Polymerase Chain Reaction Testing of Vitreous in Atypical Ocular Syphilis

Troutbeck, Robyn; Chhabra, Ramandeep; Jones, Nicholas P.

doi:10.3109/09273948.2013.770887

Cited by 22 publications

(21 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…remaining HIV+ patient was PCR positive for Treponema pallidum in a vitreous sample but had negative serology and this has been previously reported. 8 Three patients had previously been treated for syphilis, no episodes involving the eye. One patient presented with visual symptoms having just commenced doxycycline treatment for secondary syphilis; in the remainder (97%), presentation was with visual symptoms, and ocular signs provoked serology leading to diagnosis.…”

Section: Resultsmentioning

confidence: 99%

Ocular syphilis: the re-establishment of an old disease

Wells

Wood²,

Sukthankar³

et al. 2017

Eye

View full text Add to dashboard Cite

PurposeTo present the patient profiles, clinical presentations and visual outcomes in those diagnosed with ocular syphilis, attending a subspecialist uveitis service in northern England over a 15-year period.Patients and methodsRetrospective observational case series of patients presenting between January 2002 and December 2016.ResultsA total of 50 eyes of 34 patients had intraocular inflammation due to syphilis. Of these, 94% were male, and 75% were men who had sex with men. Ten (29%), all male, were HIV-positive. Presentations included isolated anterior non-granulomatous uveitis, intermediate uveitis, panuveitis, retinitis, placoid chorioretinitis and papillitis. Concurrent skin rash and/or headache were seen in 41%. Compliance with antibiotic treatment was complete, but there was a high rate of default from ophthalmological follow-up (38%). Visual improvement was seen in 92% of eyes, and at final assessment 71% had acuity of 6/9 or better.ConclusionsOcular syphilis is continuing to increase in incidence, in tandem with the continuing epidemic of early syphilis in the UK (the risk of ocular involvement being about 1%). Almost all are male, and most are men who have sex with men. Clinical presentation is variable; a high index of suspicion and a low threshold for serological testing is important; early treatment can reverse retinal changes and restore visual acuity.

show abstract

Section: Resultsmentioning

confidence: 99%

Ocular syphilis: the re-establishment of an old disease

Wells

Wood²,

Sukthankar³

et al. 2017

Eye

View full text Add to dashboard Cite

show abstract

“…Indeed, because of the variable sensitivity of CSF tests ( 26 ), no CSF test result can definitively exclude a diagnosis of neurosyphilis ( 33 ). Because experience with PCR tests on intraocular fluids is limited ( 36 , 37 ), we suggest not relying on CSF results in such complex cases, preferring to examine CSF only when an alternate or concomitant infection is suspected (e.g., Herpesviridae and Mycobacterium tuberculosis infections), because syphilis is known to mimic many other causes of uveitis. Recently, PCR in CSF has been shown to be highly specific in the diagnosis of neurosyphilis ( 26 ), offering guidance in case of treatment failure or in supporting the clinical diagnosis of ocular syphilis or neurosyphilis when several co-infections other than syphilis are also detected.…”

Section: Discussionmentioning

confidence: 99%

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

Pratas¹,

Goldschmidt²,

Lebeaux³

et al. 2018

Emerg. Infect. Dis.

View full text Add to dashboard Cite

We describe the frequency, demographic and clinical features, and visual outcomes of ocular syphilis infections observed during 2012–2015 at a tertiary reference center in Paris, France. Twenty-one cases (29 eyes) were identified. The occurrence of ocular syphilis increased from 1 case in 2012 to 5 cases in 2013, 6 cases in 2014, and 9 cases in 2015 (2.22–25.21/1,000 individual patients/year for the period). Among case-patients, an annual 20%–33% were co-infected with HIV. Seventy-six percent of ocular syphilis infections occurred in men who have sex with men. Seventy-five percent of case-patients had a good final visual outcome (best-corrected visual acuity >0.3 logMAR score). Visual outcome was worse for HIV-positive patients than for HIV-negative patients (p = 0.0139). At follow-up, the best visual outcomes were observed in patients whose mean time from first ocular symptom to consultation was 15 days (SD +19 days).

show abstract

“…Finally, although FUS has been strongly associated with rubella virus, it was not tested in our study [36]. One further pathogen that was not tested with PCR but which merits consideration in relevant clinical settings is Treponema pallidum [37]. Although Treponema pallidum infections were considered almost eradicated in developed countries, epidemiologic studies confirm steady increase of primary syphilis infections with a considerable percentage of secondary, ocular manifestations requiring prompt diagnosis and treatment [38, 39].…”

Section: Discussionmentioning

confidence: 99%

Aqueous humor polymerase chain reaction in uveitis – utility and safety

et al. 2016

View full text Add to dashboard Cite

BackgroundTo study the value and safety of aqueous humor polymerase chain reaction (PCR) analysis for Herpes simplex, varicella zoster, cytomegalovirus, Epstein-Barr virus and Toxoplasma gondii in patients with uveitis.MethodsRecords of 45 consecutive patients with anterior and posterior uveitis who underwent AC paracentesis with PCR were reviewed. The main outcome measure was frequency of PCR positivity. Secondary outcomes were alteration of treatment, safety of paracentesis, and correlation of keratitic precipitates with PCR positivity,ResultsThe overall PCR positivity was 48.9 % (22/45). Therapy was changed because of the PCR results in 14/45 patients (37.7 %). One patient experienced a paracentesis related complication (1/45, 2.2 %) without long-term sequelae.ConclusionAqueous PCR altered the diagnosis and treatment in over a third of our patients and was relatively safe. Aqueous PCR should be considered for uveitis of atypical clinical appearance, recurrent severe uveitis of uncertain etiology, and therapy refractory cases.

show abstract

Polymerase Chain Reaction Testing of Vitreous in Atypical Ocular Syphilis

Abstract: Ocular syphilis may be present in atypical fashion, and delayed treatment may lead to irreversible visual loss. Sampling of intraocular fluid for PCR testing may confirm diagnosis and lead to appropriate treatment.

Cited by 22 publications

References 6 publications

Ocular syphilis: the re-establishment of an old disease

Ocular syphilis: the re-establishment of an old disease

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

Aqueous humor polymerase chain reaction in uveitis – utility and safety

Contact Info

Product

Resources

About