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1408. Treponema pallidum-Specific Antibody Testing in the Evaluation of Neurosyphilis, a Prospective Trial
BACKGROUND: The therapeutic challenges of neurosyphilis are rooted in its diagnosis and management, with potential for complications arising from asymptomatic, unrecognized, or under-treated disease. Currently, the non-treponemal VDRL testing of cerebrospinal fluid (CSF) samples is used to predict t...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6809113/ http://dx.doi.org/10.1093/ofid/ofz360.1272 |
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author | Larsen, Travis M Campen, Natalie Larsen, Robert |
author_facet | Larsen, Travis M Campen, Natalie Larsen, Robert |
author_sort | Larsen, Travis M |
collection | PubMed |
description | BACKGROUND: The therapeutic challenges of neurosyphilis are rooted in its diagnosis and management, with potential for complications arising from asymptomatic, unrecognized, or under-treated disease. Currently, the non-treponemal VDRL testing of cerebrospinal fluid (CSF) samples is used to predict those with CNS invasion by T. pallidum. However, more extensive evaluation of those at any stage of infection demonstrates both that the incidence of CNS invasion is much greater than predicted, and there exists a large proportion of false positives from VDRL testing alone. METHODS: Subjects with suspected neurosyphilis were recruited from the infectious disease clinic after referral to LAC+USC Hospital. Informed consent was obtained and subjects underwent clinical examination, including a standardized neurological and neurocognitive evaluation and CSF sampling. A CSF-specific VDRL, FTAabs, and a T. pallidum particle agglutination index were calculated: A TPPA Index >2.0 was defined as positive and definitive evidence of neurosyphilis RESULTS: 40 subjects were recruited, 8 were HIV-negative and 32 HIV positive, of which, 1 declined to continue after CSF sampling (Table 1). Employing the CSF TPPA index, 7/31 HIV positive (22.6%) and 1/8 HIV-negative individuals (12.5%) had neurosyphilis (Table 2). Discordant results with the CSF VDRL were common; 4/31 subjects (12.9%) with a positive CSF VDRL had a TPPA Index < 2.0 (0.227, 0.227, 0.315, and 0.400) and 4/31 subjects (12.9%) with a negative CSF VDRL had a positive TPPA index (2.234, 3.333, 3.797, and 4.548, Table 3). Neurocognitive and neurologic abnormalities were commonly encountered in this population both with and without documented neurosyphilis. CONCLUSION: Our investigations demonstrate the value of CSF sampling in persons with any stage of syphilis and establish the utility of T. pallidum-specific antibody testing to greatly facilitate clinical decision-making. The diagnostic tools to evaluate the T. pallidum-specific immunological response of the CNS to syphilis are currently widely available, inexpensive, but woefully underutilized [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures. |
format | Online Article Text |
id | pubmed-6809113 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-68091132019-10-28 1408. Treponema pallidum-Specific Antibody Testing in the Evaluation of Neurosyphilis, a Prospective Trial Larsen, Travis M Campen, Natalie Larsen, Robert Open Forum Infect Dis Abstracts BACKGROUND: The therapeutic challenges of neurosyphilis are rooted in its diagnosis and management, with potential for complications arising from asymptomatic, unrecognized, or under-treated disease. Currently, the non-treponemal VDRL testing of cerebrospinal fluid (CSF) samples is used to predict those with CNS invasion by T. pallidum. However, more extensive evaluation of those at any stage of infection demonstrates both that the incidence of CNS invasion is much greater than predicted, and there exists a large proportion of false positives from VDRL testing alone. METHODS: Subjects with suspected neurosyphilis were recruited from the infectious disease clinic after referral to LAC+USC Hospital. Informed consent was obtained and subjects underwent clinical examination, including a standardized neurological and neurocognitive evaluation and CSF sampling. A CSF-specific VDRL, FTAabs, and a T. pallidum particle agglutination index were calculated: A TPPA Index >2.0 was defined as positive and definitive evidence of neurosyphilis RESULTS: 40 subjects were recruited, 8 were HIV-negative and 32 HIV positive, of which, 1 declined to continue after CSF sampling (Table 1). Employing the CSF TPPA index, 7/31 HIV positive (22.6%) and 1/8 HIV-negative individuals (12.5%) had neurosyphilis (Table 2). Discordant results with the CSF VDRL were common; 4/31 subjects (12.9%) with a positive CSF VDRL had a TPPA Index < 2.0 (0.227, 0.227, 0.315, and 0.400) and 4/31 subjects (12.9%) with a negative CSF VDRL had a positive TPPA index (2.234, 3.333, 3.797, and 4.548, Table 3). Neurocognitive and neurologic abnormalities were commonly encountered in this population both with and without documented neurosyphilis. CONCLUSION: Our investigations demonstrate the value of CSF sampling in persons with any stage of syphilis and establish the utility of T. pallidum-specific antibody testing to greatly facilitate clinical decision-making. The diagnostic tools to evaluate the T. pallidum-specific immunological response of the CNS to syphilis are currently widely available, inexpensive, but woefully underutilized [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6809113/ http://dx.doi.org/10.1093/ofid/ofz360.1272 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Abstracts Larsen, Travis M Campen, Natalie Larsen, Robert 1408. Treponema pallidum-Specific Antibody Testing in the Evaluation of Neurosyphilis, a Prospective Trial |
title | 1408. Treponema pallidum-Specific Antibody Testing in the Evaluation of Neurosyphilis, a Prospective Trial |
title_full | 1408. Treponema pallidum-Specific Antibody Testing in the Evaluation of Neurosyphilis, a Prospective Trial |
title_fullStr | 1408. Treponema pallidum-Specific Antibody Testing in the Evaluation of Neurosyphilis, a Prospective Trial |
title_full_unstemmed | 1408. Treponema pallidum-Specific Antibody Testing in the Evaluation of Neurosyphilis, a Prospective Trial |
title_short | 1408. Treponema pallidum-Specific Antibody Testing in the Evaluation of Neurosyphilis, a Prospective Trial |
title_sort | 1408. treponema pallidum-specific antibody testing in the evaluation of neurosyphilis, a prospective trial |
topic | Abstracts |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6809113/ http://dx.doi.org/10.1093/ofid/ofz360.1272 |
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