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Papp JR, Park IU, Fakile Y, Pereira L, Pillay A, Bolan GA. CDC Laboratory Recommendations for Syphilis Testing, United States, 2024. MMWR Recomm Rep 2024; 73:1-32. [PMID: 38319847 PMCID: PMC10849099 DOI: 10.15585/mmwr.rr7301a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
This report provides new CDC recommendations for tests that can support a diagnosis of syphilis, including serologic testing and methods for the identification of the causative agent Treponema pallidum. These comprehensive recommendations are the first published by CDC on laboratory testing for syphilis, which has traditionally been based on serologic algorithms to detect a humoral immune response to T. pallidum. These tests can be divided into nontreponemal and treponemal tests depending on whether they detect antibodies that are broadly reactive to lipoidal antigens shared by both host and T. pallidum or antibodies specific to T. pallidum, respectively. Both types of tests must be used in conjunction to help distinguish between an untreated infection or a past infection that has been successfully treated. Newer serologic tests allow for laboratory automation but must be used in an algorithm, which also can involve older manual serologic tests. Direct detection of T. pallidum continues to evolve from microscopic examination of material from lesions for visualization of T. pallidum to molecular detection of the organism. Limited point-of-care tests for syphilis are available in the United States; increased availability of point-of-care tests that are sensitive and specific could facilitate expansion of screening programs and reduce the time from test result to treatment. These recommendations are intended for use by clinical laboratory directors, laboratory staff, clinicians, and disease control personnel who must choose among the multiple available testing methods, establish standard operating procedures for collecting and processing specimens, interpret test results for laboratory reporting, and counsel and treat patients. Future revisions to these recommendations will be based on new research or technologic advancements for syphilis clinical laboratory science.
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2
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Muacevic A, Adler JR, Lott PW, Zahari M, Tajunisah I. Ocular Jarisch-Herxheimer Reaction in the Treatment of Ocular Syphilis: A Case Report and Review of the Literature. Cureus 2023; 15:e33696. [PMID: 36788917 PMCID: PMC9922034 DOI: 10.7759/cureus.33696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 01/13/2023] Open
Abstract
Jarisch-Herxheimer reaction (JHR) is a transient clinical phenomenon in patients with syphilis who receive antibiotic treatment. A 31-year-old man with an underlying HIV infection presented with worsening vision in the right eye two days after being treated with oral doxycycline for presumed left-eye neuroretinitis. Prior history revealed two episodes of penile discharge and ulcers that were not investigated. Examination showed bilateral optic disc swelling with right eye placoid chorioretinitis around the macula. Optical coherence tomography (OCT) demonstrated right macular edema and left macular thinning. Blood investigations confirmed syphilis infection. Subsequently, the patient was scheduled for a contrasted brain CT with oral steroid coverage due to underlying allergies. His vision incidentally improved soon after the short course of steroids. Repeated OCT demonstrated marked improvement of right macular edema, which we believe was secondary to JHR initiated by the earlier doxycycline treatment. Following oral steroid addition, improvement in vision and ocular findings were seen. At six-month post-treatment, there was right macular atrophy as a sequela of the macular edema. Ophthalmologists should be aware of ocular-related JHR complications, particularly in potentiating macular atrophy following macular edema upon initiating antibiotic treatment in syphilitic disease.
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The multifaceted presentation of syphilitic chorioretinitis examined by multimodal imaging: A case series. Am J Ophthalmol Case Rep 2022; 26:101434. [PMID: 35243169 PMCID: PMC8866844 DOI: 10.1016/j.ajoc.2022.101434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 01/27/2022] [Accepted: 02/09/2022] [Indexed: 11/21/2022] Open
Abstract
Ocular syphilis is also known as the ‘great masquerader’ for the wide variety of clinical features associated with this infection. Although chorioretinitis represents the most frequent manifestation in the posterior pole, other clinical entities can be described, including retinal vasculitis, optic disc disorders, necrotizing vasculitis and acute syphilitic posterior placoid chorioretinopathy (ASPPC).
This latter is an infrequent ocular manifestation of syphilis, whose pathophysiology remains still unknown; however, multimodal imaging, including optical coherence tomography angiography (OCTA), has enabled us to better describe its pathophysiology and clinical course.
In this study we report a case series of 3 different patients with syphilis-related chorioretinopathies; in this regard, the role of multimodal imaging has emerged has an extremely useful approach in order to better understand the pathophysiology of syphilitic chorioretinopathies. This could help clinicians (both ophthalmologist and infectious disease specialists) to early treat and prevent the severe ocular complications related to this fearsome disease.
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4
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Niemeyer KM, Chen X. Surgical repair of an inflammatory macular hole associated with ocular syphilis. Am J Ophthalmol Case Rep 2022; 26:101530. [PMID: 35464690 PMCID: PMC9020128 DOI: 10.1016/j.ajoc.2022.101530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 03/26/2022] [Accepted: 04/02/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To describe a case of an inflammatory macular hole associated with ocular syphilis and its successful surgical closure. Observations A 55-year-old man presented with count fingers vision and was found to have unilateral ocular syphilis with panuveitis and a foveal subretinal lesion. The inflammation quickly resolved with treatment, but he developed a full-thickness macular hole on day 5. A pars plana vitrectomy with membrane peel and intraocular gas was performed three months later. The macular hole was successfully closed, and the patient's vision improved to 20/200 18 months after repair. Foveal outer retinal atrophy limited final vision improvement. Conclusions and importance Ocular syphilis can rarely be associated with inflammatory macular holes. Surgical intervention can offer successful anatomic results; however, final visual outcomes may be limited by retinal scarring or atrophy from the original inflammation.
