Value in practice of the cerebrospinal fluid in Treponema pallidum hemagglutination test for confirmation of neurosyphilis

[摘要] Introduction: Treponema pallidum hemagglutination (TPHA) allows the detection of antibodies to Treponema pallidum. The TPHA (Centis) is the only confirmatory test for the diagnosis of syphilis used in Cuba and is applicable only in serum samples. Objectives: to evaluate and to apply samples of the cerebrospinal fluid (CSF) in the TPHA (CENTIS) for neurosyphilis confirmation. Methods: this research studied 78 CSF and 12 sera from 78 patients with suspected neurosyphilis, 11 CSF and 5 sera from 11 patients with suspected neuroborreliosis, 16 CSF from patients with suspected bacterial meningitis and 3 CSF of patients with suspected meningitis by leptospirosis. Samples were analyzed by VDRL (venereal disease research laboratory) and TPHA (Centis) according to procedures described for serum. Qualitative and performance parameters of the TPHA were determined. Results: the study of samples from patients with suspected neurosyphilis yielded 9.0 % (7/78) of reactive CSF according to the VDRL test, and 85.7 % (6/7) of them were positive for TPHA, thus confirming neurosyphilis. Of the 12 cases with serum and CSF samples, three were positive in TPHA, although the CSF in one case was not reactive according to VDRL, which indicates a greater sensitivity rate of the TPHA for this type of sample. In the three other cases, sera were positive in VDRL and TPHA but the CSFs samples were negative (meaning no neurosyphilis). One case was false positive for neurosyphilis. The disease was confirmed in the CSF and the serum from a patient with suspected neuroborreliosis and markers of past and treated neurosyphilis in a patient with suspected bacterial meningitis. Samples from patients with suspected leptospirosis were negative. The qualitative and performance parameters of the TPHA in terms of the CSF were acceptable. Conclusion: the cerebrospinal fluid is a useful sample for confirmation of neurosyphilis by using Treponema pallidum hemagglutination test (Centis).

[学科分类] 传染病学

[关键词] neurosyphilis;cerebrospinal fluid;Treponema pallidum hemagglutination