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"Latar Belakang. Neurosifilis merupakan infeksi susunan saraf akibat invasi bakteri Treponema Pallidum yang dapat menyebabkan kecacatan. Selain itu gejala klinis neurosifilis beragam, tidak khas, bahkan asimtomatik sehingga dapat menyebabkan kesalahan diagnosis yang cukup tinggi. Angka kejadian sifilis di Indonesia masih tinggi bahkan masih terus meningkat. Akan tetapi hingga saat ini belum diketahui prevalensi dan deskripsi neurosifilis di Indonesia. Studi ini bertujuan untuk mendapatkan prevalensi neurosifilis dan perbandingan karakteristik klinis dan penunjang antara neurosifilis dan non-neurosifilis di RSUPN dr. Cipto Mangunkusumo.Metode. Studi potong lintang dengan data rekam medis di RSUPN dr. Cipto Mangunkusumo pada pasien dengan kecurigaan neurosifilis yang dikonsulkan ke neurologi sejak Januari 2019-Januari 2024. Dilakukan evaluasi karakteristik klinis dan penunjang baik profil darah berupa serum maupun cairan serebrospinal (CSS) serta pencitraan otak.Hasil. Dari 100 subjek dengan kecurigaan neurosifilis yang dikonsulkan ke neurologi, terdapat 72 kasus neurosifilis dan 28 kasus non neurosifilis. Pada kelompok neurosifilis keluhan tersering saat dikonsulkan ke neurologi adalah gangguan penglihatan (OR 7,46 [2,83-19,64], p<0,001) dan nyeri kepala (OR 4,43 [1,22-16.14], p= 0,031). Titer RPR serum (median 1:128) dan TPHA serum kelompok neurosifilis (median 1:10240) lebih tinggi dibandingkan non neurosifilis. Kelompok neurosifilis cenderung memiliki jumlah leukosit CSS lebih tinggi (median 7 [1,00-155,0], p<0,001) dan jumlah protein lebih tinggi (median 47 [5,00-612,00], p<0,001) dibandingkan non-neurosifilis. Pada 10 subjek neurosifilis dengan gambaran pencitraan otak abnormal terdapat 3 subjek dengan gambaran space occupying lesion.Kesimpulan. Prevalensi neurosifilis pada pasien sifilis yang dikonsulkan ke neurologi di RSUPN dr. Cipto Mangunkusumo sangat tinggi (72%). Kecurigaan neurosifilis lebih tinggi pada pasien sifilis dengan keluhan gangguan penglihatan atau nyeri kepala dan memiliki kadar limfosit darah yang rendah, dengan titer RPR serum ≥1:128 dan titer TPHA serum ≥1:10.240. Selain itu studi ini juga mendapatkan 10 subjek dengan abnormalitas pencitraan otak, sehingga pada pasien sifilis terutama dengan gejala dan tanda neurologi perlu dipertimbangkan untuk dilakukan pemeriksaan pencitraan otak MRI Kepala.

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Background. Neurosyphilis is an infection of the nervous system caused by the invasion of the bacterium Treponema pallidum, which can lead to disability. Additionally, the clinical symptoms of neurosyphilis are varied, non-specific, and can even be asymptomatic, leading to a high rate of misdiagnosis. The incidence of syphilis in Indonesia remains high and continues to increase. However, to date, the prevalence and description of neurosyphilis in Indonesia are still unknown. This study aims to determine the prevalence of neurosyphilis and to compare the clinical and supporting characteristics between neurosyphilis and non-neurosyphilis patients at the National Central General Hospital Dr. Cipto Mangunkusumo.

Methods. A cross-sectional study utilizing medical records at RSUPN Dr. Cipto Mangunkusumo will be conducted on patients suspected of having neurosyphilis who were referred to neurology from January 2019 to January 2024. The study will evaluate clinical characteristics and supportive data, including blood profiles (serum), cerebrospinal fluid (CSF) analysis, and brain imaging.

Result. From 100 subjects with suspected neurosyphilis referred to neurology, there were 72 cases of neurosyphilis and 28 cases of non-neurosyphilis. In the neurosyphilis group, the most common complaints at the time of consultation were visual disturbances (OR 7.46 [2.83-19.64], p<0.001) and headaches (OR 4.43 [1.22-16.14], p=0.031). Serum RPR titers (median 1:128) and TPHA titers (median 1:10240) were higher in the neurosyphilis group compared to the non-neurosyphilis group. The neurosyphilis group tended to have higher CSF leukocyte counts (median 7 [1.00-155.0], p<0.001) and higher protein levels (median 47 [5.00-612.00], p<0.001) compared to the non-neurosyphilis group. Among 10 neurosyphilis subjects with abnormal brain imaging, 3 subjects had findings suggestive of a space-occupying lesion

Conclusion. The prevalence of neurosyphilis among syphilis patients referred to neurology at RSUPN dr. Cipto Mangunkusumo is very high (72%). Suspicion of neurosyphilis is higher in syphilis patients presenting with visual disturbances or headaches and having low blood lymphocyte levels, with serum RPR titers ≥1:128 and serum TPHA titers ≥1:10,240. Additionally, this study also identified 10 subjects with abnormalities in brain imaging. Therefore, in syphilis patients, especially those with neurological symptoms and signs, consideration should be given to performing brain MRI imaging."