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5
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Neri P, Pichi F. Acute syphilitic posterior placoid chorioretinitis: when the great mimicker cannot pretend any more; new insight of an old acquaintance. J Ophthalmic Inflamm Infect 2022; 12:9. [PMID: 35192047 PMCID: PMC8864036 DOI: 10.1186/s12348-022-00286-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Purpose
To review the multimodal imaging patterns of Acute Syphilitic Posterior Placoid Chorioretinitis (ASPPC).
Methods
A systematic review.
Results
Syphilis has started to attract the attention of researchers once again due to recent surges, with The World Health Organization (WHO) reporting around 12 million new cases per year. When left untreated, syphilis has a mortality rate of 8–58%, with a higher death rate in males. Eye manifestations occur both in secondary and tertiary stages of syphilis, although ocular involvement may occur at any stage of the disease.
Syphilis has been always recognized as “the great mimicker” since it can have multiple clinical patterns of presentation.
However, Acute Syphilitic Posterior Placoid Chorioretinitis (ASPPC) represents the typical pattern of the disease and can be easily distinguished.
In addition, the advent of modern technologies and the progress made in multimodal imaging have provided more details on its identikit: the pattern of pre-retinal, retinal, retinochoroidal and optic nerve involvement can be identified before going through the laboratory work-up for a correct and appropriate investigation of the disease.
Conclusion
This review highlights the peculiar pattern of ASPPC, by reporting the diagnostic process made by all the imaging techniques used for a correct multimodal imaging assessment.
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6
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Bierowski MJ, Wang R, Javaid HW, Amin N, Popa AL. Neurosyphilis Presenting as an Atypical Case of Posterior Placoid Chorioretinitis in a Young, HIV-Negative Male. Cureus 2021; 13:e17274. [PMID: 34540495 PMCID: PMC8447855 DOI: 10.7759/cureus.17274] [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] [Accepted: 08/17/2021] [Indexed: 11/13/2022] Open
Abstract
Ocular syphilis can occur at any time after initial infection and most commonly presents as posterior uveitis or panuveitis, although many other ocular findings have been documented. We present the case of a young, otherwise healthy Caucasian HIV-negative male who presented with acute onset of photopsias, floaters, and a rapidly progressive unilateral scotoma who was originally diagnosed with acute zonal occult outer retinopathy (AZOOR) and started on a high dose prednisone taper. Although his clinical symptoms improved on corticosteroids, he was later switched to Penicillin G treatment when his blood and cerebrospinal fluid (CSF) testing demonstrated syphilis as his underlying diagnosis. Given his ocular findings on the exam and reactive syphilitic testing, he was ultimately diagnosed with acute syphilitic posterior placoid chorioretinitis (ASPPC). Our patient's clinical improvement after a high-dose prednisone trial offers further evidence of an autoimmune component to the pathophysiology of ASPPC.
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Affiliation(s)
- Matthew J Bierowski
- Internal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Rui Wang
- Ophthalmology, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | | | - Neil Amin
- Internal Medicine, Wellspan York Hospital, York, USA
| | - Alina L Popa
- Internal Medicine, Wellspan York Hospital, York, USA
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7
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Diverse Genetic Landscape of Suspected Retinitis Pigmentosa in a Large Korean Cohort. Genes (Basel) 2021; 12:genes12050675. [PMID: 33946315 PMCID: PMC8146864 DOI: 10.3390/genes12050675] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 12/29/2022] Open
Abstract
We conducted targeted next-generation sequencing (TGS) and/or whole exome sequencing (WES) to assess the genetic profiles of clinically suspected retinitis pigmentosa (RP) in the Korean population. A cohort of 279 unrelated Korean patients with clinically diagnosed RP and available family members underwent molecular analyses using TGS consisting of 88 RP-causing genes and/or WES with clinical variant interpretation. The combined genetic tests (TGS and/or WES) found a mutation in the 44 RP-causing genes and seven inherited retinal disease (IRD)-causing genes, and the total mutation detection rate was 57%. The mutation detection rate was higher in patients who experienced visual deterioration at a younger age (75.4%, age of symptom onset under 10 years) and who had a family history of RP (70.7%). The most common causative genes were EYS (8.2%), USH2A (6.8%), and PDE6B (4.7%), but mutations were dispersed among the 51 RP/IRD genes generally. Meanwhile, the PDE6B mutation was the most common in patients experiencing initial symptoms in their first decade, EYS in their second to third decades, and USH2A in their fifth decades and older. Of note, WES revealed some unexpected genotypes: ABCC6, CHM, CYP4V2, RS1, TGFBI, VPS13B, and WDR19, which were verified by ophthalmological re-phenotyping.
