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Shields MK, Furtado JM, Lake SR, Smith JR. Syphilitic scleritis and episcleritis: A review. Asia Pac J Ophthalmol (Phila) 2024; 13:100073. [PMID: 38795870 DOI: 10.1016/j.apjo.2024.100073] [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: 04/05/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 05/28/2024] Open
Abstract
Scleritis and episcleritis are rare, but potentially sight-threatening forms of syphilis. To provide a full description of this neglected subset of ocular syphilis, we evaluated the English literature for reports of syphilitic scleritis and episcleritis, recording the demographics, clinical characteristics, serological data, management practices, treatment responses, and visual outcomes. Previously published descriptions of 44 patients with syphilitic scleritis (50 eyes) and 9 patients with syphilitic episcleritis (14 eyes) were identified. The predominant type of scleritis was anterior scleritis, accounting for 92.9% of cases, with nodular anterior scleritis being the most frequent subtype at 58.1%. Almost one-quarter of patients were co-infected with human immunodeficiency virus (HIV). Initial misdiagnosis was common and led to delays in initiating treatment with appropriate antibiotics. Visual outcomes were often good in both scleritis and episcleritis, irrespective of HIV infection status, although complications including scleral thinning, keratitis, and uveitis, along with permanent visual loss and an association with neurosyphilis, were reported. Response to antibiotic treatment was typically rapid, often within 1 week. With the rising global incidence of syphilis, testing patients with scleritis or episcleritis for this infectious disease is important to ensure prompt diagnosis and treatment for best ocular and systemic outcomes.
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Affiliation(s)
- Melissa K Shields
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia.
| | - João M Furtado
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Stewart R Lake
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - Justine R Smith
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia.
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Kayabaşı M, Köksaldı S, Saatci AO, Bajin MS. Presentation of Ocular Syphilis with Bilateral Optic Neuropathy. Neuroophthalmology 2023; 47:274-280. [PMID: 38130808 PMCID: PMC10732629 DOI: 10.1080/01658107.2023.2222800] [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: 03/31/2023] [Accepted: 05/31/2023] [Indexed: 12/23/2023] Open
Abstract
A 60-year-old otherwise healthy male presented with a 1 year history of bilateral progressive visual loss. His best-corrected visual acuity was counting fingers at 2 m with his right eye and counting fingers at 0.5 m with his left eye. Visual field testing revealed bilateral near-total loss of visual fields. Slit-lamp examination was unremarkable, apart from bilateral grade two nuclear sclerotic cataracts. Both optic discs were pale-looking with some retinal pigment epithelial alterations at the left papillomacular region. Enhanced depth imaging optical coherence tomography depicted punctate hyperreflective dots at the inner choroidal level corresponding to the retinal pigment epithelial changes in the left eye. Fundus autofluorescence imaging revealed patchy hyper-autofluorescent and hypo-autofluorescent areas, and there was mild staining in the early and late phases of the fluorescein angiogram at the papillomacular region in the left eye. A diagnosis of bilateral optic neuropathy was made. A full systemic work-up was carried out, and serological tests pointed out the presence of syphilis with normal cranial magnetic resonance imaging. He was treated accordingly. Our case clearly demonstrates the importance of a high clinical suspicion for syphilis in cases of optic neuropathy.
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Affiliation(s)
- Mustafa Kayabaşı
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
| | - Seher Köksaldı
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
| | - Ali Osman Saatci
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
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Chen C, Du KF, Xie LY, Jiang TY, Kong WJ, Dong HW, Guo CG, Li XN, Wei WB. Clinical Features of Ocular Pathology in Patients with Acquired Immunodeficiency Syndrome and Syphilis. Adv Ther 2021; 38:3362-3372. [PMID: 34019246 DOI: 10.1007/s12325-021-01755-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/20/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The present study aimed to analyze the clinical features of ocular pathology in patients with acquired immunodeficiency syndrome (AIDS) combined with syphilis. METHODS A total of 129 patients with AIDS and syphilis who first visited the Department of Ophthalmology in Beijing YouAn Hospital between 2012 and 2019 were included in the study. All patients underwent ophthalmologic examinations, such as best-corrected visual acuity (BCVA), slit lamp, intraocular pressure, dilated fundus examination, and color fundus photography as well as systemic examinations related to AIDS and syphilis. The patients were divided into four groups according to fundus disease: a normal fundi group, an HIV-related microvascular retinopathy (MVR) group, a cytomegalovirus retinitis (CMVR) group, and a syphilis-related retinopathy group. RESULTS The incidence of fundus disease was 70.7%. There were 36 patients with normal fundi (29.3%), 40 with HIV-related MVR (31.0%), 25 with CMVR (19.4%) (including 11 cases of CMVR with syphilis-related retinopathy), 26 (20.2%) with syphilis-related retinopathy, 1 (0.78%) case with acute retinal necrosis, and 1 (0.78%) case with PORN. The median blood CD4 + T-cell count in the syphilis-associated retinopathy group was 357.5 cells/μl, which was significantly higher than in the other groups; this difference was statistically significant. In the CMVR group, 11 cases with concomitant syphilis-associated retinopathy had lower BCVA and 10 (90.9%) had active inflammatory manifestations in the anterior segment. CONCLUSION The incidence of ocular pathology was high in patients co-infected with AIDS and syphilis, which might manifest in a variety of ocular manifestations; some patients may also have multiple ocular changes, which should be given great clinical attention.
