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Nagarajan E, Mundae R, Tran TM, Mammo DA, Murray J, Yamanuha J, Koozekanani D, Montezuma SR. Clinical Characteristics of a Case Series of Ocular Syphilis With 3 Cases Requiring Multiple Vitrectomies After Late Diagnosis. JOURNAL OF VITREORETINAL DISEASES 2020; 4:509-514. [PMID: 37007656 PMCID: PMC9976069 DOI: 10.1177/2474126420936586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: This work describes the characteristics and unique features of ocular syphilis. Methods: Ten serologically proven cases of ocular syphilis were retrospectively analyzed. Results: Eighteen eyes of 10 patients were affected. Nine of 10 patients were male and the mean age was 58 years (range, 36-81 years). HIV antibody testing was positive in 3 patients (30%). Five cases were first diagnosed by an ophthalmologist. One patient presented with a syphilitic rash. The most common ocular findings were panuveitis (n = 6) and cystoid macular edema (n = 4). Ocular involvement was unilateral in 2 cases and bilateral in 8. Best-corrected visual acuity improved in 13 of 18 eyes (72%) after treatment. Three cases developed recurrent retinal detachments that required repair with silicone oil. Conclusions: Most cases were HIV negative. Syphilitic uveitis can be the initial presentation of syphilis without classic systemic manifestation. Ophthalmologists play an important role in the diagnosis and treatment of syphilis.
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Affiliation(s)
- Eric Nagarajan
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Rusdeep Mundae
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Tu M. Tran
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Danny A. Mammo
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jared Murray
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Justin Yamanuha
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Dara Koozekanani
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Sandra R. Montezuma
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, MN, USA
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Syphilitic retinitis presentations: punctate inner retinitis and posterior placoid chorioretinitis. Int Ophthalmol 2020; 41:211-219. [PMID: 32875361 DOI: 10.1007/s10792-020-01569-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe two distinct presentations of syphilitic fundus features in a series of patients with ocular syphilis. METHODS This is a retrospective, interventional case series of 22 eyes from 16 serology confirmed cases. Clinical examination, fluorescein angiography, and optical coherence tomography were performed at presentation and following high-dose intravenous penicillin G. RESULTS In our cohort, the mean age was 47.6 years (range 24-59 years) and 14 patients were male (87.5%), 11 patients were positive for human immunodeficiency virus (68.8%), and 6 had bilateral involvement (37.5%). Mean best-corrected visual acuity improved from 0.99 ± 0.79 logarithm of the minimal angle of resolution (LogMAR) at the time of presentation to 0.29 ± 0.36 LogMAR on final visit (P < 0.01). Posterior segment examinations in eyes with retinitis showed two distinct types (1) discrete, placoid lesions in the macula consistent with acute syphilitic posterior placoid chorioretinitis or (2) punctate inner retinitis with corresponding fluorescein pooling in a segmental pattern. These findings rapidly resolved after antibiotic therapy. CONCLUSION In the era of resurgence, ocular syphilis may present with two phenotypes of discrete retinal lesions. Recognition of the characteristic ocular features may help make the diagnosis and monitor treatment response.
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Abstract
Onychoptosis is the periodic shedding and falling of one or more nails, in whole or part. It can be seen after fever, trauma, adverse reaction to medications, and in systemic illnesses including syphilis (syphilitic onychia). We report a case of 38-year-old man presented with subacute bilateral retrobulbar optic neuritis. Physical examination revealed diffuse onychoptosis which lead into the diagnosis of neurosyphilis. Symptoms significantly improved with appropriate treatment with intravenous penicillin G for 14 days.
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Affiliation(s)
- Ahmad A Al-Awwad
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | | | - Abdulmawla Albirini
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
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Berkenstock M, Mopuru R, Thorne J, Scott AW. Analysis of new cases of uveitis at academic and community settings. Br J Ophthalmol 2020; 105:779-782. [PMID: 32727730 DOI: 10.1136/bjophthalmol-2020-316651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/01/2020] [Accepted: 06/20/2020] [Indexed: 11/04/2022]
Abstract
PURPOSE Describe the demographics of new patients with uveitis presenting to an urban, academic centre and affiliated, suburban satellite clinics to assess if changes in infrastructure were needed for clinical care. Secondarily, examine the frequency of infectious uveitides. METHODS A retrospective chart review of single academic centre of 436 consecutive, new patients with uveitis (686 eyes) and 3 affiliated, satellite clinics seen by 8 uveitis specialists from 1 July 2013 to 31 March 2017. Demographics recorded included patient age, race, associated systemic disease, uveitis chronicity, and anatomic location. The main outcome measure was comparing frequencies of patient demographics, immunosuppressive agent use, and infectious uveitis between locations. RESULTS 366 patients (587 eyes) were evaluated at the academic clinic and 70 (99 eyes) at the satellite locations. Anterior uveitis was the most common anatomic location; more acute, unilateral cases were seen at satellites (p=0.007; p=0.002, respectively). A larger percentage of posterior and panuveitis cases presented to the academic centre (p<0.0001). There was no difference in systemic disease association (p=0.925) or infectious uveitis cases (p=0.956). The use of non-corticosteroid immunosuppressive medications was higher at the academic clinic (p<0.001). CONCLUSIONS Anterior uveitis comprised the majority of cases in both clinics. Non-corticosteroid immunosuppressive agents were used more frequently at the academic clinic, reflecting more cases of chronic posterior and panuveitis. Compounded intravitreal injections, specialised ophthalmic imaging studies and high-risk medication monitoring can be centralised in the academic clinic. Infectious uveitis cases were seen at both locations, with an increase in syphilis diagnoses at the academic centre.
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Affiliation(s)
- Meghan Berkenstock
- Ocular Immunology Division, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
| | - Renuka Mopuru
- Ocular Immunology Division, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
| | - Jennifer Thorne
- Ocular Immunology Division, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
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55
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Queiroz RDP, Smit DP, Peters RPH, Vasconcelos-Santos DV. Double Trouble: Challenges in the Diagnosis and Management of Ocular Syphilis in HIV-infected Individuals. Ocul Immunol Inflamm 2020; 28:1040-1048. [PMID: 32657637 DOI: 10.1080/09273948.2020.1772839] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Syphilis and HIV infection may coexist in the same individual. Ocular syphilis and/or neurosyphilis may develop at any stage of coinfection, with a stronger association between ocular and neurosyphilis in individuals living with HIV, than in HIV-uninfected individuals. The diagnosis of ocular syphilis in HIV-infected and -uninfected patients remains with some controversy due to unspecific clinical manifestations and limited diagnostic tests. Penicillin is the mainstay of treatment of ocular syphilis, but alternative options are warranted. This review describes the epidemiology, pathophysiology, and clinical manifestations, as well as the diagnostic and therapeutic challenges posed by ocular syphilis against the background of HIV coinfection.
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Affiliation(s)
- Rafael de Pinho Queiroz
- Department of Ophthalmology and Otolaryngology, Faculdade de Medicina da Universidade Federal de Minas Gerais , Belo Horizonte, Brazil.,Uveitis Unit, Hospital São Geraldo/Hospital das Clínicas da Universidade Federal de Minas Gerais , Belo Horizonte, Brazil
| | - Derrick P Smit
- Division of Ophthalmology, Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town, South Africa
| | - Remco P H Peters
- Foundation for Professional Development, Research Unit , East London, South Africa.,Department of Medical Microbiology, University of Pretoria , Pretoria, South Africa.,CAPHRI School of Public Health & Primary Care, Maastricht University Medical Centre , Maastricht, The Netherlands
| | - Daniel Vitor Vasconcelos-Santos
- Department of Ophthalmology and Otolaryngology, Faculdade de Medicina da Universidade Federal de Minas Gerais , Belo Horizonte, Brazil.,Uveitis Unit, Hospital São Geraldo/Hospital das Clínicas da Universidade Federal de Minas Gerais , Belo Horizonte, Brazil
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56
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Gu X, Gao Y, Yan Y, Marks M, Zhu L, Lu H, Guan Z, Shi M, Ni L, Peng R, Zhao W, Wu J, Qi T, Lu S, Qian Y, Gong W, Zhou P. The importance of proper and prompt treatment of ocular syphilis: a lesson from permanent vision loss in 52 eyes. J Eur Acad Dermatol Venereol 2020; 34:1569-1578. [PMID: 32163642 PMCID: PMC7496700 DOI: 10.1111/jdv.16347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 02/25/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ocular involvement can occur at any stage of syphilis. Prompt diagnosis and proper treatment of ocular syphilis are vital to avoid long-term consequences. OBJECTIVES To describe the risk factors for ocular syphilis and clinical features of blindness caused by syphilis. METHODS We report risk factors for ocular syphilis amongst patients seen at the Shanghai Skin Disease Hospital between October 2009 and October 2017. We identify patients with ocular syphilis resulting in blindness and report the clinical characteristics, laboratory findings and treatment outcomes of these patients. RESULTS A total of 8310 new cases of syphilis were seen, of which 213 patients had ocular disease and 50 patients had blindness due to syphilis. Increasing age and higher RPR titres were associated with ocular involvement but there was no association with HIV status. Blindness in syphilis was restricted predominantly to patients with optic nerve involvement and not patients with isolated uveitis. Fifty patients (and a total of 67 eyes) met the WHO definition of blindness prior to treatment for syphilis. At the end of follow-up, vision had improved in 24 of 67 eyes (35.8%) after treatment. Successful treatment of uveitis was associated with the best improvement in visual acuity, whilst patient with underlying optic atrophy prior to treatment had the worst visual outcome. CONCLUSIONS Ocular involvement is an important manifestation of syphilis which may result in blindness. Our data demonstrate outcomes for ocular syphilis are poor if detected late; early recognition and diagnosis is therefore vital to avoid permanent visual loss.
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Affiliation(s)
- X. Gu
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Y. Gao
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Y. Yan
- Department of OphthalmologyRenji HospitalSchool of MedicineJiaotong UniversityShanghaiChina
| | - M. Marks
- Department of Clinical ResearchLondon School of Hygiene & Tropical MedicineLondonUK
| | - L. Zhu
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - H. Lu
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Z. Guan
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - M. Shi
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - L. Ni
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - R. Peng
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - W. Zhao
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - J. Wu
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - T. Qi
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - S. Lu
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Y. Qian
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - W. Gong
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - P. Zhou
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
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Parija S, Lalitha CS. Ocular Syphilis Presenting as Acute Necrotizing Retinitis in a Human Immunodeficiency Virus-Positive Patient. J Glob Infect Dis 2020; 12:149-151. [PMID: 33343167 PMCID: PMC7733434 DOI: 10.4103/jgid.jgid_105_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/30/2020] [Accepted: 01/30/2020] [Indexed: 11/04/2022] Open
Abstract
The incidence of ocular syphilis is increasing in the developing world even in the era of effective human immunodeficiency virus (HIV) treatment, as there is a potential increase of high-risk sexual behavior. Ocular involvement in the form of uveitis is seen in all stages of syphilis. Diagnosis begins with ophthalmologic examination, but requires serologic testing for confirmation. Ocular syphilis presents with unusual presentations or mimics other diseases and is identified by serological screening. It is curable with a relatively short course of antibiotic treatment, making its recognition a priority. All ophthalmic manifestations of syphilis should be treated with a Centers for Disease Control and Prevention-approved neurosyphilis regimen. In this report, we present a case of necrotizing retinitis with no response to antiviral treatment. On subsequent serological testing it was proved as syphilis in a HIV-positive patient who responded well to intravenous antibiotics with rapid visual recovery. Hence, awareness of this disease will promote early diagnosis and treatment.
