almeida, Gabriel Berg de
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A literatura científica é escassa quanto à prevalência e ao manejo da sífilis em candidatos ao transplante renal (TxR). O presente estudo objetivou ampliar os conhecimentos sobre o assunto. Métodos: Série de casos que incluiu todos os inscritos em lista de espera para o TxR de centro único brasileiro entre 2013 e 2017, com diagnóstico sorológico de sífilis. Foi indicada avaliação oftalmológica e exame liquórico para todos os indivíduos. Os pacientes foram classificados de acordo com a forma clínica da sífilis e tratados segundo protocolos vigentes. Os dados demográficos, epidemiológicos, clínicos, laboratoriais e terapêuticos foram revisados por meio de prontuário eletrônico. Foi realizada análise estatística descritiva. Resultados: A prevalência da sífilis na população estudada foi de 3,3% (27/807). Dos 27 pacientes incluídos no estudo, 77,8% foram diagnosticados com a forma latente da doença e 22,2% com neurossífilis. A única alteração liquórica presente nos pacientes com neurossíflis foi a hiperproteinorraquia. A avaliação oftalmológica detectou comprometimento ocular da sífilis em um paciente assintomático. Onze pacientes foram transplantados, sendo que cinco destes não receberam profilaxia específica após o TxR. Não foi identificada reativação da doença dentro do período de acompanhamento mediano de 46 meses. Discussão: A soroprevalência da sífilis mostrou-se elevada na população estudada. A proporção da forma neurológica foi significativa, porém, não se podem descartar diagnósticos falso-positivos. A triagem oftalmológica foi eficaz em identificar a forma ocular da sífilis em paciente assintomático. A profilaxia específica pós-TxR para pacientes com tratamento prévio adequado parece desnecessária.
Introduction: Scientific literature is scarce regarding the prevalence and the adequate management of syphilis in patients who are candidates for kidney transplantation (KTx). The aim of this study was to increase knowledge about the subject. Methods: Case series that included all patients placed on a Brazilian single center KTx waiting list between 2013 and 2017, with serological diagnosis of syphilis. Ophthalmologic evaluation and cerebrospinal fluid examination were indicated for all subjects. Patients were classified according to the clinical form of syphilis and treated according to current protocols. Demographic, epidemiological, clinical, laboratory and therapeutic data were reviewed using electronic medical records. Descriptive statistical analysis was performed. Results: The prevalence of syphilis in the population studied was 3.3% (27/807). Of the 27 patients included in the study, 77.8% were diagnosed with the latent form of the disease and 22.2% with neurosyphilis. Increased protein level was the only cerebrospinal fluid alteration present in patients with neurosyphilis. Ophthalmologic evaluation detected ocular involvement of syphilis in an asymptomatic patient. Eleven patients were transplanted, five of whom did not receive specific prophylaxis after KTx. No disease reactivation was identified within the median follow-up period of 46 months. Discussion: Seroprevalence of syphilis was high in the studied population. The proportion of neuroshyphilis was significant; however, false-positive diagnoses cannot be ruled out. Ophthalmologic screening was effective in identifying the ocular form of syphilis in an asymptomatic patient. Specific post-KTx prophylaxis for patients with adequate prior treatment seems unnecessary.
Introduction: Scientific literature is scarce regarding the prevalence and the adequate management of syphilis in patients who are candidates for kidney transplantation (KTx). The aim of this study was to increase knowledge about the subject. Methods: Case series that included all patients placed on a Brazilian single center KTx waiting list between 2013 and 2017, with serological diagnosis of syphilis. Ophthalmologic evaluation and cerebrospinal fluid examination were indicated for all subjects. Patients were classified according to the clinical form of syphilis and treated according to current protocols. Demographic, epidemiological, clinical, laboratory and therapeutic data were reviewed using electronic medical records. Descriptive statistical analysis was performed. Results: The prevalence of syphilis in the population studied was 3.3% (27/807). Of the 27 patients included in the study, 77.8% were diagnosed with the latent form of the disease and 22.2% with neurosyphilis. Increased protein level was the only cerebrospinal fluid alteration present in patients with neurosyphilis. Ophthalmologic evaluation detected ocular involvement of syphilis in an asymptomatic patient. Eleven patients were transplanted, five of whom did not receive specific prophylaxis after KTx. No disease reactivation was identified within the median follow-up period of 46 months. Discussion: Seroprevalence of syphilis was high in the studied population. The proportion of neuroshyphilis was significant; however, false-positive diagnoses cannot be ruled out. Ophthalmologic screening was effective in identifying the ocular form of syphilis in an asymptomatic patient. Specific post-KTx prophylaxis for patients with adequate prior treatment seems unnecessary.
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Palavras-chave
Sífilis, Transplante Renal, Imunossupressão