Neurosyphilis laboratory findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Approximately 35% to 40% of persons with secondary syphilis have asymptomatic central nervous system (CNS) involvement, as demonstrated by an abnormal leukocyte cell count, protein level, or glucose level or a demonstrated reactivity to Venereal Disease Research Laboratory (VDRL) antibody test on cerebrospinal fluid (CSF) examination. Laboratory testing is helpful in supporting the diagnosis of neurosyphilis; however, no single test can be used to diagnose neurosyphilis in all instances.
Laboratory Findings
CSF Analysis
- Cerebrospinal fluid (CSF) abnormalities are common in persons with early syphilis.
- Diagnosed by finding high numbers of leukocytes in the CSF or abnormally high protein concentration in the setting of syphilis infection.
- VDRL in cerebrospinal fluid (CSF-VDRL), which is highly specific but insensitive, is the standard serologic test for CSF. Although some advocate using the FTA-ABS test to improve sensitivity.
- When reactive in the absence of substantial contamination of CSF with blood, it is considered diagnostic of neurosyphilis; however in early syphilis, it can be of unknown prognostic significance.[1]
- Most other tests are both insensitive and nonspecific and must be interpreted in relation to other test results and the clinical assessment. Therefore, the laboratory diagnosis of neurosyphilis usually depends on various combinations of reactive serologic test results, CSF cell count or protein, and a reactive CSF-VDRL with or without clinical manifestations.
HIV Co-infection
- There is anecdotal evidence that the incidence of neurosyphilis is higher in HIV patients, and some have recommended that all HIV-positive patients with syphilis should have a lumbar puncture to look for asymptomatic neurosyphilis.[2]
- Among persons with HIV infection, the CSF leukocyte count usually is elevated (>5 white blood cell count [WBC]/mm3); using a higher cutoff (>20 WBC/ mm3) might improve the specificity of neurosyphilis diagnosis.[3]
- The CSF-VDRL might be non-reactive even when neurosyphilis is present.
- Therefore, additional evaluation using FTA-ABS testing on CSF can be considered. The CSF FTA-ABS test is less specific for neurosyphilis than the CSF-VDRL but is highly sensitive; neurosyphilis is highly unlikely with a negative CSF FTA-ABS test.[4]
References
- ↑ Lukehart SA, Hook EW, Baker-Zander SA, Collier AC, Critchlow CW, Handsfield HH (1988). "Invasion of the central nervous system by Treponema pallidum: implications for diagnosis and treatment". Annals of Internal Medicine. 109 (11): 855–62. PMID 3056164. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ Walter T, Lebouche B, Miailhes P; et al. (2006). "Symptomatic relapse of neurologic syphilis after benzathine penicillin G therapy for primary or secondary syphilis in HIV-infected patients". Clin Infect Dis. 43 (6): 787–90. PMID 16912958.
- ↑ Marra CM, Maxwell CL, Smith SL, Lukehart SA, Rompalo AM, Eaton M, Stoner BP, Augenbraun M, Barker DE, Corbett JJ, Zajackowski M, Raines C, Nerad J, Kee R, Barnett SH (2004). "Cerebrospinal fluid abnormalities in patients with syphilis: association with clinical and laboratory features". The Journal of Infectious Diseases. 189 (3): 369–76. doi:10.1086/381227. PMID 14745693. Retrieved 2012-02-16. Unknown parameter
|month=ignored (help) - ↑ Jaffe HW, Larsen SA, Peters M, Jove DF, Lopez B, Schroeter AL (1978). "Tests for treponemal antibody in CSF". Archives of Internal Medicine. 138 (2): 252–5. PMID 343742. Retrieved 2012-02-16. Unknown parameter
|month=ignored (help)