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BACKGROUND: The global shift in healthcare during the COVID-19 pandemic led to challenges in the care of people living with HIV. METHODS: We conducted a retrospective study that aimed to delineate sociodemographic, clinical characteristics and outcomes, of people living with HIV diagnosed with ocular syphilis. RESULTS: Fifty-three people living with HIV were identified with ocular syphilis. Thirty-eight (71.6%) presented ocular symptoms. Twenty-three (43.3%) underwent lumbar puncture, 5 (9.4%) were positive for neurosyphilis. Forty-seven (88.6%) received treatment, 32 (68%) received standard treatment with aqueous crystalline penicillin G, and 15 (31.9%) were treated with alternative regimens due to the impossibility of hospitalization. Six (11.3%) individuals were lost to follow-up and/or did not receive treatment. Eighteen (56.2%) out of 32 individuals in the aqueous crystalline penicillin G group experienced serological response, 5 (15.6%) experienced treatment failure, and 9 (28.1%) were lost to follow-up. In the alternative therapy group, 12 out of 15 individuals (80%) experienced serological response. One (6.7%) experienced treatment failure, and 2 (13.3%) were lost to follow-up. CONCLUSIONS: During the COVID-19 health emergency in Mexico, alternative treatments for ocular syphilis demonstrated favorable clinical outcomes amid challenges in accessing hospitalization.
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COVID-19 , Infecções por HIV , Sífilis , Humanos , Masculino , Feminino , Estudos Retrospectivos , COVID-19/epidemiologia , COVID-19/complicações , Adulto , Infecções por HIV/tratamento farmacológico , Infecções por HIV/complicações , Pessoa de Meia-Idade , Sífilis/tratamento farmacológico , Sífilis/complicações , Sífilis/epidemiologia , SARS-CoV-2 , Antibacterianos/uso terapêutico , Infecções Oculares Bacterianas/epidemiologia , Infecções Oculares Bacterianas/tratamento farmacológico , Resultado do Tratamento , Neurossífilis/tratamento farmacológico , Neurossífilis/complicações , Neurossífilis/epidemiologia , Penicilina G/uso terapêuticoRESUMO
OBJECTIVE: To analyze the frequent multimodal imaging features in posterior syphilitic uveitis. PURPOSE: Syphilis infection has re-emerged as a global health problem. Multimodal imaging approach has been proposed for diagnosis and follow-up; there are not previous reports dedicated to the anatomic and visual outcomes in patients diagnosed with ocular syphilis and concomitant HIV infection. METHODS: All demographic information was recovered; a complete ophthalmological examination and multimodal imaging evaluation (retinal fluorescein angiography (FA), autofluorescence (AF), optical coherence tomography (OCT)) were performed on initial visit and 1 month after antibiotic therapy. RESULTS: 18 eyes of 9 patients were included. The most frequent features observed were: Hyperfluorescence on optic disk on FA, Hyperautofluorescence punctate pattern on AF, Vitritis on SD-OCT. After treatment, there was a functional and anatomical improvement. CONCLUSION: Ocular syphilis represents a diagnostic challenge. Multimodal imaging approach allows identification of structural changes, follow-up and early detection of complications.
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We report the findings observed in a young woman with ocular syphilis complicated with retinal and disc neovascularization successfully treated with intravitreal bevacizumab. Fluorescein angiography revealed in both eyes intense hyperfluorescence at the level of the disc, multifocal venous wall staining, multifocal paravenous leakage, multiple peripheral saccular venular dilations, diffuse retinal and macular edema, and retinal and disc neovascularization. There was no evidence of retinal ischemia in both eyes. After antibiotic and corticosteroid treatment, the neovascularization persisted in both eyes. Three consecutive doses of intravitreal bevacizumab were administered, with total regression of the retinal and disc neovascularization. Disc and retinal neovascularization along with nonocclusive retinal vasculitis may be a form of presentation of ocular syphilis. Combination of specific treatment, oral corticosteroids, and intravitreal bevacizumab may be useful for treating this clinical manifestation.
