매독 편집하기 (부분)

===뇌척수액검사===

*매독환자에서다음과같은경우에는뇌척수액검사를시행한다.
:- 신경학적증상또는징후
:- 안구의증상또는징후
:- 선천매독
:- 적절한치료에도혈청학적반응 (비트레포네마검사의역가감소)을보이지않는환자
:- 3기매독<ref name="Update on syphilis: resurgence of an old problem.">Golden MR, Marra CM, Holmes KK. Update on syphilis: resurgence of an old problem. JAMA 2003;290:1510-14</ref>
:- HIV 양성환자중신경학적증상또는징후를보이는경우, 후기잠복매독, RPR 역가≥ 1:64, CD4 임파구수<350/㎕, 또는치료후VDRL/RPR 역가가 4배이상감소하지않은경우<ref name=” Cerebrospinal fl uid abnormalities in patients with syphilis: association with clinical and laboratory features. “>Marra CM, Maxwell CL, Smith SL, et al. Cerebrospinal fl uid abnormalities in patients with syphilis: association with clinical and laboratory features. J Infect Dis 2004;189:369-76</ref>
:- 일부전문가들은 RPR 역가≥1:64인모든환자에서뇌척수액검사를권장하기도한다.

*뇌척수액검사및해석
:- 뇌척수액에서세포수와분포율, 단백질, VDRL/RPR, 그리고/또는 FTA-ABS 검사를시행한다.
:- CSF-VDRL/RPR은특이도가굉장히높으나민감도가떨어진다.
:- CSF FTA-ABS는민감도가굉장히높으나신경매독에특이적이지않다.
:- CSF FTA-ABS가음성인경우신경매독의진단을배제하는데도움이된다.<ref name="Update on syphilis: resurgence of an old problem.">Golden MR, Marra CM, Holmes KK. Update on syphilis: resurgence of an old problem. JAMA 2003;290:1510-14</ref>,<ref name="Neurosyphilis. A study of 241 patients. ">Hooshmand H, Escobar MR, Kopf SW. Neurosyphilis. A study of 241 patients. JAMA 1972;219:726-9</ref>,<ref name="Clinical signifi cance of cerebrospinal fl uid tests for neurosyphilis.">Davis LE, Schmitt JW. Clinical signifi cance of cerebrospinal fl uid tests for neurosyphilis. Ann Neurol 1990;27:211-2</ref>,<ref name="Cerebrospinal fl uid treponemal antibodies in untreated early syphilis.">Marra CM, Critchlow CW, Hook EW 3rd, Collier AC, Lukehart SA. Cerebrospinal fl uid treponemal antibodies in untreated early syphilis. Arch Neurol 1995;52:68-72</ref>
:- 신경매독의진단은일반적으로임상증상의유무와관계없이혈청학적검사결과와뇌척수액세포수의이상 (임파구증가, 백혈구감소<100 wbc/mm3) 또는단백질증가나 CSF-VDRL/RPR 양성결과를종합하여이루어진다.