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1. The lab should provide a "quantitative" RPR for follow-up use.
2. The lab, without being asked, should do a much more expensive "treponemal" test to confirm the diagnosis.
1. EBV (mononucleosis)
2. Hepatitis (which one not said)
3. Varicella
4. Measles
1. Lyme disease (also caused by spirochete!)
2. Endocarditis
3. TB
4. Malaria
1. Pregnancy, all by itself (!)
2. IV drug abuse (though infections CAN be involved)
3. Connective tissue diseases (e.g., lupus)
They are given as "titers," with the levels increasing with the denominator in steps, i.e.,
1:2 < 1:4 < 1:8 < 1:16 < 1:32 < 1:64 < 1:128 < etc.
(Some labs write out the result as 1/2, 1/4...etc., or else throw out the numerator altogether, e.g., 2, 4, 8, 16, 32, 64, 128, etc., etc.)
1. If RPR really isn't specific for Treponema, what is it measuring?
2. Of what importance is THAT in the management of patients with syphilis?
1. It measures antibody against cardiolipin, a glycolipid that leaks out of tissues injured for many different reasons
2. The higher the titer, the greater the tissue damage caused by the disease. Therefore, a quantitative RPR is highly useful in following the current activity of the disease in patients known to have had syphilis in the past.
They mean that the current level of antibody measured by RPR has changed by 2 steps or more (i.e., 2 test-tubes or more).
A four-fold increase: (past) 1:8 --> (present) 1:32
Four-fold decrease: (past) 1:256--> (present) 1:64
(Pay attention, this will be important later)
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