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Alternative cerebrospinal fluid tests to diagnose neurosyphilis in HIV-infected individuals

From the Departments of Neurology (Drs. Marra, Tantalo, and Maxwell), Medicine (Infectious Diseases) (Dr. Marra), and Laboratory Medicine (Dr. Wood, K. Dougherty), University of Washington School of Medicine, Seattle.

Address correspondence and reprint requests to Dr. Christina M. Marra, Harborview Medical Center Box 359775, 325 9th Avenue, Seattle, WA 98104-2499; e-mail: cmarra{at}u.washington.edu

Objective: To identify alternatives to the CSF-Venereal Disease Research Laboratory (VDRL) test for the diagnosis of neurosyphilis in HIV-infected individuals.

Methods: CSF fluorescent treponemal antibody (FTA) reactivity and % CSF lymphocytes that were B cells in fresh and frozen samples were determined for 47 HIV-infected cases with syphilis and 26 HIV-infected controls. As for serum, CSF fluorescent treponemal antibody reactivity 2+ was considered positive. Based on the results in controls and cases with normal CSF measures, cut-offs for elevated CSF B cells were proposed to be 9% in fresh and 20% in frozen samples. Neurosyphilis was defined as a reactive CSF-VDRL.

Results: CSF-FTA-ABS (absorbed) and CSF-FTA (unabsorbed and undiluted) were 100% sensitive for the diagnosis of neurosyphilis. Elevated % CSF B cells in fresh and cryopreserved samples was specific (100%) but not sensitive (40 and 43%) in post hoc analyses. The results of CSF-FTA and assessment of % CSF B cells together allowed 16% of cases with pleocytosis but nonreactive CSF-VDRL to be diagnosed with neurosyphilis and 26% to be diagnosed as not having neurosyphilis.

Conclusion: When the CSF-VDRL is nonreactive, CSF-FTA and % CSF B cells may help exclude or establish the diagnosis of neurosyphilis.

Received October 29, 2003. Accepted in final form February 25, 2004.

Presented in part at the 10th Conference on Retroviruses and Opportunistic Infections; February 10–14, 2003; Boston, MA (Paper #693).

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