Neurosyphilis - CSF diagnosis
3/03/02 (Brown)
Question: What is the sensitivity/specificity of cerebrospinal fluid tests for neurosyphilis?
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<2>
Unique Identifier:10772085
Authors: Luger AF. Schmidt BL. Kaulich M.
Institution: Ludwig Boltzmann Institute for Dermato-Venereological Serodiagnosis, Vienna, Austria.
Title: Significance of laboratory findings for the diagnosis of neurosyphilis.
Source: International Journal of STD & AIDS. 11(4):224-34, 2000 Apr.
Abstract: Our objective is to assess the specificity and sensitivity, and thus elaborate the relevance, of different laboratory findings for the diagnosis of neurosyphilis. One hundred and fourteen HIV-negative pairs of serum and cerebrospinal fluid (CSF) samples were examined by the Venereal Disease Research Laboratory (VDRL) test, a fluorescent treponemal antibody-absorption (FTA-ABS) test, microhaemagglutination assay with Treponema pallidum antigen (MHA-TP) test (serum) and Treponema pallidum haemagglutination assay (TPHA) test (CSF); further, albumin, total protein, and total IgG were determined and, in the CSF, cell count was performed. The donors were 60 patients with active neurosyphilis and 54 healthy persons with a former history of syphilis and with persisting positive results in the T. pallidum haemagglutination tests (serum: MHA-TP, CSF: TPHA), who supplied specimens for control. Albumin quotient, IgG index, TPHA index, modified TPHA index, Intrathecally produced T. pallidum Antigen (ITpA) index, its 2 modifications and, in 12 samples, the adenovirus group antibody (AVGA)/TPHA index were ascertained. The specificity and sensitivity of the TPHA index were 100% and 98.3%, of the modified TPHA index 50.0% and 96.7%, of the ITpA index 42.6% and 90.0%, of the modified ITpA indices 51.8% and 68.3% (first modification) and 53.7% and 63.3% (second modification). The AVGA/TPHA index yielded a specificity of 91.7% (11/12). The CSF VDRL test was positive in 55/60 (91.7%) of samples from patients with neurosyphilis and in none of the controls (0/54). A CSF-TPHA titre greater than 1:320 was observed in 59/60 (98.3%) of the neurosyphilis specimens and in none of the controls (0/54). A TPHA index above an outcome of 70, a positive CSF-TPHA test at a titre greater than 1:320 and, with lower sensitivity, the criteria of the Centers for Disease Control (CDC) guidelines yield the most reliable results for laboratory support to a diagnosis of neurosyphilis. The modified TPHA index, the ITpA index, and its 2 modifications produce results of minor sensitivity and poor specificity. Observations on the AVGA/THPA index are too limited yet for judgement. The diagnostic significance of a CSF-TPHA titre above 320 needs further confirmation on a greater number of observations made by different laboratories. CAS Registry/EC Number 0 (Antibodies, Bacterial). 0 (Antigens, Bacterial). 0 (Reagent Kits, Diagnostic).
<5>
Unique Identifier:8885070
Authors: MacLean S. Luger A.
Institution: Ludwig Boltzmann Institute of Dermato-Venerological Serodiagnosis, Vienna-Lainz Hospital, Austria.
Title: Finding neurosyphilis without the Venereal Disease Research Laboratory test.
Source: Sexually Transmitted Diseases. 23(5):392-4, 1996 Sep-Oct.
Abstract: BACKGROUND: The cerebrospinal fluid (CSF)-Venereal Disease Research Laboratory (VDRL) test is only 27% sensitive for diagnosing neurosyphilis. Discriminant analysis, used on 124 patients, shows that other commonly used laboratory tests can, in combination, identify 87% of patients with neurosyphilis with 94% specificity. STUDY DESIGN: The insensitivity of the CSF-VDRL (27% in persons with neurosyphilis) and the foreseen greater need to identify and treat neurosyphilis in the era of human immunodeficiency virus caused us to analyze the serum and cerebrospinal fluid results of 73 patients with syphilis and of 51 patients with clinically diagnosed neurosyphilis. Discriminant analysis was applied to different sets of laboratory tests to find the combination of test results best able to predict retrospectively the clinical diagnosis of syphilis or neurosyphilis, without reference to the CSF-VDRL. RESULTS: The predicting function averages 94% specificity and 87% sensitivity. Test result variables considered together are: CSF-FTA-ABS, serum FTA-ABS, CSF-TPHA, serum TPHA, and CSF cells. CONCLUSIONS: The authors conclude that clinicians or laboratories can, independently of the CSF-VDRL, compute a score showing whether the results of a set of commonly used tests suggest neurosyphilis in a patient. CAS Registry/EC Number 0 (Cardiolipins). 0 (Phosphatidylcholines). 0 (VDRL antigen). 57-88-5 (Cholesterol).
