eIn patients with syphilis, central nervous system (CNS) involvement is often difficult to determine. In patients who also are infected with human immunodeficiency virus (HIV), this is even more challenging, as cerebrospinal fluid (CSF) pleocytosis can be attributed to HIV, syphilis, or both. Hence, this study investigated (i) CSF chemokine (C-X-C motif) ligand 13 (CXCL13) as a potential marker to diagnose neurosyphilis in HIV-infected individuals and (ii) the added value of CSF CXCL13 to conventional CSF biomarkers, such as the rapid plasma reagin test (RPR), in diagnosing neurosyphilis. We included 103 syphilis patients from two centers in The Netherlands: 47 non-HIV-infected patients and 56 HIV-infected patients. A positive CSF-RPR was regarded as the gold standard for neurosyphilis. CSF CXCL13 levels were significantly higher in neurosyphilis patients when neurosyphilis was diagnosed by CSF-RPR (P ‫؍‬ 0.0002) than in the syphilis control group. The sensitivity and specificity of CSF CXCL13 (cutoff of 76.3 pg/ml) to diagnose neurosyphilis by using positive CSF-RPR as the gold standard were 50% and 90%, respectively. CSF CXCL13 had an added value to CSF-RPR positivity in 70% of HIV-positive patients and in 33% of HIV-negative patients. Our data show that CSF CXCL13 might be a potential additional marker in neurosyphilis when other markers are not conclusive. The added value of CSF CXCL13 measurement to the current neurosyphilis gold standard appears to benefit HIV-positive patients more than HIV-negative patients. In 2007, the World Health Organization estimated an incidence of 12 million new infections with Treponema pallidum each year worldwide (1). Invasion of the central nervous system (CNS) by T. pallidum may occur during any disease stage of syphilis, leading to the development of neurosyphilis in some patients (2, 3). When dual infections with HIV and syphilis exist, the diagnostic challenge increases. A positive cerebrospinal fluid (CSF) Venereal Disease Research Laboratory test (VDRL) is generally considered the gold standard for neurosyphilis (4); however, several studies have clearly shown that a positive CSF rapid plasma reagin test (RPR) is an alternative to CSF-VDRL (5, 6), and RPR is also recommended by 2014 European guidelines (IUSTI-2014) (7). When the CSF-RPR or CSF-VDRL is negative, the diagnosis relies on other markers, like CSF pleocytosis, the CSF T. pallidum particle agglutination (TPPA) index, and clinical signs and symptoms.As the laboratory diagnosis of neurosyphilis is difficult, new markers are needed, and CSF B cell chemoattractant chemokine (C-X-C motif) ligand 13 (CXCL13) is currently forwarded as an interesting marker. CXCL13 has been demonstrated to be elevated in B lymphocyte-rich CSF (8, 9). CSF CXCL13 has a higher sensitivity than the established diagnostic markers for neuroborreliosis, such as CSF pleocytosis and Borrelia-specific antibodies (10). High numbers of B lymphocytes have also been observed in CSF from patients with syphilitic meningitis (11). CXCL13 dictates homi...

Introduction The syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) is a diagnosis made by exclusion. In the literature, different etiological explanations are proposed for HaNDL, including an immune-mediated reaction after a viral infection. Case description We present a case of a 23-year-old woman with several episodes of transient headache, neurological deficits and cerebrospinal fluid lymphocytosis. All diagnostic criteria for the HaNDL syndrome were fulfilled; however, additional cerebrospinal fluid analysis showed a positive polymerase chain reaction (PCR) for human herpes virus type 7 (HHV-7). Discussion The possible role of a (prodromal) viral infection in the etiology of HaNDL is discussed. Also the role of electroencephalography (EEG) recordings is discussed. Serial EEG recordings showed generalized slowing, frontal intermittent rhythmic delta activity (FIRDA) and symmetric triphasic frontal waves with a dilation lag.

The effect of immediate incubation of blood cultures at 37°C on the turnaround time and the impact of Gram stain results on antimicrobial management were investigated. During a 6-month period, blood cultures collected at the emergency department outside laboratory operating hours were preincubated at 37°C until transportation to the laboratory. Upon the arrival of blood cultures at the laboratory, Gram stains and subcultures were made from all bottles prior to further incubation in the automated system (Bactec 9240). Data from 1 year earlier, when all blood cultures were stored at room temperature, were used for comparison. In the study period, 79 episodes of bacteremia were detected for 75 patients, compared to 70 episodes for 67 patients in the control period. Preincubation of blood cultures at 37°C resulted in a 15-h reduction in the median time to reporting of Gram stain results, from 34 to 19 h (P, <0.001). With preincubation, 3 episodes (4%) of bacteremia were not detected by the Bactec 9240 system. Based on the reporting of the Gram stain results, appropriate antimicrobial therapy was initiated for 12% of all patients with positive blood cultures, while for 24% the therapy was streamlined. Thus, immediate incubation of blood cultures reduced the time to reporting of Gram stain results. However, not all episodes of bacteremia were detected by the Bactec 9240 system after preincubation at 37°C. Blood culture results contributed importantly to appropriate antimicrobial management.Appropriate antibiotic therapy initiated in a timely manner has been shown to reduce mortality in patients with bloodstream infections (5-7). Therefore, if a bloodstream infection is suspected, blood should be collected for culture as soon as possible, preferably before antimicrobial therapy is initiated. Ideally, blood culture results lead either to the streamlining of broad-spectrum empirical therapy or to the initiation of appropriate therapy (3). Blood culture results may also help to confirm or identify the site of infection.To optimize the clinical use of blood culture results, the interval between the collection of blood and the entry of the bottles into an automated blood culture system should be kept to a minimum. However, many microbiology laboratories do not provide 24-h service, and cultures obtained outside operating hours are often stored at room temperature before entry into the system. Aside from laboratory operating hours, the use of satellite laboratories referring blood cultures to their reference laboratory can cause a significant delay in bottle entry into the system. This delayed entry has been shown to result in increased times to detection of bacteremia and longer hospital stays (1, 9).To overcome this problem, an automated blood culture system can be placed outside the laboratory, and blood cultures may be entered by health care workers. Such an approach resulted in a 10-h reduction in the interval between blood culture collection and growth detection (6). Since it is not always feasible to place a monitorin...

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