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8
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Tuddenham S, Katz SS, Ghanem KG. Syphilis Laboratory Guidelines: Performance Characteristics of Nontreponemal Antibody Tests. Clin Infect Dis 2021; 71:S21-S42. [PMID: 32578862 PMCID: PMC7312285 DOI: 10.1093/cid/ciaa306] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We reviewed the relevant syphilis diagnostic literature to address the following question: what are the performance characteristics, stratified by the stage of syphilis, for nontreponemal serologic tests? The database search included key terms related to syphilis and nontreponemal tests from 1960–2017, and for data related to the venereal disease research laboratory test from 1940–1960. Based on this review, we report the sensitivity and specificity for each stage of syphilis (primary, secondary, early latent, late latent, or unknown duration; tertiary as well as neurosyphilis, ocular syphilis, and otic syphilis). We also report on reactive nontreponemal tests in conditions other than syphilis, false negatives, and automated nontreponemal tests. Overall, many studies were limited by their sample size, lack of clearly documented clinical staging, and lack of well-defined gold standards. There is a need to better define the performance characteristics of nontreponemal tests, particularly in the late stages of syphilis, with clinically well-characterized samples. Published data are needed on automated nontreponemal tests. Evidence-based guidelines are needed for optimal prozone titrations. Finally, improved criteria and diagnostics for neurosyphilis (as well as ocular and otic syphilis) are needed.
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Affiliation(s)
- Susan Tuddenham
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Samantha S Katz
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Khalil G Ghanem
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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9
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Abstract
PURPOSE OF REVIEW In the context of a resurgence of syphilis worldwide, it can be anticipated that a rise in cases of ocular, otic, and neurosyphilis will also be seen. This article reviews the current epidemiology, manifestations, and approach to management and treatment. RECENT FINDINGS Although studies continue investigating alternate approaches and new diagnostic tests for ocular and neurosyphilis, few data exist to change current diagnostic algorithms and approaches to diagnosis, management, or follow up. SUMMARY The diagnosis of neurologic and eye/ear involvement with syphilis may be delayed because of a lack of specificity of findings, low suspicion for syphilis, fluctuation in symptoms, and/or similarities in presentation to other diseases. A high index of suspicion for syphilis and re-education about the protean manifestations of syphilis by all clinicians is required provide timely diagnosis and management of ocular, otic, and neurosyphilis.
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10
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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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11
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Pichi F, Neri P. Multimodal imaging patterns of posterior syphilitic uveitis: a review of the literature, laboratory evaluation and treatment. Int Ophthalmol 2020; 40:1319-1329. [PMID: 31927680 DOI: 10.1007/s10792-020-01285-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 01/05/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE To review the multimodal imaging patterns of posterior syphilitic uveitis. METHODS A systematic review. RESULTS The percentage of syphilis has started to increase again: The World Health Organization has reported 12 million new cases of syphilis each year. In addition, syphilis was responsible for 0.3% of deaths globally in 2002. Eye manifestations happen prevalently in secondary and tertiary stages of syphilis, even though ocular involvement can occur in all stages. Syphilis has the nickname: "the great imitator" since it has no unique clinical presentation, even though posterior uveitis is considered the most common form. Syphilis is known as "the great imitator," making its diagnosis in the presence of posterior uveitis particularly challenging as it presents similarly to other ocular conditions such as acute retinal necrosis. However, with the advent of multimodal imaging some particular patterns of pre-retinal, retinal, retinochoroidal and optic nerve involvement from syphilis can be identified to guide the diagnosis and the laboratory workup. CONCLUSION This review highlights the various patterns of pre-retinal precipitates, multifocal retinitis, retinochoroiditis (confluent and placoid) and optic neuritis caused by syphilis, the appropriate laboratory work to be obtained and the treatment to be initiated.
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Affiliation(s)
- Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, PO Box 112412, Abu Dhabi, UAE.
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, USA.
| | - Piergiorgio Neri
- Eye Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, PO Box 112412, Abu Dhabi, UAE
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, USA
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12
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Gutierrez B, Gayet S, Bertolino J, Jean E, Le Goff L, Voisin H, Sampo M, Meunier B, Harle JR, Ebbo M, Schleinitz N, Menard A, Bernit E. [Ocular syphilis, a re-emergent pathology: Series of 12 patients in one Hospital, 2017]. Rev Med Interne 2019; 41:160-167. [PMID: 31301942 DOI: 10.1016/j.revmed.2019.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 06/09/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Syphilis is a sexually transmitted disease. All organs might be affected, but ocular syphilis only occurs in 0.6 percent of patients. We collected all cases of ocular syphilis requiring hospitalization at the University Hospital Center (UHC) in Marseille in 2017. PATIENTS AND METHODS This was a retrospective monocentric study. The diagnosis of ocular syphilis was based on the combination of ocular inflammation with a positive syphilitic serology. For each patient, sex, age, HIV status, ocular and extraocular symptoms, initial visual acuity, syphilis serology, cerebrospinal fluid (CSF) analysis if done, treatment and clinical response were collected. RESULTS Ten men and two women, aged 28 to 86 years, were hospitalized. Two patients were HIV-positive. Ophtalmological lesions were heterogeneous the posterior structures were most affected. Anterior uveitis was isolated in one patient. Five patients had extraocular signs with cutaneous and/or mucosal involvement. No patient had neurological symptoms. Diagnosis of neurosyphilis through CSF analysis was definite for one patient, probable for 5 patients and ruled out for 2 patients. Six patients received treatment with penicillin G and six with ceftriaxone. Visual acuity improved in all cases. DISCUSSION Ophtalmic cases of syphilis have become more frequent over the past few years in France. The diagnosis should be suspected in cases of eye inflammation even in the absence of favourable clinical presentation or anamnesis. Search for HIV co-infection should be systematic. Our study shows that ceftriaxone remains an effective alternative to penicillin G.