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Affiliation(s)
- Chao Chen
- Department of Ophthalmology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Kui-Fang Du
- Department of Ophthalmology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Lian-Yong Xie
- Department of Ophthalmology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Tai-Yi Jiang
- Department of Infectious Diseases, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Wen-Jun Kong
- Department of Ophthalmology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Hong-Wei Dong
- Department of Ophthalmology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Chun-Gang Guo
- Department of Ophthalmology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Xiao-Na Li
- Department of Ophthalmology, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China
| | - Wen-Bin Wei
- Beijing Tongren Eye Center, Beijing key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, No.1 Dongjiaomin Lane, Dongcheng District, Beijing, 100730, China.
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Marchese A, Agarwal AK, Erba S, Scialdone A, Miserocchi E, Bandello F, Introini U, Jampol LM, Casalino G. Placoid lesions of the retina: progress in multimodal imaging and clinical perspective. Br J Ophthalmol 2021; 106:14-25. [PMID: 33468489 DOI: 10.1136/bjophthalmol-2020-318337] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 12/17/2022]
Abstract
Placoid lesions of the retina may be secondary to a wide spectrum of acquired inflammatory conditions that have been reported as single entities with different presentation and clinical course. These conditions include acute posterior multifocal placoid pigment epitheliopathy, persistent placoid maculopathy, serpiginous choroiditis, serpiginous-like choroiditis, relentless placoid chorioretinitis and acute syphilitic posterior placoid chorioretinitis. In this article, we will group these conditions under the name of 'placoids'. The recognition of the specific condition may be challenging in clinical practice, often resulting in diagnostic and therapeutic delay. Given the complex nature of placoids and their similarities, a systematic approach including differentiating between infectious and non-infectious aetiologies increases the chance of reaching the correct diagnosis. Detailed history and comprehensive clinical examination are the first steps to formulate a diagnostic hypothesis that should be corroborated by multimodal imaging and appropriate investigations. The advent of multimodal imaging has made it possible to extensively study placoids and revealed a constellation of specific findings that may help clinicians in the diagnostic process. The treatment of the conditions other than syphilis is complex and sometimes challenging. Our article is aimed at giving an overview of the individual entities associated with placoids and discussing the differential diagnosis. A practical and systematic approach is then proposed.
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Affiliation(s)
- Alessandro Marchese
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Aniruddha Kishandutt Agarwal
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Stefano Erba
- Oftalmico Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Elisabetta Miserocchi
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Ugo Introini
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Lee M Jampol
- Department of Ophthalmology, Northwestern University, Chicago, Illinois, 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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Cope AB, Mobley VL, Oliver SE, Larson M, Dzialowy N, Maxwell J, Rinsky JL, Peterman TA, Fleischauer A, Samoff E. Ocular Syphilis and Human Immunodeficiency Virus Coinfection Among Syphilis Patients in North Carolina, 2014-2016. Sex Transm Dis 2020; 46:80-85. [PMID: 30169474 DOI: 10.1097/olq.0000000000000910] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ocular syphilis (OS) has been associated with human immunodeficiency virus (HIV) coinfection previously. We compared demographic and clinical characteristics of syphilis patients with and without HIV to identify risk factors for developing OS. METHODS We reviewed all syphilis cases (early and late) reported to the North Carolina Division of Public Health during 2014 to 2016 and categorized HIV status (positive, negative, unknown) and OS status based on report of ocular symptoms with no other defined etiology. We estimated prevalence ratios (PR) and 95% confidence intervals (CI) for OS by HIV status. Among syphilis patients with HIV, we compared viral loads and CD4 cell counts by OS status. We compared symptom resolution by HIV status for a subset of OS patients. RESULTS Among 7123 confirmed syphilis cases, 2846 (39.9%) were living with HIV, 109 (1.5%) had OS, and 59 (0.8%) had both. Ocular syphilis was more prevalent in syphilis patients with HIV compared to HIV-negative/unknown-status patients (PR, 1.8; 95% CI, 1.2-2.6). Compared with other patients with HIV, the prevalence of OS was higher in patients with viral loads greater than 200 copies/mL (1.7; 1.0-2.8) and in patients with a CD4 count of 200 cells/mL or less (PR, 2.3; 95% CI, 1.3-4.2). Among 11 patients with severe OS, 9 (81.8%) were HIV-positive. Among 39 interviewed OS patients, OS symptom resolution was similar for HIV-positive (70.0%) and HIV-negative/unknown-status (68.4%) patients. CONCLUSIONS Syphilis patients with HIV were nearly twice as likely to report OS symptoms as were patients without documented HIV. Human immunodeficiency virus-related immunodeficiency possibly increases the risk of OS development in co-infected patients.
