Multicentric evaluation of a specific intrathecal anti-Treponema pallidum IgG index as a diagnostic biomarker of neurosyphilis: results from a retro-prospective case-control study. Sexually Transmitted Infections
Alberto et al. aimed to evaluate the diagnostic performance of measuring an antibody index (AI) for the intrathecal synthesis of specific anti-Treponema pallidum (T. pallidum) IgG for the diagnosis of neurosyphilis (NS).
Specific anti-T. pallidum IgG were measured simultaneously in paired cerebrospinal fluid (CSF)–serum samples collected retrospectively and prospectively between 2007 and 2022, from patients suspected of NS, in Switzerland. An AI was calculated to account for blood-brain barrier integrity. Area under the receiver operating characteristic curve, sensitivity/specificity and positive/negative predictive values of AI test were estimated. Two NS definitions were used: NS1 included patients with NS suspicion presenting with neurological symptoms and/or acute neurosensory signs, and positive T. Pallidum Hemagglutinations Assay (TPHA)/T. pallidum particle agglutination assay (TPPA) serology and CSF- TPHA/TPPA ≥320, and either CSF- leucocytes >5 cells/ mm3 and/or CSF- protein >0.45 g/L and/or a reactive CSF- venereal disease research laboratory (VDRL)/rapid plasma reagin (RPR) test. NS2 included patients with suspected NS presenting with acute ocular and/or otologic symptoms, and positive TPHA/TPPA serology, and a favourable response to NS treatment. Controls were patients diagnosed with any other central nervous system (CNS) pathologies and with positive TPHA/TPPA serology.
The study included 71 NS (43 NS1 and 28 NS2) and 110 controls. With a threshold of ≥1.7, sensitivity and specificity of the specific AI test were 90.7% (CI 77.7 to 97.4) and 100% (CI 96.7 to 100.0), respectively, for NS1 and 14.3% (CI 4 to 32.7) and 100% (CI 96.7 to 100.0) for NS2. In patients suspected of NS with a CNS involvement (NS1 group), NS could be confirmed by the positivity of this specific AI.
In conclusion, the proposed AI test of specific anti-T. pallidum IgG appears to be useful to confirm or exclude NS diagnosis in the presence of an inflammatory CSF profile and seems to show better sensitivity and specificity than other published diagnostic tools such as CSF-TPPA. This test has the potential to be an accurate tool in a disease that remains complex if the findings of the study are confirmed by larger clinical evaluations. In ocular or otic syphilis with few or no CNS inflammation, the AI test is helpful to confirm but not to exclude the diagnosis as only 14.3% (4/28) of NS2 had a positive AI, illustrating well the compartment phenomena of the infection.