Biological false‐positive venereal disease research laboratory test in cerebrospinal fluid in the diagnosis of neurosyphilis – a case‐control study

Zheng, Shuwei; Lin, Ray Junhao; Chan, Yiong‐Huak; Ngan, Cecilia Cheng-Lai

doi:10.1111/jdv.14681

Cited by 11 publications

(8 citation statements)

References 15 publications

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“…During the entire study period, not a single positive CSF-VDRL obtained in the absence of positive blood syphilis testing led to a diagnosis of neurosyphilis, highlighting the importance of considering pre-test probability prior to ordering CSF-VDRL, particularly in low-prevalence settings. This false-positivity rate is consistent with a recent study by Zheng et al, which reported a false-positive rate of 25 However, the cause of the false-positive results differed. In our study, a large percentage of patients with false-positive CSF-VDRL results were ultimately diagnosed with neoplastic meningitis, mostly meningeal carcinomatosis associated with primary lung cancer.…”

Section: Discussionsupporting

confidence: 91%

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Assessing Utilization of the Cerebrospinal Fluid Venereal Disease Research Laboratory Test for Diagnosis of Neurosyphilis: a Cohort Study

et al. 2020

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BACKGROUND: Inappropriate use of diagnostic tests contributes to rising healthcare expenditures, and improving appropriate utilization rates is important for high-value patient care. The Venereal Disease Research Laboratory (VDRL) test performed in cerebrospinal fluid (CSF) has historically been improperly utilized, although there is no recent evaluation of its use in clinical practice. OBJECTIVES: Quantify the rates of appropriate CSF-VDRL testing, determine the CSF-VDRL false-positivity rate, and describe the causes of false-positive CSF-VDRL reactivity.

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Section: Discussionsupporting

confidence: 91%

“…Zheng et al did not find any cases of neoplastic meningitis. 25 The difference between our findings is likely due in part to different populations and/or practice patterns. The Zheng study was conducted in Singapore, and importantly, their study was conducted over a 3-year period, whereas we analyzed data spanning 24 years.…”

Section: Discussionmentioning

confidence: 58%

Assessing Utilization of the Cerebrospinal Fluid Venereal Disease Research Laboratory Test for Diagnosis of Neurosyphilis: a Cohort Study

et al. 2020

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“…Antilipoidal antibodies are produced not only as a consequence of syphilis and other treponemal diseases but also in response to non-treponemal diseases of an acute and chronic nature in which tissue damage occurs ( 10 ). Although the incidence of biological false-positive VDRL tests is rare in spinal fluid samples ( 11 ), some studies have reported false-positive CSF VDRL results in the setting of central nervous system malignancy or HIV infection ( 12 – 14 ). However, for these syphilis patients, negative CSF-VDRL-10 results but positive CSF-VDRL-17 results may be indications for a very early phase of asymptomatic neurosyphilis and contribute to early diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Which Is the Optimum Antigen Concentration for the Venereal Disease Research Laboratory Test of Cerebrospinal Fluid for Neurosyphilis Diagnosis: 10 or 17 μL?

Xiao

et al. 2022

Front. Med.

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The manufacturer's instructions for the venereal disease research laboratory (VDRL) antigen test for diagnosing neurosyphilis describe testing of serum samples and do not include procedures for cerebrospinal fluid (CSF) testing. This study compared the CSF-VDRL test with 10 μL of antigen (CSF-VDRL-10) according to the American Public Health Association to the CSF-VDRL test with 17 μL of antigen (CSF-VDRL-17) according to the VDRL serum procedure. A total of 121 neurosyphilis patients and 86 syphilis/non-neurosyphilis patients were included. The sensitivities of the CSF-VDRL-10 and CSF-VDRL-17 tests were comparable for neurosyphilis diagnosis. The positive rate of the CSF-VDRL-17 test was higher than that of the CSF-VDRL-10 test. In all, 78.3% of the quantitative CSF-VDRL-17 results were consistent with those of the CSF-VDRL-10 test, 18.4% exhibited one-titer higher results than those of the CSF-VDRL-10 test, and 3.4% had positive CSF-VDRL-17 results but negative CSF-VDRL-10 results. The CSF-VDRL test with 17 μL of antigen was more sensitive, and it is worth performing longitudinal studies to understand its practical implications.

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“…6 CSF VDRL has a high specificity barring blood contamination 6 and a positive predictive value of 100% with a positive serum nontreponemal test. 7 The diagnosis of Lyme disease, however, is not straightforward, and we suggest following a diagnostic algorithm (Figure 2). His initial serum Lyme WB had only 1 positive IgG band (41 kD), with negative IgM.…”

Section: Sectionmentioning

confidence: 99%

Clinical Reasoning: A 68-Year-Old Man With Palmar Rash, Leg Pain, and Inability to Walk

Yoon

Solomon

et al. 2022

Neurology

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We are reporting a 68-year-old man with palmar rash, leg pain and inability to walk, whose neurologic examination localized to multiple roots, leading to the diagnosis of polyradiculopathy. Polyradiculopathy has both structural and non-structural etiologies. Structural etiologies include spinal stenosis, tethered cord syndrome, tumors, and leptomeningeal metastasis. Non-structural etiologies include inflammatory, infectious, metabolic, and other neoplastic processes. His palmar rash in conjunction with neurological signs/symptoms raised the suspicion for an infectious etiology, and eventually serology and lumbar puncture confirmed the final diagnosis. In this report, we will further discuss how we determined the localization of polyradiculopathy, its specific etiologies, management decisions, and a transient complication, before he achieved a significant improvement at 6 months.

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Biological false‐positive venereal disease research laboratory test in cerebrospinal fluid in the diagnosis of neurosyphilis – a case‐control study

Abstract: Biological false-positive VDRL-CSF is common in a setting where patients are tested without first establishing a serological diagnosis of syphilis. Serological testing should be performed prior to CSF evaluation for neurosyphilis.

Cited by 11 publications

References 15 publications

Assessing Utilization of the Cerebrospinal Fluid Venereal Disease Research Laboratory Test for Diagnosis of Neurosyphilis: a Cohort Study

Assessing Utilization of the Cerebrospinal Fluid Venereal Disease Research Laboratory Test for Diagnosis of Neurosyphilis: a Cohort Study

Which Is the Optimum Antigen Concentration for the Venereal Disease Research Laboratory Test of Cerebrospinal Fluid for Neurosyphilis Diagnosis: 10 or 17 μL?

Clinical Reasoning: A 68-Year-Old Man With Palmar Rash, Leg Pain, and Inability to Walk

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