Test Catalog

Test Id : VDSFT

Not Orderable

VDRL Titer, Spinal Fluid

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Overview

Test Catalog

Useful For
Suggests clinical disorders or settings where the test may be helpful

Aid in the diagnosis of neuroinvasive syphilis as part of a profile

Method Name
A short description of the method used to perform the test

Only orderable as a reflex. For more information see NSAIP / Neurosyphilis IgG Antibody Index with VDRL, Serum and Spinal Fluid.

 

Flocculation/Agglutination

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

VDRL Titer,CSF

Aliases
Lists additional common names for a test, as an aid in searching

Neurosyphilis

Syphilis

VDSFT

Neuroinvasive syphilis

Specimen Type
Describes the specimen type validated for testing

CSF

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Only orderable as a reflex. For more information see NSAIP / Neurosyphilis IgG Antibody Index with VDRL, Serum and Spinal Fluid.

 

Specimen Type: Spinal fluid

Container/Tube: Sterile vial

Specimen Volume: 2.2 mL

Collection Instructions:

1. The spinal fluid (CSF) specimen must be collected within 24 hours of the serum specimen, preferably at the same time.

2. The CSF aliquot should be from the second, third, or fourth CSF vial collected during the lumbar puncture. Do not submit CSF from the first vial due to the possibility of blood contamination, which will cause specimen rejection.

3. Label vial as spinal fluid or CSF.

4. Band CSF specimen together with the serum sample.

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.

1.5 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis Reject
Gross lipemia Reject
Spinal fluid (CSF) contaminated with blood Reject

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
CSF Refrigerated (preferred) 14 days
Frozen 14 days

Useful For
Suggests clinical disorders or settings where the test may be helpful

Aid in the diagnosis of neuroinvasive syphilis as part of a profile

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Neurosyphilis (NS) caused by the spirochete Treponema pallidum can occur at any stage of syphilis. Currently the Center for Disease Control estimates that approximately 2% of patients with syphilis will develop neuroinvasive syphilis if untreated. Early stages of NS may be asymptomatic or symptomatic, with patients typically exhibiting classic meningitis symptoms. Patients with late-stage NS patients may present with dementia paralytica or tabes dorsalis. Other manifestations of neuroinvasive syphilis include ocular or otologic syphilis, which can occur at any stage, however are more common during early NS.

 

The diagnosis of NS is challenging due to a number of factors, including the lack of consensus on the relevance of abnormal cerebrospinal fluid (CSF) findings in patients who are seropositive for syphilis but neurologically asymptomatic. With respect to diagnostic testing, numerous treponemal and non-treponemal (lipoidal) assays have been evaluated, alongside CSF protein and pleocytosis findings, however direct comparisons of these assays are limited. The Venereal Diseases Research Laboratory (VDRL) assay is currently the only assay with US Food and Drug Administration (FDA) clearance as an aid in the diagnosis of NS, however the sensitivity and specificity of this non-treponemal (lipoidal) assay is highly variable, ranging from 66.7% to 85.7% and 78.2% to 86.7%, respectively. Although no treponemal assay has FDA clearance as an aid for diagnosis of NS, studies evaluating the fluorescent treponemal antibody absorption (FTA-ABS) assay performed in CSF from patients with definitive NS was associated with a sensitivity of 90.9% to 100%. Specificity of this approach ranged from 55% to 100% however, primarily due to the issue of passive diffusion of serum antibodies across the blood-brain barrier.

 

The NS antibody index assay corrects for passive diffusion across an inflamed blood-brain barrier by measuring quantitative levels of anti-T. pallidum antibodies in serum and CSF and normalizing those to total IgG and albumin in both specimen sources. A positive NS antibody index indicates true intrathecal antibody synthesis of antibodies to T. pallidum, which alongside clinical and exposure history can be used to establish a diagnosis of NS. All NS antibody index positive samples are also reflexed for testing by the VDRL assay to acquire a semi-quantitative titer. The NS antibody index should only be ordered in patients who are seropositive for antibodies to T. pallidum in blood, who also present with neurologic manifestations suspicious for NS or who are at risk for asymptomatic NS.

Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

Only orderable as a reflex. For more information see NSAIP / Neurosyphilis IgG Antibody Index with VDRL, Serum and Spinal Fluid.

 

Negative

Reference values apply to all ages.

Interpretation
Provides information to assist in interpretation of the test results

Negative:

No non-treponemal (lipoidal) antibodies to syphilis (T. pallidum) detected. Discordant results between the neurosyphilis antibody index and the VDRL result may be due to increased sensitivity of the antibody index assay.

 

Positive:

Results are consistent with neurosyphilis.

Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

VDRL testing on spinal fluid may be falsely-negative due to lower sensitivity and testing too soon following infection.

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Miller JN. Value and limitations of nontreponemal and treponemal tests in the laboratory diagnosis of syphilis. Clin Obstet Gynecol. 1975;18(1):191-203

2. Radolf JD, Tramont EC, Salazar JC. Syphilis (Treponema pallidum). In Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Elsevier; 2020:2865-2892

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Friday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

2 to 4 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

14 days

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees :
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their account representative. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

86593

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
VDSFT VDRL Titer,CSF 31146-4
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
621959 VDRL Titer,CSF 31146-4

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports