Abstract
BackgroundThe high misdiagnosis rate of asymptomatic neurosyphilis (ANS) has long challenged infectious disease clinicians. We aim to develop a model for diagnosing ANS in asymptomatic syphilis (AS) patients without CSF indicators.Results277 AS patients with HIV-negative and underwent lumbar puncture were enrolled in this horizontal study.The area under the curve for predicting ANS by CSF leukocytes and protein was 0.643 and 0.675 [95% CI, 0.583–0.699VS.0.616–0.729]. Through LRM, the AUC increased to 0.806 [95% CI, 0.732–0.832], and the Youden's index was 0.430. If the score is ≤ 0.159, ANS can be excluded with a predictive value of 92.9%; we can identify ANS while the score is over 0.819, with a predictive value of 91.7% and a specificity of 99.25%. This study showed that the LRM can diagnose ANS in AS patients effectively.ConclusionGiven a large number of misdiagnosis ANS patients and CSF results' insufficiency, the model is more practical. Our research will help clinicians track suspected syphilis, especially those who cannot accept the CSF test.
Highlights
The high misdiagnosis rate of asymptomatic neurosyphilis (ANS) has long challenged infectious disease clinicians
Whether asymptomatic syphilis (AS) patients need Cerebrospinal fluid (CSF) examination has always been debatable; there is insufficient evidence to suggest that the identification of asymptomatic neurosyphilis helps to predict treatment outcomes, even in patients with HIV [11]
Peripheral blood lymphocyte subsets (CD3+, CD3+CD4+, CD3+CD8+, CD45+) analysis was performed on a FACSCalibur flow cytometer, reagents were provided by BD Company (BD Biosciences, San Jose, CA)
Summary
The high misdiagnosis rate of asymptomatic neurosyphilis (ANS) has long challenged infectious disease clinicians. We aim to develop a model for diagnosing ANS in asymptomatic syphilis (AS) patients without CSF indicators. Asymptomatic or symptomatic, is caused by Treponema pallidum infection and is a serious global health issue [1,2,3,4]. Treponema invades the nervous system in about one-third of patients beginning on days following primary infection, and proceed into neurosyphilis (NS) [5]. Confirmation of ANS requires evidence of Treponema pallidum invading the central nervous system. Whether AS patients need CSF examination has always been debatable; there is insufficient evidence to suggest that the identification of asymptomatic neurosyphilis helps to predict treatment outcomes, even in patients with HIV [11]. Only 35% of asymptomatic patients with HIV have accepted recommended CSF examination in practice [12]. The ANS diagnosis most depends on the combination of abnormal results of serum and CSF syphilis tests and elevation in the CSF white-cell count and protein content so far, but no
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