Association of CSF glucose concentration with neurosyphilis diagnosis

• Authors: Maciej Pastuszczak , Anna Wojas-Pelc , Andrzej Jaworek
• Languages of publication: EN

Abstracts

EN

The most specific criterion for diagnosing neurosyphilis is a reactive CSF VDRL. Unfortunately, there are in Europe, including Poland small number of specialized laboratories for serological diagnosis of syphilis. Thus, CSF serology results are obtained with delay. Therefore, the decision on recommended therapy for neurosyphilis is taken on the basis of CSF basic tests. In this paper we attempt to determine the utility of CSF glucose concentration and its cut-off values in prediction of asymptomatic neurosyphilis. CSF and blood were collected from 55 HIV-uninfected patients with syphilis of unknown duration. Patients with neurosyphilis (14.5%) were characterized by higher CSF pleocytosis (p<0.0001), elevated CSF protein concentration (p<0.05) and lower CSF glucose concentration (p<0.0001). Multivariate regression analysis identified CSF pleocytosis and CSF glucose concentration as the two independent predictors of reactive CSF VDRL (p<0.0001). In the selected group of patients with CSF pleocytosis ≥5/µL (n=25) CSF glucose concentration ≤2.72 mmol/L was associated with 100% sensitivity (95%CI: 63–100%) and 100% specificity (95%CI: 75.3–100%) for reactive CSF VDRL. CSF glucose concentration may be particularly useful as a predictive marker of neurosyphilis in HIV uninfected patients with syphilis of unknown duration with CSF plecytosis ≥5/µL.

Keywords

EN

CSF glucose concentration; Neurosyphilis

• Publisher: De Gruyter Open
• Journal: Open Medicine
• Year: 2013
• Volume: 8
• Issue: 1
• Pages: 48-51

Dates

published

1 - 2 - 2013

online

8 - 12 - 2012

Contributors

author

Maciej Pastuszczak

• Department of Dermatology, Jagiellonian University Medical College, Skawinska 8 Street, 31-066, Cracow, Poland

author

Anna Wojas-Pelc

• Department of Dermatology, Jagiellonian University Medical College, Skawinska 8 Street, 31-066, Cracow, Poland

author

Andrzej Jaworek

• Department of Dermatology, Jagiellonian University Medical College, Skawinska 8 Street, 31-066, Cracow, Poland

References

• [1] Marra MC, Maxwell CL, Tantalo LC et al. Normalization of serum rapid plasma regain titers predicts normalization of cerebrospinal fluid and clinical abnormalities after treatment of neurosyphilis. CID. 2008; 47: 893–899 http://dx.doi.org/10.1086/591534[Crossref]
• [2] Lukehart SA, Hook EW 3rd, Baker-Zander SA et al. Invasion of the central nervous system by Treponema pallidum: implications for diagnosis and treatment. Ann Intern Med. 1988; 109: 855–862 [Crossref]
• [3] Golden R, Marra CM, Holmes KK. Update on syphilis: resurgence of an old problem. JAMA. 2003; 290: 1510–1514 http://dx.doi.org/10.1001/jama.290.11.1510[Crossref]
• [4] Wharton M, Chorba TL, Vogt RL, et al.: Case definitions for public health surveillance. MMWR Recomm Rep 1990, 39: 1–43 [PubMed]
• [5] Moore JE, Hopkins H. Asymptomatic neurosyphilis. VI The prognosis of early and late asymptomatic neurosyphilis. JAMA. 1930; 95: 1637–1641 http://dx.doi.org/10.1001/jama.1930.02720220007003[Crossref]
• [6] Goh BT, van Voorst Vader PC. European guideline for the management of syphilis. Int J STD AIDS. 2001; 12: 14–27 http://dx.doi.org/10.1258/0956462011924065[Crossref]
• [7] Marra CM. Déjà vu all over again: When to perform a lumbar puncture in HIV-infected patients with syphilis. Sex Transm Dis. 2007; 34: 145–146 http://dx.doi.org/10.1097/01.olq.0000251204.18648.15[Crossref]
• [8] Marra CM, Maxwell CL, Smith SL et al. Cerebrospinal fluid abnormalities in patients with syphilis: association with clinical and laboratory features. JID. 2004; 189: 369–376 http://dx.doi.org/10.1086/381227[Crossref]
• [9] Ghanem KG. Neurosyphilis: A historical perspective and review. CNS Neurosc Ther. 2010; 16: e157–e168 http://dx.doi.org/10.1111/j.1755-5949.2010.00183.x[Crossref]
• [10] Ropper AH, Samuels MA. Chapter 2. Special Techniques for Neurologic Diagnosis (Chapter). Ropper AH, Samuels MA: Adams and Victor’s Principles of Neurology, 9e. Available at: http://www.accessmedicine.com/content.aspx?aID=3630099. Accessed July 8, 2011
• [11] Larsen SA, Stiener BM, Rudolph AL. Laboratory diagnosis and interpretation of tests for syphilis. Clin Microbiol Rev. 1995; 8: 1–21 [PubMed]
• [12] Sexually Transmitted Diseases Treatment Guidelines 2002; Centres for Disease Control and Prevention. MMWR Recomm Rep. 2001; 51: 1–78
• [13] Mcgeeney T, Yount F, Hinthorn DR, Liu C. Utility of the FTA-ABS test of cerebrospinal-fluid in the diagnosis of neurosyphilis. Sex Transm Dis. 1979; 6: 195–198 http://dx.doi.org/10.1097/00007435-197907000-00001[Crossref]
• [14] Chauhan M, Serisha B, Sankar KN et al. Audit of the use of benzathine penicillin, post-treatment syphilis serology and partner notification of patients with early infectious syphilis. Int J STD AIDS 2006; 17: 200–202 http://dx.doi.org/10.1258/095646206775809231[Crossref]

Identifiers

DOI

10.2478/s11536-012-0060-6