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Affiliation(s)
- Sucheta Parija
- Department of Ophthalmology, AIIMS, Bhubaneswar, Odisha, India
| | - C S Lalitha
- Department of Ophthalmology, AIIMS, Bhubaneswar, Odisha, India
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58
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Romo D, Nagendra G, Schechter S, Pavlish A, Cohall A, Neu N. An Educational Intervention to Improve Provider Screening for Syphilis Among Men Who Have Sex with Men Utilizing an Urban Urgent Care Center. J Community Health 2020; 44:822-827. [PMID: 30877633 DOI: 10.1007/s10900-019-00647-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Rates of syphilis are increasing in the United States especially among men who have sex with men (MSM). The purpose of this project was to implement an educational intervention based on the 2015 CDC Sexually Transmitted Diseases (STD) Treatment Guidelines for urgent care providers with an emphasis on identifying MSM sexual behavior and appropriate screening for syphilis. An urgent care center was identified as a location where men seek care and where STD testing was occurring. After a baseline provider focus group to identify barriers to STD testing, a patient survey was created and given to clients to increase identification of MSM behaviors and to prompt providers to order syphilis testing. In addition, an educational intervention was implemented to improve provider and staff screening for syphilis. The intervention occurred between September 2015-December 2015. A total of 1341 males were seen with 1067 surveys collected. The mean age was 35.6 and 57.4% were Hispanic. Overall, 72 (5.4%) males identified as MSM. Approximately 50% of all MSM identified had RPRs (n = 37) sent and of these 13.5% (n = 5) tested positive for syphilis. The focus group among urgent care providers and staff identified barriers to syphilis testing. Targeted screening of males using a self-administered questionnaire is acceptable to urgent care populations and may assist in identifying MSM which in turn may help to facilitate syphilis screening and other relevant STI testing pertinent to this population.
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Affiliation(s)
- Dina Romo
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA.,Albert Einstein Medical College, Bronx, NY, USA
| | - Gowri Nagendra
- Mailman School of Public Health, Columbia University, New York, USA
| | - Sarah Schechter
- Department of Pediatrics, NewYork-Presbyterian Hospital, New York, NY, USA
| | - April Pavlish
- Mailman School of Public Health, Columbia University, New York, USA
| | - Alwyn Cohall
- Department of Pediatrics and Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Natalie Neu
- Department of Pediatrics, Columbia University Medical Center, 630 West 168th St, New York, NY, 10032, USA.
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Casalino G, Erba S, Sivagnanavel V, Lari S, Scialdone A, Pavesio C. Spontaneous resolution of acute syphilitic posterior placoid chorioretinitis: reappraisal of the literature and pathogenetic insights. GMS OPHTHALMOLOGY CASES 2020; 10:Doc26. [PMID: 32676271 PMCID: PMC7332998 DOI: 10.3205/oc000153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute syphilitic posterior placoid chorioretinitis (ASPPC) is a rare clinical manifestation of ocular syphilis. Spontaneous resolution of this condition has been reported in a few cases. The aim of this manuscript is to report an additional case and to discuss the possible pathogenesis of this condition by reviewing the current evidence on this subject. A 45-year-old man presented to us with decreased vision in the right eye secondary to a placoid macular lesion. Fourteen days after presentation, there was a dramatic improvement of the vision, and multimodal retinal imaging showed almost complete spontaneous resolution of the placoid lesion. Syphilis serology turned out positive and a diagnosis of ASPPC was made. The pathogenesis of ASPPC is unclear, and there is contrasting evidence about the role of the cellular immune system. Since this condition may resolve spontaneously before systemic antimicrobial treatment, the presence of a placoid macular lesion should raise a high suspicion of ASPPC in order to make a timely diagnosis and to avoid progression of untreated syphilis.
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Affiliation(s)
| | - Stefano Erba
- Oftalmico Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | | | - Shervin Lari
- Royal Eye Unit, Kingston Hospital NHS Foundation Trust, London, UK
| | | | - Carlos Pavesio
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
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60
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Boghdadi G, Feldman M. An Old Disease With an Unfamiliar Face: A Case Report of Ocular Syphilis. J Med Cases 2020; 11:77-78. [PMID: 34434368 PMCID: PMC8383522 DOI: 10.14740/jmc3438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/02/2020] [Indexed: 11/28/2022] Open
Abstract
Syphilis is an infection caused by the bacterium Treponema pallidum. Patients with syphilis can present with a wide range of symptoms depending on the stage of disease. An underappreciated manifestation of syphilis is ocular involvement, which has been increasingly reported in the last several years. Delay in diagnosis and treatment of ocular syphilis can increase the risk of irreversible vision loss. Syphilis can affect almost every structure in the eye; however, most commonly presents with panuveitis. Ocular syphilis is treated similarly to neurosyphilis with prompt initiation of intravenous penicillin G.
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Affiliation(s)
- George Boghdadi
- Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL 33612, USA
| | - Max Feldman
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL 33612, USA
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Moramarco A, Mallone F, Pirraglia MP, Bruscolini A, Giustolisi R, La Cava M, Lambiase A. Clinical Features of Ocular Syphilis: a Retrospective Clinical Study in an Italian Referral Centre. Semin Ophthalmol 2020; 35:50-55. [PMID: 32036734 DOI: 10.1080/08820538.2020.1723651] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To describe the clinical characteristics and visual prognosis of ocular involvement in syphilis.Design: A retrospective cohort study.Methods: We studied the charts of 24 patients who visited our Ophthalmological Centre in Rome, Italy. All patients with serological evidence of syphilitic infection were included.Results: Ocular involvement was the first manifestation of syphilitic disease in 96% and Human Immunodeficiency Virus (HIV) seropositivity was found in 29% of the cases. The most frequent ocular manifestation was posterior uveitis. Vitreous involvement was frequent. Patients with papillitis at onset showed better visual outcome with antisyphilitic treatment. Posterior uveitis at onset and HIV seropositivity were negative prognostic factors for visual outcome. HIV-positive patients showed more severe and frequent bilateral course of ocular involvement in syphilis.Conclusions: The ophthalmologist should suspect syphilis in patien ts with uveitis or optic neuropathy associated with high-risk sexual behaviour and/or HIV, or in patients with posterior placoid chorioretinitis, necrotising retinitis, or interstitial keratitis.
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Affiliation(s)
| | - Fabiana Mallone
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
| | | | - Alice Bruscolini
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
| | | | - Maurizio La Cava
- Department of Sense Organs, University Sapienza of Rome, Rome, Italy
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Maharana P, Goel S, Desai A, Sahay P, Sharma N, Titiyal J. Bilateral nodular sclerokeratitis secondary to syphilis - A case report. Indian J Ophthalmol 2020; 68:1990-1993. [PMID: 32823453 PMCID: PMC7690538 DOI: 10.4103/ijo.ijo_2051_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Eslami M, Noureddin G, Pakzad-Vaezi K, Warner S, Grennan T. Resurgence of ocular syphilis in British Columbia between 2013-2016: a retrospective chart review. CANADIAN JOURNAL OF OPHTHALMOLOGY 2019; 55:179-184. [PMID: 31889521 DOI: 10.1016/j.jcjo.2019.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 10/31/2019] [Accepted: 11/06/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To characterize the trends and explore the demographics, ophthalmic manifestations, and outcomes of ocular syphilis cases in British Columbia. DESIGN Retrospective chart review. PARTICIPANTS Ocular syphilis cases reported to the British Columbia Centre for Disease Control (BCCDC) between January 2013 and December 2016. METHODS The demographic and clinical data were extracted from the BCCDC's centralized sexually transmitted infection database and the ophthalmologists' clinical charts. RESULTS There was a steady increase in the rate of syphilis infection per 100 000 population, from 3.4 in 2010 to 18.4 in 2018. There were 39 ocular syphilis cases identified from January 2013 to December 2016. The median age was 50 years (interquartile range: 40-59.5 years); 82.1% were male and 51.3% were HIV positive. The clinical charts belonging to 32 patients were available for review, 14 of which (43.8%) presented with bilateral ocular complaints (46 affected eyes). The most commonly noted ocular presentations were uveitis (93.5%), including retinal vasculitis in 54.3%, and optic nerve involvement in 65.2% (which included papillitis, optic nerve swelling, or pallor). Panuveitis was the most frequent type of uveitis (52.2% of all eyes); 77.8% of affected eyes with best-corrected visual acuity (BCVA) ≤20/50 on presentation had an improvement of 2 or more Snellen lines of visual acuity at their final assessment. At presentation, 37.0% of eyes had BCVA ≤20/200, which decreased to 17.1% at final assessment. CONCLUSION Ocular syphilis, although rare, is on the rise globally and can result in serious ocular sequelae. A high index of suspicion is required for proper diagnosis and treatment.
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Affiliation(s)
- Maryam Eslami
- Department of Ophthalmology and Visual Sciences, Eye Care Centre, University of British Columbia, Vancouver, B.C
| | - Gelareh Noureddin
- Department of Ophthalmology and Visual Sciences, Eye Care Centre, University of British Columbia, Vancouver, B.C
| | - Kaivon Pakzad-Vaezi
- Department of Ophthalmology and Visual Sciences, Eye Care Centre, University of British Columbia, Vancouver, B.C
| | - Simon Warner
- Department of Ophthalmology and Visual Sciences, Eye Care Centre, University of British Columbia, Vancouver, B.C
| | - Troy Grennan
- British Columbia Centre for Disease Control, Vancouver, B.C..
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Yıldız Balcı S, Turan Vural E, Özçalışkan Ş. Intermediate Uveitis as the Initial and Only Presentation of Syphilis. Turk J Ophthalmol 2019; 49:297-299. [PMID: 31650814 PMCID: PMC6823590 DOI: 10.4274/tjo.galenos.2019.72558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 06/18/2019] [Indexed: 12/01/2022] Open
Abstract
We report a patient with unilateral syphilitic intermediate uveitis without dermatological, neurological, or any systemic involvement. He presented to our clinic with complaints of eye floaters and worsening visual acuity in the left eye. He had intermediate uveitis and cystoid macular edema in that eye and both venereal disease research laboratory and microhemagglutination assay for Treponema pallidum serological tests were confirmatory for syphilis. Ocular manifestations of syphilis have variable presentations, and it should be considered when diagnosing unexplained ocular inflammatory diseases, even if the patient’s recent history and systemic evaluation are not compatible.
