CXCL13 as a Cerebrospinal Fluid Marker for Neurosyphilis in HIV-Infected Patients With Syphilis

被引:112
作者
Marra, Christina M. [1 ,2 ]
Tantalo, Lauren C.
Sahi, Sharon K.
Maxwell, Clare L.
Lukehart, Sheila A. [2 ,3 ]
机构
[1] Univ Washington, Dept Neurol, Sch Med, Harborview Med Ctr, Seattle, WA 98104 USA
[2] Univ Washington, Sch Med, Dept Med Infect Dis, Seattle, WA 98104 USA
[3] Univ Washington, Dept Global Hlth, Sch Med, Seattle, WA 98104 USA
基金
美国国家卫生研究院;
关键词
SECONDARY SYPHILIS; RELAPSE; THERAPY;
D O I
10.1097/OLQ.0b013e3181d877a1
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Background: Asymptomatic neurosyphilis is more difficult to diagnose in human immunodeficiency virus (HIV)-infected patients because HIV itself can cause cerebrospinal fluid (CSF) pleocytosis. The proportion of CSF lymphocytes that are B cells is elevated in neurosyphilis, suggesting that the CSF concentration of the B cell chemoattractant, chemokine (C-X-C motif) ligand 13 (CXCL13) concentration may also be elevated. Methods: CSF and blood were collected from 199 HIV-infected patients with syphilis and neurosyphilis. Serum and CSF CXCL13 concentrations were determined. Results: Patients with neurosyphilis had higher CSF and serum CXCL13 concentrations compared to patients with syphilis but not neurosyphilis. The odds of having symptomatic neurosyphilis were increased by 2.23-fold for every log increase in CSF CXCL13 concentration and were independent of CSF white blood cell and plasma HIV RNA concentrations, peripheral blood CD4+ T cell count and use of antiretroviral medications. A cut-off of 10 pg/mL CSF CXCL13 had high sensitivity and a cut-off of 250 pg/mL or evidence of intrathecal synthesis of CXCL13 had high specificity for diagnosis of both symptomatic and asymptomatic neurosyphilis. CSF concentrations of CXCL13 declined after treatment for neurosyphilis. Conclusions: CSF CXCL13 concentration may be particularly useful for diagnosis of neurosyphilis in HIV-infected patients because it is independent of CSF pleocytosis and markers of HIV disease.
引用
收藏
页码:283 / 287
页数:5
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