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Affiliation(s)
- B Gutierrez
- Service de medecine interne, CHU limoges, CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France.
| | - S Gayet
- Service de gériatrie, AP-HM, 278, rue Saint-Pierre, 13005 Marseille, France
| | - J Bertolino
- Service de service de médecine interne, AP-HM, 278, rue Saint-Pierre, 13005 Marseille, France
| | - E Jean
- Service de service de médecine interne, AP-HM, 278, rue Saint-Pierre, 13005 Marseille, France
| | - L Le Goff
- 8, allée Turcat-Mery, 13008 Marseille, France
| | - H Voisin
- Service d'ophtalmologie, AP-HM, 278, rue Saint-Pierre, 13005 Marseille, France
| | - M Sampo
- Service d'ophtalmologie, AP-HM, 278, rue Saint-Pierre, 13005 Marseille, France
| | - B Meunier
- Service de service de médecine interne, AP-HM, 278, rue Saint-Pierre, 13005 Marseille, France
| | - J-R Harle
- Service de service de médecine interne, AP-HM, 278, rue Saint-Pierre, 13005 Marseille, France
| | - M Ebbo
- Service de service de médecine interne, AP-HM, 278, rue Saint-Pierre, 13005 Marseille, France
| | - N Schleinitz
- Service de service de médecine interne, AP-HM, 278, rue Saint-Pierre, 13005 Marseille, France
| | - A Menard
- Service de maladies infectieuses et tropicales de l'IHU méditerranée infection, 19-21, boulevard Jean-Moulin, 13005 Marseille, France
| | - E Bernit
- Service de service de médecine interne, AP-HM, 278, rue Saint-Pierre, 13005 Marseille, France
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13
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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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14
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Oliver SE, Cope AB, Rinsky JL, Williams C, Liu G, Hawks S, Peterman TA, Markowitz L, Fleischauer AT, Samoff E. Increases in Ocular Syphilis-North Carolina, 2014-2015. Clin Infect Dis 2018; 65:1676-1682. [PMID: 29020152 DOI: 10.1093/cid/cix604] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/07/2017] [Indexed: 11/13/2022] Open
Abstract
Background Ocular syphilis is an inflammatory eye disease due to Treponema pallidum infection. In the United States, syphilis rates have increased since 2000; clusters of ocular syphilis were reported in 2015. We investigated ocular syphilis in North Carolina to describe the epidemiology and clinical course of disease. Methods We reviewed syphilis cases reported to North Carolina during 2014-2015 and abstracted information from health department interviews for cases with ocular symptoms and no other defined etiology. To assess duration and severity of ocular symptoms, we also reviewed medical records and conducted structured interviews. We compared the prevalence of ocular manifestations among reported syphilis cases by demographic and clinical characteristics. Results Among 4232 syphilis patients, 63 (1.5%) had ocular syphilis: 21 in 2014 and 42 in 2015, a 100% increase. Total syphilis cases increased 35% through 2015. No patient with ocular syphilis named another ocular syphilis patient as a sex partner. Patients presented in all syphilis stages; 24 (38%) were diagnosed in primary or secondary syphilis. Ocular manifestations were more prevalent among syphilis patients who were male, aged ≥40 years, white, and infected with human immunodeficiency virus. No risk behaviors were associated with ocular syphilis. Among 39 interviewed patients, 34 (87%) reported reduced vision during infection; 12 (31%) reported residual visual symptoms posttreatment. Conclusions In North Carolina, ocular syphilis increased from 2014 to 2015 and may be due to increased recognition of ocular manifestations, or a true increase in ocular syphilis. Many ocular syphilis patients experienced vision loss; however, most improved posttreatment.
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Affiliation(s)
- Sara E Oliver
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anna Barry Cope
- Centers for Disease Control and Prevention, Atlanta, Georgia.,North Carolina Division of Public Health, Raleigh
| | - Jessica L Rinsky
- Centers for Disease Control and Prevention, Atlanta, Georgia.,North Carolina Division of Public Health, Raleigh
| | | | - Gui Liu
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Lauri Markowitz
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aaron T Fleischauer
- Centers for Disease Control and Prevention, Atlanta, Georgia.,North Carolina Division of Public Health, Raleigh
| | - Erika Samoff
- North Carolina Division of Public Health, Raleigh
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Abstract
BACKGROUND Syphilis can have many clinical manifestations, including eye involvement, or "ocular syphilis." In 2015, an increase in reported cases of ocular syphilis and potential case clusters raised concern for an oculotropic strain of Treponema pallidum, the infectious agent of syphilis. Molecular typing was used to examine strains found in cases of ocular syphilis in the United States. METHODS In 2015, after a clinical advisory issued by the Centers for Disease Control and Prevention, pretreatment clinical specimens from US patients with ocular syphilis were sent to a research laboratory for molecular analysis of T. pallidum DNA. Molecular typing was conducted on these specimens, and results were compared with samples collected from Seattle patients diagnosed with syphilis, but without ocular symptoms. RESULTS Samples were typed from 18 patients with ocular syphilis and from 45 patients with syphilis, but without ocular symptoms. Clinical data were available for 14 ocular syphilis patients: most were men, human immunodeficiency virus-infected, and had early syphilis. At least 5 distinct strain types of Treponema pallidum were identified in these patients, and 9 types were identified in the Seattle nonocular patients. 14d/g was the most common type in both groups. An unusual strain type was detected in a small cluster of ocular syphilis patients in Seattle. CONCLUSIONS Ocular syphilis is a serious sequela of syphilis. In this preliminary study, clear evidence of a predominant oculotropic strain causing ocular syphilis was not detected. Identification of cases and prompt treatment is critical in the management of ocular syphilis.