<7>
Unique Identifier:7890932
Authors: Scheck DN. Hook EW 3rd.
Institution: University of Alabama School of Medicine, Birmingham.
Title: Neurosyphilis. [Review] [171 refs]
Source: Infectious Disease Clinics of North America. 8(4):769-95, 1994 Dec.
Abstract: Central nervous system invasion by Treponema pallidum, the causative agent of syphilis, occurs in many, if not most, patients with syphilis. Laboratory findings from untreated asymptomatic syphilis patients with abnormalities of cerebrospinal fluid are termed asymptomatic neurosyphilis and represent a group that has an increased risk for developing clinical neurosyphilis syndromes. Clinical neurosyphilis syndromes, which occur in a minority of patients, may become apparent at any time in the natural history of untreated disease and often cause serious morbidity for individuals who develop them. Because there is no single sensitive and highly specific test for neurosyphilis diagnosis, clinicians must approach this important syndrome using a combination of clinical and laboratory data and a firm understanding of the disease. [References: 171] CAS Registry/EC Number 0 (Penicillins).
<9>
Unique Identifier:8011805
Authors: Tomberlin MG. Holtom PD. Owens JL. Larsen RA.
Institution: Department of Medicine, Los Angeles County-University of Southern California Medical Center.
Title: Evaluation of neurosyphilis in human immunodeficiency virus-infected individuals.
Source: Clinical Infectious Diseases. 18(3):288-94, 1994 Mar.
Abstract: The diagnosis of neurosyphilis in patients infected with the human immunodeficiency virus (HIV) remains problematic. We examined the use of the Treponema pallidum hemagglutination (TPHA) index and quantitative tests of CSF by means of microhemagglutination-T. pallidum for diagnosis of neurosyphilis in 58 HIV-infected persons with latent syphilis who had not recently received therapy for syphilis. Five patients (9%) had reactive CSF VDRL tests and thus had proven neurosyphilis. For 13 patients (22%), CSF findings were normal and revealed no evidence of neurosyphilis. For 40 patients (69%), abnormal CSF findings were characteristic of neurosyphilis, but their CSF VDRL tests were nonreactive. Twenty-five of the 40 patients with possible neurosyphilis had pleocytosis and elevated CSF levels of protein and/or IgG. Five (12.5%) of these 40 patients had positive TPHA indices that indicated intrathecal antitreponemal antibody production, a finding that provided greater support for the diagnosis of active neurosyphilis. With use of the TPHA index, patients with CSF abnormalities can be better classified in regard to their need for therapy for neurosyphilis. CAS Registry/EC Number 0 (Albumins). 0 (Antibodies, Bacterial). 0 (Cerebrospinal Fluid Proteins). 0 (Immunoglobulin G).
<17>
Unique Identifier:2643918
Authors: Davis LE. Schmitt JW.
Institution: Neurology Service, Veterans Administration Medical Center, Albuquerque, NM 87108.
Title: Clinical significance of cerebrospinal fluid tests for neurosyphilis. [see comments.].
Source: Annals of Neurology. 25(1):50-5, 1989 Jan.
Abstract: From 1978 to 1987, 1,665 cerebrospinal fluid (CSF) fluorescent treponemal antibody absorption (CSF-FTA-ABS) tests were performed as the screening procedure for neurosyphilis. The CSF samples from 48 patients were reactive, and the medical history and results of the CSF-Venereal Disease Research Laboratory test (CSF-VDRL) for syphilis for 38 of these patients were reviewed. Likely active neurosyphilis was diagnosed if the patient had a reactive CSF-FTA-ABS test, recent onset of neurological signs consistent with neurosyphilis, abnormal CSF, and no other recognized cause for the neurological illness. Fifteen patients were so classified. Four had a reactive CSF-VDRL test. The specificity of the CSF-VDRL in diagnosing likely active neurosyphilis was 100%, but the sensitivity was only 27%. The insensitivity of the CSF-VDRL test limits its usefulness as a screening test for neurosyphilis. The CSF-FTA-ABS test appears more sensitive for screening but is less specific than the CSF-VDRL test in distinguishing currently active neurosyphilis from past syphilis. These findings imply that clinical judgment is still essential in establishing the diagnosis of active neurosyphilis.
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