Patterns of Uveitis at Two University-Based Referral Centres in Cape Town, South Africa

Rautenbach, W.L.; Steffen, Jonel; Smit, Derrick; Lecuona, Karin; Esterhuizen, Tonya

doi:10.1080/09273948.2017.1391954

Cited by 21 publications

(10 citation statements)

References 22 publications

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“…2 This resurgence in syphilis cases in the United States corresponds with recent reports of ocular syphilis in nearly all regions of the globe, including the United Kingdom, Australia, South Africa, France, and China. 1,[3][4][5][6][7][8] Ocular syphilis classically presents as uveitis in secondary or tertiary syphilis and has been shown to affect all structures of the eye. 9 Although the timing of syphilis progression varies, a recent study has recorded a median time to ocular symptom development of 11 months following infection.…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics of a Case Series of Ocular Syphilis With 3 Cases Requiring Multiple Vitrectomies After Late Diagnosis

Nagarajan

Mundae

Tran

et al. 2020

Journal of VitreoRetinal Diseases

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Purpose: This work describes the characteristics and unique features of ocular syphilis. Methods: Ten serologically proven cases of ocular syphilis were retrospectively analyzed. Results: Eighteen eyes of 10 patients were affected. Nine of 10 patients were male and the mean age was 58 years (range, 36-81 years). HIV antibody testing was positive in 3 patients (30%). Five cases were first diagnosed by an ophthalmologist. One patient presented with a syphilitic rash. The most common ocular findings were panuveitis (n = 6) and cystoid macular edema (n = 4). Ocular involvement was unilateral in 2 cases and bilateral in 8. Best-corrected visual acuity improved in 13 of 18 eyes (72%) after treatment. Three cases developed recurrent retinal detachments that required repair with silicone oil. Conclusions: Most cases were HIV negative. Syphilitic uveitis can be the initial presentation of syphilis without classic systemic manifestation. Ophthalmologists play an important role in the diagnosis and treatment of syphilis.

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Section: Introductionmentioning

confidence: 99%

Clinical Characteristics of a Case Series of Ocular Syphilis With 3 Cases Requiring Multiple Vitrectomies After Late Diagnosis

Nagarajan

Mundae

Tran

et al. 2020

Journal of VitreoRetinal Diseases

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“…Italy (19.7% of panuveitis; 4.1% of all uveitis) [16] and Australia (5.5% of all uveitis) [17] have also reported higher rates of VKH. A referral centre in South Africa has published on local uveitis patterns with zero reported VKH cases over a 1.5-year period (198 patients) [18].…”

Section: Epidemiologymentioning

confidence: 99%

Vogt-Koyanagi-Harada disease

Joye

Suhler

2021

Current Opinion in Ophthalmology

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Purpose of reviewHere, we provide an overview of Vogt-Koyanagi-Harada disease (VKH), including recent updates in our understanding of disease pathophysiology, classification and therapeutics. Recent findingsAdvancements in bioinformatics, metabolomics and genomics investigations continue to illuminate VKH pathogenesis, and may provide insight into future therapeutic options. Multimodal imaging is indispensable in the initial evaluation of VKH, and is becoming increasingly important in understanding disease pathogenesis, as well as monitoring therapeutic response. Enhanced VKH classification criteria, released in 2021, provide standardized guidelines and terminology for clinical and research purposes.

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“…The risk factors most frequently documented are male sex, homosexuality and intravenous drug abuse, but the infection rates are also increasing in females and heterosexual individuals (1)(2)(3)(4)(5)(6)(7)(8). In 3 studies from South Africa, syphilis was identified as the cause of uveitis in 7% to 16.2% of cases (9)(10)(11).Ocular syphilis is diagnosed when ocular inflammation occurs in conjunction with a serologically confirmed systemic syphilis infection, and other causes for inflammation have been excluded. The relationship between ocular syphilis and neurosyphilis has been much debated, but it is assumed that, due to the embryological origin of the retina from the central nervous system, ocular syphilis is a clinical feature of neurosyphilis.…”

Section: Introductionmentioning

confidence: 99%

CXCL13, CXCL10 and CXCL8 as Indicators of Ocular and Neurological Involvement in Patients With Ocular Syphilis: An Observational Descriptive Study

Merwe¹,

Snyders²,

Kidd³

et al. 2022

Front. Ophthalmol.

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AimTo investigate the role of the chemokines CXCL13, CXCL10 and CXCL8 in the diagnosis of ocular- and neurosyphilis by examining the serum, aqueous humour (AH) and cerebrospinal fluid (CSF) of patients with ocular syphilis.MethodsAn observational descriptive study was performed prospectively at Tygerberg Academic Hospital in Cape Town, South Africa from 1 February 2018 till 31 January 2021 which enrolled 23 participants. 14 Patients were male and 9 female, 15 patients were HIV positive, and all patients were newly diagnosed with ocular syphilis. Upon diagnosis of ocular syphilis, the HIV status of each patient was determined, and 3 samples (AH, serum and CSF) were collected to measure the levels of CXCL13, CXCL10 and CXCL8 in each. All patients were treated with 14 days of intravenous Penicillin G and topical corticosteroid drops for uveitis.ResultsThe mean concentrations of all 3 biomarkers were higher in the AH and CSF than in the serum. The mean concentrations of the 3 measured biomarkers were markedly different when comparing both AH and CSF levels to serum levels. The level of CXCL13 measured in the AH correlated well with the concentrations found in the CSF of patients with neurosyphilis. In patients with neurosyphilis, mean AH levels of CXCL13 and CXCL10 were markedly higher than in serum while mean CSF levels of CXCL10 were also markedly higher than in serum. Also, the AH/serum ratio of CXCL13 and CXCL10, as well as the CSF/serum ratio of CXCL10, was much higher in patients with neurosyphilis than without. In patients with HIV infection, mean AH CXCL13 levels were much higher than in patients without HIV infection.ConclusionThe levels of CXCL13, CXCL10 and CXCL8 in the AH of patients with neurosyphilis are similar to previously reported levels in the CSF of patients with neurosyphilis and can potentially be an adjunct in the diagnosis of ocular syphilis. Patients with ocular syphilis who tested negative for neurosyphilis with conventional CSF testing showed features of neurosyphilis when analysing the CSF chemokines.

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Patterns of Uveitis at Two University-Based Referral Centres in Cape Town, South Africa

Abstract: This study emphasizes the importance of HIV testing and investigations for infectious causes of uveitis, especially syphilis, in this population.

Cited by 21 publications

References 22 publications

Clinical Characteristics of a Case Series of Ocular Syphilis With 3 Cases Requiring Multiple Vitrectomies After Late Diagnosis

Clinical Characteristics of a Case Series of Ocular Syphilis With 3 Cases Requiring Multiple Vitrectomies After Late Diagnosis

Vogt-Koyanagi-Harada disease

CXCL13, CXCL10 and CXCL8 as Indicators of Ocular and Neurological Involvement in Patients With Ocular Syphilis: An Observational Descriptive Study

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