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Affiliation(s)
| | - Victoria L Mobley
- North Carolina Division of Public Health, Department of Health and Human Services, Raleigh, NC
| | | | - Mara Larson
- North Carolina Division of Public Health, Department of Health and Human Services, Raleigh, NC
| | - Nicole Dzialowy
- North Carolina Division of Public Health, Department of Health and Human Services, Raleigh, NC
| | - Jason Maxwell
- North Carolina Division of Public Health, Department of Health and Human Services, Raleigh, NC
| | | | | | | | - Erika Samoff
- North Carolina Division of Public Health, Department of Health and Human Services, Raleigh, NC
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Kowalski T, Fuzzard D, Williams I, Darby J, Mack HG. Bilateral Syphilitic Optic Neuropathy with Secondary Autoimmune Optic Neuropathy and Poor Visual Outcome. Case Rep Ophthalmol 2019; 10:81-88. [PMID: 31043959 PMCID: PMC6477499 DOI: 10.1159/000496142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 12/10/2018] [Indexed: 11/19/2022] Open
Abstract
We describe the case of a 65-year-old man who suffered progressive visual loss despite appropriate treatment of ocular syphilis. Our patient initially presented with a unilateral 6th nerve palsy and associated double vision, which self-resolved over 6 months. His ophthalmic examination was otherwise normal. 12 months after the initial complaint, he represented with dyschromatopsia, reduced visual acuity, tonic pupils, and optic nerve atrophy. He tested positive for syphilis and was admitted for treatment of neurosyphilis with high-dose benzylpenicillin. Despite treatment, at a 4-month review his visual acuity remained poor and progression of optic nerve atrophy was noted alongside the development of bilateral central scotomas. Further testing was congruent with a diagnosis of autoimmune optic retinopathy. We propose this to be secondary to his syphilitic infection. Syphilis is known as the "great mimicker," and despite being quite treatable, this case highlights ongoing complexity in the diagnosis and management of syphilis, unfortunately with a poor visual outcome.
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Affiliation(s)
- Tanya Kowalski
- Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Dujon Fuzzard
- Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Isla Williams
- Monash University, Alfred Hospital, Prahran, Melbourne, Victoria, Australia.,St Vincent's Hospital, Fitzroy, Victoria, Australia
| | | | - Heather Gwen Mack
- Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
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Tsen CL, Chen YS, Wu KS, Tsai HC, Chen YH, Lee YY, Sheu SJ. Ocular Manifestations of Human Immunodeficiency Virus Infection at a Tertiary Referral Center in Taiwan. Ocul Immunol Inflamm 2018; 27:1071-1076. [PMID: 30189150 DOI: 10.1080/09273948.2018.1499939] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: To investigate the prevalence and characteristics of ocular manifestations of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in patients treated at a tertiary referral center in Taiwan during a time of highly active antiretroviral therapy (HAART) Materials and Methods: A retrospective cohort study in Taiwan was performed between January 2006 and July 2016. Ocular examination and systemic information were recorded from the HIV-infected patients. Results: 1242 patients with HIV/AIDS were identified. Ninety patients had ophthalmic records, and HIV-related ocular manifestations were reported in 57 patients. The most prevalent ocular manifestations were cytomegalovirus (CMV) retinitis, ocular syphilis, and HIV microvasculopathy. Mean CD4 count was significantly lower in patients with HIV-related ocular manifestations compared to those without. Conclusion: We found that lower CD4 count, especially <200 cells/μL, was a significant factor for detecting HIV-related ocular manifestations. Comprehensive ophthalmic screening in high-risk group is helpful for early diagnosis and prompt treatment of sight-threatening ocular complications.
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Affiliation(s)
- Chui-Lien Tsen
- Department of Ophthalmology, Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan
| | - Yao-Shen Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan.,School of Medicine, National Yang-Ming University , Taipei , Taiwan
| | - Kuan-Sheng Wu
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan.,School of Medicine, National Yang-Ming University , Taipei , Taiwan
| | - Hung-Chin Tsai
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan.,School of Medicine, National Yang-Ming University , Taipei , Taiwan
| | - Ya-Hsin Chen
- Department of Ophthalmology, Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan
| | - Ying-Yen Lee
- Department of Ophthalmology, Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan.,School of Medicine, National Yang-Ming University , Taipei , Taiwan
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Tsen CL, Chen SC, Chen YS, Sheu SJ. Uveitis as an initial manifestation of acquired immunodeficiency syndrome. Int J STD AIDS 2017; 28:1224-1228. [PMID: 28201950 DOI: 10.1177/0956462417694569] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is a multisystem disease that can involve the human eyes. Using ophthalmic examination records from January 2006 to November 2015, we retrospectively reviewed all patients who were diagnosed with HIV/AIDS in our hospital. The study was performed at a tertiary referral center in southern Taiwan. Data included age, gender, ophthalmic examinations, systemic conditions, CD4 cell counts, course, and treatment. Eleven patients were identified as having AIDS with uveitis as their presenting manifestation. All were men, with a mean age of 39.5 ± 11.4 years (range 24-56). The mean CD4+ T-cell counts were 91.7 ± 50.3 cells/μl (range 27-169). Ocular diagnoses included cytomegalovirus (CMV) retinitis in five patients, ocular syphilis in four patients, and ocular toxoplasmosis in two patients. Uveitis resolved in all patients after medical treatment. However, a retinal detachment developed in two eyes in CMV retinitis and one eye in ocular syphilis. Ocular manifestations are among the most common clinical features in patients with HIV/AIDS who have varying clinical presentations that affect almost all ocular structures. This study demonstrated that ocular findings could be an initial manifestation of an underlying disease. Awareness of ocular lesions in HIV/AIDS is important for early recognition and management.
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Affiliation(s)
- Chui-Lien Tsen
- 1 Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shih-Chou Chen
- 1 Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yao-Shen Chen
- 2 Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,3 School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shwu-Jiuan Sheu
- 1 Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,3 School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Neurosyphilis and ophthalmic syphilis in persons with negative rapid plasma reagin and positive treponemal antibody test results. Sex Transm Dis 2016; 42:347-9. [PMID: 25970316 DOI: 10.1097/olq.0000000000000282] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The detection of serodiscordant syphilis test results raises several important clinical and public health questions. Based on our retrospective review, the probability of neurosyphilis in persons with serodiscordant serologies is low. The probability of ophthalmic syphilis may be higher, but we lack objective measures for that diagnosis.
