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Xu D, Jiang Y, Lun W, Cao Y, Xu X, Wang B, Li R, Chen C, Huang Y, Zeng H. Characteristic Profiling of Soluble Factors in the Cerebrospinal Fluid of Patients With Neurosyphilis. J Infect Dis 2024; 230:221-230. [PMID: 39052737 DOI: 10.1093/infdis/jiae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/17/2023] [Accepted: 01/15/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Soluble inflammatory factors in the cerebrospinal fluid (CSF) of patients with neurosyphilis have been investigated with low-throughput technology. This study aimed to illustrate the characteristics of soluble factor profiles in CSF of patients with neurosyphilis. METHODS We measured the concentrations of 45 cytokines, chemokines, and growth factors in CSF from 112 untreated syphilis cases, including latent syphilis (LS), asymptomatic neurosyphilis (ANS), meningeal neurosyphilis (MNS), meningovascular neurosyphilis (MVNS), paralytic dementia (PD), and ocular syphilis (OS). RESULTS Thirty-three differentially expressed soluble factors (DeSFs) were categorized into 3 clusters. DeSF scores of clusters 1 and 2 (DeSFS1 and DeSFS2) were positively correlated with elevated neopterin and neurofilament light subunit (NF-L) concentration, respectively. DeSF scores of cluster 3 were positively correlated with white blood cells, protein, NF-L, and neopterin. Patients with LS, ANS, and OS exhibited an overall lower abundance of DeSFs. Patients with PD exhibited significantly increased levels of clusters 1 and 3, and the highest total DeSF score, whereas patients with MNS and MVNS showed enhanced levels of cluster 2. Receiver operating characteristic analysis revealed that DeSFS1 effectively discriminated PD, and DeSFS2 discriminated MNS/MVNS with high accuracy. CONCLUSIONS Patients with neurosyphilis at different stages have distinctive patterns of soluble factors in CSF, which are correlated with immune status and neuronal damage.
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Affiliation(s)
- Dongmei Xu
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Yu Jiang
- Biomedical Innovation Center, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
- Beijing Key Laboratory for Therapeutic Cancer Vaccines, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Wenhui Lun
- Department of Dermatology and Venereology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Yu Cao
- Biomedical Innovation Center, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
- Beijing Key Laboratory for Therapeutic Cancer Vaccines, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Xiaoxue Xu
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Beibei Wang
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Rui Li
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Chen Chen
- Biomedical Innovation Center, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
- Beijing Key Laboratory for Therapeutic Cancer Vaccines, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Yuming Huang
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Hui Zeng
- Biomedical Innovation Center, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
- Beijing Key Laboratory for Therapeutic Cancer Vaccines, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
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2
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Oliveira R, Carvalho L, Ramos A, Cardoso MJ, Guimarães JT. A rare case of syphilitic uveitis in a 61-year-old non-HIV woman. Porto Biomed J 2024; 9:242. [PMID: 38264519 PMCID: PMC10803014 DOI: 10.1097/j.pbj.0000000000000242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Affiliation(s)
- Rita Oliveira
- Serviço de Patologia Clínica, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Lídia Carvalho
- Serviço de Patologia Clínica, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Angélica Ramos
- Serviço de Patologia Clínica, Centro Hospitalar Universitário de São João, Porto, Portugal
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Maria João Cardoso
- Serviço de Patologia Clínica, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - João Tiago Guimarães
- Serviço de Patologia Clínica, Centro Hospitalar Universitário de São João, Porto, Portugal
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Departamento de Biomedicina, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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3
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Franke M, Walker T, Sukharutski YA, Force CR. An Incidental Diagnosis of Neurosyphilis: A Case Report. Cureus 2023; 15:e49299. [PMID: 38957199 PMCID: PMC11218605 DOI: 10.7759/cureus.49299] [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: 11/23/2023] [Indexed: 07/04/2024] Open
Abstract
Neurosyphilis, a rare manifestation of Treponema pallidum spreading into the central nervous system, is a critical differential diagnosis due to its potentially severe neurologic effects if left untreated. We present a case of a 37-year-old woman who complained of bilateral vision loss and headaches originally concerning for idiopathic intracranial hypertension and uncontrolled diabetes. Comprehensive evaluations eventually led to a neurosyphilis diagnosis. Ophthalmologic examination revealed multifactorial visual symptoms with diabetic retinopathy contributing alongside neurosyphilis. Treatment was started promptly at the time of diagnosis and resulted in improvement in visual symptoms. This case emphasizes the importance of syphilis screening in appropriate age ranges, even in low-prevalence areas. Recognition of neurosyphilis as a potential diagnosis can impact patient outcomes and highlights the need for continued vigilance to identify the disease.
