Download PDF
CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(07): 584-589
DOI: 10.1590/0004-282X-ANP-2020-0332
Article

Spectrum of ocular manifestations and visual outcomes of neurosyphilis among 53 patients

Espectro de manifestações oculares e prognóstico visual da neurossífilis em 53 pacientes
Tatiana Vaz Leite Pinto 
1   Instituto de Ensino e Pesquisa da Santa Casa de Belo Horizonte, Belo Horizonte MG, Brazil.
,
Antônio Pereira Gomes  Neto
2   Santa Casa de Misericórdia de Belo Horizonte, Departamento de Neurologia, Belo Horizonte MG, Brazil.
,
Matheus Nader Cunha 
2   Santa Casa de Misericórdia de Belo Horizonte, Departamento de Neurologia, Belo Horizonte MG, Brazil.
,
Letícia Moreira Bernardino 
2   Santa Casa de Misericórdia de Belo Horizonte, Departamento de Neurologia, Belo Horizonte MG, Brazil.
,
Paulo Pereira Christo 
1   Instituto de Ensino e Pesquisa da Santa Casa de Belo Horizonte, Belo Horizonte MG, Brazil.
3   Universidade Federal de Minas Gerais, Hospital das Clínicas e Faculdade de Medicina, Serviço de Neurologia e Departamento de Clínica Médica, Belo Horizonte MG, Brazil.
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

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.

RESUMO

Introdução: Na era do ressurgimento da sífilis, a sífilis ocular ganhou grande atenção, pois sua prevalência está aumentando e ela pode causar cegueira e incapacidades. Objetivos: Investigar a apresentação clínica e o prognóstico da sífilis ocular. Métodos: Estudo prospectivo com 53 pacientes (90 olhos) com sífilis ocular diagnosticados na Santa Casa de Belo Horizonte, Brasil. Os diagnósticos foram feitos com base em manifestações clínicas da doença e marcadores sorológicos (um teste treponêmico e outro não treponêmico positivos ou dois testes treponêmicos positivos). Resultados: Trinta e cinco olhos (66%) eram de homens e a idade média foi de 45,3±12,0 anos. A co-infecção pelo HIV foi confirmada em 10 (18,9%) pacientes. O envolvimento ocular bilateral ocorreu em 68%. Neurite óptica foi diagnosticada em 51,7% dos olhos e uveíte, em 48,2%. A mediana do logaritmo do ângulo mínimo de resolução (logMAR) foi 1 (20/200 Snellen), enquanto que após a antibioticoterapia, a mediana foi 0,2 (20/30 Snellen). A baixa acuidade visual após o tratamento, definido como logMAR 1 (20/200 Snellen) ou pior, foi associada a: gravidade da acuidade visual na apresentação da doença (abaixo de logMAR 1.3-20/400 Snellen) (p = 0,001) e idade acima de 50 anos (p=0,001). Conclusões: O estudo confirmou o amplo espectro de manifestações clínicas da sífilis ocular. A forma mais frequente foi a neurite óptica, um diagnóstico diferencial importante das neurites inflamatórias. O diagnóstico precoce é essencial, é uma condição tratável e com excelente recuperação, na maior parte dos casos.

Keywords:

Ocular syphilis - Neurosyphilis - Ocular manifestations - Optic neuritis - Visual outcome

Palavras-chave:

Sífilis ocular - Neurossífilis - Manifestações oculares - Neurite óptica

Authors’ contributions:

TTVLP: conceptualization, formal analysis, investigation, methodology, project administration, software, writing-original draft; APGN: conceptualization, investigation, supervision, validation, writing-review & editing; MNC: conceptualization, investigation, writing-review & editing; LMN: conceptualization, investigation, writing-review & editing; PPC: conceptualization, investigation, methodology, project administration, supervision, validation, writing-review & editing..