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Abstract
As Acquired Immunodeficiency Disease (AIDS) turns thirty-years old, much progress has been made. 56,000 new cases of the Human Immunodeficiency Virus (HIV) infection are expected in Americans this year. At least half or more will be in African Americans. Reports of the association between syphilis and HIV infection are well documented. We present a case of bilateral optic neuritis and panuveitis as the initial presentation in a previously undiagnosed patient with human immunodeficiency virus (HIV) and syphilis.
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Ho EL, Spudich SS. Neurosyphilis and the impact of HIV infection. Sex Health 2015; 12:148-54. [DOI: 10.1071/sh14195] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/18/2015] [Indexed: 11/23/2022]
Abstract
Neurosyphilis is a complication of systemic syphilis. This review of the clinical presentation, diagnostic laboratory findings, treatment and management of neurosyphilis discusses the impact of HIV and the specific challenges it brings, focusing on areas of controversy, and highlighting important questions that remain to be answered.
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Chiquet C, Khayi H, Puech C, Tonini M, Pavese P, Aptel F, Romanet JP. Atteinte oculaire de la syphilis. J Fr Ophtalmol 2014; 37:329-36. [DOI: 10.1016/j.jfo.2013.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 12/03/2013] [Indexed: 11/16/2022]
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Bittencourt MG, Agbedia OO, Liu HT, Annam R, Sepah YJ, Leder HA, Sophie R, Ibrahim M, Akhtar A, Akhlaq A, Do DV, Nguyen QD. Ocular complications of HIV/AIDS in the era of HAART. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/eop.12.65] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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The immunopathobiology of syphilis: the manifestations and course of syphilis are determined by the level of delayed-type hypersensitivity. Am J Dermatopathol 2011; 33:433-60. [PMID: 21694502 DOI: 10.1097/dad.0b013e3181e8b587] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Syphilis has plagued mankind for centuries and is currently resurgent in the Western hemisphere. Although there has been a significant reduction of tertiary disease and recognition of facilitative interactions with human immunodeficiency virus infection, the natural history of syphilis has remained largely unchanged; thus, new strategies are required to more effectively combat this pathogen. The immunopathologic features of experimental syphilis in the rabbit; the course, stages, and pathology of human syphilis; and a comparison of human syphilis with leprosy suggest that the clinical course of syphilis and its tissue manifestations are determined by the balance between delayed-type hypersensitivity (DTH) and humoral immunity to the causative agent, Treponema pallidum. A strong DTH response is associated with clearance of the infecting organisms in a well-developed chancre, whereas a cytotoxic T-cell response or strong humoral antibody response is associated with prolonged infection and progression to tertiary disease. Many of the protean symptoms/appearances of secondary and tertiary human syphilis are manifestations of immune reactions that fail to clear the organism, due to a lack of recruitment and, more importantly, activation of macrophages by sensitized CD4 T cells. The Bacillus Calmette-Guerin vaccination can enhance DTH and has been shown to produce a low, but measurable, beneficial effect in the prevention of leprosy, a disease that shows a disease spectrum with characteristics in common with syphilis. In the prevention of syphilis, a potential vaccine protective against syphilis should be designed to augment the DTH response.
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Posterior syphilitic uveitis: clinical characteristics, co-infection with HIV, response to treatment. Jpn J Ophthalmol 2011; 55:486-494. [DOI: 10.1007/s10384-011-0053-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 04/06/2011] [Indexed: 11/25/2022]
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Mitchell SM, Shiew MMF, Nelson M. 5 Ocular infections. HIV Med 2011. [DOI: 10.1111/j.1468-1293.2011.00944_6.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Tucker JD, Li JZ, Robbins GK, Davis BT, Lobo AM, Kunkel J, Papaliodis GN, Durand ML, Felsenstein D. Ocular syphilis among HIV-infected patients: a systematic analysis of the literature. Sex Transm Infect 2011; 87:4-8. [PMID: 20798396 PMCID: PMC3103105 DOI: 10.1136/sti.2010.043042] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Ocular syphilis among HIV-infected patients continues to be a problem in the highly active antiretroviral therapy (HAART) era. However, outside of case reports or small case series, little is known about the clinical, laboratory, and treatment outcomes of these patients. Objective To examine the literature on HIV-infected patients and determine the results of treatment. METHODS Systematic review of cases series and case reports among HIV-infected individuals with ocular syphilis. Reviews, languages other than English and pre-1980 reports were excluded. The effect of CD4 count and virological suppression on clinical manifestations and diagnostic laboratory values was evaluated. RESULTS A total of 101 HIV-infected individuals in case series and case reports were identified. Ocular syphilis led to the HIV diagnosis in 52% of cases, including patients with CD4 count >200 cells/mm(3). Posterior uveitis was significantly more common in individuals with CD4 count <200 cells/mm(3) (p = 0.002). Three patients with confirmed ocular syphilis had negative non-treponemal tests. Ninety-seven per cent of patients with visual impairment improved following intravenous penicillin or ceftriaxone. CONCLUSIONS Non-treponemal tests may be negative in HIV-infected patients with ocular syphilis. Ocular syphilis remains an important clinical manifestation that can lead to initial HIV diagnosis.
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Affiliation(s)
- Joseph D Tucker
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRJ-504, Boston 02114, USA.