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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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Thomas S, Wiselka M, Dhar J, Bibby K. Syphilis Presenting as Acute Multifocal Retino-Choroiditis. J R Soc Med 2017; 99:371-2. [PMID: 16816270 PMCID: PMC1484550 DOI: 10.1177/014107680609900723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Shery Thomas
- Department of Ophthalmology, Leicester Royal Infirmary, Leicester LE1 5WW, UK
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18
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Dutta Majumder P, Chen EJ, Shah J, Ching Wen Ho D, Biswas J, See Yin L, Gupta V, Pavesio C, Agrawal R. Ocular Syphilis: An Update. Ocul Immunol Inflamm 2017; 27:117-125. [DOI: 10.1080/09273948.2017.1371765] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Elizabeth J. Chen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Janika Shah
- Singapore National Eye Centre, Singapore, Singapore
| | - Dawn Ching Wen Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jyotirmay Biswas
- Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Leo See Yin
- Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Vishali Gupta
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Carlos Pavesio
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
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19
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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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20
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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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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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22
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Drancourt M. Infectious Retinitis and Uveitis. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00018-6] [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: 11/27/2022] Open
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23
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Abstract
PURPOSE Ocular syphilis has become rare in the developed world, but is a common presentation to ophthalmology departments in South Africa. We investigated the proportion of patients diagnosed with ocular syphilis who went on to receive lumbar punctures, and determined the fraction of these who had cerebrospinal fluid findings suggestive of neurosyphilis. We aimed to determine whether the use of lumbar punctures in ocular syphilis patients was beneficial in picking up cases of neurosyphilis. METHODS Retrospective study of case notes of patients admitted to two district hospitals in Durban, South Africa, with ocular syphilis over a 20-month period. RESULTS A total of 31 of 68 ocular syphilis patients underwent lumbar puncture, and of these, eight (25.8%) had findings suggestive of neurosyphilis. CONCLUSIONS Lumbar puncture in ocular syphilis patients should continue to be a routine part of the investigation of these patients; a large proportion of ocular syphilis patients show cerebrospinal fluid findings suggestive of neurosyphilis, are at risk of the complications of neurosyphilis, and should be managed accordingly.
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Affiliation(s)
- Ian Reekie
- a Hairmyres Hospital , East Kilbride , UK
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25
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Fukushima K, Yanagisawa N, Sasaki S, Sekiya R, Sekiya N, Suganuma A, Ajisawa A, Imamura A. [Ocular Syphilis Complicated with HIV Infection: A Report of 3 Cases]. ACTA ACUST UNITED AC 2016; 90:310-5. [PMID: 27529966 DOI: 10.11150/kansenshogakuzasshi.90.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We present 3 cases of ocular syphilis in patients who had been newly diagnosed as having HIV. All the patients had only complained of ophthalmologic symptoms at the time of their initial visit. Treatment with penicillin was successful, resulting in no significant sequelae. Ocular syphilis may lead to reduced visual acuity or even blindness if left untreated. However, the diagnosis may be challenging, since patients may lack symptoms that are commonly observed in cases with primary and secondary syphilis. Considering the recent increase in the number of syphilis patients, clinicians should be aware of ocular syphilis and should have a high index of suspicion for syphilis in any patient at risk so as to ensure a prompt diagnosis.
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[Management of uveomeningitis in internal medicine: Proposal for a diagnostic work-up]. Rev Med Interne 2015; 37:25-34. [PMID: 26541836 DOI: 10.1016/j.revmed.2015.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 07/03/2015] [Accepted: 09/26/2015] [Indexed: 01/14/2023]
Abstract
Uveomeningitis relates to an inflammatory state extending from iris and ciliary bodies to the choroid behind the eye. Because of a close contact between eye and brain, and barrier disruption, the inflammation can spread into the central nervous system (CNS). We review the clinical manifestations of uveitis, which are known to provide helpful clues to the diagnosis and describe the infectious, inflammatory, and neoplastic conditions classically associated with the uveomeningitis. Inflammatory or auto-immune diseases are probably the most common clinically recognized causes of uveomeningitis associated with a significant pleiocytosis. These entities often cause inflammation of various tissues in the body, including ocular structures and the meninges (i.e., sarcoidosis, Behçet's disease, and Vogt-Koyanagi-Harada syndrome). The association of an infectious uveitis with an acute or a chronic meningo-encephalitis is unusual but occasionally the eye examination may suggest an infectious etiology or even a specific organism responsible for an uveomeningitis. One should consider the diagnosis of primary ocular-CNS lymphoma in patients of 40 years of age or older with bilateral uveitis, especially with prominent vitritis, showing poor response to corticosteroid therapy. Finally, an algorithm for the diagnostic approach of uveomeningitis is proposed.
