ro13-9904 and Chorioretinitis

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Topics: Administration, Oral; Adult; Anti-Bacterial Agents; Ceftriaxone; Chorioretinitis; Doxycycline; Endophthalmitis; Eye Infections; Female; HIV Infections; Humans; Injections, Intravenous; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Report of clinical/multimodal imaging outcomes of patients with syphilitic uveitis alternatively treated with intravenous(IV) ceftriaxone, due to unavailability of penicillin G.. Chart review of all cases of syphilitic uveitis presenting to Hospital São Geraldo/HC-UFMG and treated with intravenous ceftriaxone, between January and August 2014. Clinical, serological and ophthalmological data were collected.. Twelve consecutive patients with syphilitic uveitis receiving IV ceftriaxone were identified. All 24 eyes had active intraocular inflammation on clinical examination. All patients received IV ceftriaxone (2-4 g daily) for 14-21 days, supplemented with oral corticosteroid as needed in 9 patients (75%), after documented clinical response. Improvement in intraocular inflammation was seen in all 24 eyes, with median best-corrected visual acuity (BCVA) increasing from 20/50 to 20/20, after a mean follow-up of 5.3 months.. IV ceftriaxone may be an effective alternative for treatment of syphilitic uveitis, in the setting of unavailability of penicillin G.

Topics: Administration, Oral; Adult; Aged; Anti-Bacterial Agents; Ceftriaxone; Chorioretinitis; Complementary Therapies; Eye Infections, Bacterial; Fluorescein Angiography; Glucocorticoids; Humans; Infusions, Intravenous; Male; Middle Aged; Multimodal Imaging; Retrospective Studies; Syphilis; Syphilis Serodiagnosis; Tomography, Optical Coherence; Uveitis, Posterior; Visual Acuity

To report a case of acute posterior placoid chorioretinitis, a rare manifestation of ocular syphilis.. The patient was examined at age 59 with symptoms of subacute severe unilateral vision loss of the right eye. He underwent fundus examination, automated perimetry, optical coherence tomography imaging and fluorescein angiography. There was a close follow-up for 3 months.. At time of presentation, the visual acuity in the right eye was hand movement. Fundus examination showed a central retinal placoid yellowish lesion going beyond the temporal vascular arcades. Optical coherence tomography showed thickening of the neuroretina and disappearance of the inner and outer segment junction. Fluorescein angiography showed in the early phase areas of hypofluorescence followed by hyperfluorescence and late staining. Serologic examinations were positive for secondary syphilis. After treatment with intravenous ceftriaxone 2g/d for 2 weeks there was a complete functional recovery with regression of the fundus lesion.. Acute syphilitic posterior placoid chorioretinitis has been described as a rare chorioretinal manifestation in patients with syphilis. The pathogenesis of this entity still remains unknown. Since there are no pathognomonic features of ocular syphilis, findings may often mimic those of other diseases. Maintaining an awareness of the different manifestations of this disease allows ophthalmologists to play a key role in the early diagnosis of syphilis.

Topics: Anti-Bacterial Agents; Ceftriaxone; Chorioretinitis; Eye Infections, Bacterial; Fluorescein Angiography; Follow-Up Studies; Humans; Injections, Intravenous; Male; Middle Aged; Serologic Tests; Syphilis; Tomography, Optical Coherence

The ocular manifestations of syphilis are protean and can affect every structure of the eye. There has been a recent increase of syphilis infection in Europe. We report recent cases of ocular syphilis infection in a tertiary center.. During a 2.5-year period (2005-2007) we collected the medical records of eight male patients with ocular syphilis. The diagnosis was based on serological tests on blood samples and cerebrospinal fluid. All patients underwent a check-up to rule out another etiological diagnosis and to detect the presence of any other sexually transmitted infections.. The ocular lesions included: chorioretinitis (one case), retinitis (two cases), panuveitis with macular edema (two cases), episcleritis (one case), anterior optic neuritis (one case), and retrobulbar optic neuropathy (one case). Infection of the cerebrospinal fluid was detected in three of the five patients tested. In six cases, the inflammation was unilateral, and the anatomical and functional prognosis was excellent at the 6-month follow-up visit. Co-infection with human immunodeficiency virus was reported in five patients, with a CD4 T lymphocyte count greater than 300/mm(3). Most of the patients were treated with parenteral ceftriaxone (1 g daily) for 3 weeks with good tolerance. One patient was treated with intravenous penicillin G (18 MUI daily). Only one patient with anterior optic neuritis required systemic steroid therapy associated with antibiotics. Sequelae included sectorial atrophy of the optic nerve with visual field loss (n = 1) and abnormalities of the retinal pigment epithelium (n = 3).. All patients with ocular syphilis exhibited functional improvement and resolution of ocular inflammation after a specific antibiotic treatment. As a great imitator, syphilis should be considered in all patients with uveitis, scleritis, episcleritis, or optic neuritis, especially in men with high-risk sexual behavior.