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Li JZ, Tucker JD, Lobo AM, Marra CM, Davis BT, Papaliodis GN, Felsenstein D, Durand ML, Yawetz S, Robbins GK. Ocular syphilis among HIV-infected individuals. Clin Infect Dis 2010; 51:468-71. [PMID: 20604717 DOI: 10.1086/654797] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We describe a human immunodeficiency virus (HIV)-infected individual with ocular manifestations of secondary syphilis. Twelve other cases of HIV-associated ocular syphilis are also presented. Six of 12 individuals had normal cerebrospinal fluid study results, and 3 patients required retreatment within 1.5 years. In patients with HIV infection, clinicians should be vigilant for ocular syphilis despite normal cerebrospinal fluid measures and for syphilis reinfection.
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Affiliation(s)
- Jonathan Z Li
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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Pietzsch M, Kutschan A, Hager A, Wiegand W. [Bilateral panuveitis with papillary swelling]. Ophthalmologe 2009; 106:740-5. [PMID: 19655150 DOI: 10.1007/s00347-008-1900-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Lues (syphilis) is a chronic cyclic infectious disease which can continue for decades if untreated. A simultaneous HIV infection can result in false negative results in serological tests for lues. The occurrence of neurolues has frequently been described in HIV positive patients. In the differential diagnosis an early ocular manifestion of lues should be considered. A 40-year-old homosexual patient presented in our hospital with bilateral pain-free increasing loss of vision. The ophthalmological examination revealed an intermediately expressed panuveitis with streaky opacity of the vitreous body and pronounced bilateral papillary swelling. Following systemic anti-inflammatory therapy with cortisone the situation worsened after initial improvement. The serological investigations revealed both HIV and lues infections. Intravenous therapy with mega units of penicillin led to a slow improvement of clinical symptoms and also vision. In cases of uveitis of unclear origin together with a HIV infection and suspected lues, regular serological testing should be carried out because the occurrence of late complications of lues can be avoided by the diagnosis of lues and adequate treatment.
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Affiliation(s)
- M Pietzsch
- Augenabteilung, Asklepios Klinik Nord/Heidberg, Deutschland.
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Ho AC, Guyer DR, Yannuzzi LA, Brown GC. Ocular Syphilis: Classic Manifestations and Recent Observations. Semin Ophthalmol 2009. [DOI: 10.3109/08820539309060210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Banker AS. Posterior segment manifestations of human immunodeficiency virus/acquired immune deficiency syndrome. Indian J Ophthalmol 2008; 56:377-83. [PMID: 18711265 PMCID: PMC2636133 DOI: 10.4103/0301-4738.42413] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Ocular manifestations can occur in up to 50% of human immunodeficiency virus (HIV)/acquired immune
deficiency syndrome (AIDS) patients and posterior segment involvement is the most common presentation.
The posterior segment manifestations of AIDS can be divided into four categories: retinal vasculopathy,
opportunistic infections, unusual malignancies and neuro-ophthalmologic abnormalities. Retinal
microvasculopathy and cytomegalovirus (CMV) retinitis are the most common manifestations, even in the
era of highly active anti-retroviral therapy (HAART). Highly active anti-retroviral therapy has been shown
to cause regression of CMV retinitis, reduce the incidence of CMV-related retinal detachments, and prolong
patient survival. Immune recovery uveitis is a new cause of vision loss in patients on HAART. Diagnosis and
treatment are guided by the particular conditions and immune status of the patient.
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Affiliation(s)
- Alay S Banker
- Banker's Retina Clinic and Laser Centre, 5 Subhash Society, Behind Ishvar Bhuvan, Ahmedabad 380 009, India.
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Biswas J, Sudharshan S. Anterior segment manifestations of human immunodeficiency virus/acquired immune deficiency syndrome. Indian J Ophthalmol 2008; 56:363-75. [PMID: 18711264 PMCID: PMC2636142 DOI: 10.4103/0301-4738.42412] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Ocular complications are known to occur as a result of human immunodeficiency virus (HIV) disease. They
can be severe leading to ocular morbidity and visual handicap. Cytomegalovirus (CMV) retinitis is the
commonest ocular opportunistic infection seen in acquired immune deficiency syndrome (AIDS). Though
posterior segment lesions can be more vision-threatening, there are varied anterior segment manifestations
which can also lead to ocular morbidity and more so can affect the quality of life of a HIV-positive person.
Effective antiretroviral therapy and improved prophylaxis and treatment of opportunistic infections have led
to an increase in the survival of an individual afflicted with AIDS. This in turn has led to an increase in the
prevalence of anterior segment and adnexal disorders. Common lesions include relatively benign conditions
such as blepharitis and dry eye, to infections such as herpes zoster ophthalmicus and molluscum contagiosum
and malignancies such as squamous cell carcinoma and Kaposi′s sarcoma. With the advent of highly active
antiretroviral therapy, a new phenomenon known as immune recovery uveitis which presents with increased
inflammation, has been noted to be on the rise. Several drugs used in the management of AIDS such as
nevirapine or indinavir can themselves lead to severe inflammation in the anterior segment and adnexa of the
eye. This article is a comprehensive update of the important anterior segment and adnexal manifestations in
HIV-positive patients with special reference to their prevalence in the Indian population.