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27
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Marty AS, Cornut PL, Janin-Manificat H, Perard L, Debats F, Burillon C. [Clinical and paraclinical features of syphilitic uveitis]. J Fr Ophtalmol 2015; 38:220-8. [PMID: 25637233 DOI: 10.1016/j.jfo.2014.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 07/14/2014] [Accepted: 09/25/2014] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Syphilis, caused by Treponema pallidum agent, results in polymorphic and non-specific ocular manifestations. Early diagnosis and institution of individualized treatment play a large role in the prognosis. The increase in syphilis over the past several years requires the ophthalmologist to consider this diagnosis in the setting of any intraocular inflammatory involvement. PURPOSE To describe epidemiological, clinical and paraclinical features and natural history of syphilitic uveitis. MATERIALS AND METHODS Retrospective, descriptive and non-comparative study of a series of patients hospitalized between 2007 and 2013 in our department of ophthalmology for management of ocular inflammation associated with a positive syphilitic serology. RESULTS Thirteen patients of mean age 52.5 years ± 12.9 (33-82 years) were included. All were male and were followed for six months. Co-infection with human immunodeficiency virus (HIV) was present in four of them. Other risk factors discovered on history were unprotected sexual relations, multiple partners, homosexual relations, co-infection with another sexually transmitted disease (STD) or an occupational risk. Decreased visual acuity (VA) was present in all patients, with an average initial VA of 0.71 ± 0.81 LogMAR, i.e. 2/10. Involvement was bilateral in 38% (n=5) of cases. Papilledema was present in 10 patients. Seven patients exhibited vasculitis, 6 patients a necrotizing retinitis, 2 patients with placoid lesions, 7 patients with panuveitis and 2 patients with macular edema. We did not find any patients with isolated anterior uveitis. Three patients exhibited concomitant extraocular involvement with cutaneous palmoplantar lesions. Spectral domain optical coherence tomography (SD-OCT) found a fragmentation of the external limiting membrane and a disorganization of the ellipsoid line in two patients. Cerebrospinal fluid was studied for all patients. Eight of them exhibited lymphocytic meningitis, and we found the presence of anti-Treponema pallidum hemagglutination assay antibody (TPHA) in 9 patients and anti-veneral disease research laboratory antibody (VDRL) in 1 patient. Syphilis polymerase chain reaction (PCR) in the aqueous humor was positive in 50% (n=6) of studied cases and the PCR for Epstein Barr virus came back positive in four specimens out of eight. False positive reactions were observed for Lyme disease in eight patients. The four HIV-positive patients showed bilateral lesions more frequently, but less severe and with a favorable outcome. Antibiotic treatment with ceftriaxone (2 grams per day intramuscularly for 15 to 21 days) and local treatment (corticoids and mydriatics) in the case of inflammation of the anterior segment, allowed a regression of the inflammation in all of our patients as well as an improvement in VA (average final VA 0.09 ± 0.17 LogMAR, i.e. approximately 8/10). One Jarisch Herxheimer reaction occurred and was resolved with systemic corticosteroid therapy. A change in the retinal pigment epithelium was the main sequela in 44% of cases (n=8 eyes). CONCLUSION Every structure of the eye may be involved with syphilis; therefore, syphilis must be systematically sought during the etiologic assessment of ocular inflammation even in the absence of historical risk factors. HIV-positive patients must be handled in the same way as immunocompetent patients. Collaboration with the internist is essential for the diagnosis, monitoring, and staging, especially in search of neurosyphilis. The clinical course is favorable with early treatment.
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Affiliation(s)
- A-S Marty
- Service d'ophtalmologie, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003, Lyon, France.
| | - P-L Cornut
- Centre ophtalmologique pôle vision, clinique du Val-d'ouest, 39, chemin de la Vernique, 69130, Écully, France
| | - H Janin-Manificat
- Service d'ophtalmologie, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003, Lyon, France
| | - L Perard
- Service de médecine interne, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003, Lyon, France
| | - F Debats
- Hôpital de la Croix-Rousse, service d'ophtalmologie, 103, Grande rue de la Croix-Rousse, 69004, Lyon, France
| | - C Burillon
- Service d'ophtalmologie, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003, Lyon, France
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Pilozzi-Edmonds L, Kong LY, Szabo J, Birnbaum LM. Rapid progression to gummatous syphilitic hepatitis and neurosyphilis in a patient with newly-diagnosed HIV. Int J STD AIDS 2014; 26:985-7. [PMID: 25525055 DOI: 10.1177/0956462414564401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 11/24/2014] [Indexed: 11/17/2022]
Abstract
We review the literature on hepatic involvement in patients with HIV and syphilis co-infection and describe a case of rapid progression to neurosyphilis and presumed gummatous syphilitic hepatitis in a patient newly diagnosed with HIV. To our knowledge, this is the first case of syphilitic hepatitis with gummas described in the HIV population.
