Spectrum of ocular manifestations and visual outcomes of neurosyphilis among 53 patients
ABSTRACT Background: In the era of the re-emergence of syphilis, ocular syphilis has gained attention because its prevalence has increased and it can cause blindness and disability. Objectives: To investigate the clinical presentation and prognosis of ocular syphilis. Methods: Prospective study o...
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| Format: | Article |
| Language: | English |
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Academia Brasileira de Neurologia (ABNEURO)
2021-08-01
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| Series: | Arquivos de Neuro-Psiquiatria |
| Subjects: | |
| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2021000700584&tlng=en |
| _version_ | 1818976601645252608 |
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| author | Tatiana Vaz Leite Pinto Antônio Pereira Gomes Neto Matheus Nader Cunha Letícia Moreira Bernardino Paulo Pereira Christo |
| author_facet | Tatiana Vaz Leite Pinto Antônio Pereira Gomes Neto Matheus Nader Cunha Letícia Moreira Bernardino Paulo Pereira Christo |
| author_sort | Tatiana Vaz Leite Pinto |
| collection | DOAJ |
| description | ABSTRACT Background: In the era of the re-emergence of syphilis, ocular syphilis has gained attention because its prevalence has increased and it can cause blindness and disability. Objectives: To investigate the clinical presentation and prognosis of ocular syphilis. Methods: Prospective study on 53 patients (90 eyes) with ocular syphilis diagnosed at the Santa Casa of Belo Horizonte, Brazil. The diagnosis was based on clinical manifestations of the disease and on serological markers (positive serum treponemal and non-treponemal tests or two positive treponemal tests). Results: Thirty-five eyes (66%) were from men and the mean age was 45.3 ± 12.0 years. HIV coinfection was confirmed in 10 patients (18.9%). Forty-four (84.9%) had VDRL titers ≥ 1:32. Bilateral ocular involvement occurred in 68%. Optic neuritis was diagnosed in 51.7% of the eyes and uveitis in 48.2%. Regarding visual acuity, the median baseline logarithm of the minimum angle of resolution (logMAR) was 1 (20/200 Snellen), while after antibiotic therapy, the median was 0.2 (20/30 Snellen). Poor visual acuity after treatment, defined as the best-corrected visual acuity (BCVA; logMAR 1; 20/200 Snellen) or worse, was associated with severe BCVA at presentation (below logMAR 1.3; 20/400 Snellen) (p = 0.001) and age over 50 years (p = 0.001). Conclusions: This study confirms the wide spectrum of clinical manifestations of ocular syphilis. The most frequent form was optic neuritis, an important differential diagnosis from other causes of inflammatory neuritis. Early diagnosis is essential, given that this is a treatable condition with excellent visual recovery in most cases. |
| first_indexed | 2024-12-20T16:14:27Z |
| format | Article |
| id | doaj.art-acc068a59e9e41188e285a24feef4c8e |
| institution | Directory Open Access Journal |
| issn | 1678-4227 |
| language | English |
| last_indexed | 2024-12-20T16:14:27Z |
| publishDate | 2021-08-01 |
| publisher | Academia Brasileira de Neurologia (ABNEURO) |
| record_format | Article |
| series | Arquivos de Neuro-Psiquiatria |
| spelling | doaj.art-acc068a59e9e41188e285a24feef4c8e2022-12-21T19:33:52ZengAcademia Brasileira de Neurologia (ABNEURO)Arquivos de Neuro-Psiquiatria1678-42272021-08-0179758458910.1590/0004-282x-anp-2020-0332Spectrum of ocular manifestations and visual outcomes of neurosyphilis among 53 patientsTatiana Vaz Leite Pintohttps://orcid.org/0000-0003-0057-0591Antônio Pereira Gomes Netohttps://orcid.org/0000-0002-0755-9478Matheus Nader Cunhahttps://orcid.org/0000-0002-1290-7051Letícia Moreira Bernardinohttps://orcid.org/0000-0002-2304-2313Paulo Pereira Christohttps://orcid.org/0000-0003-1224-5243ABSTRACT Background: In the era of the re-emergence of syphilis, ocular syphilis has gained attention because its prevalence has increased and it can cause blindness and disability. Objectives: To investigate the clinical presentation and prognosis of ocular syphilis. Methods: Prospective study on 53 patients (90 eyes) with ocular syphilis diagnosed at the Santa Casa of Belo Horizonte, Brazil. The diagnosis was based on clinical manifestations of the disease and on serological markers (positive serum treponemal and non-treponemal tests or two positive treponemal tests). Results: Thirty-five eyes (66%) were from men and the mean age was 45.3 ± 12.0 years. HIV coinfection was confirmed in 10 patients (18.9%). Forty-four (84.9%) had VDRL titers ≥ 1:32. Bilateral ocular involvement occurred in 68%. Optic neuritis was diagnosed in 51.7% of the eyes and uveitis in 48.2%. Regarding visual acuity, the median baseline logarithm of the minimum angle of resolution (logMAR) was 1 (20/200 Snellen), while after antibiotic therapy, the median was 0.2 (20/30 Snellen). Poor visual acuity after treatment, defined as the best-corrected visual acuity (BCVA; logMAR 1; 20/200 Snellen) or worse, was associated with severe BCVA at presentation (below logMAR 1.3; 20/400 Snellen) (p = 0.001) and age over 50 years (p = 0.001). Conclusions: This study confirms the wide spectrum of clinical manifestations of ocular syphilis. The most frequent form was optic neuritis, an important differential diagnosis from other causes of inflammatory neuritis. Early diagnosis is essential, given that this is a treatable condition with excellent visual recovery in most cases.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2021000700584&tlng=enOcular syphilisNeurosyphilisOcular manifestationsOptic neuritisVisual outcome |
| spellingShingle | Tatiana Vaz Leite Pinto Antônio Pereira Gomes Neto Matheus Nader Cunha Letícia Moreira Bernardino Paulo Pereira Christo Spectrum of ocular manifestations and visual outcomes of neurosyphilis among 53 patients Arquivos de Neuro-Psiquiatria Ocular syphilis Neurosyphilis Ocular manifestations Optic neuritis Visual outcome |
| title | Spectrum of ocular manifestations and visual outcomes of neurosyphilis among 53 patients |
| title_full | Spectrum of ocular manifestations and visual outcomes of neurosyphilis among 53 patients |
| title_fullStr | Spectrum of ocular manifestations and visual outcomes of neurosyphilis among 53 patients |
| title_full_unstemmed | Spectrum of ocular manifestations and visual outcomes of neurosyphilis among 53 patients |
| title_short | Spectrum of ocular manifestations and visual outcomes of neurosyphilis among 53 patients |
| title_sort | spectrum of ocular manifestations and visual outcomes of neurosyphilis among 53 patients |
| topic | Ocular syphilis Neurosyphilis Ocular manifestations Optic neuritis Visual outcome |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2021000700584&tlng=en |
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