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Affiliation(s)
- Sevcan Yıldız Balcı
- University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Ece Turan Vural
- University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Şehnaz Özçalışkan
- University of Health Sciences, Beyoğlu Eye Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
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Centers for Disease Control and Prevention Syphilis Summit: Difficult Clinical and Patient Management Issues. Sex Transm Dis 2019; 45:S10-S12. [PMID: 30102680 DOI: 10.1097/olq.0000000000000851] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Despite over a century of clinical experience in diagnosing and managing patients with syphilis, many thorny clinical questions remain unanswered. We focus on several areas of uncertainty for the clinician: the role of serologic tests in diagnosing syphilis and assessing syphilis treatment responses, and the risk of neurosyphilis and ocular syphilis in patients with syphilis. We also address whether clinical approaches should differ in patients who are, and are not, infected with HIV. The current increases in syphilis rates in the United States and elsewhere underscore our urgent need to definitively address these issues.
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Shanmugam VK, Phillpotts M, Brady T, Dalal M, Haji-Momenian S, Akin E, Nataranjan K, McNish S, Karcher DS. Retinal vasculitis with Chronic Recurrent Multifocal Osteomyelitis: a case report and review of the literature. BMC Rheumatol 2019; 3:29. [PMID: 31388650 PMCID: PMC6676622 DOI: 10.1186/s41927-019-0076-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 06/24/2019] [Indexed: 12/22/2022] Open
Abstract
Background Concurrent presentation of retinal vasculitis with mixed sclerotic and lytic bone lesions is rare. Case presentation We present the case of a 37-year old woman with a several year history of episodic sternoclavicular pain who presented for rheumatologic evaluation due to a recent diagnosis of retinal vasculitis. We review the differential diagnosis of retinal vasculitis, along with the differential diagnosis of mixed sclerotic and lytic bone lesions. Ultimately, bone marrow biopsy confirmed diagnosis of chronic recurrent multifocal osteomyelitis (CRMO). Concurrent presentation of CRMO with retinal vasculitis is extremely rare but important to recognize. The patient demonstrated clinical response to prednisone and tumor necrosis factor-alpha inhibition (TNF-i). Conclusion This case reports and unusual presentation of CRMO spectrum disease involving the sternum and sternoclavicular joint with concurrent retinal vasculitis.
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Affiliation(s)
- Victoria K Shanmugam
- 1Division of Rheumatology, The George Washington University School of Medicine and Health Sciences, 2300 M Street, NW, Washington, DC 20037 USA
| | - Marc Phillpotts
- 1Division of Rheumatology, The George Washington University School of Medicine and Health Sciences, 2300 M Street, NW, Washington, DC 20037 USA
| | - Timothy Brady
- 1Division of Rheumatology, The George Washington University School of Medicine and Health Sciences, 2300 M Street, NW, Washington, DC 20037 USA
| | - Monica Dalal
- 2Department of Ophthalmology, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
| | - Shawn Haji-Momenian
- 3Department of Radiology, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
| | - Esma Akin
- 3Department of Radiology, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
| | - Kavita Nataranjan
- 4Department of Hematology, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
| | - Sean McNish
- 1Division of Rheumatology, The George Washington University School of Medicine and Health Sciences, 2300 M Street, NW, Washington, DC 20037 USA
| | - Donald S Karcher
- 5Department of Pathology, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Washington, DC 20037 USA
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Vadboncoeur J, Labbé AC, Fortin C, Serhir B, Rabia Y, Najem K, Jaworski L, Aubin MJ. Ocular syphilis: case series (2000-2015) from 2 tertiary care centres in Montreal, Canada. Can J Ophthalmol 2019; 55:30-37. [PMID: 31712031 DOI: 10.1016/j.jcjo.2019.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 04/15/2019] [Accepted: 05/27/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To describe the demographics, clinical presentation, proportion of co-infection with human immunodeficiency virus (HIV), and treatment of patients with ocular syphilis seen at the ophthalmology department of 2 tertiary centres in Montreal, Canada. DESIGN Retrospective case series. PARTICIPANTS AND METHODS A total of 169 eyes of 115 patients, seen between 2000 and 2015, with a positive syphilis treponemal serology and a likely syphilis-related ophthalmologic diagnosis. Subgroup analysis was performed between HIV-infected and HIV-uninfected patients. RESULTS Mean age of onset was 55 years, and 79% were male. Mean presenting logMAR visual acuity was 0.7. HIV status was available for 66%, of whom 49% were HIV-infected. The anatomical ocular diagnoses included isolated anterior uveitis (18%) and posterior segment involvement (42%). Both eyes were affected in 47%. Lumbar puncture (LP) was performed in 55%, of whom 22% had a positive cerebrospinal fluid (CSF) Venereal Disease Research Laboratory (VDRL) test. Antibiotherapy, consisting of intravenous penicillin alone or in addition to intramuscular benzathine penicillin, was administered in 65 patients (69%). Treatment allowed a visual improvement of -0.23 logMAR. HIV-infected patients were younger men (p < 0.01) and had more abnormal CSF analysis (p = 0.02), but there were no statistically significant differences in the anatomical location of ocular inflammation or visual function improvement. CONCLUSIONS Given its varied presentations, syphilis must always be part of the differential diagnosis of intraocular inflammation. HIV testing and an LP are required in the evaluation of ocular syphilis, which should be treated as neurosyphilis with the appropriate regimen.
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Affiliation(s)
| | - Annie-Claude Labbé
- Division of Infectious Diseases and Medical Microbiology, Hôpital Maisonneuve-Rosemont (HMR), CIUSSS de l'Est-de-l'Île-de-Montréal, Montreal, Que.; Department of Microbiology, Infectious Diseases and Immunology, Faculty of Medicine, Montreal, Que
| | - Claude Fortin
- Department of Microbiology, Infectious Diseases and Immunology, Faculty of Medicine, Montreal, Que.; Department of Medical Microbiology and Infectious Diseases, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Que
| | - Bouchra Serhir
- Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, Ste-Anne-de-Bellevue, Que
| | - Yasmine Rabia
- Ophthalmology Resident, Université de Montréal, Montreal, Que
| | - Kinda Najem
- Department of Ophthalmology, CUO-HMR, CIUSSS de l'Est-de-l'Île-de-Montréal, Montreal, Que
| | | | - Marie-Josée Aubin
- Department of Ophthalmology, CUO-HMR, CIUSSS de l'Est-de-l'Île-de-Montréal, Montreal, Que.; Department of Social and Preventive Medicine, School of Public Health, Université de Montreal, Montreal, Que
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Ghanimi Zamli AK, Irma Ngah NS, Chew-Ean T, Muhammed J, Wan Hitam WH, Hussein A, Zunaina E. Clinical Profile and Visual Outcomes of Ocular Syphilis: A Five-year Review in Hospital Universiti Sains, Malaysia. Cureus 2019; 11:e4015. [PMID: 31007973 PMCID: PMC6453624 DOI: 10.7759/cureus.4015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/05/2019] [Indexed: 11/05/2022] Open
Abstract
Introduction Ocular syphilis is a sight-threatening condition. It can occur at any stage of syphilis infection, which present either with acute inflammation during the primary, secondary, and early latent stages or with chronic inflammation during tertiary infection, affecting virtually every ocular structure. This study was to report on the clinical presentation of ocular syphilis that presented to eye clinic Hospital Universiti Sains Malaysia. Methodology This was a retrospective study where medical records of ocular syphilis patients who attended eye clinic in Hospital Universiti Sains Malaysia from January 2013 to June 2017 were reviewed. Results A total of 10 patients (13 eyes) with ocular syphilis were identified out of 106 cases that presented with ocular inflammation. The mean age of presentation was 69.8 ± 6.4 years and seven of them (70%) were female. All patients were Malay and human immunodeficiency virus (HIV) was negative. The ocular manifestations included panuveitis (four eyes, 30.8%), anterior uveitis (two eyes, 15.4%), posterior uveitis (seven eyes, 53.8%) and optic neuritis (two eyes, 15.4%). Seven (53.8%) eyes presented with visual acuity of worse than 6/60, five (38.5%) eyes had visual acuity between 6/15 to 6/60, and one (7.7%) eye had visual acuity of 6/12 or better. Nine patients received an intravenous benzylpenicillin regime and one patient received an intramuscular penicillin injection. Out of 13 eyes affected, 11 (84.6%) eyes had improved visual acuity of at least one Snellen line after treatment. Visual acuity of 6/12 or better increased to four (30.8%) eyes. Conclusions Posterior uveitis was the commonest presentation of ocular syphilis in HIV-negative patients. Early detection and treatment of ocular syphilis can result in resolution of inflammation and improvement of vision.
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Affiliation(s)
| | | | - Tan Chew-Ean
- Ophthalmology, Universiti Sains Malaysia, Kota Bharu, MYS
| | | | | | - Adil Hussein
- Ophthalmology, Universiti Sains Malaysia, Kota Bharu, MYS
| | - Embong Zunaina
- Ophthalmology, Universiti Sains Malaysia, Kota Bharu, MYS
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Oliver GF, Stathis RM, Furtado JM, Arantes TE, McCluskey PJ, Matthews JM, Smith JR. Current ophthalmology practice patterns for syphilitic uveitis. Br J Ophthalmol 2019; 103:1645-1649. [DOI: 10.1136/bjophthalmol-2018-313207] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 11/22/2018] [Accepted: 12/14/2018] [Indexed: 01/15/2023]
Abstract
BackgroundSyphilitic uveitis is re-emerging alongside the systemic infection. In July 2017, an international group of uveitis-specialised ophthalmologists formed the International Ocular Syphilis Study Group to define current practice patterns.Methods103 Study Group members based in 35 countries completed a 25-item questionnaire focused on case load, clinical presentations, use and interpretation of investigations, treatment and clinical indicators of poor prognosis.ResultsMembers managed a mean of 6.1 patients with syphilitic uveitis in clinics that averaged 707 annual cases of uveitis (0.9%); 53.2% reported increasing numbers over the past decade. Patients presented to more members (40.2%) during secondary syphilis. Uveitis was usually posterior (60.8%) or pan (22.5%); complications included optic neuropathy, macular oedema and posterior synechiae. All members diagnosed syphilitic uveitis using serological tests (simultaneous or sequential testing algorithms), and 97.0% routinely checked for HIV co-infection. Cerebrospinal fluid (CSF) analysis was ordered by 90.2% of members, and 92.7% took uveitis plus Venereal Disease Research Laboratory test (VDRL) or fluorescent treponemal antibody absorption test (FTA-ABS) to indicate neurosyphilis. Patients were commonly co-managed with infectious disease physicians, and treated with penicillin for at least 10–14 days, plus corticosteroid. Features predicting poor outcome included optic neuropathy (86.3%) and initial misdiagnosis (63.7%). Reasons for delayed diagnosis were often practitioner-related. 82.5% of members tested every patient they managed with uveitis for syphilis.ConclusionThis comprehensive report by an international group of uveitis-specialised ophthalmologists provides a current approach for the management of syphilitic uveitis.