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Introducción: La sífilis es una enfermedad de transmisión sexual causada por el Treponema pallidum. Reportes recientes de diferentes regiones del mundo sugieren que la sífilis ocular está reemergiendo en paralelo con el incremento de la incidencia de la infección sistémica a nivel global. Objetivo: Profundizar en el conocimiento sobre la sífilis, especialmente, en la sífilis ocular, que se encuentra en la bibliografía especializada. Métodos: Fundamentalmente se consultaron artículos de los últimos 5 años, en idioma español e inglés, disponibles en textos completos. Las bases de datos consultadas fueron: PubMed, SciELO y Google académico. Conclusiones: La sífilis ocular puede presentarse en cualquier estadío de la enfermedad e imitar diferentes afecciones inflamatorias oculares, por lo que debe tenerse presente en el diagnóstico diferencial de toda uveítis. El tratamiento oportuno de estos pacientes puede minimizar el daño visual, pero su diagnóstico es a menudo un desafío para el oftalmólogo(AU)
Introduction: Syphilis is a sexually transmitted disease caused by Treponema pallidum. Recent reports from different regions of the world suggest that ocular syphilis is re-emerging, in parallel with the increasing incidence of systemic infection globally. Objective: To deepen the knowledge on syphilis and especially ocular syphilis found in the specialized literature. Methods: The articles consulted were mainly from the last 5 years, in Spanish and English, available in full text. The databases consulted were PubMed, SciELO and Google academic. Conclusions: Ocular syphilis can present at any stage of the disease and mimic different ocular inflammatory conditions, so it should be taken into account in the differential diagnosis of any uveitis. Prompt treatment of these patients can minimize visual damage but its diagnosis is often a challenge for the ophthalmologist(AU)
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Humanos , Sífilis/epidemiologia , Infecções Sexualmente Transmissíveis/etiologia , Literatura de Revisão como Assunto , Bases de Dados BibliográficasRESUMO
The objective of this work was to collect updated information on Treponema pallidum, Chlamydia trachomatis and Neisseria gonorrhoeae, causing sexually transmitted infections (STIs) and etiological agents of eye infections, to provide relevant information on this public health problem. For this, a bibliographic review was carried out using different electronic databases such as: PubMed central, google academic, Lilacs, Scopus, Science Direct and Scielo, between March 2009 and August 2019. According to the WHO, more than a million people a day contract a sexually transmitted infection. For T. pallidum, a global prevalence of 0.5% is estimated for both men and women. It is a causative agent of syphilis and ocular syphilis, which manifests as uveitis. Overall, a prevalence of 2.8% in men and 3.8% in women for C. trachomatis is estimated. It is associated with oculo-genital disease, which includes STIs, inclusion conjunctivitis in adults and neonatal ophthalmia. Among its complications is trachoma, which is the leading cause of infectious blindness worldwide. Regarding N. gonorrhoeae, it has a global selection of 0.9% and 0.7% in women and men, respectively. It manifests with gonococcal conjunctivitis and neonatal ophthalmia. We can conclude that the information that relates T. pallidum, C. trachomatis and N. gonorrhoeae with their ocular compromise problems is insufficient, and even more so if we seek to find them related to each other, which makes it difficult to access data of clinical utility for visual health.
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Infecções por Chlamydia , Infecções Oculares Bacterianas , Doenças Genitais , Gonorreia , Adulto , Chlamydia trachomatis , Feminino , Gonorreia/epidemiologia , Humanos , Recém-Nascido , MasculinoRESUMO
Syphilis and HIV infection may coexist in the same individual. Ocular syphilis and/or neurosyphilis may develop at any stage of coinfection, with a stronger association between ocular and neurosyphilis in individuals living with HIV, than in HIV-uninfected individuals. The diagnosis of ocular syphilis in HIV-infected and -uninfected patients remains with some controversy due to unspecific clinical manifestations and limited diagnostic tests. Penicillin is the mainstay of treatment of ocular syphilis, but alternative options are warranted. This review describes the epidemiology, pathophysiology, and clinical manifestations, as well as the diagnostic and therapeutic challenges posed by ocular syphilis against the background of HIV coinfection.
