Use of Lumbar Punctures in the Management of Ocular Syphilis

Reekie, Ian; Reddy, Yaviche

doi:10.1080/08820538.2016.1228986

Cited by 17 publications

(17 citation statements)

References 7 publications

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“…Four cases were known to be HIV positive, one HIV negative, and the status was unknown for the remaining three cases. Thirty-one (45.6%) patients underwent lumbar puncture (not all of whom had CSF serologica testing) and, of these, a quarter (n = 8) had CSF findings felt to be consistent with neurosyphilis [ 53 ]. In five cases this was a reactive CSF FTA-ABS and, in three cases, this was a CSF lymphocyic pleocytosis.…”

Section: Resultsmentioning

confidence: 99%

Neurosyphilis in Africa: A systematic review

et al. 2017

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IntroductionNeurological involvement is one of the most important clinical manifestations of syphilis and neurological disease occurs in both early and late syphilis. The impact of HIV co-infection on clinical neurosyphilis remains unclear. The highest prevalence of both syphilis and HIV is in Africa. Therefore it might be expected that neurosyphilis would be an important and not uncommon manifestation of syphilis in Africa and frequently occur in association with HIV co-infection; yet few data are available on neurosyphilis in Africa. The aim of this study is to review data on neurosyphilis in Africa since the onset of the HIV epidemic.MethodsWe searched the literature for references on neurosyphilis in Africa for studies published between the 1st of January 1990 and 15th February 2017. We included case reports, case series, and retrospective and prospective cohort and case-control studies. We did not limit inclusion based on the diagnostic criteria used for neurosyphilis. For retrospective and prospective cohorts, we calculated the proportion of study participants who were diagnosed with neurosyphilis according to the individual study criteria. Depending on the study, we assessed the proportion of patients with syphilis found to have neurosyphilis, and the proportion of patients with neurological syndromes who had neurosyphilis. Due to heterogeneity of data no formal pooling of the data or meta-analysis was undertaken.ResultsAmongst patients presenting with a neurological syndrome, three studies of patients with meningitis were identified; neurosyphilis was consistently reported to cause approximately 3% of all cases. Three studies on stroke reported mixed findings but were limited due to the small number of patients undergoing CSF examination, whilst neurosyphilis continued to be reported as a common cause of dementia in studies from North Africa. Ten studies reported on cases of neurosyphilis amongst patients known to have syphilis. Studies from both North and Southern Africa continue to report cases of late stage syphilis, including tabes dorsalis and neurosyphilis, in association with ocular disease.DiscussionThis is the first systematic review of the literature on neurosyphilis in Africa since the beginning of the HIV epidemic. Neurosyphilis continues to be reported as a manifestation of both early and late syphilis, but the methodological quality of the majority of the included studies was poor. Future well-designed prospective studies are needed to better delineate the incidence and clinical spectrum of neurosyphilis in Africa and to better define interactions with HIV in this setting.

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Section: Resultsmentioning

confidence: 99%

Neurosyphilis in Africa: A systematic review

et al. 2017

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“…The eyes, especially the retina and the optic nerve, are considered part of the central nervous system [11]. This explains the frequent association of ocular syphilis with neurosyphilis and justifies the recent classification of ocular syphilis as a form of neurosyphilis [12].…”

Section: Discussionmentioning

confidence: 99%

Ocular syphilis – a case series of four patients

Jahnke

Sunderkötter

Lange

et al. 2021

J Deutsche Derma Gesell

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Summary Ocular manifestations of syphilis with visual impairment symptoms may occur already at the stage of secondary syphilis. They may also be the only manifestation of syphilis and mimic other diseases of the eye. Therefore, in all patients with uveitis, optic neuritis, optic atrophy, acute ocular muscle paresis, or loss of visual acuity, syphilis infection should be ruled out, even if the medical history does not initially raise suspicion. Ocular involvement should be treated as neurosyphilis. Delayed diagnosis and inadequate therapy are often associated with irreversible consequences for the affected patient. As with any syphilis infection, HIV infection should be considered and excluded, especially in the case of ocular manifestations.

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“…These differences in ocular syphilitic forms could be related to several treponemal strains originating from distinct regions and diverse isolation dates ( 32 ). Five different strains in 14 patients have been identified previously ( 33 ).…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the sensitivity of PCR tests on CSF could be questioned because sensitivity was low even in intraocular samples. 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.…”

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.

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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).

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Use of Lumbar Punctures in the Management of Ocular Syphilis

Cited by 17 publications

References 7 publications

Neurosyphilis in Africa: A systematic review

Neurosyphilis in Africa: A systematic review

Ocular syphilis – a case series of four patients

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

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