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de-la-Torre A, Valdés-Camacho J, de Mesa CL, Uauy-Nazal A, Zuluaga JD, Ramírez-Páez LM, Durán F, Torres-Morales E, Triviño J, Murillo M, Peñaranda AC, Sepúlveda-Arias JC, Gómez-Marín JE. Coinfections and differential diagnosis in immunocompetent patients with uveitis of infectious origin. BMC Infect Dis 2019; 19:91. [PMID: 30683065 PMCID: PMC6347798 DOI: 10.1186/s12879-018-3613-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 12/11/2018] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Making a definite diagnosis of infectious uveitis is a challenging task because many other infectious, and non-infectious uveitis, may have similar non-specific symptoms and overlapping clinical appearances. Co-infections in immunocompetent patients are not frequently proved with traditional serologic-diagnostic tools. METHODS Descriptive transversal study, in a Uveitis Service of an Ophthalmology Reference Center, in Bogotá, Colombia, from July 2014 to February 2016. Aqueous humor (AH) and/or vitreous fluid, blood and serum samples were collected from consecutive patients suspected of having infectious uveitis. The diagnosis of ocular toxoplasmosis (OT) was confirmed by the Goldmann-Witmer coefficient (GWC) and by polymerase chain reaction (PCR). Differential diagnosis by PCR in AH was done for viral origin such as Cytomegalovirus (CMV), Herpes simplex virus type 1 (HSV1), Herpes simplex virus type 2 (HSV2), Varicella zoster virus (VZV), Epstein-Barr virus (EBV) and Mycobacterium tuberculosis. RESULTS In 66 Colombian patients with uveitis of presumed infectious origin: 22 (33.3%) were confirmed as OT, 16 (24.2%) as undetermined OT, five (7.5%) as co-infections and 23 (34.8%) as other uveitis. Toxoplasma coinfection with M. tuberculosis was identified in one case by PCR and in four cases with HSV by GWC. The initial clinical diagnosis changed, after laboratory examination, in 21 cases (31.8%). CONCLUSIONS Clinical diagnosis can be changed by laboratory examination in a significant proportion of cases of uveitis. Diagnosis of OT should combine the use of PCR and GWC to reach the maximum of confirmation of cases. The use of multiple laboratory methods is necessary to identify co-infections and viral infections that can mimic OT in immunocompetent patients.
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Affiliation(s)
- Alejandra de-la-Torre
- Unidad de Inmunología, Grupo de Investigación en Neurociencias (NeURos), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 # 63 C 69, Bogotá, Colombia.
| | - Juanita Valdés-Camacho
- GEPAMOL, Centro de Investigaciones Biomédicas, Facultad de Ciencias de la Salud, Universidad del Quindío, Armenia, Colombia
| | - Clara López de Mesa
- Departamento de Investigación, Escuela Superior de Oftalmología-Instituto Barraquer de América, Bogotá, Colombia
| | - Andrés Uauy-Nazal
- Departamento de Investigación, Escuela Superior de Oftalmología-Instituto Barraquer de América, Bogotá, Colombia
| | - Juan David Zuluaga
- GEPAMOL, Centro de Investigaciones Biomédicas, Facultad de Ciencias de la Salud, Universidad del Quindío, Armenia, Colombia
| | - Lina María Ramírez-Páez
- Departamento de Investigación, Escuela Superior de Oftalmología-Instituto Barraquer de América, Bogotá, Colombia
| | - Felipe Durán
- Unidad de Inmunología, Grupo de Investigación en Neurociencias (NeURos), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 # 63 C 69, Bogotá, Colombia.,Departamento de Investigación, Escuela Superior de Oftalmología-Instituto Barraquer de América, Bogotá, Colombia
| | - Elizabeth Torres-Morales
- GEPAMOL, Centro de Investigaciones Biomédicas, Facultad de Ciencias de la Salud, Universidad del Quindío, Armenia, Colombia
| | - Jessica Triviño
- GEPAMOL, Centro de Investigaciones Biomédicas, Facultad de Ciencias de la Salud, Universidad del Quindío, Armenia, Colombia
| | - Mateo Murillo
- GEPAMOL, Centro de Investigaciones Biomédicas, Facultad de Ciencias de la Salud, Universidad del Quindío, Armenia, Colombia
| | - Alba Cristina Peñaranda
- Departamento de Investigación, Escuela Superior de Oftalmología-Instituto Barraquer de América, Bogotá, Colombia
| | - Juan Carlos Sepúlveda-Arias
- Grupo de Investigación Infección e Inmunidad, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Jorge Enrique Gómez-Marín
- GEPAMOL, Centro de Investigaciones Biomédicas, Facultad de Ciencias de la Salud, Universidad del Quindío, Armenia, Colombia
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Queiroz RDP, Inês DV, Diligenti FT, Schnor VH, Melamed J, Campos WR, Vasconcelos-Santos DV. The ghost of the great imitator: prognostic factors for poor outcome in syphilitic uveitis. J Ophthalmic Inflamm Infect 2019; 9:2. [PMID: 30659387 PMCID: PMC6338615 DOI: 10.1186/s12348-019-0169-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 01/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Syphilitic uveitis is reemerging globally, may lead to any type of intraocular inflammation, and is potentially sight-threatening. We aim to characterize clinical features and prognostic factors in patients with syphilitic posterior uveitis. METHODS Retrospective chart review at two tertiary university-based referral centers in Brazil. Clinical data, laboratory results, and treatment outcomes were analyzed. Statistical analysis was performed using Fisher's exact test for categorical variables and Mann-Whitney U test for continuous variables. RESULTS Forty-four patients (81 eyes) were consecutively diagnosed with syphilitic posterior uveitis between March 2011 and April 2013.Thirty-one were male (70.5%) and the mean age was 43.8 years (range 15-81). HIV confection was disclosed in 12 patients (29.3%). The most prevalent finding was vitritis (85.2%), followed by retinal involvement (76.4%) and optic disc abnormalities (63.5%). After treatment, mean visual acuity improved from 1.2 (20/320) to 0.6 (20/80; median 20/30), but 19 eyes (23.5%) persisted with ≤ 1.0 (20/200). Factors associated with final visual acuity ≤ 1.0 despite therapy were prior use of systemic corticosteroids (p = 0.001), higher Venereal Disease Research Laboratory titers (p = 0.004), longer duration of symptoms (p = 0.024), and worse initial VA (p < 0.001). CONCLUSIONS Syphilitic uveitis is reemerging. Delayed diagnosis and inadvertent use of systemic corticosteroids are potentially modifiable prognostic factors to be considered for possibly improving outcomes.
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Affiliation(s)
- Rafael de Pinho Queiroz
- Departamento de Oftalmologia e Otorrinolaringologia, Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Alfredo Balena 190. Sala 199, Belo Horizonte, MG 30.130-100 Brazil
- Hospital São Geraldo/Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Programa de Pós-graduação em Ciências da Saúde – Infectologia e Medicina Tropical – UFMG, Belo Horizonte, Brazil
| | - Daniele Viana Inês
- Departamento de Oftalmologia e Otorrinolaringologia, Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Alfredo Balena 190. Sala 199, Belo Horizonte, MG 30.130-100 Brazil
| | - Felipe Telöken Diligenti
- Hospital de Clínicas de Porto Alegre – Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Victor Haygert Schnor
- Hospital de Clínicas de Porto Alegre – Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jacobo Melamed
- Hospital de Clínicas de Porto Alegre – Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Wesley Ribeiro Campos
- Departamento de Oftalmologia e Otorrinolaringologia, Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Alfredo Balena 190. Sala 199, Belo Horizonte, MG 30.130-100 Brazil
- Hospital São Geraldo/Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Daniel Vítor Vasconcelos-Santos
- Departamento de Oftalmologia e Otorrinolaringologia, Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Alfredo Balena 190. Sala 199, Belo Horizonte, MG 30.130-100 Brazil
- Hospital São Geraldo/Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Programa de Pós-graduação em Ciências da Saúde – Infectologia e Medicina Tropical – UFMG, Belo Horizonte, Brazil
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GOOD VISUAL OUTCOME IN A BILATERAL MULTIFOCAL SYPHILITIC CHORIORETINITIS, DESPITE LATE DIAGNOSIS. Retin Cases Brief Rep 2019; 13:84-87. [PMID: 28125501 DOI: 10.1097/icb.0000000000000541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report a case of a good visual outcome in a patient with bilateral multifocal syphilitic chorioretinitis, despite the late diagnosis. METHODS Ophthalmologic examination, multimodal imaging, including fundus photography, angiography, and optical coherence tomography. RESULTS The authors describe a 47-year-old heterosexual man with a bilateral multifocal syphilitic chorioretinitis that was lately diagnosed and despite that had a good visual outcome. CONCLUSION The diagnosis of ocular syphilis is a challenge; however, once it has been made, even lately, it is eminently treatable.
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Abstract
PURPOSE OF REVIEW The aim of this review is to highlight recent changes in opportunistic ocular infections (OOIs) in the era of modern combination antiretroviral therapy (cART), in the setting of HIV-infected patients. RECENT FINDINGS Improvements in modern cART has led to a progressive decline in the incidence of OOIs and mortality among patients with AIDS. Not only has there been a decreasing incidence of cytomegalovirus (CMV) retinitis, but there also has been a decline in progression of such retinitis when it does occur in AIDS patients, since the introduction of cART. Nevertheless, CMV retinitis remains the major cause of vision loss in AIDS patients. Although the incidence of CMV retinitis has declined overall, the incidence of ocular syphilis has increased during the cART era. Moreover, the impact of having HIV plays a role with respect to multidrug-resistant (MDR) tuberculosis and has resulted in a high prevalence of presumed ocular tuberculosis in HIV/MDR-TB co-infected patients. Although immune reconstitution uveitis (IRU) has been an important cause of visual deficits in developed countries, OOIs remain an important cause of blindness in the developing world. SUMMARY Reconstituting the immune system with effective cART while increasing accessibility of screening examinations is key to the success of blindness prevent in HIV-infected individuals, particularly in developing countries.
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Borges CR, Almeida SMD, Sue K, Koslyk JLA, Sato MT, Shiokawa N, Teive HAG. Neurosyphilis and ocular syphilis clinical and cerebrospinal fluid characteristics: a case series. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:373-380. [PMID: 29972419 DOI: 10.1590/0004-282x20180054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 03/19/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND During the first decade of this century, a significant increase in the incidence of syphilis was documented. OBJECTIVE To study clinical and laboratory characteristics of central nervous system and ocular syphilis. METHODS A retrospective case series of 13 patients with a clinical and laboratory diagnosis of neurosyphilis and/or ocular syphilis who had been admitted to the Neurology and Neuro-ophthalmology Service of the Hospital de Clínicas, Federal University of Paraná. RESULTS Nine patients had a diagnosis of neurosyphilis and two of them also had ocular syphilis. Four patients had a diagnosis of ocular syphilis alone. Among the patients with a diagnosis of neurosyphilis, six had symptomatic syphilitic meningitis, of whom one manifested as cranial nerve palsy alone, one as cranial nerve palsy plus ocular syphilis, two as transverse myelitis (syphilitic meningomyelitis), one as meningitis worsening the patient's myasthenia gravis symptoms and one as meningitis plus ocular syphilis. Additionally, we diagnosed three patients with meningovascular neurosyphilis. In the univariate analysis, patients without ocular syphilis showed greater levels of total protein and white blood cells in the cerebrospinal fluid than patients with ocular syphilis. CONCLUSION This Brazilian case series of patients with neurosyphilis and ocular syphilis highlights the wide variability of this disease. A high degree of diagnostic suspicion is necessary when facing neurological and ocular symptoms for rapid diagnosis and appropriate management of patients.