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Francos JL, Gulotta H, Corti M, Dabadie M. Uveítis sifilítica en pacientes con infección por el virus de la inmunodeficiencia humana. Enferm Infecc Microbiol Clin 2008; 26:475-6. [DOI: 10.1157/13125646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Song JH, Hong YT, Kwon OW. Acute syphilitic posterior placoid chorioretinitis following intravitreal triamcinolone acetonide injection. Graefes Arch Clin Exp Ophthalmol 2008; 246:1775-8. [PMID: 18751717 DOI: 10.1007/s00417-008-0928-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Revised: 07/22/2008] [Accepted: 07/30/2008] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We describe the ophthalmic features and clinical course of two cases of acute syphilitic posterior placoid chorioretinitis (ASPPC) that developed after intravitreal triamcinolone acetonide (IVTA) injection. METHODS Case report. RESULTS Two patients with ocular inflammation of unknown origin developed severe chorioretinitis after IVTA injection. Multiple retinal infiltrates, placoid subretinal lesions, and ground-glass opacity of the retina with hyperemic optic discs were observed in both patients. The etiology of the chorioretinitis was confirmed by serology to be syphilis. Appropriate treatment for neurosyphilis was instituted. Both eyes became atrophied and had poor visual outcome: 10/200 in one patient and no light perception in the other at 6 months after IVTA injection. CONCLUSIONS The fundus picture shown in these cases may be typical of ASPPC after IVTA injection. Clinical suspicion of ASPPC upon observation of these characteristic features is crucial for early diagnosis and treatment.
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Affiliation(s)
- Ji Hun Song
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
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Parc CE, Chahed S, Patel SV, Salmon-Ceron D. Manifestations and treatment of ocular syphilis during an epidemic in France. Sex Transm Dis 2007; 34:553-6. [PMID: 17667532 DOI: 10.1097/01.olq.0000253385.49373.1a] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To review cases of ocular syphilis presenting to a tertiary uveitis clinic during a syphilis epidemic in France between January 2001 and January 2004. STUDY DESIGN Retrospective chart and patient database review. RESULTS Ten patients who presented with symptoms and signs of uveitis tested positive for active syphilis. Some of the patients also presented with a rash or headache. Human immunodeficiency virus (HIV) antibody testing was positive in eight of the 10 patients, with CD4 cell counts >200 cells/mm3 in seven of the patients. Ocular inflammation resolved and visual acuity improved in all patients after treatment. CONCLUSIONS A diagnosis of ocular syphilis should be considered in any patient with visual loss associated with a rash or headache, irrespective of the patient's CD4 cell count. Ocular syphilis in HIV-positive patients should be treated as neurosyphilis, whereas ocular syphilis in non-HIV patients can be treated as secondary syphilis.
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Affiliation(s)
- Christine E Parc
- Department of Ophthalmology, Cochin Hospital, Paris V University, Paris, France.
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Basta MST, Sankar KN, Dayan M. Unilateral syphilitic perioptic neuritis in a patient coinfected with human immunodeficiency virus type 1. Sex Transm Infect 2007; 83:183-4. [PMID: 17569719 PMCID: PMC2659087 DOI: 10.1136/sti.2006.024067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Perioptic neuritis caused by secondary syphilis is a rare ophthalmic manifestation in the HIV-infected host. Early diagnosis and treatment of this condition is required to prevent further visual damage. We report a case of unilateral syphilitic perioptic neuritis in a patient coinfected with HIV-1.
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Affiliation(s)
- Medhat S T Basta
- Genitourinary medicine department, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE, UK.
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Jeng BH, Holland GN, Lowder CY, Deegan WF, Raizman MB, Meisler DM. Anterior Segment and External Ocular Disorders Associated with Human Immunodeficiency Virus Disease. Surv Ophthalmol 2007; 52:329-68. [PMID: 17574062 DOI: 10.1016/j.survophthal.2007.04.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The eye is a common site for complications of human immunodeficiency virus (HIV) infection. Although cytomegalovirus retinitis remains the most prevalent of the blinding ocular disorders that can occur in individuals with the acquired immunodeficiency syndrome (AIDS), several important HIV-associated disorders may involve the anterior segment, ocular surface, and adnexae. Some of these entities, such as Kaposi sarcoma, were well described, but uncommon, before the HIV epidemic. Others, like microsporidial keratoconjunctivitis, have presentations that differ between affected individuals with HIV disease and those from the general population who are immunocompetent. The treatment of many of these diseases is challenging because of host immunodeficiency. Survival after the diagnosis of AIDS has increased among individuals with HIV disease because of more effective antiretroviral therapies and improved prophylaxis against, and treatment of, opportunistic infections. This longer survival may lead to an increased prevalence of anterior segment and external ocular disorders. In addition, the evaluation and management of disorders such as blepharitis and dry eye, which were previously overshadowed by more severe, blinding disorders, may demand increased attention, as the general health of this population improves. Not all individuals infected with HIV receive potent antiretroviral therapy, however, because of socioeconomic or other factors, and others will be intolerant of these drugs or experience drug failure. Ophthalmologists must, therefore, still be aware of the ocular findings that develop in the setting of severe immunosuppression. This article reviews the spectrum of HIV-associated anterior segment and external ocular disorders, with recommendations for their evaluation and management.