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Affiliation(s)
- Madeline Franke
- Internal Medicine, Texas A&M College of Medicine, Houston, USA
| | - Tanner Walker
- Internal Medicine, Texas A&M College of Medicine, Houston, USA
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4
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Lucas V, De Paepe A, Vanden Bossche S, Sven D. The great imitator: latent neurosyphilis presenting with uveitis and labyrinthitis. Acta Neurol Belg 2023; 123:2017-2019. [PMID: 36057737 DOI: 10.1007/s13760-022-02083-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Verniers Lucas
- Department of Radiology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium.
| | - Andreas De Paepe
- Department of General Internal Medicine and Infectious Diseases, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Stephanie Vanden Bossche
- Department of Radiology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Dekeyzer Sven
- Department of Radiology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
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5
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Liu L, Xu D, Chen F, Cai S, Wei J, Deng J, Zheng J, Jin Q, Lun W. Identification of potential biomarkers for diagnosis of syphilis from the cerebrospinal fluid based on untargeted metabolomic analysis. Mol Omics 2023. [PMID: 37185577 DOI: 10.1039/d3mo00026e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The infection rate of syphilis continues to rise globally, and the difficulty in diagnosis of neurosyphilis promptly needs to be resolved. More specific and sensitive diagnostic markers for latent syphilis and neurosyphilis should be found. Here the metabolic profiles of 88 cerebrospinal fluid samples from syphilis patients and controls were analyzed by LC/MS-based untargeted metabolomics. In total, 272 metabolites based on 3937 features obtained in ESI- mode and 252 metabolites based on 3799 features in ESI+ mode were identified. The experimental process was evaluated by principal component analysis, partial least squares discriminant analysis, and hierarchical cluster analysis. A clear separation between latent syphilis and neurosyphilis was found. Levels of lipid and linoleic acid metabolites, such as 9-oxo-octadecadienoic acid and 9,10,13-trihydroxyoctadecenoic acid, were increased in syphilis patients. In patients with neurosyphilis, significant changes in levels of 5-hydroxy-L-tryptophan (5-HTP) and acetyl-N-formyl-5-methoxykynurenamine (AFMK) in the tryptophan-kynurenine pathway were also detected. Only one metabolite, theophylline, differed significantly between symptomatic and asymptomatic neurosyphilis patients. Additionally, KEGG analysis revealed significant enrichment of tryptophan metabolism pathways, indicating a high correlation between tryptophan metabolism and syphilis symptoms. Levels of linoleic acid metabolites, 5-HTP, AFMK and theophylline were significantly altered in different patients. The role of these differential metabolites in the development of syphilis is worthy of further exploration. Our results may promote the development of biomarkers for diagnosis of latent syphilis from neurosyphilis, and for that of asymptomatic neurosyphilis from symptomatic neurosyphilis in the future.