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Infecções Oculares Bacterianas , Infecções por HIV/complicações , Sífilis , Antibacterianos/uso terapêutico , Infecções Oculares Bacterianas/complicações , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/tratamento farmacológico , Humanos , Penicilinas/uso terapêutico , Sífilis/complicações , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Sorodiagnóstico da SífilisRESUMO
Resume: La sífilis ocular es una forma infrecuente de neurosífilis, que se puede presentar en cualquier estadio de la enfermedad. La presentación clínica puede ser heterogénea, siendo la forma más frecuente la uveítis. El diagnóstico se confirma con serología, debiéndose realizar estudio del líquido cefalorraquídeo para descartar compromiso meníngeo. Su detección y tratamiento precoz permiten la prevención de complicaciones neurológicas como la ceguera irreversible. Presentamos el caso clínico de un paciente que se presenta con panuveítis y diagnóstico serológico de sífilis presentando excelente respuesta al tratamiento instaurado.
Abstract. Ocular syphilis is an uncommon type of neurosyphilis, which can occur at any stage of the disease. The clinical presentation can be heterogeneous, with uveitis being the most frequent form. The diagnosis is confirmed with serology and a study of the cerebrospinal fluid should be performed to rule out meningeal involvement. Its diagnosis and early treatment allow the prevention of neurological complications such as irreversible blindness. We present a clinical case of a patient who presents with panuveitis and serological diagnosis of syphilis presenting an excellent response to treatment.
Resumo: A sífilis ocular é uma apresentação atípica do neurosífilis, que pode ocorrer em qualquer estágio da doença. A apresentação clínica pode ser heterogênea, sendo a uveíte a forma mais frequente. O diagnóstico é confirmado com sorologia e um estudo do líquido cefalorraquidiano deve ser realizado para descartar o compromisso meníngeo. Seu diagnóstico e tratamento precoce permitem prevenir complicações neurológicas como cegueira irreversível. Apresentamos um caso clínico de um paciente com panuveíte e diagnóstico sorológico de sífilis e excelente resposta ao tratamento.
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PURPOSE: To describe the spectral domain optical coherence tomography (SD-OCT) features of a punctate inner retinitis, a rare ocular manifestation of syphilis, in an HIV positive adult patient. OBSERVATIONS: In the right eye, SD-OCT images during the active period showed hyperreflectivity of the full thickness of the inner retina, precluding the individualization of the layers. In addition, multifocal areas with higher hyperreflectivity were identified within the affected retina. Once the lesion became inactive, SD-OCT images revealed inner retina layers atrophy, disruption of the ellipsoid layer, and multifocal damage to the retinal pigment epithelium layer. CONCLUSION AND IMPORTANCE: Punctate inner retinitis affects the full thickness retina, leading to severe retinal damage, along with multifocal damage of the retinal pigment epithelium. The multifocal white retinal lesions observed within the affected retinal area correlated with the presence of intense hyperreflective dots within the retina showed by SD-OCT. These lesions are deeper than was described in other reports.
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ABSTRACT Background During the first decade of this century, a significant increase in the incidence of syphilis was documented. Objective To study clinical and laboratory characteristics of central nervous system and ocular syphilis. Methods A retrospective case series of 13 patients with a clinical and laboratory diagnosis of neurosyphilis and/or ocular syphilis who had been admitted to the Neurology and Neuro-ophthalmology Service of the Hospital de Clínicas, Federal University of Paraná. Results Nine patients had a diagnosis of neurosyphilis and two of them also had ocular syphilis. Four patients had a diagnosis of ocular syphilis alone. Among the patients with a diagnosis of neurosyphilis, six had symptomatic syphilitic meningitis, of whom one manifested as cranial nerve palsy alone, one as cranial nerve palsy plus ocular syphilis, two as transverse myelitis (syphilitic meningomyelitis), one as meningitis worsening the patient's myasthenia gravis symptoms and one as meningitis plus ocular syphilis. Additionally, we diagnosed three patients with meningovascular neurosyphilis. In the univariate analysis, patients without ocular syphilis showed greater levels of total protein and white blood cells in the cerebrospinal fluid than patients with ocular syphilis. Conclusion This Brazilian case series of patients with neurosyphilis and ocular syphilis highlights the wide variability of this disease. A high degree of diagnostic suspicion is necessary when facing neurological and ocular symptoms for rapid diagnosis and appropriate management of patients.