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Affiliation(s)
- Bennie H Jeng
- The Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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Affiliation(s)
- Charles Huang
- Department of Ophthalmology and Visual Sciences, University of California at Davis, Sacramento, California, USA
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Affiliation(s)
- Rasha Ali
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Boston, MA 02114, USA
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Erol N, Topbas S. Acute syphilitic posterior placoid chorioretinitis after an intravitreal triamcinolone acetonide injection. ACTA ACUST UNITED AC 2006; 84:435. [PMID: 16704715 DOI: 10.1111/j.1600-0420.2005.00641.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- Torsten W Wiegand
- Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
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Kosobucki BR, Freeman WR. Retinal Disease in HIV-infected Patients. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50098-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Syphilis is a sexually transmitted disease with protean manifestations resulting from infection by Treponema pallidum. It is systemic early from the outset, the primary pathology being vasculitis. Acquired syphilis can be divided into primary, secondary, latent, and tertiary stages. The infection can also be transmitted vertically resulting in congenital syphilis, and occasionally by blood transfusion and non-sexual contact. Diagnosis is mainly by dark field microscopy in early syphilis and by serological tests. The management in the tropics depends on the diagnostic facilities available: in resource poor countries, primary syphilis is managed syndromically as for anogenital ulcer. The introduction of rapid "desktop" serological tests may simplify and promote widespread screening for syphilis. The mainstay of treatment is with long acting penicillin. Syphilis promotes the transmission of HIV and both infections can simulate and interact with each other. Treponemes may persist despite effective treatment and may have a role in reactivation in immunosuppressed patients. Partner notification, health education, and screening in high risk populations and pregnant women to prevent congenital syphilis are essential aspects in controlling the infection.
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Affiliation(s)
- B T Goh
- The Ambrose King Centre, The Royal London Hospital, Whitechapel, London E1 1BB, UK.
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41
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Affiliation(s)
- Kabir Sardana
- Department of Dermatology and Venereology, Lady Hardinge Medical College, New Delhi, India
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Tran THC, Cassoux N, Bodaghi B, Fardeau C, Caumes E, Lehoang P. Syphilitic uveitis in patients infected with human immunodeficiency virus. Graefes Arch Clin Exp Ophthalmol 2005; 243:863-9. [PMID: 16158310 DOI: 10.1007/s00417-005-1137-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2004] [Revised: 12/21/2004] [Accepted: 01/05/2005] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND This work investigates the incidence and clinical features of syphilitic uveitis in patients infected with human immunodeficiency virus (HIV). MATERIAL AND METHODS We retrospectively reviewed syphilitic uveitis in patients coinfected with HIV that presented at a referral center between July 2001 and November 2003. RESULTS Twelve patients (20 eyes) were included. The ocular manifestations of syphilis led to the discovery of HIV-1 seropositivity in three patients. All patients were male and homosexual. One patient has been previously treated for syphilis with benzathine penicillin G. One patient presented with anterior uveitis and 11 patients had panuveitis or posterior uveitis. Necrotizing retinitis was noted in seven eyes (35%), posterior placoid chorioretinitis in six eyes (30%) and optic nerve involvement in five eyes (25%). Of nine patients with available cerebrospinal fluid (CSF) studies, seven (77.8%) had CSF abnormalities. Eleven patients were treated with intravenous penicillin G and one with intravenous ceftriaxone sodium. One patient required a second course of antibiotics to control uveitis. Ocular inflammation decreased and visual acuity improved in all nine patients for whom follow-up was available after treatment. CONCLUSION Manifestations of syphilitic uveitis in HIV-infected patients are multiple, with high frequencies of posterior uveitis, posterior placoid chorioretinitis, necrotizing retinitis and optic nerve involvement. Syphilitic uveitis in HIV-infected patients seems to have a more severe course and may relapse despite high-dose intravenous penicillin therapy.
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Affiliation(s)
- Thi Ha Chau Tran
- Service d'Ophtalmologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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Körber A, Dissemond J, Lehnen M, Franckson T, Grabbe S, Esser S. Syphilis bei HIV-Koinfektion. Syphilis with HIV coinfection. J Dtsch Dermatol Ges 2004; 2:833-40. [PMID: 16281586 DOI: 10.1046/j.1439-0353.2004.04071.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In recent years a rising incidence of syphilis has been observed, especially in the population of homosexual men. Because of altered sexual behavior in terms of increased promiscuity paralleled by decreased use of condoms and the fact that a syphilis infection increases the susceptibility to HIV coinfection, the incidence of HIV is also rising once again in this population. In patients with HIV coinfection, the course of syphilis is often atypical or dramatic. Stage-specific features suggesting coinfection include prolonged primary ulcers persisting well into the secondary stage, numerous atypical cutaneous findings in the second stage and a rapid progression from stage to stage. The diagnosis of syphilis may be more difficult because of false positive or false negative serological findings in patients with HIV coinfection. Whether or not the CNS is more often involved is this patient group has not been established by prospective studies and remains controversial. However, WHO and CDC recommendations include evaluation of the CSF in HIV-infected patients with either late syphilis or when the time course is unknown period. There is worldwide agreement on the therapy of syphilis in patients with HIV coinfection. Patients with early syphilis should be treated with 2.4 benzathine penicillin i.m. once or twice; patients with late syphilis, twice or three times. Patients presenting with clinical or serological signs of neurosyphilis require 18-24 million IU penicillin i.v. daily for at least 2 weeks.
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Affiliation(s)
- Andreas Körber
- Klinik und Poliklinik für Dermatologie und Venerologie, STD-Kompetenzzentrum Nordrhein, Universitätsklinikum Essen
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Lynn WA, Lightman S. Syphilis and HIV: a dangerous combination. THE LANCET. INFECTIOUS DISEASES 2004; 4:456-66. [PMID: 15219556 DOI: 10.1016/s1473-3099(04)01061-8] [Citation(s) in RCA: 266] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
HIV and syphilis affect similar patient groups and co-infection is common. All patients presenting with syphilis should be offered HIV testing and all HIV-positive patients should be regularly screened for syphilis. Syphilis agent may enhance the transmission of the other, probably through increased incidence of genital ulcers. Detection and treatment of syphilis can, therefore, help to reduce HIV transmission. Syphilis may present with non-typical features in the HIV-positive patient: there is a higher rate of symptomless primary syphilis and proportionately more HIV-positive patients present with secondary disease. Secondary infection may be more aggressive and there is an increased rate of early neurological and ophthalmic involvement. Diagnosis is generally made with serology but the clinician should be aware of the potential for false-negative serology in both primary and, less commonly, in secondary syphilis. All HIV-positive patients should be treated with a penicillin-based regimen that is adequate for the treatment of neurosyphilis. Relapse of infection is more likely in the HIV-positive patient and careful follow-up is required.
