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Infectious Optic Neuropathies
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Imran Rizvi, Ravindra Kumar Garg
Ophthalmological manifestations are common in syphilis. Common eye complications are scleritis, panuveitis, dacyroadenitis, chorioretinitis, vitritis, keratitis, oculomotor palsies and optic neuropathy.33 Ocular involvement is generally part of central nervous system involvement. The optic nerve in syphilis is involved in secondary or tertiary stages.2 The syphilitic optic neuropathy can be unilateral or bilateral, often without involvement of the anterior segment.2 Syphilitic optic neuropathy presents either as papillitis, chiasmal syndrome, neuroretinitis, optic nerve gumma or optic nerve perineuritis.34–36 There can also be cortical vision loss. Appropriate tests for the diagnosis of ocular syphilis are fluorescent treponemal antibody absorption assay or the Treponema pallidum particle agglutination assay. The non-treponemal tests, like venereal disease research laboratory (VDRL), fail to diagnose late stages of syphilis.37 Intravenous penicillin G is the drug of choice for all forms of syphilis. Intramuscular benzathine penicillin along with oral probenecid is another option. Newer treatment options include drugs with good cerebrospinal fluid penetration, like ceftriaxone and azithromycin.38
Urinary Tract Infections, Genital Ulcers and Syphilis
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
For serology, non-treponemal tests, for example, rapid plasma reagent (RPR) and Venereal Disease Research Laboratory (VDRL) tests, are usually performed as screening tests but are non-specific; they are usually reported as a titre, for example, 1:32. Treponemal tests, for example; Treponema pallidum particle agglutination assay (TPPA), Treponema pallidum haemagglutination (TPHA) and fluorescent treponemal antibody absorption (FTA-ABS), detect antibodies against specific treponemal antigens so are more specific. Some rapid diagnostic tests (RDTs) are available; however, they do not differentiate between active or previously treated infection. False positives occur in endemic treponemal infections, for example; yaws, bejel, pinta and some immune conditions. Neurosyphilis requires examination of the cerebrospinal fluid (CSF).
Vulval Ulceration
Published in Tony Hollingworth, Differential Diagnosis in Obstetrics and Gynaecology: An A-Z, 2015
Primary syphilis typically gives rise to a single, painless indurated ulcer with a clear serous discharge, known as a chancre. It appears between 10 and 90 (average 21) days following infection. Less commonly, chancres may be painful, multiple, and destructive; therefore, any anogenital ulcer should be considered to be due to syphilis until proven otherwise. Genital lesions in women often escape notice because they are hidden inside the vagina or on the cervix. A chancre must be distinguished from an epi-thelioma. If an epithelioma is suspected, both the ulcer and swelling should be excised and examined histologically. The serous fluid from a chancre contains the spirochete Treponema pallidum, which can be seen under a microscope with the aid of dark ground illumination. Serological testing with treponemal enzyme immunoassay (EIA) is recommended if primary syphilis is suspected. Antitreponemal EIA for IgM is usually positive 2 weeks following infection and IgG by 4–5 weeks. The currently recommended serological tests to confirm diagnosis include the Venereal Disease Research Laboratory/rapid plasma reagin test (VDRL/RPR), Treponema pallidum particle agglutination assay (TPPA), or Treponema pallidum particle haemagglutination assay (TPPHA). To exclude primary syphilis in the sexual contacts of those infected with syphilis, or in patients with dark-ground negative ulcerative lesions, serological tests should be performed at 6 weeks and 3 months post presentation.
