Chronic Falsepositive Vdrl Test Lasting Longer Than 6 Months

Systemic lupus erythematosus and other connective tissue disorders

Intravenous drug use

Rheumatoid arthritis

Reticuloendothelial malignancy

Age (elderly person)

Hashimoto's thyroiditis

Reproduced with pemmission from Roos KL: Syphilitic meningitis. In Roos KL (ed): Meningitis: 100 Maxims in Neurology London, Amold, 1997, pp 171-181.

with neurosyphilis have a positive VDRL test. A CSF examination should be performed in patients with a reactive MHA-TP or FTA-ABS. The diagnosis of neurosyphilis is made in the presence of a reactive serological test with either neurological manifestations consistent with neurosyphilis or CSF evidence of a lymphocytic pleocytosis and an elevated protein concentration, and/or a positive CSF- VDRL test. Most clinicians treat patients for neurosyphilis when they have a positive serological test and a CSF lymphocytic pleocytosis with an elevated protein concentration whether the CSF-VDRL is reactive or not. A reactive cSf-VDRL establishes the diagnosis but a nonreactive test does not exclude the diagnosis. Screening for the presence of syphilis in HIV-1-infected individuals should be performed by the serum FTA-ABS test as the nontreponemal tests for syphilis may be falsely negative in HIV-infected individuals. A loss of reactivity to the treponemal tests in individuals infected with HIV-1 with advanced immunosuppression occurs. [88] In HIV-infected individuals with neurosyphilis, the CSF should demonstrate a lymphocytic pleocytosis and an elevated protein concentration. When the CSF-VDRL is negative, a CSF FTA-ABS or CSF MHA-TP should be obtained. The lack of CSF FTA-ABS or CSF MHA-TP reactivity excludes a diagnosis of neurosyphilis. The CSF FTA-ABS and CSF MHA-TP are not routinely recommended for the screening of neurosyphilis in non-HIV-infected individuals because reactivity of these tests on CSF does not establish the diagnosis of neurosyphilis.^

Management. Primary, secondary, and latent syphilis are treated with benzathine penicillin; neurosyphilis is treated with intravenous aqueous crystalline penicillin G 2 to 4 million units every 4 hr for 10 to 14 days. An alternate regimen is procaine penicillin, 2.4 million units intramuscularly daily with probenecid, 500 mg orally four times a day, both for 10 to 14 days. Patients with a history of penicillin allergies should be skin tested and desensitized if necessary. y , y The frequency with which intravenous antibiotics are unsuccessful in the therapy of neurosyphilis is extremely low. In those instances in which a progression of clinical disease or persistence of a CSF lymphocytic pleocytosis or a reactive CSF-VDRL is present, re-treatment of the patient with an additional 24 million units/d for 10 days is reasonable. The initial CSF pleocytosis will resolve 6 months after penicillin therapy in 80 percent of patients. Serial CSF-VDRL titers should decrease with treatment. Re-examination of the CSF should occur in HIV-infected patients with neurosyphilis.

Natural Arthritis Pain Remedies

Natural Arthritis Pain Remedies

It's time for a change. Finally A Way to Get Pain Relief for Your Arthritis Without Possibly Risking Your Health in the Process. You may not be aware of this, but taking prescription drugs to get relief for your Arthritis Pain is not the only solution. There are alternative pain relief treatments available.

Get My Free Ebook


Post a comment