RESUMO Introdução Na primeira década deste século observou-se um aumento significativo da incidência de sífilis no mundo. Objetivo Estudar características clínicas e laboratoriais da sífilis no Sistema Nervoso Central e da sífilis ocular. Métodos Estudou-se, retrospectivamente, uma série de treze casos com diagnóstico clínico e laboratorial de neurossífilis e/ou sífilis ocular, admitidos aos Serviços de Neurologia ou Neuroftalmologia do Hospital de Clínicas da Universidade Federal do Paraná. Resultados Nove pacientes tiveram diagnóstico de neurosífilis e dois destes apresentaram concomitantemente sífilis ocular. Quatro pacientes tiveram somente o diagnóstico de sífilis ocular. Dos pacientes com diagnóstico de neurosífilis, seis apresentaram meningite sifilítica sintomática, dentre os quais um se apresentou com paralisia isolada de par craniano, um com paralisia de par craniano associada sífilis ocular, dois com mielite transversa (manifestação de meningomielite), um com meningite que agravou sintomas de Miastenia Gravis e um com meningite isolada associada a sífilis ocular. Houve 3 casos de neurosífilis meningovascular. Na análise univariada, pacientes sem manifestações oculares de sífilis apresentaram maiores níveis proteína total e leucócitos do que os pacientes com sífilis ocular. Conclusão Essa série brasileira de casos de pacientes com neurosífilis e sífilis ocular destaca a alta variabilidade clínica desta doença. Alto grau de suspeição diagnóstica é necessário quando em frente a sintomas neurológicos e oculares para rápido diagnóstico e adequado manejo dos pacientes.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Infecções Oculares Bacterianas/diagnóstico , Neurossífilis/diagnóstico , Sorodiagnóstico da Sífilis , Imageamento por Ressonância Magnética , Angiofluoresceinografia , Infecções Oculares Bacterianas/complicações , Infecções Oculares Bacterianas/líquido cefalorraquidiano , Estudos Retrospectivos , Neurossífilis/complicações , Neurossífilis/líquido cefalorraquidianoRESUMO
PURPOSE: To report the spectral domain optical coherence tomography (SD-OCT) features of a focal retinitis in an elderly male patient with bilateral syphilitic panuveitis. OBSERVATIONS: In the left eye (LE), spectral domain SD-OCT images during the active period revealed hyperreflectivity extending through the full thickness of the retina with no individualization of the layers, except for the retinal pigment epithelium. Once the lesion healed, SD-OCT imaging revealed an inner retinal atrophy and a mild disruption of the retinal pigment epithelium. CONCLUSIONS AND IMPORTANCE: In our patient, treponemal infection seemed to produce full-thickness retinal damage with partial involvement of the retinal pigment epithelium. The severe retinal damage, in this case, led to a poorer visual outcome than in other forms of syphilitic retinal involvement.
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Resumen: la neuritis óptica es infrecuente como manifestación de sífilis ocular, la falta de características típicas genera retraso en el diagnóstico. Describimos el caso de una mujer de 47 años , inmunocompetente con historia de 4 meses de disminución progresiva de la agudeza visual de predominio izquierdo, asociado a dolor, inyección conjuntival y cefalea, al examen físico con visión de bultos y al fondo de ojo con signos de inflamación ocular dentro de la evaluación diagnostica presenta: VDRL y FTA-ABS positivo en suero, positividad de ANAS y anticuerpos anticardiolipinas igG, LCR con VDRL reactivo, se diagnostica neuritis óptica por neurosifilis en presencia de anticuerpos antifosfolipidos, iniciando tratamiento con penicilina cristalina 24 000 000 de unidades día por 14 días. En pacientes con signos de inflamación ocular debe realizarse VDRL, confirmarse con prueba treponemica, y realizar punción lumbar, el tratamiento precoz se asocia a mejora de desenlaces visuales.
Abstract :optic neuritis is uncommon as an ocular syphilis clinical presentation; the lack of typical features generates delay in the diagnosis. We describe the case of a 47-year-old woman, immunocompetent with a 4-month history of left visual acuity progressive of left side reduction, associated with pain, conjunctival injection and headache, physical examination with lumpy vision and fundus with signs of ocular inflammation, within the diagnostic evaluation, serum VDRL, FTA-ABS was reactive, with ANAS and IgG anticardiolipin antibodies serum positivity, lumbar punction was taken with reactive VDRL, optic neuritis by neurosyphilis was diagnosed, with antiphospholipid antibodies cross reactivity , treatment with crystalline penicillin 24 000 000 of units day for 14 days was started . In patients with signs of ocular inflammation, VDRL should be performed, confirmed with a treponemal test, and a lumbar puncture should be performed. Early treatment is associated with improvement of visual outcomes.