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Affiliation(s)
- Laura Pilozzi-Edmonds
- Department of Internal Medicine, McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Ling Yuan Kong
- Department of Internal Medicine, McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Jason Szabo
- McGill AIDS Centre, McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Leora M Birnbaum
- Department of Internal Medicine, McGill University Health Center, McGill University, Montreal, QC, Canada
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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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Acute syphilitic posterior placoid chorioretinitis: report of a case series and comprehensive review of the literature. Retina 2013; 32:1915-41. [PMID: 22863970 DOI: 10.1097/iae.0b013e31825f3851] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To describe the clinical and angiographic features of a series of patients with acute syphilitic posterior placoid chorioretinitis (ASPPC) in the context of previously published cases. METHODS A retrospective, noncomparative, multicenter chart review was performed on 16 patients with active ASPPC. Positive serologic tests supported the diagnosis in all patients. Color and red-free photographs as well as fluorescein angiography were obtained in each case. Indocyanine green angiography, optical coherence tomography, and fundus autofluorescence were performed on selected patients. A total of 44 previously published cases of ASPPC were identified using both a Medline Search and references listed in articles identified. RESULTS Ocular involvement was bilateral in 9 of our 16 patients (56.3%). The mean and median ages at presentation were 40 and 38 years, respectively (range 28-57 years). Nine patients (56.3%) were human immunodeficiency virus positive, with most recent CD4 cell counts ranging from 160 cells/μL to 450 cells/μL and a median CD4 cell count of 250 cells/μL. Seven of 16 patients (43.8%) had a history of mucocutaneous manifestations of secondary syphilis, whereas 4 (25.0%) had evidence of neurosyphilis. Anterior chamber and/or vitreous inflammation was evident in 13 patients (81.3%). Fifteen of 16 patients had positive venereal disease research laboratory or rapid plasma regain titers, and 13 of 13 tested patients had a positive serum fluorescent treponemal antibody absorption. The initial vision in the 25 affected eyes ranged from 20/20 to counting fingers, with a median of 20/80. In all patients, posterior segment examination in the involved eyes revealed a large, yellowish, placoid, outer retinal lesion. Fluorescein angiography showed progressive hyperfluorescence in the area of the lesion, often with scattered focal hypofluorescence, or leopard spotting. Inflammation subsided, the yellowish lesions resolved, and vision improved shortly after antibiotic therapy in 20 of 25 affected eyes. Visual acuity at last visit ranged from 20/20 to 20/150, with a median final vision of 20/25. A review of the literature revealed 44 previously reported cases of ASPPC. Shared demographic, clinical, and angiographic features were summarized. CONCLUSION Acute syphilitic posterior placoid chorioretinitis is an uncommon but clinically and angiographically distinct manifestation of ocular syphilis. All patients with characteristic clinical and angiographic findings of ASPPC should be tested for both neurosyphilis and human immunodeficiency virus coinfection. Vision recovery typically followed completion of appropriate antibiotic therapy.
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Karunaratne I, Sharma S, Dick A, Carrington D, Horner P. Shared care approach to managing ophthalmological disease in patients with positive treponemal serology: a case series. Int J STD AIDS 2012; 23:291-6. [PMID: 22581958 DOI: 10.1258/ijsa.2011.011210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Ocular syphilis presenting initially as various manifestations of intraocular inflammation is a rare but an important manifestation of syphilis. Ocular phenotypes are varied and mimic other infectious and non-infectious ocular diseases. Uncertainties exist in optimal management of ocular manifestations of syphilis due to a lack of evidence from randomized controlled trials. In this article we report seven cases of syphilis representing a spectrum of ophthalmic manifestations and highlight key issues around diagnosis and management. We underscore the importance of interdisciplinary approach by ophthalmologists and genitourinary (GU) physicians in improving the outcome of this subgroup of patients in the absence of robust evidence.
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Affiliation(s)
- I Karunaratne
- Bristol Sexual Health Centre, University of Bristol, Bristol, UK.
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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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van der Vaart R, Greven C, Manning R, Haines N, Kurup SK. Unilateral solitary choroidal granuloma as presenting sign of secondary syphilis. Graefes Arch Clin Exp Ophthalmol 2011; 249:1575-7. [PMID: 21562892 DOI: 10.1007/s00417-011-1661-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 12/21/2010] [Accepted: 12/29/2010] [Indexed: 11/28/2022] Open
Affiliation(s)
- Robert van der Vaart
- Department of Ophthalmology, Wake Forest University Eye Center, Winston-Salem, NC 27157, USA
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Abstract
BACKGROUND Syphilis is a condition caused by the spirochete Treponema pallidum (T. pallidum). Because of its ubiquitous nature, it has been coined as "the great masquerader." Syphilis can present with a wide array of clinical symptoms and manifestations, making it difficult to diagnose. The spectrum of visual system manifestations is broad and involves the anterior and posterior segments. We report a rare case of ocular perineuritis in an HIV-positive patient with neurosyphilis. CASE REPORT A 33-year-old HIV-positive white male presented with blurred vision and floaters of 2 weeks duration. He reported coinciding neurological symptoms including headaches, nausea, and extreme weight loss. He also manifested an erythematous rash on his scalp. Fundoscopy revealed bilateral disc edema. CONCLUSIONS Syphilitic ocular perineuritis is a condition that manifests with swollen optic discs in the absence of raised intracranial pressure or visual disturbance. This condition is due to inflammation of the optic nerve sheath and is often mistaken for papilledema or papillitis. Optic perineuritis is an infrequently reported complication of syphilitic disease. Early diagnosis of neurosyphilis and its complications is critical, because it is easily treated with penicillin when initiated early on.
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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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Yeh S, Lee WL, Rosenbaum RB, Rosenbaum JT. Hearing loss, uveomeningitis, and stroke in a 55‐year‐old man. Arthritis Care Res (Hoboken) 2011; 63:298-306. [DOI: 10.1002/acr.20302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Steven Yeh
- Casey Eye Institute, Oregon Health & Science University, Portland
| | - Wai L. Lee
- Providence Arthritis Center, Portland, Oregon
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39
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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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Puech C, Gennai S, Pavese P, Pelloux I, Maurin M, Romanet JP, Chiquet C. Ocular manifestations of syphilis: recent cases over a 2.5-year period. Graefes Arch Clin Exp Ophthalmol 2010; 248:1623-9. [DOI: 10.1007/s00417-010-1481-z] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2010] [Revised: 07/23/2010] [Accepted: 07/24/2010] [Indexed: 12/01/2022] Open
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Abstract
Neurosyphilis literally means syphilitic infection of the central nervous system, but it is often referred to incorrectly as "tertiary syphilis." Neurosyphilis can occur at any time in the course of syphilis, even in the earliest, primary, stage. Early forms of neurosyphilis primarily affect the meninges, cerebrospinal fluid, and cerebral or spinal cord vasculature. Late forms of neurosyphilis primarily affect the brain and spinal cord parenchyma. Uveitis and hearing loss related to syphilis are most common in early syphilis and may be accompanied by early neurosyphilis. The treatment for syphilis-related eye disease and hearing loss is the same as the treatment for neurosyphilis. Neurosyphilis is more commonly seen in patients infected with HIV, and much of the recent literature pertains to this risk group. This article provides a critical review of recent literature on the diagnosis, clinical findings, risk factors, and management of neurosyphilis.
