RESUMEN
BACKGROUND: Syphilis is a re-emerging sexually-transmitted infection, caused by the spirochete Treponema pallidum, that may penetrate early into the central nervous system. The venereal disease research laboratory test (VDRL) on the cerebrospinal fluid (CSF) is the most widely used for neurosyphilis diagnosis. We evaluated the performance of two other nontreponemal tests (rapid plasma reagin [RPR] and unheated serum reagin [USR] tests) in comparison with the VDRL in CSF. METHODS: We analyzed CSF samples from 120 individuals based on VDRL reactivity in the CSF and the clinical picture of neurosyphilis. RESULTS: High inter-rater reliability was found among all three tests, with equivalent sensitivity and specificity. Intraclass correlation coefficient for absolute agreement was 1 for VDRL versus USR, 0.99 for VDRL versus RPR, and 0.99 for RPR versus USR. CONCLUSIONS: Rapid plasma reagin and unheated serum reagin tests were identified as excellent alternatives for neurosyphilis diagnosis.
Asunto(s)
Anticuerpos Antibacterianos/líquido cefalorraquídeo , Neurosífilis/líquido cefalorraquídeo , Neurosífilis/diagnóstico , Serodiagnóstico de la Sífilis/métodos , Adulto , Análisis de Varianza , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neurosífilis/sangre , Neurosífilis/inmunología , Valores de Referencia , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Estadísticas no ParamétricasRESUMEN
ABSTRACT Syphilis is a re-emerging sexually-transmitted infection, caused by the spirochete Treponema pallidum, that may penetrate early into the central nervous system. The venereal disease research laboratory test (VDRL) on the cerebrospinal fluid (CSF) is the most widely used for neurosyphilis diagnosis. We evaluated the performance of two other nontreponemal tests (rapid plasma reagin [RPR] and unheated serum reagin [USR] tests) in comparison with the VDRL in CSF. Methods: We analyzed CSF samples from 120 individuals based on VDRL reactivity in the CSF and the clinical picture of neurosyphilis. Results: High inter-rater reliability was found among all three tests, with equivalent sensitivity and specificity. Intraclass correlation coefficient for absolute agreement was 1 for VDRL versus USR, 0.99 for VDRL versus RPR, and 0.99 for RPR versus USR. Conclusions: Rapid plasma reagin and unheated serum reagin tests were identified as excellent alternatives for neurosyphilis diagnosis.
RESUMO A sífilis é uma infecção reemergente sexualmente transmissível pelo espiroqueta Treponema pallidum, que pode penetrar precocemente no sistema nervoso central. O teste venereal disease research laboratory test (VDRL) no líquido cefalorraquidiano (LCR) é o mais amplamente utilizado para diagnóstico de neurossífilis. Avalia-se o desempenho de dois outros testes não treponêmicos (rapid plasma reagin - RPR and unheated serum reagin - USR tests) em comparação ao VDRL no LCR. Métodos: Foram analisadas amostras de LCR de 120 indivíduos com base no quadro clínico compatível com neurossifilis e reatividade no VDRL no LCR. Resultados: Os testes apresentaram elevada concordância. O coeficiente de correlação intraclasse para concordância absoluta foi de 1 para VDRL versus USR, 0,99 para VDRL versus RPR e 0,99 para RPR versus USR. Conclusões: Os testes rapid plasma reagin e unheated serum reagin foram identificados como excelentes alternativas para o diagnóstico de neurossífilis.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Serodiagnóstico de la Sífilis/métodos , Anticuerpos Antibacterianos/líquido cefalorraquídeo , Neurosífilis/diagnóstico , Neurosífilis/líquido cefalorraquídeo , Valores de Referencia , Estudios de Casos y Controles , Reproducibilidad de los Resultados , Análisis de Varianza , Sensibilidad y Especificidad , Estadísticas no Paramétricas , Neurosífilis/inmunología , Neurosífilis/sangreRESUMEN
INTRODUCTION: Neurosyphilis (NS) is an entity which still frequently presents to our Neurology Department. The prozone phenomenon occurs in approximately 2% of all cases of late primary syphilis or secondary syphilis; we have found no cases described of prozone and neurosyphilis occurring together. CLINICAL CASE: We present the unusual case of a 44 year old patient with NS and dementia PGP (progressive general paralysis). Initially serum VDRL was negative, but in CSF reacted at dilutions of 1:32. When serum VDRL was repeated using dilutions, it was reactive 1:128 and serum FTA was also reactive. The patient was treated with i.v. crystalline penicillin, after which his condition improved. CONCLUSIONS: We wish to draw attention to the possibility that patients with a dementia syndrome and negative serum VDRL may have the prozone phenomenon, and the laboratory should therefore be asked to do serial dilutions.
Asunto(s)
Cardiolipinas/análisis , Colesterol/análisis , Neurosífilis/diagnóstico , Neurosífilis/inmunología , Fosfatidilcolinas/análisis , Adulto , Reacciones Falso Negativas , Humanos , MasculinoRESUMEN
La incidencia de la neurosífilis ha disminuido sustancialmente como consecuencia de la antibioticoterapia disponible para la sífilis, sin embargo, reportes recientes describen la asociación frecuente de neurosífilis y síndrome de inmunodeficiencia adquirida (SIDA), así como un comportamiento más agresivo e incluso atípico de la primera en este grupo de pacientes. Se revisó las características clínicas de la neurosífilis en cinco pacientes con infección por el virus de inmunodeficiencia humana (VIB), con manifestaciones de sífilis secundaria y serología positiva para esta última, hospitalizados entre junio de 1987 y diciembre de 1989. Todos los pacientes eran de sexo masculino, de hábitos homosexuales o bisexuales y sin antecedentes de sífilis previa. La neurosífilis fue asintomática en los cinco y el estudio del líquido cefalorraquídeo (LCR) demostró pleocitosis con predominio mononuclear en tres, hiperproteinorraquia en dos, Pandy-Nonne positivo en los cinco, VDRL positivo en tres y FTA-ABS positivo en los cuatro en quienes fue determinado
Asunto(s)
Adulto , Humanos , Masculino , Neurosífilis/inmunología , Síndrome de Inmunodeficiencia Adquirida/complicacionesRESUMEN
IgM antibodies against Treponema pallidum were investigated in the serum and in the CSF of 9 patients with symptomatic neurosyphilis, before the treatment and in several occasions after the treatment. Tests used were the FTA-Abs test, the IgM-solid phase hemadsorption test and an IgM-Elisa test. Titers of reactions decreased after treatment but they were still reactive in the blood and in the CSF during the second year after the treatment.
Asunto(s)
Anticuerpos Antibacterianos/análisis , Inmunoglobulina M/análisis , Neurosífilis/inmunología , Treponema pallidum/inmunología , Humanos , Inmunoglobulina M/líquido cefalorraquídeo , Neurosífilis/tratamiento farmacológico , Penicilina G/uso terapéutico , Serodiagnóstico de la SífilisRESUMEN
Anticorpos antitreponêmicos da classe IgM foram pesquisados no soro e no LCR de 9 casos de neurossífilis sintomática, antes e, em diversos momentos, depois do tratamento. Esses anticorpos foram investigados mediante reaçöes de imunofluorescência (IgM-FTA-Abs), hemadsorçäo em fase sólida e imunoenzimática (ELISA). Os títulos das reaçöes reduziram-se, mas houve persistência da reatividade no soro e no LCR no segundo ano após tratamento