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Humanos , Feminino , Pessoa de Meia-Idade , Visão Ocular , Sífilis , Neurite Óptica , Anticorpos Antifosfolipídeos , Fundo de Olho , Anticorpos , Dor , Punção Espinal , Imunoglobulina G , Acuidade Visual , Anticorpos AnticardiolipinaRESUMO
PURPOSE: To characterize the immunologic profile in aqueous humor (AqH) of HIV-infected individuals with cytomegalovirus retinitis (CMVr) or ocular syphilis and to assess if AqH and plasma represent independent cytokine compartments. METHODS: Concentrations of 27 cytokines in AqH and plasma of HIV-infected individuals with CMVr (n = 23) or ocular syphilis (n = 16) were measured by multiplex assay. Cytokine profiles of both groups were compared. RESULTS: Individuals with CMVr had higher plasma concentrations of interleukin (IL)-7, IL-8, IL-10, interferon (IFN)-γ, IFN-α2, G-CSF, IP-10 and IL-1α; as well as higher AqH concentrations of IL-1α, IP-10 and GM-CSF than those with ocular syphilis. AqH and plasma levels correlated only for IP-10 in both ocular infections. CONCLUSIONS: Individuals with CMVr had higher plasma cytokine levels than those with ocular syphilis. The immunologic profiles in AqH and plasma are independent. Therefore, AqH cytokine concentrations cannot be inferred from plasma cytokine concentrations in the population studied.
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Humor Aquoso/metabolismo , Citocinas/sangue , Retinite por Citomegalovirus/sangue , Infecções Oculares Bacterianas/sangue , Infecções por HIV/sangue , Sífilis/sangue , Adulto , Humor Aquoso/virologia , Contagem de Linfócito CD4 , Feminino , Humanos , Masculino , RNA Viral/genética , Carga ViralRESUMO
Introduction: Ocular manifestations in patients with syphilis may involve almost any of the structures of the eye. Objectives: To describe ten new cases of syphilis with eye involvement and to briefly discuss the management and therapy of such condition. Material and Methods: Ten cases were retrospectively studied over 13 years. Demographic factors, ophthalmologic examination, and laboratory tests were assessed. Results: Seven of the 10 cases were male and 3 were female. The mean age of patients was 39,7 years. Disease presentation included: panuveitis (6 patients), optic neuritis (3), retinal vasculitis (1) and Argyll-Robertson pupil (1). Cerebrospinal fluid VDRL test was positive in 6 patients and 3 patients were HIV (+). Conclusions: Syphilis is able to display diverse ophthalmologic manifestations. Not in all the cases the CSF-VDRL test was positive. Antitreponemal therapy generates a fast and effective response in the affected patients.
Introducción: Las manifestaciones oculares de los pacientes con sífilis pueden comprometer cualquiera de las estructuras del ojo. Objetivos: Describir diez nuevos casos de sífilis con compromiso ocular y realizar una breve discusión de su manejo y tratamiento. Pacientes y Métodos: Se estudiaron, de forma retrospectiva, diez casos en un período de 13 años. Se evaluaron factores demográficos, exámenes oftalmológico y de laboratorio. Resultados: De los diez casos, 7 eran hombres y 3 mujeres. El promedio de edad fue de 39,7 años. Las presentaciones fueron: panuveítis (n: 6), neuritis óptica (n: 3), vasculitis retinal (n: 1) y pupila de Argyll-Robertson (n: 1). Se obtuvo VDRL (+) en líquido cefalorraquídeo en 6 pacientes y serología para VIH (+) en 3 pacientes. Conclusiones: La sífilis puede producir variadas manifestaciones oftalmológicas. No en todos los casos el VDRL resultó positivo en el LCR. El tratamiento anti-treponémico produce una rápida y efectiva respuesta en los pacientes afectados.