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Affiliation(s)
- Christina M Marra
- University of Washington School of Medicine, Harborview Medical Center, Box 359775, 325 Ninth Avenue, Seattle, WA 98104, USA.
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42
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Robinson CC, Duker JS. Infectious retinitis and uveitis. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00017-4] [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: 10/23/2022] Open
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Amaratunge BC, Camuglia JE, Hall AJ. Syphilitic uveitis: a review of clinical manifestations and treatment outcomes of syphilitic uveitis in human immunodeficiency virus-positive and negative patients. Clin Exp Ophthalmol 2010; 38:68-74. [PMID: 20447104 DOI: 10.1111/j.1442-9071.2010.02203.x] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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44
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Neurosyphilis presenting with dementia, chronic chorioretinitis and adverse reactions to treatment: a case report. CASES JOURNAL 2009; 2:8334. [PMID: 19918420 PMCID: PMC2769430 DOI: 10.4076/1757-1626-2-8334] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Accepted: 08/13/2009] [Indexed: 11/08/2022]
Abstract
Neurosyphilis results from infection of the brain, meninges or spinal cord by Treponema pallidum and develops in about 25%-40% of persons who are not treated for syphilis. This article reports a rare case of active neurosyphilis with mild dementia, chronic chorioretinitis, and hearing loss. During the treatment with Penicillin, a rare combination of complications such as Jarisch-Herxheimer and Hoigné reactions were observed.The clinical feature is characterized by a slow progressive cognitive decline and behavior changes for the last 2 years. Neuropsychological examination revealed mild dementia (MMSE = 23) with impaired memory and attention and executive function. Left sided chronic chorioretinitis and hearing loss were documented. High dose intravenous penicillin therapy was complicated by Jarisch-Herxheimer and Hoigne reactions. During the follow up examinations at 6 and 12 months, the clinical signs, neuropsychological examination, and cerebrospinal fluid (CFS) samples showed improvement of dementia, CSF findings, and hydrocephalus.In conclusion, this atypical presentation of neurosyphilis in combination with rare complications of treatment is worthy of attention. Neurosyphilis should be part of the differential diagnosis of each patient showing cognitive deterioration and behaviour disturbances.
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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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Kunkel J, Schürmann D, Pleyer U, Rüther K, Kneifel C, Krause L, Reichert M, Ignatius R, Schneider T. Ocular syphilis – indicator of previously unknown HIV-infection. J Infect 2009; 58:32-6. [DOI: 10.1016/j.jinf.2008.11.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 11/05/2008] [Accepted: 11/08/2008] [Indexed: 10/21/2022]
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47
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Maves RC, Cachay ER, Young MA, Fierer J. Secondary syphilis with ocular manifestations in older adults. Clin Infect Dis 2008; 46:e142-5. [PMID: 18462103 DOI: 10.1086/588483] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We describe 4 patients (age, >50 years) with secondary syphilis. All patients presented with ocular syphilis, and 2 presented with syphilis-negative rapid plasma reagin titers due to a prozone phenomenon. Three male patients reported sildenafil use. The presentation of these patients with ocular syphilis suggests the need for additional clinical studies involving older patients.
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Affiliation(s)
- Ryan C Maves
- United States Naval Medical Research Center Detachment, Lima, Peru.
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Abstract
PURPOSE OF REVIEW The present review updates the reader on publications from the past 5 years relevant to ocular syphilis. RECENT FINDINGS Articles from this period are easily grouped into three categories: descriptions of syphilitic ocular manifestations, ocular syphilis in the setting of HIV infection, and treatment of syphilitic ocular disease. While all of the entities described were previously recognized, many are unusual and their description in connection with syphilis is a reminder to be vigilant for this uncommon but everpresent disease. Ocular syphilis can be more severe in patients with HIV infection who are not taking highly active antiretroviral therapy, while with this treatment syphilis is an increasingly likely cause of ocular inflammation. Ocular syphilis should be treated like neurosyphilis, with daily intravenous or intramuscular penicillin for 2 weeks. The prevalence of syphilis has increased markedly in the past 5 years, most notably among men who have sex with men. The fluorescent treponemal antibody assay and similar tests remain the appropriate diagnostic tests for syphilis in patients with ocular inflammation. SUMMARY Syphilis lingers on the differential diagnosis of all forms of ocular inflammation and should be considered when evaluating such patients.
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Thomas S, Wiselka M, Dhar J, Bibby K. Syphilis presenting as acute multifocal retino-choroiditis. J R Soc Med 2006. [PMID: 16816270 DOI: 10.1258/jrsm.99.7.371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Shery Thomas
- Department of Ophthalmology, Leicester Royal Infirmary, Leicester LE1 5WW, UK
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Rajan MS, Pantelidis P, Tong CYW, French GL, Graham EM, Stanford MR. Diagnosis of Treponema pallidum in vitreous samples using real time polymerase chain reaction. Br J Ophthalmol 2006; 90:647-8. [PMID: 16622098 PMCID: PMC1857041 DOI: 10.1136/bjo.2005.083196] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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