Purpose
To 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.
Methods
This 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.
Results
A 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.
Conclusion
Ocular 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.
Below: Represents the color photo of the left eye at pre-treatment
and post-treatment phases.
Notes: (A) Color photo of left eye with
sclerokeratitis discloses 2+ scleral injection at the nasal quadrant associated
with limbal corneal thinning at 9 o’clock position. (B) Color photo of
left eye with sclerokeratitis discloses resolution of scleral injection and
limbal corneal thinning with frequent instillation of topical prednisolone
acetate at the 10th day of penicillin therapy.
Full article at: http://goo.gl/NUljae
By:
1Department of Ophthalmology/Uveitis, Dunya
Goz Hospital, Ankara, Turkey
2Department of Ophthalmology, Boston
University School of Medicine, Boston, MA, USA
3Department of Ophthalmology, Dunya Eye
Hospital Ltd, Ankara, Turkey
Correspondence: Ozlem Sahin, Department of
Ophthalmology/Uveitis, Dunya Goz Hospital, Tunus Caddesi No 28 Kavaklıdere,
Cankaya, Ankara 06690, Turkey, Tel +90 312 416 7000, Email moc.oohay@8511melzo
More at: https://twitter.com/hiv
insight
No comments:
Post a Comment