Clinical and laboratory characteristics of ocular syphilis, co-infection, and therapy response

Abstract

PurposeTo describe the clinical presentation of patients diagnosed with presumed latent ocular syphilis and congenital ocular syphilis at tertiary referral center in Turkey, and to compare the clinical findings with patients described in other studies, specifically focusing on demographics and co-infections.MethodsThis is a retrospective study reviewing the medical records of patients diagnosed with ocular inflammation between January 2012 and June 2014 at a tertiary referral center in Turkey. Ocular syphilis was diagnosed on the basis of non-treponemal and treponemal antibody tests, and cerebrospinal fluid analysis. All the patients diagnosed with ocular syphilis were tested for human immunodeficiency virus (HIV), Toxoplasma gondii, rubella, cytomegalovirus, and herpes.ResultsA total of 1,115 patients were evaluated between January 2012 and June 2014, and 12 patients (1.07%) were diagnosed with ocular syphilis based on the inclusion criteria. None of the patients were seropositive for HIV. Two patients were seropositive for T. gondii-specific IgG. Clinical presentations include non-necrotizing anterior scleritis, non-necrotizing sclerokeratitis, anterior uveitis, intermediate uveitis, posterior uveitis, panuveitis, and optic neuritis. All of the patients showed clinical improvement in the level of ocular inflammation with intravenous penicillin 24 million U/day for 10 days. Three patients received additional oral methotrexate as an adjunctive therapy. Two cases received low-dose trimethoprim–sulfamethoxazole.ConclusionOcular syphilis is an uncommon cause of ocular inflammation in HIV-negative patients. Central retinochoroiditis is the most common ocular manifestation, and it is the most common cause of visual impairment. Ocular syphilis might present associated with co-infections such as T. gondii in developing countries. Oral methotrexate might be beneficial as an adjunctive therapy for ocular syphilis in resolving the residual intraocular inflammation and cystoid macular edema after specific therapy with intravenous penicillin.

Increase in Ocular Syphilis Cases at Ophthalmologic Reference Center, France, 2012–2015

“…Syphilis is known to display diverse ophthalmologic manifestations, which our study affirmed. The most common finding was posterior uveitis manifesting as placoid chorioretinitis (58%), which has been noted in previous reports ( 14 , 23 , 29 – 31 ). Posterior placoid chorioretinitis is an extremely specific clinical sign for the diagnosis of syphilis.…”

“…A predominantly male cohort of patients has been reported in all studies, including ours ( 7 , 14 , 22 , 23 , 28 ). In our study, 76% of ocular syphilitic cases occurred in MSM.…”

“…We considered placoid chorioretinitis to be the presence of > 1 placoid, yellowish, outer retinal lesions. Fundus fluorescein angiography, indocyanine green angiography, and fundus autofluorescence indicate a typical fluorescent pattern in cases of placoid chorioretinitis ( 22 , 23 ).…”

“…The use of corticosteroids to control the degree of inflammation remains undefined in the current treatment guidelines. Oral and topical corticosteroids have been used in the past in association with antibiotic treatment ( 4 , 23 , 38 – 40 ). Although topical corticosteroids can be used freely to help control anterior segment inflammation ( 40 ), intravitreal injections of triamcinolone appear to be harmful ( 39 , 41 ).…”

Eye lesions in syphilis

“…Всем пациентам была проведена визометрия, биомикроскопия, офтальмоскопия глазного дна, кинетическая периметрия и ультразвуковое исследование (УЗИ) в B-режиме, оптическая когерентная томография (ОКТ), электрофизиологические исследования (ЭФИ), включая электроретинографию (ЭРГ). Значимость использования ОКТ в диагностике поражения органа зрения при сифилисе определяется высокой разрешающей способностью метода в сравнении с УЗИ, магнитно-резонансной томографией (МРТ) и компьютерной томографией (КТ) для визуализации поражения структур глазного яблока, вплоть до клеточного уровня [26][27][28][29]. По результатам обследования были отобраны 2 наиболее показательных клинических примера.…”