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Affiliation(s)
- W A Lynn
- Institute of Opthalmology, Moorfield Eye Hospital, London, UK.
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Sardana K, Sehgal VN. Genital ulcer disease and human immunodeficiency virus: a focus. Int J Dermatol 2004. [DOI: 10.1111/j.1365-4632.2004.02268.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Syphilitic chorioretinitis is a rare manifestation of secondary syphilis. The Authors report a case of a patient tested positive for human immune deficiency virus. A 26-Year-old man presented with a history of suddenly blurred vision in the right eye. Because of a central scotoma, visual acuity was reduced to counting fingers. Slit-lamp examination found one-plus anterior chamber cells and one-plus vitreous cells. Results of ophthalmoscopic examination showed a large yellow lesion in the macular area with a papillar edema and peripheral vasculitis. Serum and cerebrospinal fluid were positive for syphilitic serology. Visual acuity improved to 20/20 after three courses of intravenous ceftriaxone (2g/day for 15 days). The fundus lesion resolved almost completely, resulting in slight pigmentary changes in the macular area. This case report highlights the need for syphilitic serology in cases of uveitis in immunocompromised patients.
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Affiliation(s)
- O Kirsch
- Service d'Ophtalmologie, Centre Hospitalier Universitaire de Bicêtre, 78, rue du Général Leclerc, 94275 Le Kremlin Bicêtre Cedex
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Abstract
The ocular posterior segment manifestations of AIDS may be divided into four categories: retinal vasculopathy, unusual malignancies, neuro-ophthalmologic abnormalities, and opportunistic infections. Microvasculopathy is the most common manifestation. Opportunistic infections, particularly cytomegalovirus retinitis and progressive outer retinal necrosis, are the most likely to result in visual loss due to infection or subsequent retinal detachment. Diagnosis and treatment are guided by the particular conditions and immune status of the patient.
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Affiliation(s)
- Tamara R Vrabec
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Abstract
Syphilis is a sexually transmitted infection which is systemic from the outset and has increased in incidence worldwide over the last decade. There has been concern as to whether or not co-infection with HIV can modify the clinical presentation of syphilis and, as a genital ulcer disease, it can facilitate the transmission of HIV infection. Diagnosis is based on the microscopic identification of the causative treponeme and serological testing. Recommendations for the treatment of syphilis have been based on expert opinion, case series, some clinical trials and 50 years of clinical experience. Penicillin, given intramuscularly, is the mainstay of treatment and the favoured preparations for early infectious syphilis are benzathine penicillin as a single injection or a course of daily procaine penicillin injections for 10 to 14 days. The duration of treatment is longer for late syphilis. There has been concern that benzathine penicillin may not prevent the development of neurosyphilis but that is a rare outcome with this therapy. The main alternative to penicillin is doxycycline, but the place of azithromycin and ceftriaxone is yet to be established. It is not necessary to carry out examination of the cerebrospinal fluid in patients with early infectious syphilis but it should be performed in those with neurological or ocular signs, psychiatric signs or symptoms, when there is evidence of treatment failure and in those who are co-infected with HIV. Follow-up is an essential part of management and should be particularly assiduous, for at least 24 months, in those co-infected with HIV. Partner notification should be mandatory to try to contain the spread of infection.
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Affiliation(s)
- David Pao
- Department of Genitourinary Medicine, Guy's & St Thomas' Hospitals, Lambeth Palace Road, London SE1 7EH, UK
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Venkatesh P, Verma L, Garg SP, Tewari HK. Rapid seroconversion to Treponema pallidum and HIV positivity in a patient with retinal vasculitis. Clin Exp Ophthalmol 2002; 30:297-9. [PMID: 12121373 DOI: 10.1046/j.1442-9071.2002.00538.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A patient with idiopathic retinal vasculitis was found to have rapid conversion of serological tests for Treponema pallidum and HIV. The diagnosis was confirmed by Venereal Disease Research Laboratory (VDRL) testing and dark ground illumination for T. pallidum, and enzyme-linked immunosorbent assay (ELISA) and Western blot assay tests for HIV. Following treatment with intravenous penicillin, the fundus lesions resolved and visual acuity recovered from inaccurate light projection to 6/24 in the right eye and from counting fingers close to face to 2/60 in the left eye. Serological tests for T. pallidum in patients with concurrent HIV infection may be unpredictable. Hence, it is important to repeat these tests even in the early treatment phase of patients with retinal vasculitis who have shown initial seronegativity. This enables earlier diagnosis and initiation of specific treatment.
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Affiliation(s)
- Pradeep Venkatesh
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
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Freigassner PS, Schuhmann G, Ardjomand N, El Shabrawi Y, Haas A. Retinitis syphilitica in an HIV-positive patient following acute retinal necrosis syndrome. Retina 2002; 21:674-7. [PMID: 11756898 DOI: 10.1097/00006982-200112000-00022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- P S Freigassner
- Department of Ophthalmology, University Eye Clinic of Graz, Austria.
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