Clinical prediction and diagnosis of neurosyphilis in HIV-negative patients: a case-control study

Yong Lu,Jinghua Li,Liuyuan Wang,Ligang Yang,Zhenyu Wang,Ping Lv,Bin Yang,Xiaohui Zhang,Jing Gu,Wenjing Chen,Huachun Zou,Hongfang Liu,Mei Gu,Yahui Liu,Yumao Cai,Heping Zheng,Wujian Ke,Chun Hao

doi:10.1186/s12879-019-4582-2

Abstract

BackgroundEarly diagnosis and treatment of neurosyphilis is of great significance for regression. There is no gold standard for the diagnosis of neurosyphilis. We did this study to explore the factors associated with the clinical diagnosis of neurosyphilis and assess their accuracy for the diagnosis of neurosyphilis.MethodsWe retrospectively reviewed 100 cases of syphilis patients who underwent lumbar puncture at a major dermatology hospital in Guangzhou, China between April 2013 and November 2016. Fifty patients who were clinically diagnosed with neurosyphilis were selected as case group. Control group consisted of 50 general syphilis patients who were matched with age and gender. The records of patients were reviewed to collect data of socio-demographic information, clinical symptom, and laboratory indicators. Multivariable logistic regression was used to explore diagnostic indictors, and ROC analysis was used to assess diagnostic accuracy.ResultsNeurological symptoms (odds ratio (OR) = 59.281, 95% CI:5.215–662.910, P = 0.001), cerebrospinal fluid (CSF) Treponema pallidum particle agglutination (TPPA) titer (OR = 1.004, 95% CI:1.002–1.006, P < 0.001), CSF protein (OR = 1.005, 95% CI:1.000–1.009, P = 0.041), and CSF white blood cell (WBC) (OR = 1.120, 95% CI:1.017–1.233, P = 0.021) were found to be statistically associated with neurosyphilis. In ROC analysis, CSF TPPA titer had a sensitivity of 90%, a specificity of 84%, and an area under curve (AUC) of 0.941.ConclusionCSF TPPA can potentially be considered as an alternative test for diagnosis of neurosyphilis. Combining with neurological symptoms, CSF protein, CSF WBC, the diagnosis would have a higher sensitivity.

Highlights

Diagnosis and treatment of neurosyphilis is of great significance for regression
Our result showed that neurological symptoms, Serum Treponema pallidum particle agglutination (TPPA) titer, Serum treponema pallidum immunoglobulin M (TP-IgM), cerebrospinal fluid (CSF) TPPA titer, CSF protein, CSF white blood cell (WBC), and CSF chlorides were predictors of neurosyphilis
CSF TPPA titer had a sensitivity of 90%, a specificity of 84%, and an area under curve (AUC) of 0.941

Summary

Introduction

Diagnosis and treatment of neurosyphilis is of great significance for regression. Treponema pallidum (T. pallidum) is the causative agent of syphilis, which can invade the central nervous system (CNS) at any stage after exposure [1, 2]. There is no gold standard for the diagnosis of neurosyphilis. One commonly used diagnostic criteria developed by the Centers for Disease Control and Prevention (CDC) of the United States mentioned that neurosyphilis can be divided into two categories. One is “confirmed” neurosyphilis which can be diagnosed by the criterion that a reactive Venereal Disease Research Laboratory test (VDRL) in cerebrospinal fluid (CSF). “presumptive” neurosyphilis which can be diagnosed by the following criteria: (1) a nonreactive VDRL in CSF, (2) elevated CSF protein or leukocyte count, and (3) clinical symptoms or signs consistent with neurosyphilis without alternate known causes accounting for these [8]. CSF TT (Treponema pallidum haemagglutination assay (TPHA)/ Treponema pallidum particle agglutination (TPPA)) and intrathecal synthesis of immunoglobulins should be taken into consideration [9]

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