Publication History

Received: 24 August 2020

Accepted: 06 November 2020

Article published online:
01 June 2023

© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • REFERENCES

  • 1 Hook EW. Syphilis. Lancet. 2017 Apr 15;389(10078):1550-7. https://doi.org/10.1016/S0140-6736(16)32411-4
  • 2 Northey LC, Skalicky SE, Gurbaxani A, McCluskey PJ. Syphilitic uveitis and optic neuritis in Sydney, Australia. Br J Ophthalmol. 2015 Sep;99(9):1215-9. https://doi.org/10.1136/bjophthalmol-2014-306168
  • 3 Shah BB, Lang AE. Acquired neurosyphilis presenting as movement disorders. Mov Disord. 2012 May;27(6):690-5. https://doi.org/10.1002/mds.24950
  • 4 Davis JL. Ocular syphilis. Curr Opin Ophthalmol. 2014 Nov;25(6):513-8. https://doi.org/10.1097/ICU.20200332202003320099
  • 5 Oliver SE, Aubin M, Atwell L, Matthias J, Cope A, Mobley V, et al. Ocular Syphilis - Eight Jurisdictions, United States, 2014-2015. MMWR Morb Mortal Wkly Rep. 2016 Nov 4;65(43):1185-8. https://doi.org/10.15585/mmwr.mm6543a2
  • 6 Secretaria de Vigilância em Saúde. Boletim epidemiológico - Sífilis ano V. Brasil: Ministério da Saúde; 2016. 29 p.
  • 7 Secretaria de Vigilância em Saúde. Boletim epidemiológico - Sífilis ano V. Brasil: Ministério da Saúde; 2019. 42 p.
  • 8 Woolston SL, Dhanireddy S, Marrazzo J. Ocular syphilis: a clinical review. Curr Infect Dis Rep. 2016 Nov;18(11):36. https://doi.org/10.1007/s11908-016-0542-9
  • 9 Messias A, Jorge R, Cruz AAV. [Logarithmic visual acuity charts: reasons to use and how to design it]. Arq Bras Oftalmol. 2010 May 6;73(1):96-100. https://doi.org/10.1590/S0004-27492010000100019
  • 10 Ho EL, Tantalo LC, Jones T, Sahi SK, Marra CM. Point-of-care treponemal tests for neurosyphilis diagnosis. Sex Transm Dis. 2015 Jan;42(1):48-52. https://doi.org/10.1097/OLQ.20200332202003320222
  • 11 Lee SY, Cheng V, Rodger D, Rao N. Clinical and laboratory characteristics of ocular syphilis: a new face in the era of HIV co-infection. J Ophthalmic Inflamm Infect. 2015 Dec;5(1):56. https://doi.org/10.1186/s12348-015-0056-x
  • 12 Tsuboi M, Nishijima T, Yashiro S, Teruya K, Kikuchi Y, Katai N, et al. Prognosis of ocular syphilis in patients infected with HIV in the antiretroviral therapy era. Sex Transm Infect. 2016 Dec;92(8):605-10. https://doi.org/10.1136/sextrans-2016-052568
  • 13 Mathew RG, Goh BT, Westcott MC. British ocular syphilis study (BOSS): 2-year national surveillance study of intraocular inflammation secondary to ocular syphilis. Invest Ophthalmol Vis Sci. 2014;55(8):5394-400. https://doi.org/10.1167/iovs.14-14559
  • 14 Hoogewoud F, Frumholtz L, Loubet P, Charlier C, Blanche P, Lebeaux D, et al. Prognostic factors in syphilitic uveitis. Ophthalmology. 2017 Dec;124(12):1808-16. https://doi.org/10.1016/j.ophtha.2017.06.003
  • 15 Zhang X, Du Q, Ma F, Lu Y, Wang M, Li X. Characteristics of syphilitic uveitis in northern China. BMC Ophthalmol. 2017 Jun 19;17(1):95. https://doi.org/10.1186/s12886-017-0491-6
  • 16 Balaskas K, Sergentanis TN, Giulieri S, Guex-Crosier Y. Analysis of significant factors influencing visual acuity in ocular syphilis. Br J Ophthalmol. 2011 Nov;95(11):1568-72. https://doi.org/10.1136/bjo.2010.194498
  • 17 Marra CM. Neurosyphilis. Continuum (Minneap Minn). 2015 Dec;21(6):1714-28. https://doi.org/10.1212/CON.20200332202003320250
  • 18 Marra CM, Sahi SK, Tantalo LC, Ho EL, Dunaway SB, Jones T, et al. Toll-like receptor polymorphisms are associated with increased neurosyphilis risk. Sex Transm Dis. 2014 Jul;41(7):440-6. https://doi.org/10.1097/OLQ.20200332202003320149
  • 19 Oliver S, Sahi SK, Tantalo LC, Godornes C, Fanfair RN, Markowitz LE, et al. Molecular typing of treponema pallidum in Ocular Syphilis. Sex Transm Dis. 2016 Aug;43(8):524-7. https://doi.org/10.1097/OLQ.20200332202003320478