Clinical Manifestations and Outcomes of Syphilis-associated Uveitis in Northern Spain

Fonollosa, Alex; Martínez-Indart, Lorea; Artaraz, Joseba; Martínez-Berriotxoa, Agustín; Agirrebengoa, Koldo; García, M.; López‐Soria, Leire; Sorribas, M.; Díaz-Valle, D.; Blanco, R.; Rueda-Gotor, Javier; Adán, Alfredo; Llorenç, Víctor; Cordero‐Coma, Miguel; Distéfano, Laura; Segura, Antonio; Blanco, Ana

doi:10.3109/09273948.2014.943349

Cited by 28 publications

(51 citation statements)

References 20 publications

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“…Coinfection of syphilis and HIV was only observed in one patient, and the sexual history was difficult to assess in our study because of traditional Chinese customs. Compared with other reports [4, 10], the frequency of co-infection of HIV in our patients with syphilitic uveitis was much lower, which may be due to the low prevalence of HIV in China, especially in northern China [16]. There were more female patients than male patients in our cohort.…”

Section: Discussioncontrasting

confidence: 74%

Characteristics of syphilitic uveitis in northern China

Zhang¹,

Du²,

Ma³

et al. 2017

BMC Ophthalmol

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BackgroundTo describe the characteristics of patients with syphilitic uveitis in northern China.MethodsA case series of 21 patients (33 eyes) diagnosed with syphilitic uveitis from 2011 to 2016 at a tertiary center in northern China was retrospectively analyzed.ResultsTwenty-one patients (33 eyes) were diagnosed as syphilitic uveitis. Posterior segment involvement was found in 32 eyes (97.0%). Vitreous haze, neuroretinitis, and posterior placoid chorioretinitis were mainly found in patients with a relatively short duration of the disease, while diffuse chorioretinitis, pseudoretinitis pigmentosa, cystoid macular edema, and epiretinal membrane were found in patients with relatively long duration of ocular involvement. A low best-corrected visual acuity (P = 0.022) and a delay of syphilis treatment (P < 0.001) were associated with a significantly worse visual outcome.ConclusionsSyphilitic uveitis should be included in the differential diagnosis of any form of posterior ocular inflammation. The pattern of ocular involvement may change with the disease progression.

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Section: Discussioncontrasting

confidence: 74%

Characteristics of syphilitic uveitis in northern China

Zhang¹,

Du²,

Ma³

et al. 2017

BMC Ophthalmol

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“…Since the use of penicillin in the mid‐20th century, the spread of the disease has been largely controlled, although efforts to eradicate it entirely have been unsuccessful (World Health Organization ). During the last decade, the number of syphilis cases has been on the rise in developed western countries, primarily attributable to increased cases among men and, specifically, among men reporting to have sex with men (MSM; Fonollosa et al …”

Section: Introductionmentioning

confidence: 99%

The great imitator on the rise: ocular and optic nerve manifestations in patients with newly diagnosed syphilis

Klein

Fischer

Goldstein

et al. 2018

Acta Ophthalmologica

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Purpose Ocular manifestations of syphilis have been reported in 2–10% of systemic infection. The purpose of this study was to report the incidence of ocular syphilis and various ocular manifestations, particularly optic nerve involvement, in newly diagnosed cases. Methods This was a retrospective study. Medical records of newly diagnosed syphilis patients between January 2009 and January 2017 in a tertiary medical centre were reviewed. Results There were 123 new systemic syphilis cases out of 569,222 (0.02%) admissions to the Tel Aviv Medical Center during the study period. Ninety‐three of the 123 patients (76%) underwent ophthalmological examination. Twenty‐three of the 93 patients (25%, mean age 48.6 ± 12.9 years, 20 males) had ocular syphilis, and in 12/23 (52%) patients, the ocular symptoms and findings prompted syphilis investigation. Eighteen of the 23 (78%) had optic nerve involvement, and the most common was inflammatory disc oedema. Older age (p = 0.0005) and tertiary stage disease (p = 0.0441) were associated with ocular manifestations and the presence of optic nerve findings. Human immunodeficiency virus (HIV) was associated with ocular but not optic nerve findings. Treatment included intravenous penicillin G, and four patients with severe optic neuropathy were also treated with systemic corticosteroids. Visual acuity significantly improved in most patients (p < 0.05). Conclusion Ocular syphilis was found in one‐quarter of the patients diagnosed with systemic syphilis and preceded the diagnosis of systemic disease in one‐half of them. Optic nerve involvement was a common manifestation. A high index of suspicion for Treponema infection is required in patients presenting with optic nerve involvement to facilitate prompt diagnosis and treatment. Post‐treatment visual outcome was good.

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“…Most studies (31/32) were retrospective; only one was a prospective study [26]. Nine studies compared the clinical features and treatment outcomes between patients coinfected with HIV versus patients without HIV infection [17, 19, 22, 23, 26, 27, 33, 34, 37]. …”

Section: Resultsmentioning

confidence: 99%

“…Antibacterial agents were used as monotherapy in 286 patients in 15 studies [14, 17, 20, 23, 27, 30, 34, 35, 37, 39, 40, 42–45]. The mean age of the patients ranged from 37 to 58 years.…”

Section: Resultsmentioning

confidence: 99%

“…Eight studies [17, 21, 22, 24, 27, 28, 30, 36] involving 190 patients (318 eyes) reported ocular complications that included cataract ( n = 41), ocular hypertension ( n = 15), posterior synechiae ( n = 15), chorioretinal scarring ( n = 12), epiretinal membrane ( n = 12), macular edema ( n = 10), optic disc atrophy ( n = 10), and retinal detachment ( n = 8) (Table 5). …”

Section: Resultsmentioning

confidence: 99%

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Clinical Features and Treatments of Syphilitic Uveitis: A Systematic Review and Meta-Analysis

Zhang

Zhu

2017

Journal of Ophthalmology

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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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Clinical Manifestations and Outcomes of Syphilis-associated Uveitis in Northern Spain

Abstract: In our series, patients with syphilitic uveitis were more usually middle-aged men and were frequently co-infected with HIV. Although most patients showed posterior segment involvement, visual prognosis was good.

Cited by 28 publications

References 20 publications

Characteristics of syphilitic uveitis in northern China

Characteristics of syphilitic uveitis in northern China

The great imitator on the rise: ocular and optic nerve manifestations in patients with newly diagnosed syphilis

Clinical Features and Treatments of Syphilitic Uveitis: A Systematic Review and Meta-Analysis

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