Cargando…

Clinical and laboratory characteristics of ocular syphilis: a new face in the era of HIV co-infection

BACKGROUND: Ocular syphilis is reemerging as an important cause of uveitis in the new era of common co-infection with HIV. This study will reveal the clinical and laboratory characteristics in the group of individuals co-infected with ocular syphilis and HIV compared with HIV-negative individuals. I...

Descripción completa

Detalles Bibliográficos
Autores principales: Lee, Sun Young, Cheng, Vincent, Rodger, Damien, Rao, Narsing
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4546070/
https://www.ncbi.nlm.nih.gov/pubmed/26297110
http://dx.doi.org/10.1186/s12348-015-0056-x
_version_ 1782386846744969216
author Lee, Sun Young
Cheng, Vincent
Rodger, Damien
Rao, Narsing
author_facet Lee, Sun Young
Cheng, Vincent
Rodger, Damien
Rao, Narsing
author_sort Lee, Sun Young
collection PubMed
description BACKGROUND: Ocular syphilis is reemerging as an important cause of uveitis in the new era of common co-infection with HIV. This study will reveal the clinical and laboratory characteristics in the group of individuals co-infected with ocular syphilis and HIV compared with HIV-negative individuals. In this retrospective observational case series, medical records of patients diagnosed with ocular syphilis with serologic support from 2008 to 2014 were reviewed. Ocular and systemic manifestation and laboratory profiles were reviewed. RESULTS: Twenty-nine eyes of 16 consecutive patients (10 HIV-positive and 6 HIV-negative) were included. All patients were males, and mean age of onset for ocular syphilis was 43 (mean 42.65 ± 13.13). In both HIV-positive and HIV-negative groups, ocular manifestations of syphilis were variable including anterior uveitis (4 eyes), posterior uveitis (8 eyes), panuveitis (13 eyes), and isolated papillitis (4 eyes). In HIV-positive patients, panuveitis was the most common feature (12/18 eyes, 67 %) and serum rapid plasma reagin (RPR) titers were significantly higher (range 1:64–1:16,348; mean 1:768; p = 0.018) than in HIV-negative patients. Upon the diagnosis of ocular syphilis in HIV-positive patients, HIV-1 viral load was high (median 206,887 copies/ml) and CD4 cell count ranged from 127 to 535 cells/ml (mean 237 ± 142; median 137). Regardless of HIV status, cerebrospinal fluid (CSF) exam was frequently abnormal: positive CSF fluorescent treponemal antibody absorption (FTA-ABS) or Venereal Disease Research Laboratory (VDRL) test results in seven patients or either elevated CSF WBC count or elevated CSF protein in six patients. CONCLUSIONS: Our results reveal that the patients with ocular syphilis with high serum RPR titers may have concomitant HIV infection requiring further testing for HIV status and ocular syphilis is likely associated with the central nervous system involvement and therefore needs to be managed according to the treatment recommendations for neurosyphilis.
format Online
Article
Text
id pubmed-4546070
institution National Center for Biotechnology Information
language English
publishDate 2015
publisher Springer Berlin Heidelberg
record_format MEDLINE/PubMed
spelling pubmed-45460702015-08-26 Clinical and laboratory characteristics of ocular syphilis: a new face in the era of HIV co-infection Lee, Sun Young Cheng, Vincent Rodger, Damien Rao, Narsing J Ophthalmic Inflamm Infect Original Research Article BACKGROUND: Ocular syphilis is reemerging as an important cause of uveitis in the new era of common co-infection with HIV. This study will reveal the clinical and laboratory characteristics in the group of individuals co-infected with ocular syphilis and HIV compared with HIV-negative individuals. In this retrospective observational case series, medical records of patients diagnosed with ocular syphilis with serologic support from 2008 to 2014 were reviewed. Ocular and systemic manifestation and laboratory profiles were reviewed. RESULTS: Twenty-nine eyes of 16 consecutive patients (10 HIV-positive and 6 HIV-negative) were included. All patients were males, and mean age of onset for ocular syphilis was 43 (mean 42.65 ± 13.13). In both HIV-positive and HIV-negative groups, ocular manifestations of syphilis were variable including anterior uveitis (4 eyes), posterior uveitis (8 eyes), panuveitis (13 eyes), and isolated papillitis (4 eyes). In HIV-positive patients, panuveitis was the most common feature (12/18 eyes, 67 %) and serum rapid plasma reagin (RPR) titers were significantly higher (range 1:64–1:16,348; mean 1:768; p = 0.018) than in HIV-negative patients. Upon the diagnosis of ocular syphilis in HIV-positive patients, HIV-1 viral load was high (median 206,887 copies/ml) and CD4 cell count ranged from 127 to 535 cells/ml (mean 237 ± 142; median 137). Regardless of HIV status, cerebrospinal fluid (CSF) exam was frequently abnormal: positive CSF fluorescent treponemal antibody absorption (FTA-ABS) or Venereal Disease Research Laboratory (VDRL) test results in seven patients or either elevated CSF WBC count or elevated CSF protein in six patients. CONCLUSIONS: Our results reveal that the patients with ocular syphilis with high serum RPR titers may have concomitant HIV infection requiring further testing for HIV status and ocular syphilis is likely associated with the central nervous system involvement and therefore needs to be managed according to the treatment recommendations for neurosyphilis. Springer Berlin Heidelberg 2015-08-22 /pmc/articles/PMC4546070/ /pubmed/26297110 http://dx.doi.org/10.1186/s12348-015-0056-x Text en © Lee et al. 2015 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Research Article
Lee, Sun Young
Cheng, Vincent
Rodger, Damien
Rao, Narsing
Clinical and laboratory characteristics of ocular syphilis: a new face in the era of HIV co-infection
title Clinical and laboratory characteristics of ocular syphilis: a new face in the era of HIV co-infection
title_full Clinical and laboratory characteristics of ocular syphilis: a new face in the era of HIV co-infection
title_fullStr Clinical and laboratory characteristics of ocular syphilis: a new face in the era of HIV co-infection
title_full_unstemmed Clinical and laboratory characteristics of ocular syphilis: a new face in the era of HIV co-infection
title_short Clinical and laboratory characteristics of ocular syphilis: a new face in the era of HIV co-infection
title_sort clinical and laboratory characteristics of ocular syphilis: a new face in the era of hiv co-infection
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4546070/
https://www.ncbi.nlm.nih.gov/pubmed/26297110
http://dx.doi.org/10.1186/s12348-015-0056-x
work_keys_str_mv AT leesunyoung clinicalandlaboratorycharacteristicsofocularsyphilisanewfaceintheeraofhivcoinfection
AT chengvincent clinicalandlaboratorycharacteristicsofocularsyphilisanewfaceintheeraofhivcoinfection
AT rodgerdamien clinicalandlaboratorycharacteristicsofocularsyphilisanewfaceintheeraofhivcoinfection
AT raonarsing clinicalandlaboratorycharacteristicsofocularsyphilisanewfaceintheeraofhivcoinfection