Diagnosis of neurosyphilis by examination of the cerebrospinal fluid.

Luger, Anton; Schmidt, B; Steyrer, K; Schönwald, E

doi:10.1136/sti.57.4.232

Cited by 25 publications

(17 citation statements)

References 30 publications

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“…In our study, carrying out a LUMBAR PUNCTURE among patients who were selected in accordance with the criteria laid out above, in the Material and Methods section, seems to have been appropriate, given that this allowed us to detect five patients (15%) who had positive CSF VDRL tests (which therefore confirmed the diagnosis of neurosyphilis). If we add the criteria set forth by Luger et al 11,12 , this percentage increases to 43.8% (14 patients).…”

Section: Discussionmentioning

confidence: 99%

“…On Reibergrams, this can be seen to be connected with intrathecal production of specific antibodies (IgG quotient), which would indicate local activity, while the IgG index itself might have less sensitivity in this regard 12,13,14,15,16 . These diagnostic alternatives have made it possible to obtain information in cases of symptomatic HIV-negative patients.…”

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confidence: 99%

“…These can also help in this regard, since it occurs in HIV-negative patients with symptoms and signs of neurosyphilis 11,12,13 . TPHA is an indirect hemagglutination test through which it is possible to assay for anti-T. pallidum specific antibodies in serum and CSF.…”

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Cerebrospinal fluid examination may be useful in diagnosing neurosyphilis in asymptomatic HIV+ patients with syphilis

Salamano

Ballesté

Perna

et al. 2016

Arq. Neuro-Psiquiatr.

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ARTICLE Cerebrospinal fluid examination may be useful in diagnosing neurosyphilis in asymptomatic HIV+ patients with syphilisEl examen del líquido céfalo raquídeo puede ser útil en el diagnóstico de neurosífilis en pacientes VIH + asintomáticos con sífilis Whether lumbar puncture should be indicated for diagnosing neurosyphilis in patients who are coinfected with the human immunodeficiency virus (HIV) and Treponema pallidum (T. pallidum) but do not have any symptoms or neurological signs is a matter for discussion 1,2 . The European guidelines recommend lumbar puncture in cases of symptomatic patients (neurological, ophthalmological or otological symptoms) and asymptomatic HIV-positive patients with Venereal Disease Research Laboratory (VDRL) test results greater than or equal to 1/32 in serum and CD4 less than or equal to 350. These guidelines suggest that lumbar puncture should not be compulsory but that it could be indicated in cases of late latent syphilis or syphilis of undetermined duration 3 . In 2002, the Centers for Disease Control and Prevention (CDC) recommended lumbar puncture for patients with late latent syphilis or syphilis of undetermined duration. This recommendation was later revised to include reactive VDRL ≥ 1/32 in serum and CD4 cell counts ≤ 350 cells/ml. Since 2010, CDC has not been recommending lumbar puncture for asymptomatic patients. AbstrACtLumbar puncture in neurologically asymptomatic HIV+ patients is still under debate. There are different criteria for detecting neurosyphilis through cerebrospinal fluid (CSF), especially in cases that are negative through the Venereal Disease Research Laboratory (VDRL), regarding cellularity and protein content. However, a diagnosis of neurosyphilis can still exist despite negative VDRL. Treponema pallidum hemagglutination assay (TPHA) titers and application of the TPHA index in albumin and IgG improve the sensitivity, with a high degree of specificity. Thirty-two patients were selected for this study. VDRL was positive in five of them. The number of diagnoses reached 14 when the other techniques were added. It was not determined whether cellularity and increased protein levels were auxiliary tools in the diagnosis. According to our investigation, CSF analysis using the abovementioned techniques may be useful in diagnosing neurosyphilis in these patients.Keywords: neurosyphilis, HIV positive, VDRL, TPHA in CSF, TPHA indexes. resumo La punción lumbar (PL) en pacientes VIH+ neurológicamente asintomáticos es controversial. Existen diferentes criterios para detectar en el líquido cefalorraquídeo (LCR) neurosífilis (NS): el examen Venereal Disease Research Laboratory (VDRL) en primer lugar, en caso de negatividad: la celularidad y el tenor de proteinas. Sin embargo el diagnóstico de NS puede ser sostenido a pesar de la negatividad de las técnicas mencionadas. La titulación del Treponema pallidum hemagglutination assay (TPHA) y la aplicación del índice de TPHA en Albúmina e Ig G mejoran la sensibilidad asociando elevado grado de especificidad. 32 pacien...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Cerebrospinal fluid examination may be useful in diagnosing neurosyphilis in asymptomatic HIV+ patients with syphilis