Ocular Syphilis: Experience over 11 Years at a German Ophthalmology Reference Centre
Published in Ocular Immunology and Inflammation, 2023
R. Yaici, A. Balasiu, C.R. MacKenzie, M. Roth, K. Beseoglu, C. Holtmann, G. Geerling, R. Guthoff
The serology results were obtained from the Institute of Medical Microbiology and Hospital Hygiene, Heinrich-Heine University, Duesseldorf. The standard testing for syphilis included non-treponemal and treponemal tests and the so-called reverse sequence syphilis-screening algorithm was employed. Initial screening, a treponemal test, was done by means of chemiluminescence immunoassay (CLIA) (DiaSorin, Sallugia, Italy). A positive screening test was confirmed by a Treponema pallidum particle agglutination assay (TPPA) (Fujirebio, Gent, Belgium) and fluorescent treponemal antibody absorption (FTA-ABS) (Mast Diagnostica, Reinfeld, Germany). Thereafter, an anti-lipoidal antibody test (Venereal Disease Research Laboratory [VDRL] or rapid plasma reagin [RPR] [Biokit, Barcelona, Spain]) was used to determine disease activity and therapy effectiveness. IgM and IgG immunoblot assays (Viramed Biotech, Planegg, Germany) were performed additionally in some cases.
Acute Syphilitic Posterior Placoid Chorioretinitis Misdiagnosed as Systemic Lupus Erythematosus Associated Uveitis
Published in Ocular Immunology and Inflammation, 2020
Chunli Chen, Shuya Wang, Xiaorong Li
Labial salivary gland biopsy (Figure 8) that showed lobule atrophy of labial gland and multiple focus lymphocytic infiltration was grade 3 with Focus score (FS) = 1 according to Chisholm classification5, which was supportive of Sjogren’s syndrome (SS). The laboratory examination showed that human leucocyte antigen-27 (HLA-27) was negative, phospholipid syndrome antibody was negative, CD3 + T cell subset was 85.47%, perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) was positive, and cytoplasmic antibodies against neutrophils (c-ANCA) were negative. CT scan of the lung revealed scattered bullae and mild interstitial pulmonary fibrosis in the inferior lobe of the right lung. Color doppler ultrasound showed mitral regurgitation and reduced left ventricular diastolic function. Further laboratory examination revealed that the treponema pallidum antibody (19.5 S/CO), toluidine red unheated serum test (TRUST) (1:32), and treponema pallidum particle agglutination assay (TPPA) were positive, favoring a diagnosis of active syphilis, while other infection-related indicators i.e., human immunodeficiency virus (HIV) antibodies, T-spot, EB virus antibodies, and antibodies against cytomegalovirus (CMV) were negative. The pathologic results of perineal skin biopsy (Figure 9) were consistent to the feature of verruca plana by showing squamous hyperplasia with papillary hyperplasia, hyperkeratosis of the epidermis, and thickening of granular and spinous layer. The diagnoses of SLE, ASPPC, and SS were established according to the detailed examination mentioned above.
Enterovirus-associated hemophagocytic lymphohistiocytosis with multiorgan failure
Published in Baylor University Medical Center Proceedings, 2020
Azaan Ramani, Sivakumar Sudhakaran, Robert S. Rahimi, Joseph Guileyardo, Uriel S. Sandkovsky
His symptoms persisted, and follow-up laboratory tests revealed worsening liver enzymes, which prompted repeat hospitalization. At the time of admission, his aspartate aminotransferase was 5451 IU/L; alanine aminotransferase, 3818 IU/L; alkaline phosphatase, 701 IU/L; and total bilirubin, 10.9 mg/dL. Upon admission, prednisone was continued and the patient was started on antibiotics empirically. An extensive infectious workup was negative, including blood cultures, cryptococcal antigen, Histoplasma urine and serum antigen, Leptospira antibody, and Coccidioides serum antibody by enzyme-linked immunosorbent assay. Stool polymerase chain reaction (PCR) and cultures were negative for Salmonella, Shigella, Escherichia coli, Campylobacter, Vibrio, and Yersinia. Stool smear and PCR for Cryptosporidium, Cyclospora, and Isospora was also negative. Serum PCR was negative for herpes simplex, varicella zoster, cytomegalovirus, adenovirus, and influenza. Treponema pallidum particle agglutination assay was negative for syphilis. Enterovirus was detected in the plasma and respiratory panel by PCR.