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Affiliation(s)
- Conrado Regis Borges
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Curitiba PR, Brasil
| | - Sérgio Monteiro de Almeida
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Curitiba PR, Brasil.,Faculdades Pequeno Príncipe Curitiba, Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba PR, Brasil
| | - Karen Sue
- Universidade Federal do Paraná, Hospital de Clínicas, Serviço de Neuro-Oftalmologia, Curitiba PR, Brasil
| | - Jéssyca Luana Alves Koslyk
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Curitiba PR, Brasil
| | - Mario Teruo Sato
- Universidade Federal do Paraná, Hospital de Clínicas, Serviço de Neuro-Oftalmologia, Curitiba PR, Brasil
| | - Naoye Shiokawa
- Universidade Federal do Paraná, Hospital de Clínicas, Serviço de Neuro-Oftalmologia, Curitiba PR, Brasil
| | - Hélio Afonso Ghizoni Teive
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Curitiba PR, Brasil
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Lapere S, Mustak H, Steffen J. Clinical Manifestations and Cerebrospinal Fluid Status in Ocular Syphilis. Ocul Immunol Inflamm 2018; 27:126-130. [PMID: 30230943 DOI: 10.1080/09273948.2018.1521436] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To review the clinical manifestations, cerebrospinal fluid findings and outcomes of patients diagnosed with ocular syphilis. METHODS Retrospective case review of all patients treated with ocular syphilis at Groote Schuur Hospital in Cape Town, South Africa between January 2008 and January 2013. RESULTS A total of 77 eyes of 49 patients were included. Panuveitis was the most common presenting sign (48.9%). A lumbar puncture was performed on 37 patients (75.5%) and 64.8% (24/37) of samples had positive treponemal testing (CSF-FTA) while 24.3% (9/37) had positive non-treponemal testing (CSF-VDRL). Elevated CSF lymphocyte cell count was a strong predictor of neurosyphilis (p = 0.06 for CSF-FTA positive samples and p = 0.03 for CSF-VDRL positive samples). CONCLUSION The majority of patients (64.8%) who underwent lumbar puncture had cerebrospinal fluid findings suggestive of neurosyphilis. Elevated CSF lymphocyte cell count and total protein count are highly suggestive of neurosyphilis.
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Affiliation(s)
- Steven Lapere
- a Department of Ophthalmology , Groote Schuur Hospital , Cape Town , South Africa
| | - Hamzah Mustak
- a Department of Ophthalmology , Groote Schuur Hospital , Cape Town , South Africa
| | - Jonel Steffen
- a Department of Ophthalmology , Groote Schuur Hospital , Cape Town , South Africa
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Mustapha M, Abdollah Z, Ahem A, Mohd Isa H, Bastion MLC, Din NM. Ocular syphilis: resurgence of an old disease in modern Malaysian society. Int J Ophthalmol 2018; 11:1573-1576. [PMID: 30225238 DOI: 10.18240/ijo.2018.09.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 12/06/2017] [Indexed: 01/09/2023] Open
Affiliation(s)
- Mushawiahti Mustapha
- Department of Ophthalmology, Pusat Perubatan Universiti, Jalan Yaacob Latiff, Cheras 56000, Malaysia
| | - Zakaria Abdollah
- Department of Ophthalmology, Pusat Perubatan Universiti, Jalan Yaacob Latiff, Cheras 56000, Malaysia
| | - Amin Ahem
- Department of Ophthalmology, Pusat Perubatan Universiti, Jalan Yaacob Latiff, Cheras 56000, Malaysia
| | - Hazlita Mohd Isa
- Department of Ophthalmology, Pusat Perubatan Universiti, Jalan Yaacob Latiff, Cheras 56000, Malaysia
| | | | - Norshamsiah Md Din
- Department of Ophthalmology, Pusat Perubatan Universiti, Jalan Yaacob Latiff, Cheras 56000, Malaysia
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Clinical Manifestations and Ophthalmic Outcomes of Ocular Syphilis at a Time of Re-Emergence of the Systemic Infection. Sci Rep 2018; 8:12071. [PMID: 30104765 PMCID: PMC6089995 DOI: 10.1038/s41598-018-30559-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 07/26/2018] [Indexed: 01/20/2023] Open
Abstract
Recent reports from different world regions suggest ocular syphilis is re-emerging, in parallel with an increasing incidence of the systemic infection globally. We conducted a large observational study of 127 persons consecutively treated for ocular syphilis at public medical centers in Brazil over a 2.5-year period ending July 2015. Of 104 individuals serologically tested for human immunodeficiency virus (HIV), 34.6% were positive. Ophthalmological evaluations included measurement of Snellen visual acuity and intraocular pressure, and assessment of inflammation by slit lamp examination and dilated posterior eye examination. Involvements in 214 eyes were anterior (6.1%), intermediate (8.4%), posterior (76.2%) and pan- (8.4%) uveitis, and scleritis (0.9%). Multiple anterior and posterior eye complications were observed, including cataract in the anterior eye (incidence rate, 0.18/eye-year) and epiretinal membrane in the posterior eye (incidence rate, 0.09/eye-year); incidence rates of reduction in best-corrected visual acuity to ≤20/50 and ≤20/200 were 0.10 and 0.06/eye-year, respectively. Rates of complications and visual acuity loss did not differ significantly between HIV- positive and negative individuals. In an era of re-emergence, syphilis has ocular complications that may compromise vision, despite treatment with appropriate anti-microbial drugs.
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Rich C, Papanagnou D, Curley D, Zhang XC. Neurosyphilis: A Simulation Case for Emergency Medicine Residents. Cureus 2018; 10:e2984. [PMID: 30237945 PMCID: PMC6141056 DOI: 10.7759/cureus.2984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Neurosyphilis is a dangerous and increasingly more prevalent sexually transmitted infection of the central nervous system caused by the bacterium Treponema pallidum that can present during the advanced stages of the disease (tertiary syphilis). Health care providers must remain vigilant in screening for syphilis in patients with high-risk behaviors as a delay in diagnosis and treatment may lead to symptom progression and debilitating sequelae years later. To date, there have been no published simulation case studies on neurosyphilis. This simulation case, based on a real patient encounter, is written for emergency medicine residents to diagnose and manage a patient presenting with the sequelae of neurosyphilis. This case was run for four separate iterations at a simulation center with two residents and an attending physician acting as confederates. Following the case, learners were provided with bedside debriefing, and a question and answer session. Based on post-simulation qualitative assessment, junior residents alone were less likely to perform a comprehensive integumentary exam without the presence of senior residents, although both groups failed to elicit pertinent sexual history until they discovered syphilitic lesions. After case completion and debriefing, all learners were able to demonstrate the understanding of the primary learning objectives.
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Affiliation(s)
- Chana Rich
- Emergency Medicine, Alpert Medical School of Brown University , Providence, USA
| | | | - David Curley
- Emergency Medicine, Alpert Medical School of Brown University, Providence, USA
| | - Xiao Chi Zhang
- Emergency Medicine, Thomas Jefferson University, Philadelphia, USA
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79
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Abstract
Syphilis is an infectious disease that can cause a wide variety of ocular signs. One of the rarest manifestations of ocular syphilis is acute syphilitic posterior placoid chorioretinitis (ASPPC). We report the case of an immunocompetent 38-year-old woman diagnosed with unilateral, atypical, acute syphilitic posterior placoid chorioretinitis. Fundoscopic examination revealed a yellow-white, subretinal, placoid lesion at the posterior pole, which is typical sign of ASPPC. In the periphery of the retina, multifocal choroiditis was also found. Fundus and angiographic changes in ASPPC may mimic other chorioretinal diseases. Accurate diagnosis of ASPPC as a presenting sign of syphilis is important for the prompt initiation of systemic antibiotic treatment.
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Affiliation(s)
- Z Szepessy
- Augenklinik, Semmelweis Universität, Mária Str. 39, 1085, Budapest, Ungarn.
| | - B B Entz
- Augenabteilung, Csolnoky Ferenc Krankenhaus, Veszprém, Ungarn
| | - Z Z Nagy
- Augenklinik, Semmelweis Universität, Mária Str. 39, 1085, Budapest, Ungarn
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80
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Pratas AC, Goldschmidt P, Lebeaux D, Aguilar C, Ermak N, Benesty J, Charlier C, Benveniste E, Merabet L, Sedira N, Hope-Rapp E, Chaumeil C, Bodaghi B, Héron E, Sahel JA, Lortholary O, Errera MH. Increase in Ocular Syphilis Cases at Ophthalmologic Reference Center, France, 2012-2015. Emerg Infect Dis 2018; 24:193-200. [PMID: 29350138 PMCID: PMC5782877 DOI: 10.3201/eid2402.171167] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
We describe the frequency, demographic and clinical features, and visual outcomes of ocular syphilis infections observed during 2012-2015 at a tertiary reference center in Paris, France. Twenty-one cases (29 eyes) were identified. The occurrence of ocular syphilis increased from 1 case in 2012 to 5 cases in 2013, 6 cases in 2014, and 9 cases in 2015 (2.22-25.21/1,000 individual patients/year for the period). Among case-patients, an annual 20%-33% were co-infected with HIV. Seventy-six percent of ocular syphilis infections occurred in men who have sex with men. Seventy-five percent of case-patients had a good final visual outcome (best-corrected visual acuity >0.3 logMAR score). Visual outcome was worse for HIV-positive patients than for HIV-negative patients (p = 0.0139). At follow-up, the best visual outcomes were observed in patients whose mean time from first ocular symptom to consultation was 15 days (SD +19 days).
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Abstract
Ocular syphilis is not a new issue but due to increasing rates of new cases is now a contemporary issue. The clinical features are unspecific and can be manifested as all forms of ocular inflammation. Unspecific anterior uveitis is the most frequent ocular involvement; however, typical distinctive patterns are superficial white preretinal precipitates within a panuveitis and acute syphilitic posterior placoid chorioretinitis. The diagnosis should be confirmed by serological tests. Treatment is based on parenteral administration of penicillin.
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Abstract
Treponema pallidum subspecies pallidum (T. pallidum) causes syphilis via sexual exposure or via vertical transmission during pregnancy. T. pallidum is renowned for its invasiveness and immune-evasiveness; its clinical manifestations result from local inflammatory responses to replicating spirochaetes and often imitate those of other diseases. The spirochaete has a long latent period during which individuals have no signs or symptoms but can remain infectious. Despite the availability of simple diagnostic tests and the effectiveness of treatment with a single dose of long-acting penicillin, syphilis is re-emerging as a global public health problem, particularly among men who have sex with men (MSM) in high-income and middle-income countries. Syphilis also causes several hundred thousand stillbirths and neonatal deaths every year in developing nations. Although several low-income countries have achieved WHO targets for the elimination of congenital syphilis, an alarming increase in the prevalence of syphilis in HIV-infected MSM serves as a strong reminder of the tenacity of T. pallidum as a pathogen. Strong advocacy and community involvement are needed to ensure that syphilis is given a high priority on the global health agenda. More investment is needed in research on the interaction between HIV and syphilis in MSM as well as into improved diagnostics, a better test of cure, intensified public health measures and, ultimately, a vaccine.