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Affiliation(s)
- Liguo Liu
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
| | - Dongmei Xu
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Fengxin Chen
- Infections Disease Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Shengnan Cai
- Department of infectious diseases, Yantai Qishan Hospital, Yantai, Shandong, 264001, China
| | - Jin Wei
- Department of dermatology and venereology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Jiaheng Deng
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
| | - Jianhua Zheng
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
| | - Qi Jin
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
| | - Wenhui Lun
- Department of dermatology and venereology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
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6
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Zhou J, Zhang H, Tang K, Liu R, Li J. An Updated Review of Recent Advances in Neurosyphilis. Front Med (Lausanne) 2022; 9:800383. [PMID: 36203756 PMCID: PMC9530046 DOI: 10.3389/fmed.2022.800383] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
Neurosyphilis is caused by Treponema pallidum invading the central nervous system, of which the incidence is increasing worldwide. Due to its variable clinical manifestations, diagnosis of neurosyphilis remains challenging, especially the asymptomatic form. This review focuses on recent advances in neurosyphilis, including epidemiology, clinical manifestations, laboratory findings, comorbidities, diagnosis, treatment, prognosis, and basic research. The expansion of men who have sex with men and the infection of human immunodeficiency virus mainly accounted for the increasing incidence of neurosyphilis. The rate of some historically described forms of neurosyphilis in the pre-antibiotic era declined significantly; atypical features are more prevalent. Neurosyphilis, regarded as a great mimicker for neuro-ophthalmic, audio-vestibular, and psychiatric disorders, often presents concomitantly with other diseases, including metabolic disorders. Studies on long non-coding RNAs, miRNAs, chemokines, and metabolites in peripheral blood and cerebrospinal fluid may facilitate exploring the pathogenesis and identifying novel biomarkers of neurosyphilis. The drug resistance of Treponema pallidum to penicillin has not been reported; ceftriaxone was proposed to be more effective than penicillin, whereas few randomized controlled trials supported this view. This study may pave the way for further research, especially the diagnosis and treatment of neurosyphilis.
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Affiliation(s)
- Jia Zhou
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hanlin Zhang
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Keyun Tang
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Runzhu Liu
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jun Li
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Jun Li
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7
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He S, Messner AH, Mirani G. Otosyphilis: A Rare Cause of Reversible Hearing Loss in a Teenage Male. Cureus 2022; 14:e23468. [PMID: 35494944 PMCID: PMC9038597 DOI: 10.7759/cureus.23468] [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] [Accepted: 03/23/2022] [Indexed: 11/05/2022] Open
Abstract
A high index of suspicion and a thorough neurotologic examination at the onset of presentation are imperative to generate the diagnosis of otosyphilis. Complete audiologic recovery is rare but possible in approximately 20%-25% of patients after appropriate treatment. We present a case of reversible hearing loss secondary to otosyphilis in a teenage male patient with a new diagnosis of human immunodeficiency virus (HIV). Audiology findings were consistent with mixed hearing loss. Lumbar puncture results were consistent with neurosyphilis. Prompt treatment with a 14-day course of intravenous penicillin led to the complete recovery of hearing. In this case report, the pathophysiology, symptomology, and management of otosyphilis are discussed.
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8
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Treponema pallidum Tp0751 alters the expression of tight junction proteins by promoting bEnd3 cell apoptosis and IL-6 secretion. Int J Med Microbiol 2022; 312:151553. [DOI: 10.1016/j.ijmm.2022.151553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 02/04/2022] [Accepted: 03/13/2022] [Indexed: 02/02/2023] Open
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9
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Garcia JJB, Coralde JL, Bagnas MAC, Khu KJO. Isolated Cranial Nerve VI Palsy and Neurosyphilis: A Case Report and Review of Related Literature. IDCases 2022; 27:e01377. [PMID: 35036319 PMCID: PMC8749207 DOI: 10.1016/j.idcr.2022.e01377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 11/26/2022] Open
Abstract
An isolated cranial nerve VI palsy is a rare initial manifestation of undiagnosed neurosyphilis. A 33-year-old male presented with a one month history of progressive headache and diplopia. Neurologic examination only revealed an isolated abducens palsy on the left. Cranial imaging was unremarkable. Examination of his cerebrospinal fluid revealed lymphocytic predominant leukocytosis and elevated protein. Microbiologic work-up were all negative. Further work-up revealed the patient to be serum Rapid Plasma Reagin and Enzyme Immunoassay reactive. Enzyme-linked immunosorbent assay for Human Immunodeficiency Virus also tested positive. His cerebrospinal fluid was then sent for Rapid Plasma Reagin to confirm the diagnosis of neurosyphilis. He completed 14 days of intravenous penicillin and was eventually discharged with partial resolution of the abducens palsy. We describe the second case of neurosyphilis presenting only with an isolated cranial nerve VI involvement. On further review, ours was the first case documented on an individual who had an undiagnosed Human Immunodeficiency Virus infection. There are various differentials for an isolated cranial neuritis but infectious causes, particularly neurosyphilis, should be considered among young individuals with known risk factors despite their apparently benign medical history.
