Lin, Li-Rong, Lin, Dan-Hong, Tong, Man-Li, Liu, Li-Li, Fan, Jin-Yi, Zhu, Xiao-Zhen, Gao, Kun, Chen, Mei-Jun, Zheng, Wei-Hong, Zhang, Hui-Lin, Li, Shu-Lian, Lin, Hui-Ling, Lin, Zhi-Feng, Niu, Jian-Jun, and Yang, Tian-Ci
Background Neurosyphilis (NS) is difficult to diagnose, especially in syphilis patients with negative cerebrospinal fluid (CSF) rapid plasma reagin (RPR) or Venereal Disease Research Laboratory (VDRL) tests. Methods We conducted a cross-sectional study and an analysis of macrophage migration inhibitory factor (MIF) in syphilitic patients to identify a novel marker for the diagnosis of NS, with a focus on probable NS (NS with negative VDRL/RPR tests). For this purpose, CSF and serum MIF concentrations were determined in 43 NS and 43 syphilis/non-NS (N-NS) patients at the Zhongshan Hospital of the Medical College of Xiamen University from July 2014 to June 2015. Sixty-three blood donors were used as healthy controls. Results NS patients had higher CSF (median [IQR]: 8.77 ng/ml [4.76–19.13]) and serum (52.58 ng/ml [28.31–95.94]) MIF concentrations than N-NS patients did (4.08 [2.21–9.68] and 34.30 [19.77–59.75], respectively). Using a cut-off point of 6.63 ng/ml, CSF MIF had a sensitivity of 74.42% and a specificity of 67.74% for the diagnosis of NS. The sensitivity was higher than that of CSF RPR (39.53%) and increased protein (48.84%) tests and similar to that of CSF pleocytosis (67.44%). Additionally, the sensitivity of CSF MIF, which was 92.31% for the diagnosis of probable NS, was higher than that of CSF pleocytosis (65.38%) and increased protein (53.85%) tests. By integrating all CSF parameters (pleocytosis, increased protein and MIF), the sensitivity would be improved to 100% by parallel testing, which would avoid missed diagnoses. Moreover, the specificity would be improved to 100% by the serial testing algorithm, which would again avoid misdiagnosis. Conclusions CSF MIF concentrations can be used as a novel CSF marker to establish or exclude a diagnosis of NS. [ABSTRACT FROM AUTHOR]