Mazzini Cardiolipin Microflocculation Test for Syphilis

Summary The adaptation of cardiolipin antigen to the Mazzini technic has been described. Only minor changes have been found necessary, the technic otherwise remaining essentially the same. The availability of the emulsion immediately after preparation renders possible its use in emergencies and in adapting the test to a particular serological routine. Despite the fact that well-known technics use cardiolipin-lecithin antigen, the results may not be uniform in either sensitivity or specificity; the technic of preparing the emulsion and performing the test exerts great influence on the type of results obtained. The susceptibility of cardiolipin antigen to produce zonal reactions with strongly positive sera is its most serious limitation. This limitation has been overcome by decreasing the quantity of serum, by the addition of saline solution after the primary rotation and by the rerotation of the test at a slower speed for an additional 4 minutes. The test requires a very small amount (0.03 ml) of serum for its performance; a desirable feature in those cases when blood is obtainable in small quantity only, and when multiple tests constitute the serological routine. The increase in sensitivity of the cardiolipin technic has been accomplished with no loss of specificity. In fact, the specificity is also increased. Although the specificity has been found superior to that of the lipoidal antigen, false-positive reactions still will be obtained with sera from individuals with a variety of diseases other than syphilis. Further studies on the preparation of consistently satisfactory lots of lecithin are indicated. Further investigations to determine the nature of the impurities in, or oxidation or hydrolysis of, lecithin solutions and their role in causing nonstable emulsions are also of vital importance. The application of the test to spinal fluid has been accomplished without altering either the stability of the antigen emulsion or the spinal fluid. The results obtained seem to indicate that the test is of real value in the diagnosis and treatment of neurosyphilis either as an adjunct to the complement-fixation test or independently.