"ABSTRAKSifilis adalah penyakit menular seksual kronik yang memiliki manifestasi klinis yang bervariasi dan menetap untuk waktu yang lama. Neurosifilis merupakan salah satu komplikasi sifilis sistemik dengan temuan di cairan serebrospinal dengan atau tanpa gejala yang jelas. Pemeriksaan yang saat ini tersedia dalam mendukung diagnosis hanya tersedia pemeriksaan analisis cairan serebrospinal dan serologi Treponema pallidum. Saat ini belum diketahui prevalensi neurosifilis di rumah sakit peneliti dan profil serologi Treponema pallidum dari bahan cairan serebrospinal. Penelitian ini merupakan penelitian potong lintang, dilakukan November 2017-Maret 2018 terhadap 50 cairan serebrospinal dan darah yang diperiksakan analisis cairan serebrospinal dengan keterangan klinis terduga infeksi intrakranial. Serum dan cairan serebrospinal diperiksakan RPR, TPHA, anti-Treponema pallidum ELISA IgG dan khusus cairan serebrospinal diperiksa pula rapid test Treponema pallidum. Uji statistik menggunakan chi quare and Fisher exact test. Dari penelitian terhadap 50 cairan serebrospinal dan serum didapatkan rapid test Treponema pallidum, RPR dan TPHA cairan serebrospinal reaktif 4 8 . Dari bahan serum didapatkan RPR reaktif 8 16 dan TPHA reaktif 9 18 . Anti-Treponema pallidum ELISA IgG positif 4 sampel 8 . Dari 50 sampel didapatkan 7 14 neurosifilis, 4 confirmed neurosyphilis dan 3 probable neurosyphilis sesuai kriteria Center for Disease Control and Prevention. Profil analisis cairan serebrospinalnya tidak berwarna, jernih, tidak ada bekuan, hitung sel 12.71 9.20 sel/ l, dominasi mononuklear 11.57 9.47 sel/ l, Pandy positif, protein cairan 42.29 21.49 mg/dl, glukosa cairan 55 5.16 mg/dl, glukosa serum 101.04 20.10 mg/dl, dan klorida 122.14 2.48 mEq/L. Pemeriksaan RPR, TPHA, dan anti-Treponema pallidum ELISA IgG dengan bahan serum dan cairan serebrospinal memiliki hubungan bermakna. Dari penelitian ini didapatkan 14 sesuai dengan neurosifilis dari populasi penelitian dan didapatkan 85.71 dengan HIV reaktif. Pada pasien HIV disarankan RPR dan TPHA serum untuk pemeriksaan skrining sifilis.

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ABSTRACTSyphilis is a chronic sexually transmitted disease that has varying clinical manifestations and persist for a long time. Neurosyphilis is one of the complications of systemic syphilis with findings in cerebrospinal fluid with or without obvious symptoms. Examinations currently available for diagnostic support were cerebrospinal fluid analysis and serology of Treponema pallidum. There is currently no known prevalence of neurosyphilis in the research hospital and serologic profile of Treponema pallidum from cerebrospinal fluid. This study was a cross sectional study, conducted November 2017-March 2018 against 50 cerebrospinal fluid and blood samples that examined cerebrospinal fluid analysis with clinical information of suspected intracranial infection. Serum and cerebrospinal fluid examined by RPR, TPHA, anti-Treponema pallidum ELISA IgG and particulary rapid test Treponema pallidum for cerebrospinal fluid. Statistic tests were chi quare and Fisher exact test. From a total of 50 cerebrospinal fluid and serum, 4 8 had reactive cerebrospinal fluid T. pallidum rapid tests, RPRs and TPHAs. From serum there were 8 16 reactive RPRs and 9 18 reactive TPHAs. Anti-Treponema pallidum ELISA IgG was positif 4 samples 8 . Among the 50 samples, 7 14 had neurosyphilis, 4 were confirmed neurosyphilis and 3 were probable neurosyphilis according to Center for Disease Control and Prevention criteria. The cerebrospinal fluid analysis profile is colorless, clear, without clot, cell count 12.71 9.20 cells/ l, mononuclear 11.57 9.47 cells/ l, positive for Pandy, cerebrospinal fluid protein 42.29 21.49 mg/dl, glucose 55 5.16 mg/dl, serum glucose 101.04 20.10 mg/dl, and chloride 122.14 2.48 mEq/L. Rapid Plasma Reagin, TPHA, and anti-Treponema pallidum ELISA IgG were associated between serum specimen and cerebrospinal fuid. Neurosyphilis was found in 14 of our patient population and 85.71 was reactive for HIV. Rapid Plasma Reagin and TPHA in sera were recommended for syphilis screening for HIV patient. "