Up-to-date immunology methods for examination of the cerebrospinal fluid in patients sufferingfrom neurosyphilis

Abstract

The authors conducted a comparative study of the diagnostic value (sensitivity, specificity, efficiency and predictive value of positive and negative results) of immunology methods (microprecipitation test, RPR, complement-fixation test, immunofluorescence test with whole spinal fluid, ELISA, passive hemagglutination test, Treponema pallidum immobilization test, immunoblotting) for studying the cerebrospinal fluid in 37 neurosyphilitic patients and 31 patients with syphilis in the anamnesis but without any clinical and laboratory data confirming the syphilitic affection of the nervous system. The highest diagnostic efficiency indices for neurosyphilis were noted for such methods as microprecipitation test (80.9%), passive hemagglutination test (98.5%) and immunoblotting (97.0%), which enables the authors to recommend the methods as standard neurosyphilis diagnostics methods in the territory of the Russian Federation. It was revealed that antibodies for pale treponema antigens Tr17 and Tr47 were detected in the course of immunoblotting most often regardless of any clinical manifestations and duration of the syphilitic infection. The authors set the priorities for individual examination methods when diagnosing asymptomatic, early and late meningovascular neurosyphilis. They also developed a diagnostic algorithm for detecting neurosyphilis based on the sequential application of ELISA/immunoblotting, microprecipitation test and passive hemagglutination test.