A 24 year old male patient with h/o primary syphilis in the form of genital ulcer &mucocutaneous lesions, presents with features Suggestive of neurosyphilis in the form of meningitis for which appropriate treatment was staed. What will you do for monitoring of treatment
The Venereal Disease Research Laboratory test (VDRL) is a blood test for syphilis that was developed by the eponymous lab. The VDRL test is used to screen for syphilis (it has high sensitivity), whereas other, more specific tests are used to diagnose the disease. The VDRL is a nontreponemal serological screening for syphilis that is also used to assess response to therapy, to detect central nervous system involvement, and as an aid in the diagnosis of congenital syphilis. The basis of the test is that an antibody produced by a patient with syphilis reacts with an extract of ox hea (diphosphatidyl glycerol). It therefore detects anti-cardiolipin antibodies (IgG, IgM or IgA), visualized through foaming of the test tube fluid, or "flocculation". The rapid plasma reagin (RPR) test uses the same antigen as the VDRL, but in that test, it has been bound to several other molecules, including a carbon paicle to allow visualization of the flocculation reaction without the need of a microscope. Many other medical conditions can produce false positive results, including some viruses (mononucleosis, hepatitis), drugs, pregnancy, rheumatic fever, rheumatoid ahritis, lupus, and leprosy. The syphilis anti-cardiolipin antibodies are beta-2 glycoprotein independent, whereas those that occur in the antiphospholipid antibody syndrome (associated to lupus for example) are beta-2 glycoprotein dependent, and this can be used to tell them apa in an ELISA assay.This test is very useful as the trend of titres are correlated to disease activity (i.e. falling titres indicate successful treatment). It has a very good sensitivity for syphilis, except in late teiary form Ref Harrison20th edition pg 2456
Venereal disease Research Laboratory test (VDRL)
TPI
FTS-AB
ELISA
C.N.S