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Key Words
- AIDS, Acquired Immunodeficiency Syndrome
- CALAS, Cryptococcal Antigen Latex Agglutination System
- CDC, Centers for Disease Control and Prevention
- CN, cranial nerve
- CNS, central nervous system
- CSF, erebrospinal fluid
- EIA, Enzyme immunoassay
- FTA-ABS, Fluorescent Treponemal Antibody Absorption
- HIV, Human Immunodeficiency Virus
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- RBC, red blood cells
- RPR, Rapid Plasma Reagin
- USA, United States of America
- VDRL, Venereal Disease Research Laboratory
- WBC, white blood cells
- abducens nerve
- casse report
- cranial nerve VI
- neuritis
- neurosyphilis
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Affiliation(s)
- Jao Jarro B. Garcia
- Division of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Philippines
| | - Jalea L. Coralde
- Division of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Philippines
| | | | - Kathleen Joy O. Khu
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Philippines
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10
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Cohen SP, Wang EJ, Doshi TL, Vase L, Cawcutt KA, Tontisirin N. Chronic pain and infection: mechanisms, causes, conditions, treatments, and controversies. BMJ MEDICINE 2022; 1:e000108. [PMID: 36936554 PMCID: PMC10012866 DOI: 10.1136/bmjmed-2021-000108] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/10/2022] [Indexed: 12/20/2022]
Abstract
Throughout human history, infection has been the leading cause of morbidity and mortality, with pain being one of the cardinal warning signs. However, in a substantial percentage of cases, pain can persist after resolution of acute illness, manifesting as neuropathic, nociplastic (eg, fibromyalgia, irritable bowel syndrome), or nociceptive pain. Mechanisms by which acute infectious pain becomes chronic are variable and can include immunological phenomena (eg, bystander activation, molecular mimicry), direct microbe invasion, central sensitization from physical or psychological triggers, and complications from treatment. Microbes resulting in a high incidence of chronic pain include bacteria such as the Borrelia species and Mycobacterium leprae, as well as viruses such as HIV, SARS-CoV-2 and herpeses. Emerging evidence also supports an infectious cause in a subset of patients with discogenic low back pain and inflammatory bowel disease. Although antimicrobial treatment might have a role in treating chronic pain states that involve active infectious inflammatory processes, their use in chronic pain conditions resulting from autoimmune mechanisms, central sensitization and irrevocable tissue (eg, arthropathy, vasculitis) or nerve injury, are likely to cause more harm than benefit. This review focuses on the relation between infection and chronic pain, with an emphasis on common viral and bacterial causes.
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Affiliation(s)
- Steven P Cohen
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Departments of Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Departments of Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Eric J Wang
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Tina L Doshi
- Departments of Anesthesiology & Critical Care Medicine and Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lene Vase
- Department of Psychology, Aarhus University Hospital, Aarhus, Denmark
| | - Kelly A Cawcutt
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Nuj Tontisirin
- Department of Anaesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, Mahidol University, Bangkok, Thailand
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11
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Emami S, Christakis PG. A masquerader epidemic: five heterogeneous ocular syphilis presentations. Can J Ophthalmol 2021; 57:e81-e83. [PMID: 34537137 DOI: 10.1016/j.jcjo.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/07/2021] [Accepted: 08/17/2021] [Indexed: 11/27/2022]
Affiliation(s)
| | - Panos G Christakis
- University of Toronto, Toronto, Ont.; Toronto Western Hospital, Toronto, Ont..
