Fluorescent Antibody Tests for Syphilis Using Cerebrospinal Fluid: Clinical Correlation in 150 Cases

Escobar, Mario R.; Dalton, Harry P.; Allison, Marvin J.

doi:10.1093/ajcp/53.6.886

Cited by 50 publications

(15 citation statements)

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“…[9][10][11] We therefore obtained records on all patients with positive FTAabs results in the CSF from 1990 to 1999 at the Tygerberg Hospital, Cape Town, South Africa. These were extracted from a computerised hospital based data system, noting that the hospital has a geographically defined catchment area and provides both paediatric and psychiatric services.…”

Section: Methodsmentioning

confidence: 99%

Neurosyphilis in the modern era

Timmermans

Carr²

2004

Journal of Neurology, Neurosurgery & Psychiatry

185

103

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Objective: To review the nature of the presentation of neurosyphilis, the value of diagnostic tests, and the classification of the disease. Methods: A retrospective review was carried out of the records of patients who had been identified as possible cases of neurosyphilis by a positive FTA-abs test in the CSF. The review extended over 10 years at a single hospital which served a population of mixed ancestry in a defined catchment area in the Western Cape province of South Africa. Patients were placed in predefined diagnostic categories, and clinical, radiological, and laboratory features were assessed. Results: 161 patients met diagnostic criteria for neurosyphilis: 82 presented with combinations of delirium and dementia and other neuropsychiatric conditions, and the remainder had typical presentations such as stroke (24), spinal cord disease (15), and seizures (14). The average age of presentation ranged from 35.9 to 42.6 years in the different categories of neurosyphilis. Of those followed up, 77% had residual deficits from their initial illness. Cerebrospinal fluid (CSF) VDRL was positive in 73% of cases. Conclusions: The diagnosis of neurosyphilis can be made with reasonable certainty if there is an appropriate neuropsychiatric syndrome associated with a positive CSF VDRL. If the VDRL is negative, a positive FTA-abs in an appropriate clinical setting, associated with raised CSF cell count, protein, or IgG index, is a useful method of identifying neurosyphilis. Tabes dorsalis has become uncommon, but this is likely to be the only manifestation of neurosyphilis that has been altered during the antibiotic era.

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Section: Methodsmentioning

confidence: 99%

Neurosyphilis in the modern era

Timmermans

Carr²

2004

Journal of Neurology, Neurosurgery & Psychiatry

185

103

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“…on March 23, 2019 by guest http://cmr.asm.org/ ined in neurosyphilis diagnosis (164) and, while more sensitive than the CSF-VDRL test, may not be specific for neurosyphilis (91), possibly because of the passive transfer of serum-derived antibodies to the CSF. Thus, some investigators suggest that the use of the FTA-ABS CSF test should be limited to ruling out neurosyphilis in cases with a negative test result (154,195).…”

Section: Antibodies In Diagnostic Testingmentioning

confidence: 99%

Biological Basis for Syphilis

2006

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SUMMARY Syphilis is a chronic sexually transmitted disease caused by Treponema pallidum subsp. pallidum. Clinical manifestations separate the disease into stages; late stages of disease are now uncommon compared to the preantibiotic era. T. pallidum has an unusually small genome and lacks genes that encode many metabolic functions and classical virulence factors. The organism is extremely sensitive to environmental conditions and has not been continuously cultivated in vitro. Nonetheless, T. pallidum is highly infectious and survives for decades in the untreated host. Early syphilis lesions result from the host's immune response to the treponemes. Bacterial clearance and resolution of early lesions results from a delayed hypersensitivity response, although some organisms escape to cause persistent infection. One factor contributing to T. pallidum's chronicity is the paucity of integral outer membrane proteins, rendering intact organisms virtually invisible to the immune system. Antigenic variation of TprK, a putative surface-exposed protein, is likely to contribute to immune evasion. T. pallidum remains exquisitely sensitive to penicillin, but macrolide resistance has recently been identified in a number of geographic regions. The development of a syphilis vaccine, thus far elusive, would have a significant positive impact on global health.

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“…The FTA-CSF tests using IgG and IgM seem to be specific and sensitive and together may detect up to 66-66% of previous or recent, treated or untreated cases of syphilis. The superiority of the fluorescent treponemal antibody test regarding sensitivity and specificity to other serological tests has already been reported by Harris et al (1960), Escobar et al (1970), Kasatiya et al (1972, Duncan et al (1972) and Wilkinson (1973). Abnormal specimens of fluid are found in the primary stage of syphilis in 7-25o% of patients.…”

Section: Resultsmentioning

confidence: 73%