Laboratory diagnostics of neurosyphilis: ways of optimization. Part 1. «Classical» research methods

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BACKGROUND

According to official statistics in the Russian Federation, there has been an increase in the proportion of neurosyphilis (NS), a severe form of infection which is difficult to diagnose in a laboratory, while the overall incidence of syphilis has declined in recent decades.

OBJECTIVE

To analyze the current literature data on the use of classical approaches to cerebrospinal fluid diagnosis of NS.

RESULTS

It has been noted that the determination of the number of white blood cells and the total protein in cerebrospinal fluid (CSF) remains the traditional NS diagnosis, although these indicators are not specific for NS. The use of direct T. pallidum detection is currently limited. Dark-field microscopy has low sensitivity, other direct methods are labour-intensive and inaccessible. PCR is an acceptable direct research method, although the results have been encouraging only for nested PCR use. The results of immunological tests remain priority, upon that VDRL is being preferred among the non-treponemal tests due to its high specificity. IFA with solid liquor and TPHA with determination of the antibodies titer to T. pallidum are priority methods among treponemal tests. The TPHA titer values greater than 1:320 or than 1:640 indicate an intrathecal synthesis of antibodies to T. pallidum.

Keywords:

neurosyphilis

T.pallidum

diagnosis

direct tests

non-treponemal tests

treponemal tests

Authors:

Potekaev N.N.

Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology;
The Russian National Research Medical University named after N.I. Pirogov

ORCID: 0000-0002-9578-5490

Dmitriev G.A.

Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology;
Gabrichevsky Institute Of Epidemiology And Microbiology

ORCID: 0000-0002-4440-9516

Frigo N.V.

Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology;
State Research Center — Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency

ORCID: 0000-0001-6231-971X

Kitaeva N.V.

Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology

ORCID: 0000-0002-3620-2494

Dolya O.V.

Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology;
Peoples’ Friendship University of Russia

ORCID: 0000-0001-5019-4593

Mahnovskaya T.S.

Peoples’ Friendship University of Russia

ORCID: 0000-0002-1928-4029

Zhdanovich A.V.

COMPANY «ECOLAB»

ORCID: 0000-0001-5131-1501

Received:

19.06.2023

Accepted:

25.09.2023

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