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    What does this CSF analysis report indicate?

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Posted on Fri, 11 Aug 2017 in Brain and Spine
Question: I have blood and CSF results I need reviewed for possible neurosyphilis. Blood test VDRL and RPR negative. Blood FTA-ABS nonreactive. CSF VDRL non reactive, CSF WBC 2, CSF WBC 2 , protein 30. They did not perform a FTA-ABS test on the CSF and I've read that is more accurate and that the FTA-ABS on blood would not show neurosyphilis. Do I need to have the FTA-ABS test done on CSF?
doctor
Answered by Dr. Olsi Taka 3 hours later
Brief Answer:
Not necessarily.

Detailed Answer:
I read your question carefully and I understand your concern.

It is true that FTA-ABS test in the CSF is the most sensitive test for neurosyphilis. So if you need a short answer, if you want the one single test to definitively rule out neurosyphilis then FTA-ABS of CSF would be the one, if negative it would rule it out.

However, often one can reach to such conclusions even looking at the situation as a whole. You have had more than one test which is negative. In over 70% of cases, there are changes in cell and protein levels.

Furthermore, CSF VDRL is negative. Admittedly there may be false negatives, but combined with the non raised cell count, I would say that it is very reassuring.

So unless clinical picture (of which not much info is presented) is highly suggestive of neurosyphilis, I wouldn't necessarily do FTA-ABS. If on the other hand, the clinical suspicion is strong then FTA-ABS should be done.

I remain at your disposal for other questions.
Regards


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Olsi Taka 26 minutes later
Thank you. I was told that the FTA-ABS test would show positive in blood for life so I can rule out any type of syphilis infection because it was negative /non reactive. Is this true?
doctor
Answered by Dr. Olsi Taka 18 minutes later
Brief Answer:
please read below

Detailed Answer:
It does remain positive in the blood for many many years, in most people for life. However, after decades of non-exposure to the antigen in some individuals, it may turn negative.

There are no studies that I know of on percentages of people turning negative as it would require repeat testing of healthy patients for decades, not really an interest in that. But as I said, it remains positive for many years, longer than other tests, even for life.

Let me know if I can further assist you.
Regards



Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Olsi Taka 24 minutes later
I have been suffering from tinnitus, anxiety, muscle loss, weakness, confusion, agoraphobia , muscle and joint pain but I am also withdrawaling from 20 years of clonazepam usage which can cause a lot of symptoms. I'm not sure if i'm suffering from withdrawal or neurosyphilis. I'm worried I have syphilis and my doctors are wrong. Any advice would be appreciated. Thank you Doctor.
doctor
Answered by Dr. Olsi Taka 23 minutes later
Brief Answer:
please read below.

Detailed Answer:
Those symptoms you describe are non-specific, meaning they can be manifested in a variety of settings and conditions. While it can manifest in a variety of ways neuro syphilis is certainly not the most common cause. So, given the normal tests as well I certainly do not see any reason to suspect it and do not think CSF FTA-ABS necessary based on those symptoms alone.

Withdrawal from Clonazepam, on the other hand, would explain the symptoms well, it can lead to anxiety exacerbation which can manifest in many ways. After 20 years of usage, it is not an easy process, it will be tough.

Withdrawal should be as gradual as possible if symptoms worsen after a lowering of the dose maybe dose should be brought back to prior dosage for some more time and lowered more gradually.

At times when there is a chronic anxiety, disorder medication may be necessary, not with benzodiazepines like clonazepam which is not appropriate for long term use as they cause physical dependence and tolerance, but antidepressant which are the most commonly used anti-anxiety medication.

I hope to have been of help.
Regards


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Olsi Taka 18 minutes later
Thank you for your help Doctor. You were very helpful and thorough.
doctor
Answered by Dr. Olsi Taka 6 hours later
Brief Answer:
Hope you feel better soon.

Detailed Answer:
Thank you for your kind words. Hope you feel better soon.
Above answer was peer-reviewed by : Dr. Nagamani Ng
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Dr. Olsi Taka

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Practicing since :2004

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