Diagnosis of Neurosyphilis through Treponemal Methods Based on Hemagglutination in Cerebrospinal Fluid in PLWHIV and without HIV: Systematic Review

Neurosyphilis (NS) is the severe form of syphilis caused by the invasion of Treponema pallidum subspecies pallidum in the Central Nervous System (CNS). The laboratory diagnosis is based on the analyses of Cerebrospinal Fluid (CSF) with the VDRL, considered “gold standard”, despite recent studies reporting low sensitivity (40%- 70%). The treponemal tests based on hemagglutination were performed for use in serum and plasma with great diagnostic accuracy. PURPOSE: This systematic review aims to analyse original studies with treponemal tests based hemagglutination on CSF in order to verify the diagnostic accuracy of these tests in the diagnosis of NS.

Methods: A search was performed in the electronic databases: EMBASE, Scielo, MEDLINE/PUBMED, LILACS, Cochrane Library, Trials and “grey literature” with the following DECS contained in the title or abstract, in English, Portuguese and Spanish: “Neurosyphilis” and "Cerebrospinal fluid" and "diagnosis" and "TPPA" or "TPHA" from 2010 to June 2021.

Results: 317 articles were identificated for reading the title and abstract and 27 articles were selected for full reading. Studies have shown that treponemal tests based on hemagglutination are useful when the CSF-VDRL is non-reactive and there are neurological symptoms.

Conclusion: The sensitivity of CSF-TPPA or CSF-TPHA ranges from 75%-85% and specificity ranges from 88.9% to 100% with titers ≥ 1:640 in TPPA and ≥ 1:80 in TPHA for the diagnosis of NS while when titers <1:640 are used, the sensitivity and specificity tend to decrease. There was no difference in the accuracy of the tests between PLWHIV and without HIV.

Published Date: 2022-03-07; Received Date: 2022-02-07