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

Pratas, Ana; Goldschmidt, Pablo; Lebeaux, David; Aguilar, Claire; Ermak, Natalia; Benesty, Jonathan; Charlier, Caroline; Benveniste, Edgar; Merabet, Lilia; Sédira, Neila; Hope-Rapp, Emilie; Chaumeil, C.; Bodaghi, Bahram; Héron, Emmanuel; Sahel, José‐Alain; Lortholary, Olivier; Errera, Marie‐Hélène

doi:10.3201/eid2402.171167

Cited by 40 publications

(24 citation statements)

References 39 publications

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“…[4][5][6] However, the vision is frequently impacted in this condition: in the largest series published to date, including 85 persons from The Netherlands, 58.8% presented with reduction in vision to a level that typically limits driving (Snellen visual acuity < 6/12) and 29.4% suffered blindness (Snellen visual acuity < 6/60). 7 Current studies from the United States, 6,8 Western Europe 9,10 and Brazil 11 suggest syphilitic uveitis is increasing in prevalence and incidence, in parallel with the systemic infection.…”

Section: Introductionmentioning

confidence: 99%

Current ophthalmology practice patterns for syphilitic uveitis

et al. 2019

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BackgroundSyphilitic uveitis is re-emerging alongside the systemic infection. In July 2017, an international group of uveitis-specialised ophthalmologists formed the International Ocular Syphilis Study Group to define current practice patterns.Methods103 Study Group members based in 35 countries completed a 25-item questionnaire focused on case load, clinical presentations, use and interpretation of investigations, treatment and clinical indicators of poor prognosis.ResultsMembers managed a mean of 6.1 patients with syphilitic uveitis in clinics that averaged 707 annual cases of uveitis (0.9%); 53.2% reported increasing numbers over the past decade. Patients presented to more members (40.2%) during secondary syphilis. Uveitis was usually posterior (60.8%) or pan (22.5%); complications included optic neuropathy, macular oedema and posterior synechiae. All members diagnosed syphilitic uveitis using serological tests (simultaneous or sequential testing algorithms), and 97.0% routinely checked for HIV co-infection. Cerebrospinal fluid (CSF) analysis was ordered by 90.2% of members, and 92.7% took uveitis plus Venereal Disease Research Laboratory test (VDRL) or fluorescent treponemal antibody absorption test (FTA-ABS) to indicate neurosyphilis. Patients were commonly co-managed with infectious disease physicians, and treated with penicillin for at least 10–14 days, plus corticosteroid. Features predicting poor outcome included optic neuropathy (86.3%) and initial misdiagnosis (63.7%). Reasons for delayed diagnosis were often practitioner-related. 82.5% of members tested every patient they managed with uveitis for syphilis.ConclusionThis comprehensive report by an international group of uveitis-specialised ophthalmologists provides a current approach for the management of syphilitic uveitis.

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Section: Introductionmentioning

confidence: 99%

Current ophthalmology practice patterns for syphilitic uveitis

et al. 2019

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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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“…Ocular manifestations occur in about 0.6–2% of all patients with syphilis at any stage of disease. [ 7 ] Clinical manifestations of ocular syphilis pose a diagnostic challenge to all clinicians. Some ocular findings described in syphilis include scleritis, interstitial keratitis, granulomatous or non-granulomatous anterior uveitis, intermediate uveitis, retinitis, chorioretinitis, choroiditis, papillitis, neuroretinitis, retinal vasculitis and placoid chorioretinitis[ 8 9 ] Hence, syphilitic uveitis may be considered a great masquerader.…”

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confidence: 99%

Clinical manifestations and outcomes of ocular syphilis in Asian Indian population: Analysis of cases presenting to a tertiary referral center

Tyagi

Kaza

Pathengay

et al. 2020

Indian J Ophthalmol

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Purpose: To describe disease manifestations and outcomes of ocular syphilis in Asian Indian population. Methods: Retrospective analysis of patients diagnosed with ocular syphilis at a tertiary referral center in India. Demographics, history, extraocular and ocular manifestations, ocular and systemic investigations, treatment and visual acuity outcomes were noted. All patients were diagnosed after necessary laboratory investigations including HIV ELISA (Human immunodeficiency virus, enzyme-linked immunosorbent assay), VDRL (venereal disease research laboratory), and TPHA (treponema pallidum hemagglutination). Results: Totally, 20 patients with mean age at presentation 38.25 ± 9.76 were analyzed. 9/20 patients had bilateral involvement. 8/20 had concurrent HIV at presentation with an average CD4 counts of 592.25 ± 411.34 cells/microliter. The mean duration of symptoms at time of presentation was 15.45 ± 35.15 weeks. VDRL test was reactive in 45% (9/20) patients whereas, all patients had a reactive TPHA test. Clinical manifestations included outer retinal placoid chorioretinitis lesions (8/20, 40%), followed by retinitis mimicking acute retinal necrosis as the second most common phenotype (4/20, 20%). Other presenting manifestations noted were panuveitis, miliary retinitis lesions, retinal vasculitis, intermediate uveitis, and anterior uveitis. The clinical phenotypes in immunocompromised included panuveitis, acute retinal necrosis and isolated anterior uveitis. Mean follow up duration was 6.32 ± 6.15 months. An improvement in mean best corrected visual acuity (BCVA) of (0.63 LogMAR, approximately 6 Snellen lines, P < 0.02) was noted at last follow-up. Conclusion: Phenotypic manifestations of ocular syphilis are varied. Non-treponemal tests like VDRL may be unreliable when compared with treponemal tests in diagnosing ocular syphilis. Syphilitic uveitis is considered equivalent to neurosyphilis and is treated similar to neurosyphilis.

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

Cited by 40 publications

References 39 publications

Current ophthalmology practice patterns for syphilitic uveitis

Current ophthalmology practice patterns for syphilitic uveitis

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

Clinical manifestations and outcomes of ocular syphilis in Asian Indian population: Analysis of cases presenting to a tertiary referral center

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