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Cerebrospinal fluid findings in asymptomatic patients with reactive serum fluoresecent treponemal antibody absorption tests
Author(s) -
Traviesa Daniel C.,
Prystowsky Stephen D.,
Nelson Barbara J.,
Johnson Kenneth P.,
Clavan Barbara S.
Publication year - 1978
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.410040608
Subject(s) - medicine , asymptomatic , cerebrospinal fluid , physical examination , syphilis , treponema , neurosyphilis , gastroenterology , antibody , neurological examination , medical history , penicillin , immunology , antibiotics , surgery , human immunodeficiency virus (hiv) , biology , microbiology and biotechnology
It is common to examine the cerebrospinal fluid in untreated or inadequately treated asymptomatic patients with a reactive serum fluorescent treponemal antibody absorption (FTA‐ABS) test before initiating antibiotic therapy for syphilis. This prospective study evaluated the usefulness of such examination. Four hundred thirty‐two patients over 40 years old, reporting for annual physical examination, had a serum FTA‐ABS test. Thirty‐seven (8.6%) patients and 2 of 4 spouses were reactive repeatedly. Of the 39 patients with reactive tests, 7 had a history of pencillin therapy for syphilis, 5 had received heavy metal therapy, and 27 had no history of syphilis. These 39 patients had a neurological examination, serum VDRL, Treponema pallidum immobilization (TPI), and repeat FTA‐ABS tests by two other laboratories. The TPI test was reactive in 30 (77%). Four had nonspecific neurological signs. Routine CSF examination (cells, total protein, VDRL, glucose, IgG%) on 30 patients with a history of inadequate treatment had a low diagnostic yield. Two patients had an unexplained total protein elevation (57 and 61 mg/dl) and 1 had a mildly increased IgG% (15%). All cell counts, VDRL tests, and glucose levels were normal. Agarose electrophoresis demonstrated one or more CSF immunoglobulin bands in 10 (36%) of 28 patients, possibly representing an immunological marker of past or latent central nervous system infection.