Salamano

Ballesté

Perna

et al. 2016

Arq. Neuro-Psiquiatr.

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“…On the other hand, cerebrospinal leukocytosis and elevated protein concentration are nonspecific findings and therefore considered as presumptive diagnosis (18,21). Some authors suggest that both the fluorescent treponemal antibody test (FTAAbs) and the T. pallidum microhemagglutination test (MHA-TP) are more sensitive, although less specific than the VDRL test (21)(22)(23) in the diagnosis of neurosyphilis, but this is not accepted by everyone (24,25). It is also believed that a nonreactive result in the FTA-Abs CSF test (21,23,26) could be used to rule out neurosyphilis.…”

Section: Introductionmentioning

confidence: 96%

Evaluation of theTreponema pallidum particle agglutination technique (TP.PA) in the diagnosis of neurosyphilis

Castro

Prieto

Águas

et al. 2006

J. Clin. Lab. Anal.

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The Treponema pallidum particle agglutination technique (TP.PA) was evaluated, in comparison with the Venereal Disease Research Laboratory (VDRL) test, microhemagglutination assay for Treponema pallidum antibodies (MHA-TP), and fluorescent treponemal antibody-ABS (FTA-Abs) test for the diagnosis of neurosyphilis. We have studied 198 cerebrospinal fluid (CSF) samples from patients with syphilis, including neurosyphilis, treated syphilis, and with other neurological manifestations than neurosyphilis. All tests were nonreactive in these last group of patients. In the neurosyphilis patients, sensitivity of the TP.PA was 100%. The performance of this test in CSF from patients with primary syphilis was as good as that of the other tests. In secondary and latent syphilis, the TP.PA results (27 reactive samples/73) were similar to those of the MHA-TP (25 reactive samples/73). In the individuals treated for syphilis, the TP.PA, FTA-Abs, and MHA-TP tests were found to be reactive in eight, six, and eight samples, respectively. In conclusion, it seems that the TP.PA can be used in CSF to diagnose neurosyphilis, although as for other serological tests, interpretation of results should be done in conjunction with other neurosyphilis parameters.

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“…[otherwise undiagnosed] progressive neurologic symptoms." The CSF FTA-ABS yields many false positives unless it is titered and compared to total CSF protein [8], and it is not regarded as acceptable for diagnosing neurosyphilis [9]. The same applies to the microhemagglutination assay for T. pallidum antibodies or other specific anti-treponemal antibody tests.…”

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confidence: 99%

Editorial Commentary: Polymerase Chain Reaction for the tpp47 Gene: A New Test for Neurosyphilis

Musher

2016

Clinical Infectious Diseases

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Diagnosis of neurosyphilis by examination of the cerebrospinal fluid.

Cited by 25 publications

References 30 publications

Cerebrospinal fluid examination may be useful in diagnosing neurosyphilis in asymptomatic HIV+ patients with syphilis

Cerebrospinal fluid examination may be useful in diagnosing neurosyphilis in asymptomatic HIV+ patients with syphilis

Evaluation of theTreponema pallidum particle agglutination technique (TP.PA) in the diagnosis of neurosyphilis

Editorial Commentary: Polymerase Chain Reaction for the tpp47 Gene: A New Test for Neurosyphilis

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