title: Evaluation of treponemal serum tests performed on cerebrospinal fluid for diagnosis of neurosyphilis.
abstract: OBJECTIVE
  We evaluated the use of treponemal serum tests in cerebrospinal fluid (CSF) to diagnose neurosyphilis since CSF-Venereal Disease Research Laboratory (VDRL) is specific but lacks sensitivity.
  
  
  METHODS
  We tested CSF specimens using the following treponemal serum tests: INNO-LIA, Treponema pallidum particle agglutination (TP-PA), Trep-Sure, and Maxi-Syph. The reference standard to calculate sensitivity and specificity was having two or more reactive/positive tests on CSF.
  
  
  RESULTS
  The reference standard group included 11 cases that fulfilled the definition of neurosyphilis (reactive CSF-VDRL plus symptoms) and three cases that did not fulfill the definition: two cases had neurologic symptoms but a nonreactive CSF-VDRL, and one had several positive CSF syphilis tests (reactive VDRL and positive treponemal and syphilis polymerase chain reaction) but no history (referred sample). Controls included 18 patients in whom a CSF-VDRL was performed the same week as patients in the reference group. The sensitivity was 85.7% (12/14) for CSF-VDRL, 92.9% (13/14) for Trep-Sure, 100% (10/10) for Maxi-Syph, 92.3% (12/13) for INNO-LIA, and 83.3% (10/12) for TP-PA. Specificity was 100% for all tests.
  
  
  CONCLUSIONS
  Treponemal serum tests performed on CSF were useful in identifying two patients with nonreactive CSF-VDRL.
authors.affiliation: From the Department of Pathology and Laboratory Medicine and jguarne@emory.edu.
authors.forename: Jeannette
authors.initials: J
authors.lastname: Guarner
authors.affiliation: Syphilis Laboratory Reference and Research Branch and.
authors.forename: Heather
authors.initials: H
authors.lastname: Jost
authors.affiliation: Syphilis Laboratory Reference and Research Branch and.
authors.forename: Allan
authors.initials: A
authors.lastname: Pillay
authors.affiliation: Syphilis Laboratory Reference and Research Branch and.
authors.forename: Yongcheng
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Syphilis Laboratory Reference and Research Branch and.
authors.forename: David
authors.initials: D
authors.lastname: Cox
authors.affiliation: Mern Technology, Toronto, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Notenboom
authors.affiliation: Program Development and Quality Improvement Branch, Centers for Disease Control and Prevention, Atlanta, GA; and From the Department of Medicine, Emory University, Atlanta, GA;
authors.forename: Kimberly
authors.initials: K
authors.lastname: Workowski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000907:Antibodies, Bacterial / Q000134:cerebrospinal fluid*; D016022:Case-Control Studies; D004269:DNA, Bacterial / Q000134:cerebrospinal fluid; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009494:Neurosyphilis / Q000134:cerebrospinal fluid* / Q000175:diagnosis* / Q000382:microbiology; D012680:Sensitivity and Specificity; D013588:Syphilis Serodiagnosis / Q000379:methods*; D014210:Treponema pallidum / Q000276:immunology* / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial; D004269:DNA, Bacterial
keywords: Cerebrospinal fluid; Neurosyphilis; Treponemal tests; VDRL