Cerebrospinal Fluid Changes and Clinical Features of Neurosyphilis Compared with Latent Syphilis Infection in the Central Nervous System: A Cross-Sectional Study

Figures & data

Table 1 Basic Parameters and Cerebrospinal Fluid Parameters Between Neurosyphilis and Central Nervous System Latent Syphilis Patients

	Neurosyphilis(n=59)	Latent Syphilis(n=30)	Z/t/χ^2	P
No. of total subjects	59	30
Age, years	51.36±15.15	47.3±18.54	1.106	0.272
Median (range)	51 (21–83)	50 (20–87)
Gender			2.793	0.106
Female	42 (71.2%)	16 (53.3%)
Male	17 (28.8%)	14 (46.7%)
Cerebrospinal fluid
TPPA positive	59/59	30/30
TRUST titer (median, range)^#	Negative (Negative −1:64)	Negative	21.873	0.000
Pandy’s test^#	36/59	3/30	21.026	0.000
Totalprotein (mg/dl)^#	47.60 (25.40–63.00)	27.25 (15.20–35.00)	−4.257	0.000
Nucleated cells (×10^6/L)^#	8.00 (2.00–15.00)	1.00 (0–2.00)	−5.751	0.003
Red blood cells(×10^6/L)	2.00 (0–40.00)	0 (0–2.00)	−2.829	0.388
Chloride (mmol/L)	125.12±3.83	124.86±4.29	0.284	0.777
Glucose(mmol/L)	3.60±3.83	3.81±1.04	−0.949	0.310
LDH(U/L)	19.00 (14.00–27.00)	16.00 (12.00–23.00)	−1.355	0.177
IgG(mg/L)^#	65.90 (40.50–156.75) (n=46)	32.55 (21.55–57.90) (n=24)	−3.328	0.000
Microalbumin(mg/L)	285.50 (189.80–423.75) (n=20)	209.00 (190.60–410.50) (n=13)	−1.953	0.052
Serum
TPPA positive	59/59	30/30
TRUST titer (median, range)^#	Negative (Negative −1:64)	Negative (Negative −1:64)	9.332	0.230

Notes: ^#P<0.05. The data are represented by mean ± SD or median and quartile.

Abbreviations: TRUST, toluidine red unheated serum test; TPPA, treponema pallidum particle assay; LDH, lactate dehydrogenase; IgG, immunoglobulin G.

Figure 1 The cerebrospinal fluid markers of nucleated cells (A), red blood cells (B), CSF-TRUST(C), LDH (D), chloride (E), glucose (F), Totalprotein (G), IgG (H), microalbumin (I) from neurosyphilis and latent syphilis infection in the central nervous system are analyzed. *, P<0.05; **, P <0.01; ***, P <0.001; ****, P <0.0001.

Abbreviations: NS, neurosyphilis; LS, latent syphilis; CSF, cerebrospinal fluid; TRUST, toluidine red unheated serum test; LDH, lactate dehydrogenase; IgG, immunoglobulin G; ns, no significance.

Figure 2 The serum markers of serum-TRUST (A), complement C3 (B), complement C4 (C), IgG (D), IgA (E), and IgM (F)from neurosyphilis and latent syphilis infection in the central nervous system are analyzed. The plasma detection results of PT (G), APTT (H), TT (I), Fib (J), and D-D (K) for the two groups are represented. The hematological index including lymphocyte, monocyte, neutrophil, eosinophil, and basophil for the two groups is shown (M). Comparison of biochemical indexes between the two groups (N and O). *, P<0.05; **, P <0.01; ***, P <0.001; ****, P <0.0001.

Abbreviations: LDH, lactate dehydrogenase; TP, total protein; mAlb, microalbumin; IgG, immunoglobulin G; IgM, immunoglobulin M; CRP, C-reactive protein; PT, Prothrombin time; APTT, activated partial thromboplastin time; TT, thrombin time; Fib, fibrinogen; DD, D-dimer; INR, international normalized ratio; WBC, white blood cell; Lym, lymphocyte; Mon, monocyte; Neu, neutrophil; PLT, platelet; Eos, eosinophil; Bas, basophil; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte; HCT, hematocrit; RDW-CT, red cell distribution width coefficient of variation; ALT, alanine aminotransferase; AST, aspartate aminotransferase; mAlb, microalbumin; Hb, hemoglobin; G, globulin; ALB, albumin; ROC, receiver operating characteristic curve; AUC, area under curve; ALP, alkalinephosphatase; TB, total bilirubin; CB, conjugated bilirubin; Cr, creatinine; UA, uric acid; TG, triglyceride; TC, total cholesterol; LDLC, low-density lipoprotein cholesterol; HDLC, high-density lipoprotein cholesterol; Glu, glucose; K, potassium ion; Na, sodium ion; Cl, chloride ion; ns, no significance.

Figure 3 Heat map of correlation analysis between urine, serum, plasma, and peripheral blood test results and cerebrospinal fluid test results of neurosyphilis. *, P<0.05.

Table 2 Evaluation of Cerebrospinal Fluid Indexes of Neurosyphilis

Variable	AUC	95% CI	P value
CSF red blood cells^#	0.677	0.565–0.789	0.007
CSF nucleated cells^#	0.871	0.800–0.942	0.000
CSF TRUST titer^#	0.746	0.647–0.844	0.000
CSF chloride	0.518	0.384–0.652	0.781
CSF glucose	0.445	0.321–0.568	0.395
CSF totalprotein^#	0.777	0.683–0.871	0.000
CSF TRUST titer + nucleated cells^#	0.933	0.883–0.983	0.000
CSF TRUST titer + totalprotein^#	0.867	0.793–0.941	0.000
CSF TRUST titer+ nucleated cells+ total-protein^#	0.989	0.000–1.000	0.000

Note: ^#P<0.05.

Abbreviations: CSF, cerebrospinal fluid; AUC, area under curve; TRUST, toluidine red unheated serum test; CI, confidence interval.

Figure 4 ROC curve for neurosyphilis diagnosis indicators.