Topics: Adult; Aged; Anti-Bacterial Agents; CD4 Lymphocyte Count; Ceftriaxone; Chorioretinitis; Doxycycline; Eye Infections, Bacterial; Fluorescent Antibody Technique; HIV Infections; Humans; Macular Edema; Male; Middle Aged; Optic Neuritis; Panuveitis; Retrospective Studies; Scleritis; Syphilis; Syphilis Serodiagnosis

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents; Ceftriaxone; Chorioretinitis; Female; Humans; Lyme Disease; Methylprednisolone; Treatment Outcome; Young Adult

A 48-year-old man presented with visual dimness in the right eye that had developed 2 weeks previously. Dilated fundus examination showed few vitreous cells and numerous yellow, placoid lesions in both eyes. His right eye had more severe serous retinal detachment involving the macula. Fluorescein angiography demonstrated early irregular hypofluorescence with late staining in the areas of the yellow placoid lesions. He started a regimen of 60 mg of oral prednisone daily. Two weeks later, a serologic fluorescent treponemal antigen absorption test was positive for Ig G and Ig M. He was referred to an infectious disease specialist for antibiotic therapy. A week later, he returned, having stayed on prednisone only and not having taken the internist's antibiotic prescription. Meanwhile, the chorioretinitis in his right eye, which had initially been at a more advanced stage, was resolved with the use of steroids. The chorioretinitis in his left eye, which was aggravated at an earlier stage, ultimately recovered. Our case had atypical courses such that one eye improved and the other worsened during the same steroid treatment period. This result was inconsistent with that of previous reports showing that oral steroid influences the clinical course of acute syphilitic posterior placoid chorioretinitis.

Topics: Acute Disease; Anti-Bacterial Agents; Ceftriaxone; Chorioretinitis; Diagnosis, Differential; Eye Infections, Bacterial; Fluorescein Angiography; Follow-Up Studies; Fundus Oculi; Humans; Injections, Intravenous; Male; Middle Aged; Syphilis

This work investigates the incidence and clinical features of syphilitic uveitis in patients infected with human immunodeficiency virus (HIV).. We retrospectively reviewed syphilitic uveitis in patients coinfected with HIV that presented at a referral center between July 2001 and November 2003.. Twelve patients (20 eyes) were included. The ocular manifestations of syphilis led to the discovery of HIV-1 seropositivity in three patients. All patients were male and homosexual. One patient has been previously treated for syphilis with benzathine penicillin G. One patient presented with anterior uveitis and 11 patients had panuveitis or posterior uveitis. Necrotizing retinitis was noted in seven eyes (35%), posterior placoid chorioretinitis in six eyes (30%) and optic nerve involvement in five eyes (25%). Of nine patients with available cerebrospinal fluid (CSF) studies, seven (77.8%) had CSF abnormalities. Eleven patients were treated with intravenous penicillin G and one with intravenous ceftriaxone sodium. One patient required a second course of antibiotics to control uveitis. Ocular inflammation decreased and visual acuity improved in all nine patients for whom follow-up was available after treatment.. Manifestations of syphilitic uveitis in HIV-infected patients are multiple, with high frequencies of posterior uveitis, posterior placoid chorioretinitis, necrotizing retinitis and optic nerve involvement. Syphilitic uveitis in HIV-infected patients seems to have a more severe course and may relapse despite high-dose intravenous penicillin therapy.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Chorioretinitis; Eye Infections, Bacterial; Fluorescein Angiography; HIV Infections; Homosexuality; Humans; Incidence; Male; Middle Aged; Penicillin G; Retinal Necrosis Syndrome, Acute; Retrospective Studies; Risk Factors; Syphilis; Uveitis

The authors report 30 chinese patients of ocular Lyme borreliosis, which is a tick-borne spirochaetal disease involving multiple organ systems. The ocular manifestations begin as conjunctivitis, and then as uveitis, choroidoretinitis, keratitis and vitritis. Diagnosis is based on case history and clinical and laboratory findings. Early cases may be cured by oral antibiotics while intravenous drip of large dosage is needed for advanced cases, with a relapsing rate of 16%. Prolonged systemic corticosteroids may predispose the patient to antibiotic failure; however, topical corticosteroids in combination with antibiotics may minimize ocular inflammation and complications.

Topics: Adolescent; Adult; Aged; Borrelia burgdorferi Group; Ceftriaxone; Child; Chorioretinitis; Conjunctivitis, Bacterial; Female; Humans; Lyme Disease; Male; Middle Aged; Penicillins; Uveitis

Intraocular inflammations as chief manifestation of a T. pallidum infection associated with stage II syphilis are rarely documented in the recent literature. We report on a 35 year old patient with bilateral choroiditis, retinal vasculitis and papillitis persisting retrospectively since he had received some medication for syphilis 8 years previously. This patient was at high risk for other sexually transmitted diseases, however, he did not show HIV-seroconversion. General symptoms like uneasiness, fatigue, depressions and intermittent weight loss were mentioned. Reduction of visual acuity with topical corticosteroid therapy led to another medical work-up, and a systemic therapy with Ceftriaxone for 14 days resulted in better vision, better perimetric results and less inflammatory cell in the vitreous but evident optic atrophy.

Topics: Adult; Ceftriaxone; Chorioretinitis; Drug Therapy, Combination; Follow-Up Studies; Humans; Male; Methylprednisolone; Neurosyphilis; Papilledema; Retinal Detachment; Syphilis Serodiagnosis; Visual Acuity; Visual Fields