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12
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Montebello A, Harmsworth D, Cassar PJ, Vella S. Neurosyphilis in a suspected case of giant cell arteritis. BMJ Case Rep 2021; 14:e242733. [PMID: 34497053 PMCID: PMC8438723 DOI: 10.1136/bcr-2021-242733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2021] [Indexed: 11/03/2022] Open
Abstract
A 67-year-old man had a few month history of deteriorating visual acuity. He had originally presented to ophthalmology with right-sided visual blurring. This subsequently progressed to involve the left eye. At this point, he was empirically treated with high-dose glucocorticoids, both orally and intravenously, with the suspicion that giant cell arteritis was causing acute visual deterioration of his left eye. Unfortunately, his symptoms did not improve. During an admission to hospital for a pneumonia, he underwent further investigations for this bilateral visual loss. He was diagnosed with left neuroretinitis and right vitritis. A thorough workup revealed positive syphilis serology and cerebrospinal fluid was positive on venereal disease research laboratory testing. He was diagnosed and treated for neurosyphilis with intravenous benzylpenicillin 4 million units 4 hourly for 14 days. His left-sided vision improved but he still suffers from severe visual impairment in his right eye.
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Affiliation(s)
| | - Daniela Harmsworth
- Rheumatology and General Internal Medicine, Mater Dei Hospital, Msida, Malta
| | - Paul John Cassar
- Rheumatology and General Internal Medicine, Mater Dei Hospital, Msida, Malta
- University of Malta Medical School, Msida, Malta
| | - Sandro Vella
- Diabetes and Endocrinology, Mater Dei Hospital, Msida, Malta
- University of Malta Medical School, Msida, Malta
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13
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Jahnke S, Lange CSD, Wienrich R, Kreft B. Okuläre Syphilis - eine Fallserie von vier Patienten. J Dtsch Dermatol Ges 2021; 19:987-992. [PMID: 34288478 DOI: 10.1111/ddg.14464_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/09/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Stephanie Jahnke
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Halle (Saale) der Martin-Luther-Universität Halle- Wittenberg, Halle (Saale)
| | - Cord Sunderkötter Danica Lange
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Halle (Saale) der Martin-Luther-Universität Halle- Wittenberg, Halle (Saale)
| | - Ricarda Wienrich
- Universitätsklinik und Poliklinik für Augenheilkunde, Universitätsklinikum Halle (Saale) der Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
| | - Burkhard Kreft
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Halle (Saale) der Martin-Luther-Universität Halle- Wittenberg, Halle (Saale)
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14
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Alqurashi MM, Badr M, Bukhari A. Ocular Syphilis Presenting As Non-arteritic Anterior Ischemic Optic Neuropathy. Cureus 2021; 13:e16694. [PMID: 34466324 PMCID: PMC8396798 DOI: 10.7759/cureus.16694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 11/11/2022] Open
Abstract
Syphilis is a sexually transmitted disease caused by the spirochetal bacteria Treponema pallidum. It can cross the blood-brain barrier within days of the infection, causing neurosyphilis and ocular syphilis at any stage of the disease. Ocular syphilis can manifest in any part of the eye but usually as posterior uveitis and pan-uveitis or various types of inflammatory or immune-mediated optic neuritis. Misdiagnosing ocular syphilis as a non-infectious disease has been reported even when seen by ophthalmologists due to the wide variety of possible presentations. In this case report, we describe a case of ocular syphilis that presented with a non-arteritic anterior ischemic optic neuropathy (NA-AION), which to our knowledge, has not been described before in the literature.
