Evaluation of Treponemal Serum Tests Performed on Cerebrospinal Fluid for Diagnosis of Neurosyphilis

• Type of Material: Article
• Authors: Jeannette Guarner, Emory University; Heather Jost, Emory University; Allan Pillay, Emory University; Yongcheng Sun, Emory University; David Cox, Emory University; Robert Notenboom, Mern Technology; Kimberly Workowski, Emory University
• Language: English
• Date: 2015-04-01
• Publisher: Oxford University Press
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © American Society for Clinical Pathology.
• Final Published Version (URL): http://dx.doi.org/10.1309/AJCPWSL3G8RXMCQR
• Title of Journal or Parent Work: American Journal of Clinical Pathology
• ISSN: 1943-7722
• Volume: 143
• Issue: 4
• Start Page: 479
• End Page: 484
• Grant/Funding Information: Supported in part by the NIH/NIAID (Emory CFAR P30 AI050409).
• Keywords: Science & Technology; Pathology; TREATMENT GUIDELINES; Life Sciences & Biomedicine; Treponemal tests; ANTIBODIES; MANAGEMENT; INNO-LIA SYPHILIS; ASSAY; VDRL; PALLIDUM; Cerebrospinal fluid; Neurosyphilis; BLOOD
• Research Categories: Health Sciences, Public Health; Health Sciences, General

Abstract

Objectives: We evaluated the use of treponemal serum tests in cerebrospinal fluid (CSF) to diagnose neurosyphilis since CSF-Venereal Disease Research Laboratory (VDRL) is specific but lacks sensitivity. Methods: We tested CSF specimens using the following treponemal serum tests: INNO-LIA, Treponema pallidum particle agglutination (TP-PA), Trep-Sure, and Maxi-Syph. The reference standard to calculate sensitivity and specificity was having two or more reactive/positive tests on CSF. Results: The reference standard group included 11 cases that fulfilled the definition of neurosyphilis (reactive CSF-VDRL plus symptoms) and three cases that did not fulfill the definition: two cases had neurologic symptoms but a nonreactive CSF-VDRL, and one had several positive CSF syphilis tests (reactive VDRL and positive treponemal and syphilis polymerase chain reaction) but no history (referred sample). Controls included 18 patients in whom a CSF-VDRL was performed the same week as patients in the reference group. The sensitivity was 85.7% (12/14) for CSF-VDRL, 92.9% (13/14) for Trep-Sure, 100% (10/10) for Maxi-Syph, 92.3% (12/13) for INNO-LIA, and 83.3% (10/12) for TP-PA. Specificity was 100% for all tests. Conclusions: Treponemal serum tests performed on CSF were useful in identifying two patients with nonreactive CSF-VDRL.