Intrathecal IgA synthesis in neurosyphilis

Ebinger, Martin; Grauer, M; Uhr, Manfred

doi:10.1016/j.jns.2004.09.028

Cited by 7 publications

(3 citation statements)

References 7 publications

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“…Hence, the pattern of intrathecal immunoglobulin in NS is IgG dominant, with occasional IgM and IgA intrathecal synthesis. Our data are consistent with a previous report that approximately 50% of patients with neurosyphilis show intrathecal synthesis of IgM ( 33 ), and in contrast with this previous report, the data show the absence of IgA synthesis in NS ( 23 ). IgA ITS does not necessarily discriminate neurosyphilis from other inflammatory CNS disorders.…”

Section: Discussionsupporting

confidence: 92%

Intrathecal immunoglobin synthesis and its role in patients with neurosyphilis

Huang

Ying

Luo

et al. 2022

Front. Public Health

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BackgroundIntrathecal protein synthesis (ITS) occurs in various central nervous system disorders, but few quantitative studies have focused on ITS for neurosyphilis (NS) in southwestern China. We made a study to quantitatively assess the ITS in patients with NS and to investigate the association between ITS and the stages of NS.MethodsCSF–serum specimen pairs from 142 patients (66 NS and 76 non-NS/syphilis) were collected for routine CSF and serum tests. The NS group was divided into slight and severe subgroups according to the NS stages. Three formulas for the quantitative determination of the intrathecal synthesis were calculated to characterize the specimens, including the Ig index (QIg/Qalb), Ig extended index (Ig_EI), and intrathecally synthesized fraction (IgIF) using the hyperbolic function. The role of QTPPA/QIgG as an antibody index (AI = Q specific Ig/QIgG) was also explored.ResultsSero_TRUST titres (1:16, 1:1-1:256), sero_TPPA titres (1:163840, 1:1280-1:1310720), total protein (MTP), and CSF_Igs (p < 0.05) were found to be significantly elevated in the NS group. Intrathecal Ig synthesis can be identified using all three formulas in the NS group. The pattern of Ig intrathecal synthesis was IgIF-G (48.62%) > IgIF-A = IgIF-M (p < 0.05), with the dominant intrathecal fraction being IgG (median, 48.62%), which was also verified by QIgG> Qalb> QIgM = QIgA. In the slight NS group, the intrathecal fractions of IgM (>0 in 4 out of 20 cases) and IgG (>0 in 16 out of 20) were lower than the intrathecal fractions of IgM (>0 in 19 out of 35 cases) and IgG (>0 in 33 out of 38) in the severe group (p < 0.05). The area under the curve (AUC) of the CSF_TPPA antibody index was 0.867 (0.792, 0.922), with an optimal cutoff point of 0.81, providing a sensitivity of 88.91% and specificity of 84.62%.ConclusionAlthough the intrathecal synthesis pattern is IgG dominant in patients with NS, brain-derived IgM and IgA can also be found. Moreover, intrathecal IgM and IgG were associated with a parenchymatous type of neurosyphilis. Syphilis-specific antibodies are a new potential tool for NS diagnosis.

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Section: Discussionsupporting

confidence: 92%

Intrathecal immunoglobin synthesis and its role in patients with neurosyphilis

Huang

Ying

Luo

et al. 2022

Front. Public Health

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“…Several studies have evaluated the performance measures of detecting intrathecal production of T. pallidumspecific IgG in the diagnosis of neurosyphilis, but data have been inconsistent [85][86][87][88].…”

Section: Csf Lipoidal and Treponemal-specific Testsmentioning

confidence: 99%

REVIEW: Neurosyphilis: A Historical Perspective and Review

Ghanem

2010

CNS Neuroscience & Therapeutics

287

227

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Treponema pallidum subspecies pallidum, the causative agent of syphilis, disseminates to the central nervous system within days after exposure. Clinical manifestations can occur during any stage of the infection, and include asymptomatic neurosyphilis, acute meningeal syphilis, meningovascular syphilis, paretic neurosyphilis, and tabetic neurosyphilis. The majority of cases are reported in HIV-infected patients but the epidemiology of modern neurosyphilis is not well defined because of the paucity of population-based data. Decreasing reports of late neurosyphilis have been countered with increasing reports of early neurologic involvement. This review summarizes the clinical manifestations, diagnosis, and therapy of neurosyphilis, focusing on areas of continued controversy, and highlighting several important questions that remain unanswered. Since 2000, the rates of syphilis continue to increase. Given the effectiveness of penicillin therapy, these trends suggest a failure of prevention. Regrettably, rather than become an infection of historical significance, syphilis in the era of HIV continues to challenge researchers and clinicians.

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“…Mais ces données sont insuffisantes [24,25], et des données issues de LCR de patients atteints de neurosyphilis parenchymateuses ou méningovasculaires ne montrent qu'occasionnellement une synthèse d'IgM concomitante [26].…”

Section: Encadré 1 Diagnostic De Neurosyphilis Par éTude Du Lcr Et Sunclassified

Neurosyphilis and cognitive disorders

Forest

Verny

2013

Gériatrie Et Psychologie Neuropsychiatrie Du Viellissement

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À partir d'un cas que nous avons observé dans notre unité, qui pose le problème d'une intrication entre une maladie infectieuse (neurosyphilis) et une maladie d'Alzheimer (MA) prodromale responsable d'un syndrome confusionnel inhabituel par la sévérité des manifestations comportementales et sa durée, nous proposons de faire le point sur les manifestations cliniques (démentielles et psycho-comportementales) ainsi que les difficultés de diagnostic de la neurosyphilis. Nous discuterons ensuite des polypathologies avec association de différentes causes de démences dans la population âgée où les diagnostics multiples sont prédominants. Abstract.We report the case of a 75 year old man, admitted for a delirium which was unusual by its severity and duration. Underlying disorders were an infectious disease (neurosyphilis) and prodromal Alzheimer's disease. This association was thought to be responsible for the delirium intensity. According to a literature review, we discuss the difficulties of cerebral neurosyphilis diagnosis, its cognitive and behavioural symptoms. We also discuss the cumulative effects of multi morbidities on clinical presentation, underlining a frequent problem in elderly patients in whom multiple causes of cognitive impairment often coexist.

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Intrathecal IgA synthesis in neurosyphilis

Cited by 7 publications

References 7 publications

Intrathecal immunoglobin synthesis and its role in patients with neurosyphilis

Intrathecal immunoglobin synthesis and its role in patients with neurosyphilis

REVIEW: Neurosyphilis: A Historical Perspective and Review

Neurosyphilis and cognitive disorders

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