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Affiliation(s)
- Moayad M Alqurashi
- Division of Adult Infectious Diseases, Deprtment of Medicine, Prince Sultan Military Medical City, Riyadh, SAU
| | - Maha Badr
- Department of Ophthalmology, Prince Sultan Military Medical City, Riyadh, SAU
| | - Abdullah Bukhari
- Department of Medicine, Faculty of Medicine, Imam Mohammed Ibn Saud Islamic University, Riyadh, SAU
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15
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Jahnke S, Sunderkötter C, Lange D, Wienrich R, Kreft B. Ocular syphilis - a case series of four patients. J Dtsch Dermatol Ges 2021; 19:987-991. [PMID: 33951294 DOI: 10.1111/ddg.14464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/09/2021] [Indexed: 01/18/2023]
Abstract
Ocular manifestations of syphilis with visual impairment symptoms may occur already at the stage of secondary syphilis. They may also be the only manifestation of syphilis and mimic other diseases of the eye. Therefore, in all patients with uveitis, optic neuritis, optic atrophy, acute ocular muscle paresis, or loss of visual acuity, syphilis infection should be ruled out, even if the medical history does not initially raise suspicion. Ocular involvement should be treated as neurosyphilis. Delayed diagnosis and inadequate therapy are often associated with irreversible consequences for the affected patient. As with any syphilis infection, HIV infection should be considered and excluded, especially in the case of ocular manifestations.
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Affiliation(s)
- Stephanie Jahnke
- University Hospital and Clinic for Dermatology and Venereology, University Hospital Halle (Saale) of Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Cord Sunderkötter
- University Hospital and Clinic for Dermatology and Venereology, University Hospital Halle (Saale) of Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Danica Lange
- University Hospital and Clinic for Dermatology and Venereology, University Hospital Halle (Saale) of Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ricarda Wienrich
- University Hospital and Clinic for Ophthalmology, University Hospital Halle (Saale) of Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Burkhard Kreft
- University Hospital and Clinic for Dermatology and Venereology, University Hospital Halle (Saale) of Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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16
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Tsan GL, Claiborne RT. Ocular syphilis. Clin Exp Optom 2021; 104:756-759. [PMID: 33831337 DOI: 10.1080/08164622.2021.1906848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Syphilis is a sexually transmitted, systemic, inflammatory disease caused by the spirochaete, Treponema pallidum. The natural history of untreated syphilis progresses through four distinct stages: primary, secondary, latent, and tertiary syphilis. Ocular involvement can occur at any stage of syphilis and any part of the eye can be affected. With the exception of syphilitic posterior placoid chorioretinitis, the diverse manifestations of ocular syphilis have few distinct features that can be used to assist in clinical diagnosis. Therefore, ocular syphilis should always be a part of the differential diagnosis of most, if not all, ocular infectious and inflammatory presentations. Specifically, uveitis presentations, high-risk sexual history, illicit drug use history, treatment failure, prior history of syphilis should prompt further diagnostic workup for ocular syphilis. A presumptive diagnosis of ocular syphilis relies on serological testing, both treponemal and nontreponemal tests. All patients with ocular syphilis should have their cerebrospinal fluids tested for the co-existence of neurosyphilis and their blood tested for human immunodeficiency virus co-infection. In the United States, Centers for Disease Control and Prevention recommend that ocular syphilis be managed according to its treatment guidelines for neurosyphilis, with parenteral aqueous crystalline penicillin G the drug of choice. With the timely diagnosis and appropriate treatment, ocular syphilis is curable. However, delayed diagnosis of ocular syphilis may result in long-term visual impairment. Delayed diagnosis occurs because of its diverse presentations mimicking other ocular diseases, and failure of the clinician to order serological testing. With the recent worldwide resurgence of ocular syphilis, clinicians should be familiar with the manifestation, diagnosis, and treatment of ocular syphilis.
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Affiliation(s)
- Grace L Tsan
- Optometry Service, Veterans Affairs Portland Health Care System, Portland, OR, USA
| | - Richard T Claiborne
- Department of Optometry, Northwest Permanente-Kaiser Permanente, Portland, OR, USA
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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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