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Affiliation(s)
- Rosanna W Peeling
- London School of Hygiene &Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - David Mabey
- London School of Hygiene &Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Mary L Kamb
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Xiang-Sheng Chen
- National Center for STD Control, Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Dermatology, Nanjing, China
| | - Justin D Radolf
- Department of Medicine, UConn Health, Farmington, Connecticut, USA
| | - Adele S Benzaken
- Department of Surveillance, Prevention and Control of STI, HIV/AIDS and Viral Hepatitis, Ministry of Health, Brasília, Brazil
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Tsuboi M, Nishijima T, Yashiro S, Teruya K, Kikuchi Y, Katai N, Gatanaga H, Oka S. Time to development of ocular syphilis after syphilis infection. J Infect Chemother 2017; 24:75-77. [PMID: 28958728 DOI: 10.1016/j.jiac.2017.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 07/26/2017] [Accepted: 08/12/2017] [Indexed: 11/18/2022]
Abstract
To provide an estimate of the incubation period of ocular syphilis based on serology using both clinical data and stored serum samples, we retrospectively reviewed patients with HIV-1 infection who presented with ocular syphilis between August 1997 and July 2015 in a tertiary hospital in Japan. The incubation period of ocular syphilis was defined as the time from syphilis infection to the development of ocular symptoms due to ocular syphilis. During the study period, 20 patients were diagnosed with ocular syphilis and 8 patients were enrolled in the present study. All patients were Japanese men who have sex with men with a median age of 46 years (IQR 41.5-53.5). The median CD4 count was 668.5/μL (IQR 567.8-734.3) and 5 of the 8 patients had HIV-1 viral load of less than 50 copies/mL. All study patients presented to our clinic because of the development of ocular symptoms, and they did not have any other symptoms compatible with primary, secondary, or tertiary syphilis. The median time between syphilis infection and development of ocular symptoms was 11 months (IQR 4-19, range 2.5-45). Seven out of eight (87.5%) cases developed ocular syphilis within 2 years of syphilis infection. Ocular syphilis should be suspected even in patients with early syphilis who present with ocular symptoms. Moreover, routine serologic screening for syphilis among patients with HIV-1 infection is critical for prevention of irreversible visual loss in ocular syphilis cases.
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Affiliation(s)
- Motoyuki Tsuboi
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Takeshi Nishijima
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Shigeko Yashiro
- Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Katsuji Teruya
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoshimi Kikuchi
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Naomichi Katai
- Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroyuki Gatanaga
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan; Center for AIDS Research, Kumamoto University, Kumamoto, Japan
| | - Shinichi Oka
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan; Center for AIDS Research, Kumamoto University, Kumamoto, Japan
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84
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Argemi X, Hansmann Y, Martin M, Lefebvre N, Douiri N, Christmann D, Chanson JB, Sauer A, De Martino S. [Neurosyphilis: A retrospective study of 13 cases at Strasbourg University Hospital]. J Fr Ophtalmol 2017; 40:654-660. [PMID: 28867237 DOI: 10.1016/j.jfo.2017.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 03/09/2017] [Accepted: 03/17/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE After a decade of constant decline, the number of syphilis cases has been steadily increasing since the 2000s, particularly in HIV infected patients. Neurosyphilis is a rare manifestation of this sexually transmitted disease for which we performed a retrospective study and analyzed clinical manifestations. PATIENTS AND METHODS We reviewed retrospectively all the neurosyphilis cases admitted to Strasbourg University Hospital between 2004 and 2014. We included and analyzed 13 patients admitted during this period who met the diagnostic criteria for neurosyphilis. RESULTS Nine of 13 patients had isolated visual manifestations; three (23.1%) experienced posterior uveitis, two (15.4%), panuveitis, and 4 (30.8%) had papillitis. Out of five patients (38.5%) who were HIV positive, three (60%) had a CD4 cell count above 400/mm3 at the time of diagnosis of neurosyphilis. All patients received parenteral penicillin G or cephalosporin, and 5/13 (38.5%) received systemic corticotherapy. CONCLUSION Ophthalmologists appear as key players in the identification, management and follow-up of neurosyphilis, since ocular findings are key diagnostic features in these patients.
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Affiliation(s)
- X Argemi
- Maladies infectieuses et tropicales, nouvel hôpital Civil, 1, quai-Louis-Pasteur, 67000 Strasbourg, France.
| | - Y Hansmann
- Maladies infectieuses et tropicales, nouvel hôpital Civil, 1, quai-Louis-Pasteur, 67000 Strasbourg, France
| | - M Martin
- Immunologie clinique, nouvel hôpital Civil, 1, quai-Louis-Pasteur, 67000 Strasbourg, France
| | - N Lefebvre
- Maladies infectieuses et tropicales, nouvel hôpital Civil, 1, quai-Louis-Pasteur, 67000 Strasbourg, France
| | - N Douiri
- Maladies infectieuses et tropicales, nouvel hôpital Civil, 1, quai-Louis-Pasteur, 67000 Strasbourg, France
| | - D Christmann
- Maladies infectieuses et tropicales, nouvel hôpital Civil, 1, quai-Louis-Pasteur, 67000 Strasbourg, France
| | - J-B Chanson
- Neurologie, hôpital de Hautepierre, 67000 Strasbourg, France
| | - A Sauer
- Ophtalmologie, nouvel hôpital Civil, 67000 Strasbourg, France
| | - S De Martino
- Laboratoire de bactériologie, CHU de Strasbourg, 67000 Strasbourg, France
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85
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Nielsen HM, Shakar S, Weinreich U, Hansen M, Fisker R, Nielsen H, Baudendistel TE, Aronowitz P. Morbo Serpentino. J Hosp Med 2017; 12:942. [PMID: 28914283 DOI: 10.12788/jhm.2821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | - Shakil Shakar
- Department of Pulmonary Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Ulla Weinreich
- Department of Pulmonary Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Mary Hansen
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | - Rune Fisker
- Department of Nuclear Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Denmark
| | | | - Paul Aronowitz
- Department of Medicine, University of California, Davis, California, USA
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86
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Lobo AM, Gao Y, Rusie L, Houlberg M, Mehta SD. Association between eye diagnosis and positive syphilis test results in a large, urban sexually transmitted infection/primary care clinic population. Int J STD AIDS 2017; 29:357-361. [PMID: 28820347 DOI: 10.1177/0956462417726700] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In 2015, the Centers for Disease Control and Prevention (CDC) and the American Academy of Ophthalmology (AAO) released clinical advisories on rising cases of ocular syphilis. We examined the association between eye disease and syphilis infection among primary care and sexually transmitted infection (STI) clinic patients attending an urban lesbian, gay, bisexual, transgender (LGBT) health center. We conducted a retrospective medical record review of all patients who underwent syphilis testing at Howard Brown Health between 1 January 2010 and 31 December 2015. Confirmed eye diagnosis was based on International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes for conjunctivitis, uveitis, keratitis, retinitis, and red eye. Demographic information, syphilis treatment, HIV status, and high-risk behaviors were abstracted. Syphilis diagnosis was defined by available laboratory data (enzyme immunoassay [EIA], rapid plasma reagin [RPR] titer, fluorescent treponemal antibody absorption [FTA-Abs], Treponema pallidum Ab). Multivariable logistic regression with robust variance was used to identify independent associations. During the study period, 71,299 syphilis tests were performed on 30,422 patients. There were 2288 (3.2%) positive syphilis tests. Seventy-seven patients had a confirmed eye diagnosis (0.25%). Patients with eye disease had higher probability of at least one positive syphilis test (33%) compared to those without eye disease (8%) ( p < 0.01). Of patients with eye disease, 77% were men who had sex with men (MSM) and 65% were HIV-positive. Patients with eye disease had 5.97 (95% CI: 3.70, 9.63) higher odds of having syphilis compared to patients without eye disease. When adjusted for age, race, gender/sexual orientation, insurance status, and HIV status, this association between positive syphilis test and eye disease decreased but was still significant (OR 2.00, 95% CI 1.17, 3.41). Patients who present with an eye diagnosis to STI/primary care clinic have a higher probability of positive syphilis tests even after adjusting for other risk factors for syphilis. High-risk patients with eye symptoms should have routine STI testing and in keeping with CDC and AAO recommendations, full ophthalmologic examination.
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Affiliation(s)
- Ann-Marie Lobo
- 1 Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Yan Gao
- 2 Division of Epidemiology & Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | | | | | - Supriya D Mehta
- 2 Division of Epidemiology & Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
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87
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Ocular syphilis: the re-establishment of an old disease. Eye (Lond) 2017; 32:99-103. [PMID: 28776596 DOI: 10.1038/eye.2017.155] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/30/2017] [Indexed: 11/09/2022] Open
Abstract
PurposeTo present the patient profiles, clinical presentations and visual outcomes in those diagnosed with ocular syphilis, attending a subspecialist uveitis service in northern England over a 15-year period.Patients and methodsRetrospective observational case series of patients presenting between January 2002 and December 2016.ResultsA total of 50 eyes of 34 patients had intraocular inflammation due to syphilis. Of these, 94% were male, and 75% were men who had sex with men. Ten (29%), all male, were HIV-positive. Presentations included isolated anterior non-granulomatous uveitis, intermediate uveitis, panuveitis, retinitis, placoid chorioretinitis and papillitis. Concurrent skin rash and/or headache were seen in 41%. Compliance with antibiotic treatment was complete, but there was a high rate of default from ophthalmological follow-up (38%). Visual improvement was seen in 92% of eyes, and at final assessment 71% had acuity of 6/9 or better.ConclusionsOcular syphilis is continuing to increase in incidence, in tandem with the continuing epidemic of early syphilis in the UK (the risk of ocular involvement being about 1%). Almost all are male, and most are men who have sex with men. Clinical presentation is variable; a high index of suspicion and a low threshold for serological testing is important; early treatment can reverse retinal changes and restore visual acuity.
