From the Department of Neurology, University of Washington School of Medicine, Seattle, WA.
Sex Transm Dis. 2021 Aug 1;48(8S):S54-S57. doi: 10.1097/OLQ.0000000000001450.
The diagnosis of neurosyphilis relies in large part on the cerebrospinal fluid (CSF) Venereal Disease Research Laboratory (VDRL) test, which is diagnostically specific but not sensitive.
We determined the sensitivity and specificity of 3 CSF tests in addition to the CSF-VDRL in participants with syphilis enrolled in a research study: detection of Treponema pallidum ribosomal RNA, T. pallidum particle agglutination titer, and chemokine (C-X-C motif) ligand 13 (CXCL13) concentration. Neurosyphilis was defined as asymptomatic or symptomatic meningitis: CSF white blood cells >10/μL without or with neurological symptoms, including new vision or hearing loss.
Cerebrospinal fluid-VDRL, CSF T. pallidum ribosomal RNA detection, and CSF T. pallidum particle agglutination titer ≥1:640 were specific (89%-96%) but not sensitive (12%-48%). In contrast, diagnostic sensitivity of CSF-CXCL13 thresholds established from receiver operating characteristic curves using the Youden index was 78% to 83% and specificity was 76% to 81%. In individuals with nonreactive CSF-VDRL, neurosyphilis diagnosis could be confirmed by CSF-CXCL13 concentration in 69% to 75%.
Further studies of CSF-CXCL13 should include CSF samples from multiple cohorts and countries and should use standard neurosyphilis definitions to establish uniform thresholds for diagnosis.
神经梅毒的诊断在很大程度上依赖于脑脊液（CSF）性病研究实验室（VDRL）检测，该检测具有诊断特异性，但不敏感。
我们在一项研究中确定了梅毒患者的 3 种 CSF 检测（除了 CSF-VDRL）的敏感性和特异性：检测梅毒核糖体 RNA、梅毒颗粒凝集滴度和趋化因子（C-X-C 基序）配体 13（CXCL13）浓度。神经梅毒定义为无症状或有症状的脑膜炎：CSF 白细胞计数>10/μL 而无或有神经系统症状，包括新的视力或听力损失。
CSF-VDRL、CSF 梅毒核糖体 RNA 检测和 CSF 梅毒颗粒凝集滴度≥1:640 具有特异性（89%-96%）但不敏感（12%-48%）。相比之下，使用约登指数的接收者操作特征曲线建立的 CSF-CXCL13 阈值的诊断敏感性为 78%至 83%，特异性为 76%至 81%。在非反应性 CSF-VDRL 的个体中，CSF-CXCL13 浓度可在 69%至 75%的情况下确认神经梅毒的诊断。
应进一步研究 CSF-CXCL13，包括来自多个队列和国家的 CSF 样本，并应使用标准的神经梅毒定义来建立统一的诊断阈值。
