A Cluster of Ocular Syphilis Cases – Seattle, Washington, and San Francisco, California, 2014-2015.

October 22, 2015 at 2:01 pm

MMWR Morb Mortal Wkly Rep. 2015 Oct 16 V.64 N.40 P.1150-1.

Woolston S, Cohen SE, Fanfair RN, Lewis SC, Marra CM, Golden MR.

1Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington; 2San Francisco Department of Public Health; 3Division of Infectious Diseases, University of California, San Francisco; 4Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC; 5Department of Neurology, University of Washington; 6HIV/STD Control Program, Public Health – Seattle & King County.

Corresponding author: Robyn Neblett Fanfair, 404-639-6044, iyo5@cdc.gov

From December 1, 2014, to January 30, 2015, in King County, Washington, four cases of ocular syphilis, defined as clinical signs or symptoms consistent with ocular disease (e.g., uveitis or vision loss) in a person with laboratory-confirmed syphilis of any stage, were reported.

All four cases occurred in men who have sex with men (MSM), two of whom were sex partners. Median age of the four patients was 39 years (range = 29–52 years).

Three of the patients were infected with human immunodeficiency virus (HIV). Among the three HIV-infected patients, the median CD4 count was 111 cells/ml, and the median HIV-RNA was 34,740 copies/ml.

All four patients had visual symptoms, including vision loss, flashing lights, and blurry vision.

Ophthalmologic examinations were performed and all four were diagnosed with uveitis. All four patients had positive serum from rapid plasma reagin (RPR) testing (titer range = 1:256–1:4096).

Based on history, one patient had late latent syphilis, and the remaining three received diagnoses of early latent syphilis. The three patients with early latent syphilis had cerebrospinal fluid (CSF) analysis performed; two had positive CSF in venereal disease research laboratory (VDRL) testing.

Three patients received treatment with aqueous crystalline penicillin G for 14 days, and one was treated with 10 days of procaine penicillin and probenecid. All four patients had initial improvement in ocular symptoms after treatment.

However, one patient still had a blind spot in one eye 1 month after treatment, and two patients were considered legally blind after 5 months; the fourth patient was lost to follow-up.

FULL TEXT

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6440a6.htm

PDF (see p.1150-1)

http://www.cdc.gov/mmwr/pdf/wk/mm6440.pdf

 

Entry filed under: Antimicrobianos, Bacterias, Bacteriemias, HIV/SIDA, HIV/SIDA Complicaciones, HIV/SIDA Trastornos Oculares, Infecciones de transmision sexual, Infecciones oftalmológicas, Metodos diagnosticos, REPORTS, Update. Tags: .

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