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88
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Hoogewoud F, Frumholtz L, Loubet P, Charlier C, Blanche P, Lebeaux D, Benhaddou N, Sedira N, Coutte L, Vanhaecke C, Launay O, Le Jeunne C, Héron E, Monnet D, Lortholary O, Sahel JA, Dupin N, Brézin A, Errera MH, Salah S, Groh M. Prognostic Factors in Syphilitic Uveitis. Ophthalmology 2017; 124:1808-1816. [PMID: 28779905 DOI: 10.1016/j.ophtha.2017.06.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/02/2017] [Accepted: 06/02/2017] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To identify predictors of treatment success in syphilitic uveitis (SU). DESIGN Retrospective multicentric analysis of patients treated for SU. PARTICIPANTS A total of 95 eyes (66 patients, mean [standard deviation] aged 49 [12.5] years, 31 [47%] of whom were human immunodeficiency virus [HIV]+) were analyzed. METHODS Activity of SU was assessed at 1 week and 1 month after treatment onset, and at last follow-up. Improvement was defined by a ≥2-step decrease of both anterior chamber and vitreous haze inflammation levels, and by the size reduction in chorioretinal lesions. MAIN OUTCOME MEASURES Recovery was defined as the resolution of inflammation in all anatomic structures at 1 month. RESULTS Panuveitis and posterior uveitis were the most frequent findings. Inflammatory parameters were higher in HIV+ patients. Recovery was reported in 65% and 85% of eyes at 1 month and at last follow-up, respectively. In multivariate analysis, after adjusting for initial best-corrected visual acuity and the antimicrobial treatment regimen, clinical improvement at 1 week (corrected risk ratios [cRR], 3.5 [2.3-3.8]; P = 0.001) was predictive of recovery at 1 month, whereas the use of periocular dexamethasone injections (cRR, 0.05 [0.02-0.6]; P = 0.01) and methylprednisolone pulses negatively affected the outcomes of eyes. CONCLUSIONS Early improvement is the strongest predictor of ophthalmological recovery in SU.
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Affiliation(s)
- Florence Hoogewoud
- Department of Ophthalmology, National Referral Center for Rare Ocular Diseases, Hôpital Cochin, Paris, France
| | - Laure Frumholtz
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Paul Loubet
- IAME, UMR 1137, INSERM, Hôpital Bichat, Paris, France; Department of Infectious Diseases, Hôpital Bichat-Claude Bernard, Paris, France
| | - Caroline Charlier
- Necker-Pasteur Center for Infectious Diseases and Tropical Medicine, Hôpital Necker Enfants Malades, Paris, France
| | - Philippe Blanche
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Paris, France; Department of Infectious Diseases, Hôpital Cochin, Paris, France
| | - David Lebeaux
- Necker-Pasteur Center for Infectious Diseases and Tropical Medicine, Hôpital Necker Enfants Malades, Paris, France
| | - Nadjet Benhaddou
- National Referral Center for Syphilis, Hôpital Cochin, APHP, Paris, France
| | - Neila Sedira
- Department of Internal Medicine, Centre Hospitalier National des Quinze-Vingt, Paris, France; DHU ViewMaintain, Sorbonne-Pierre et Marie Curie University, Paris, France
| | - Laetitia Coutte
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Paris, France; Department of Infectious Diseases, Hôpital Cochin, Paris, France
| | | | - Odile Launay
- Department of Infectious Diseases, Hôpital Cochin, Paris, France
| | - Claire Le Jeunne
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Emmanuel Héron
- Department of Internal Medicine, Centre Hospitalier National des Quinze-Vingt, Paris, France; DHU ViewMaintain, Sorbonne-Pierre et Marie Curie University, Paris, France
| | - Dominique Monnet
- Department of Ophthalmology, National Referral Center for Rare Ocular Diseases, Hôpital Cochin, Paris, France
| | - Olivier Lortholary
- Necker-Pasteur Center for Infectious Diseases and Tropical Medicine, Hôpital Necker Enfants Malades, Paris, France
| | - José-Alain Sahel
- Department of Ophthalmology IV, Centre Hospitalier National des Quinze-Vingt, Paris, France; DHU ViewMaintain, Sorbonne-Pierre et Marie Curie University, Paris, France
| | - Nicolas Dupin
- National Referral Center for Syphilis, Hôpital Cochin, APHP, Paris, France; Department of Dermatology, Hôpital Cochin, Paris, France
| | - Antoine Brézin
- Department of Ophthalmology, National Referral Center for Rare Ocular Diseases, Hôpital Cochin, Paris, France
| | - Marie-Hélène Errera
- Department of Ophthalmology IV, Centre Hospitalier National des Quinze-Vingt, Paris, France; DHU ViewMaintain, Sorbonne-Pierre et Marie Curie University, Paris, France
| | - Sawsen Salah
- Department of Ophthalmology, National Referral Center for Rare Ocular Diseases, Hôpital Cochin, Paris, France
| | - Matthieu Groh
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Paris, France; Present address: Department of Internal Medicine, Hôpital St. Louis, Paris, France.
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89
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Saleh MGA, Campbell JP, Yang P, Lin P. Ultra-Wide-Field Fundus Autofluorescence and Spectral-Domain Optical Coherence Tomography Findings in Syphilitic Outer Retinitis. Ophthalmic Surg Lasers Imaging Retina 2017; 48:208-215. [PMID: 28297032 DOI: 10.3928/23258160-20170301-03] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 11/02/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To determine the ultra-wide-field fundus autofluorescence (UWFFAF) and optical coherence tomography (OCT) features of syphilitic outer retinopathy (SOR). PATIENTS AND METHODS Retrospective chart review. RESULTS Three patients with SOR were investigated. Treatment with parenteral penicillin led to improvement of outer retinopathy, visual acuity, and symptoms. UWFFAF showed speckled hyperautofluorescence, hypoautofluorescence, and normal autofluorescence, similar to what has been described as a trizonal pattern in acute zonal occult outer retinopathy (AZOOR) in the chronic case of SOR, but with hyperautofluorescent areas in the two acute cases. OCT showed disruption of the photoreceptor outer segment ellipsoid zone and external limiting membrane, which improved after penicillin treatment, and corresponded to normalization of the hyperautofluorescent areas on UWFFAF. There was irregularity and nodular thickening of retinal pigment epithelium on OCT in areas of mottled hyperautofluorescence. CONCLUSION SOR can present similarly to AZOOR on UWFFAF and should be highly suspected in cases presenting like AZOOR. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:208-215. ].
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90
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Mir TA, Reddy AK, Burkholder BM, Walsh J, Shifera AS, Khan IR, Thorne JE. Clinical Features and Incidence Rates of Ocular Complications in Patients With Retinal Vasculitis. Am J Ophthalmol 2017; 179:171-178. [PMID: 28501390 DOI: 10.1016/j.ajo.2017.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/26/2017] [Accepted: 05/03/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the incidence rates of visual loss and ocular complications in patients with retinal vasculitis (RV). DESIGN Retrospective cohort study. METHODS Clinical data were collected for 96 patients (175 eyes) diagnosed with RV from 2003 to 2013. Main outcome measures included rates of visual loss and ocular complications. Comparison of outcomes in patients with a relapsing vs nonrelapsing disease also were analyzed. RESULTS Over a median follow-up of 44 months (range: 1-153 months), the rate of visual loss to 20/50 or worse was 0.13 per eye-year (/EY, 95% confidence interval [CI], 0.09/EY to 0.18/EY) and to 20/200 or worse was 0.06/EY (95% CI, 0.04/EY to 0.08/EY). The most common complications were cataract (0.31/EY), epiretinal membrane (0.16/EY), and recurrent macular edema (0.09/EY). Patients with a relapsing course (median number of relapses = 1, range: 1-6) appeared to have greater risk for visual loss to 20/50 (odds ratio [OR] = 2.07; 95% CI, 0.88-4.90, P = .09) and 20/200 or worse (OR = 2.49; 95% CI, 0.98-6.30, P = .05). Immunosuppressive drug therapy lowered the risk of visual loss, independent of relapsing disease course (OR = 0.79; 95% CI, 0.66-0.94, P = .01 and OR = 0.73; 95% CI, 0.57-0.93, P = .01 for the 20/50 or worse and 20/200 or worse thresholds, respectively). CONCLUSIONS Rates of visual loss and complications among patients with RV were similar to reported rates in noninfectious uveitides. Treatment with immunosuppressive drugs lowered the risk of visual loss. A relapsing course suggested an increased risk for visual loss but was not statistically significant, perhaps owing to low numbers of recurrences.
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91
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Zhang T, Zhu Y, Xu G. Clinical Features and Treatments of Syphilitic Uveitis: A Systematic Review and Meta-Analysis. J Ophthalmol 2017; 2017:6594849. [PMID: 28751982 PMCID: PMC5511639 DOI: 10.1155/2017/6594849] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 04/05/2017] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To investigate the clinical features and efficacies of treatments for syphilitic uveitis. METHODS PubMed was searched for studies of syphilitic uveitis published between January 1990 and October 2016. The clinical features were summarized and appraised. The pooled success rate was defined as an improved or maintained final visual acuity and was calculated with 95% confidence intervals (CIs). Heterogeneity, subgroup analysis, sensitivity analysis, and publication bias were assessed. RESULTS Thirty-two studies involving 670 patients were analyzed. The most common type of syphilitic uveitis was papillitis. The pooled success rate was 0.91 (95% CI 0.84-0.97) for antibacterial agents alone (15 studies, 286 patients); 0.95 (95% CI 0.91-0.98) for antibacterial agents and systemic corticosteroids combined (11 studies, 245 patients); and 0.91 (95% CI 0.80-0.98) for antibacterial agents, systemic corticosteroids, and other immunosuppressants combined (3 studies, 73 patients). Subgroup analyses revealed no correlations of the efficacy of antibacterial agent monotherapy with study characteristics, such as human immunodeficiency virus coinfection status. CONCLUSIONS This systematic review and meta-analysis revealed the efficacy of antibacterial agents for treating syphilitic uveitis. Coadministration of systemic corticosteroids or immunosuppressants did not elicit further improvements in the clinical outcomes of antibacterial agents.
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Affiliation(s)
- Ting Zhang
- Department of Ophthalmology, Eye and Ear Nose Throat Hospital, Shanghai Medical School, Fudan University, 83 Fenyang Road, Shanghai 200031, China
| | - Ying Zhu
- Department of Ophthalmology, Xiangya Hospital, Central South University, 87 Xiang Ya Road, Changsha 410008, China
| | - Gezhi Xu
- Department of Ophthalmology, Eye and Ear Nose Throat Hospital, Shanghai Medical School, Fudan University, 83 Fenyang Road, Shanghai 200031, China
- Key Laboratory of Visual Impairment and Restoration, 83 Fenyang Road, Shanghai 200031, China
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Abstract
Often referred to as 'The Great Mimicker', syphilis infections have been on the rise since 2000 including cases of primary and secondary syphilis where 19,999 were reported in the USA in 2014. The increase in cases has led the USPSTF to recommend screening for syphilis infection in persons who are at increased risk of infection. Changes in screening and re-emergence of the disease necessitates review of the multitude of circumstances a patient can present for care. Immunocompetent patients begin to show classic symptoms within 10-90 days following infection with the spirochete. In the immunocompromised patient, the presenting symptoms are often atypical and more complex. With the rise in HIV infections, syphilitic infections have become increasingly common worldwide and several atypical presentations have been observed. The following case is an atypical presentation of syphilis involving both central and peripheral nervous system findings in a patient without significant medical history.
