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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2019; 77(02): 91-95
DOI: 10.1590/0004-282X20180155
Article

A comparison of nontreponemal tests in cerebrospinal fluid for neurosyphilis diagnosis: equivalent detection of specific antibodies

Uma comparação de testes não treponêmicos no líquido cefalorraquidiano para diagnóstico de neurossífilis: detecção equivalente de anticorpos específicos.
Isadora Versiani
1   Universidade Federal do Estado do Rio de Janeiro, Escola de Medicina e Cirurgia, Rio de Janeiro RJ, Brasil;
,
Mauro Jorge Cabral-Castro
2   Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Pós-Graduação em Doenças Infecciosas e Parasitárias, Rio de Janeiro RJ, Brasil.
,
Marzia Puccioni-Sohler 
1   Universidade Federal do Estado do Rio de Janeiro, Escola de Medicina e Cirurgia, Rio de Janeiro RJ, Brasil;
2   Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Pós-Graduação em Doenças Infecciosas e Parasitárias, Rio de Janeiro RJ, Brasil.
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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.

Keywords:

cerebrospinal fluid - neurosyphilis

Palavras-chaves:

líquido cefalorraquidiano - neurossifilis


Publication History

Received: 21 May 2018

Accepted: 10 October 2018

Article published online:
21 August 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Berger J, Dean D. Neurosyphilis. In: Biller J, Ferro J. Handbook of clinical neurology. Amsterdam: Elsevier B.V; 2014. p. 1461-72.
  • 2 Bhai S, Lyons JL. Neurosyphilis update: atypical is the new typical. Curr Infect Dis Rep. 2015 May;17(5):481. https://doi.org/10.1007/s11908-015-0481-x
  • 3 Ho EL, Lukehart SA. Syphilis: using modern approaches to understand an old disease. J Clin Invest. 2011 Dec;121(12):4584-92. https://doi.org/10.1172/JCI57173
  • 4 Ministério da Saúde (BR), Secretaria de Vigilância em Saúde, Departamento de Vigilância, Prevenção e Controle das Doenças Sexualmente Transmissíveis, AIDS e Hepatites Virais. Manual técnico para diagnóstico da sífilis. Brasília, DF: Ministério da Saúde; 2016.
  • 5 Golden MR, Marra CM, Holmes KK. Update on syphilis: resurgence of an old problem. JAMA. 2003 Sep;290(11):1510-4. https://doi.org/10.1001/jama.290.11.1510
  • 6 Marra CM, Tantalo LC, Maxwell CL, Ho EL, Sahi SK, Jones T. The rapid plasma reagin test cannot replace the venereal disease research laboratory test for neurosyphilis diagnosis. Sex Transm Dis. 2012 Jun;39(6):453-7. https://doi.org/10.1097/OLQ.0b013e31824b1cde
  • 7 Centers for Disease Control and Prevention (US), Department of Health and Human Services. Syphilis: a provider's guide to treatment and prevention. Atlanta: Centers for Disease Control and Prevention; 2017.
  • 8 Marra CM. Neurosyphilis. Continuum (Minneap Minn). 2015 Dec;21 6 Neuroinfectious Disease:1714-28.
  • 9 Zhang HL, Lin LR, Liu GL, Zeng YL, Wu JY, Zheng WH, et al. Clinical spectrum of neurosyphilis among HIV-negative patients in the modern era. Dermatology. 2013;226(2):148-56. https://doi.org/10.1159/000347109
  • 10 Lin LR, Lin DH, Tong ML, Liu LL, Fan JY, Zhu XZ, et al. Macrophage migration inhibitory factor as a novel cerebrospinal fluid marker for neurosyphilis among HIV-negative patients. Clin Chim Acta. 2016 Dec;463:103-8. https://doi.org/10.1016/j.cca.2016.10.018
  • 11 Ho EL, Marra CM. Treponemal tests for neurosyphilis: less accurate than what we thought? Sex Transm Dis. 2012 Apr;39(4):298-9. https://doi.org/10.1097/OLQ.0b013e31824ee574
  • 12 Tong ML, Zhang HL, Zhu XZ, Fan JY, Gao K, Lin LR, et al. Re-evaluating the sensitivity of the rabbit infectivity test for Treponema pallidum in modern era. Clin Chim Acta. 2017 Jan;464:136-41. https://doi.org/10.1016/j.cca.2016.11.031
  • 13 Castro R, Prieto ES, Pereira FLM. Nontreponemal tests in the diagnosis of neurosyphilis: an evaluation of the Venereal Disease Research Laboratory (VDRL) and the Rapid Plasma Reagin (RPR) tests. J Clin Lab Anal. 2008;22(4):257-61. https://doi.org/10.1002/jcla.20254
  • 14 Zhu L, Gu X, Peng RR, Wang C, Gao Z, Zhou P, et al. Comparison of the cerebrospinal fluid (CSF) toluidine red unheated serum test and the CSF rapid plasma reagin test with the CSF venereal disease research laboratory test for diagnosis of neurosyphilis among HIV-negative syphilis patients in China. J Clin Microbiol. 2014 Mar;52(3):736-40. https://doi.org/10.1128/JCM.02522-13