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Affiliation(s)
- Michael Hunter
- Internal Medicine, Mercy Health Youngstown, Youngstown, Ohio, USA
| | - Patrick Brine
- Internal Medicine, Mercy Health Youngstown, Youngstown, Ohio, USA
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93
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Urzua CA, Lantigua Y, Abuauad S, Liberman P, Berger O, Sabat P, Velasquez V, Castiglione E, Calonge M. Clinical Features and Prognostic Factors in Presumed Ocular Tuberculosis. Curr Eye Res 2017; 42:1029-1034. [PMID: 28157425 DOI: 10.1080/02713683.2016.1266663] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To characterize the clinical features in patients with presumed ocular tuberculosis (TB) and determine prognostic factors of visual outcomes and complications in this disease. MATERIAL AND METHODS Retrospective case series of 35 patients (29 females, 6 males) with presumed ocular TB from referral centers in Chile and Spain between 2002 and 2012. Medical records were reviewed, and data regarding clinical features, complications, best-corrected visual acuity (BCVA), duration of disease, extraocular manifestations, and therapy were retrieved. Prognostic factors for low vision (BCVA 20/50 or less), legal blindness (BCVA 20/200 or less), and complications (cataract, glaucoma, and macular lesion) were evaluated. To calculate correlations, we used Spearman's rank correlation test. To determine clinical predictors, we used the binary logistic regression test. RESULTS Anterior and non-granulomatous uveitis was the most common types of inflammation. Only 2 (5.7%) patients had respiratory symptoms, and 6 (17.1%) patients had an abnormal chest X-ray at diagnosis. All patients received combined antitubercular therapy with a mean duration of 6.9 ± 2.3 months. A longer duration of symptoms at diagnosis was associated with both low vision and legal blindness. Older patients had a higher risk of legal blindness. A longer duration of symptoms as well as anterior inflammation demonstrated an increased risk for cataract formation. The duration of the symptoms and baseline BCVA had a positive correlation with the final BCVA. Prognostic factors of macular lesions were not found. CONCLUSIONS The diagnosis of ocular TB can be difficult due to the lack of extraocular manifestations and the broad spectrum of ocular features. A longer duration of symptoms at diagnosis was associated with poorer visual outcomes and cataracts. Therefore, efforts should be made to avoid a delay in the diagnosis of ocular TB and to identify prognostic factors for visual outcomes and complications.
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Affiliation(s)
- Cristhian A Urzua
- a Uveitis Department , Hospital del Salvador , Santiago , Chile.,b Ophthalmology Department , University of Chile , Santiago , Chile
| | - Yrbani Lantigua
- c IOBA (Institute of Applied Ophthalmobiology), University of Valladolid , Valladolid , Spain
| | - Sergio Abuauad
- b Ophthalmology Department , University of Chile , Santiago , Chile
| | - Paulina Liberman
- d Ophthalmology Department , Pontificia Universidad Católica de Chile , Santiago , Chile
| | - Osvaldo Berger
- d Ophthalmology Department , Pontificia Universidad Católica de Chile , Santiago , Chile
| | - Pablo Sabat
- a Uveitis Department , Hospital del Salvador , Santiago , Chile.,b Ophthalmology Department , University of Chile , Santiago , Chile
| | - Victor Velasquez
- a Uveitis Department , Hospital del Salvador , Santiago , Chile.,b Ophthalmology Department , University of Chile , Santiago , Chile
| | - Enzo Castiglione
- b Ophthalmology Department , University of Chile , Santiago , Chile
| | - Margarita Calonge
- c IOBA (Institute of Applied Ophthalmobiology), University of Valladolid , Valladolid , Spain.,e Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN) , Valladolid , Spain
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94
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Rasool N, Stefater JA, Eliott D, Cestari DM. Isolated presumed optic nerve gumma, a rare presentation of neurosyphilis. Am J Ophthalmol Case Rep 2017; 6:7-10. [PMID: 29260044 PMCID: PMC5722128 DOI: 10.1016/j.ajoc.2017.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/14/2016] [Indexed: 11/26/2022] Open
Abstract
Purpose The incidence of syphilitic infections continues to rise and represents a major public health concern, particularly in patients co-infected with human immunodeficiency virus (HIV). The infection has a multitude of clinical presentations and is often referred to as the 'great imitator.' We present a rare case of an isolated presumed syphilitic optic nerve gumma and characterize it using newer imaging modalities. Observations A 36-year-old HIV-positive man, compliant with treatment, presented with a five day history of decreased vision in the left eye. On examination his visual acuity was 20/30 with mild dyschromatopsia and an inferior altitudinal field defect in the left eye. Funduscopy demonstrated small cup to disc ratios bilaterally and a swollen and hyperemic left optic disc. Following five months of stable vision, the patient's vision in the left eye declined to 20/60, associated with diffuse visual field loss and continued swelling of the left optic disc. Subsequent magnetic resonance imaging with contrast demonstrated enhancement of the left optic nerve, and his serologies were positive for syphilis. Fluorescein angiography and optical coherence tomography were used to better characterize the lesion being most consistent with a syphilitic optic nerve gumma. Conclusions and importance Gummas of the central nervous system are a rare presentation of neurosyphilis and the last reported gumma of the optic nerve was in 1990. Such lesions have not been characterized using newer imaging modalities including optical coherence tomography and fluorescein angiography, both of which may assist in the diagnosis of this rare entity. With the increased prevalence of syphilis and remarkable response to therapy, syphilitic gummas should be considered in at-risk patients presenting with an optic neuropathy.
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Affiliation(s)
- Nailyn Rasool
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.,Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - James A Stefater
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Dean Eliott
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Dean M Cestari
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
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Molina-Sócola FE, López-Herrero F, Medina-Tapia A, Rueda-Rueda T, Contreras-Díaz M, Sánchez-Vicente JL. Syphilitic posterior placoid chorioretinitis as initial presentation of early neurosyphilis. ACTA ACUST UNITED AC 2016; 92:490-494. [PMID: 27956326 DOI: 10.1016/j.oftal.2016.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/16/2016] [Accepted: 10/17/2016] [Indexed: 12/01/2022]
Abstract
CASE REPORT A 36 year-old male with a recent HIV diagnosis, presented with loss of vision of his left eye. Ophthalmoscopy revealed a unilateral yellowish placoid lesion in the macula. After fluorescein angiography, optical coherence tomography, optical coherence tomography angiography, syphilis serology, and cerebrospinal fluid results, he was diagnosed with neurosyphilis and syphilitic posterior placoid chorioretinitis. DISCUSSION Acute syphilitic posterior placoid chorioretinitis is a rare ocular manifestation of syphilis. All patients with characteristic clinical and angiographic findings of acute syphilitic posterior placoid chorioretinitis should be tested for a neurosyphilis and human immunodeficiency virus co-infection. Early treatment with intravenous penicillin is usually effective with good visual results.
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Affiliation(s)
- F E Molina-Sócola
- Servicio de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - F López-Herrero
- Servicio de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A Medina-Tapia
- Servicio de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - T Rueda-Rueda
- Servicio de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M Contreras-Díaz
- Servicio de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J L Sánchez-Vicente
- Servicio de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
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Blackburn R, Estrada CA, McCollum D. Empathy as a Diagnostic Tool in a 33-Year-Old Man with Eye Pain and Vision Loss: Exercises in Clinical Reasoning. J Gen Intern Med 2016; 31:1389-1392. [PMID: 27456235 PMCID: PMC5071291 DOI: 10.1007/s11606-016-3797-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/26/2016] [Accepted: 06/23/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Reaford Blackburn
- Tinsley Harrison Internal Medicine Residency Program, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Carlos A Estrada
- Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA. .,The University of Alabama at Birmingham, 720 Faculty Office Tower, 510 20th Street South, Birmingham, AL, 35294-3407, USA.
| | - David McCollum
- The University of Alabama at Birmingham, 720 Faculty Office Tower, 510 20th Street South, Birmingham, AL, 35294-3407, USA
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97
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[Ocular syphilis: 9 cases]. J Fr Ophtalmol 2016; 39:750-755. [PMID: 27765446 DOI: 10.1016/j.jfo.2016.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/19/2016] [Accepted: 08/30/2016] [Indexed: 11/21/2022]
Abstract
Syphilis is a disease with ocular involvement may be opening and cover all ocular structures. The objective of the study was to retrospectively identify and describe all cases of ocular syphilis diagnosed in the ophthalmology department of Besançon University Hospital from March 2004 to April 2014. Between March 2004 and April 2014, we diagnosed and monitored 9 male patients (13 eyes) with ocular syphilis (1 interstitial keratitis, chorioretinitis associated with a 1 hyalite, 3 panuvéites, 1 chorioretinitis after placoid, 3 bilateral papillary edema). Patients had a mean age of 52.6 years (32-77 years) at diagnosis and the inaugural symptoms were in 100% of cases decreased visual acuity. The follow-up period ranged from 1 month to 5 years. The curative treatment included intravenous antibiotics penicillin G for 3 weeks. All patients had an improvement in their AV (AV initial range "counting fingers" and 0.6 versus AV final between 0.5 and 1 in decimal scale). Syphilis is a disease currently on the rise. It must be systematically sought before any inflammatory disease of the eye or papilledema.
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99
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Kim Y, Yu SY, Kwak HW. Non-human Immunodeficiency Virus-related Ocular Syphilis in a Korean Population: Clinical Manifestations and Treatment Outcomes. KOREAN JOURNAL OF OPHTHALMOLOGY 2016; 30:360-368. [PMID: 27729756 PMCID: PMC5057012 DOI: 10.3341/kjo.2016.30.5.360] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 10/19/2015] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe the clinical manifestations and treatment outcomes of ocular syphilis in patients without human immunodeficiency virus (HIV) infection. Methods A total of 45 eyes from 39 patients with ocular syphilis confirmed by serologic tests were reviewed retrospectively. The included cases were all non-HIV-infected patients presenting with intraocular inflammation from 2002 to 2014 at Kyung Hee University Hospital. Medical records of 45 eyes were analyzed and included best-corrected visual acuity and ophthalmologic examination findings of the anterior and posterior segments to determine the focus of inflammation. Optical coherence tomography and fluorescein angiography findings as well as both medical and surgical management were also analyzed. Results The mean patient age was 61.0 years (range, 37 to 89 years). Bilateral ocular involvement occurred in 6 patients (15.4%), and diagnoses at presentation were most frequently related to posterior uveitis (38%), followed by panuveitis (29%) and optic neuritis (11%). Isolated interstitial keratitis and intermediate uveitis were uncommon (4%, both). Twenty-eight eyes (62.2%) were treated with penicillin, and 11 eyes (24.4%) underwent surgical treatment. The mean baseline best corrected visual acuity was 0.79 ± 0.59 (mean ± standard deviation, logarithm of the minimum angle of resolution) and significantly improved to 0.60 ± 0.63 at the final follow-up after treatment (p = 0.019). Mean visual improvement was significantly greater in the penicillin-treated group (p = 0.001). Visual impairment at the final visit occurred in 11 eyes (24.4%). Among the visual impairment group, 10 eyes (90.1%) had posterior segment-involving uveitis. Conclusions Visual outcomes of treated, non-HIV-related ocular syphilis were favorable regardless of time to presentation. Posterior segment-involving uveitis at presentation was associated with poor visual outcome.
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Affiliation(s)
- Yonguk Kim
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Seung-Young Yu
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyung Woo Kwak
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
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