Neurosyphilis cerebrospinal fluid findings in patients with ocular syphilis

Ocul Immunol Inflamm. 2021 Jan 2;29(1):95-101. doi: 10.1080/09273948.2019.1672193. Epub 2019 Oct 24.

Abstract

Purpose: To evaluate neurosyphilis cerebrospinal fluid (CSF) findings and initial ophthalmic manifestations in patients with syphilitic uveitis.Methods: We retrospectively reviewed the records of CSF analysis of 14 patients with syphilitic uveitis with treponemal analysis - chemiluminescent immunoassay and TPHA- and non-treponemal analysis - Rapid Plasma Reagin test - RPR.Results: 86% were males and 43% HIV+. Ocular signs of syphilis lead to the diagnosis of syphilis in 78% of patients. Typical syphilitic uveitis presentations included: acute syphilitic posterior placoid chorioretinitis (50% of patients), retinitis (21% of patients) and punctate inner retinitis (7% of patients). 57% of patients had definite neurosyphilis by the CDC criteria, while 71% had CSF abnormalities suggestive of central nervous system involvement.Conclusion: Based on international guidelines, the frequent CSF abnormalities found in syphilitic uveitis patient supports the diagnosis of neurosyphilis in a majority of patients.

Keywords: Cerebrospinal fluid; lumbar puncture; neurosyphilis; ocular syphilis; uveitis.

MeSH terms

  • Adult
  • Antibodies, Bacterial / cerebrospinal fluid*
  • Belgium / epidemiology
  • Cerebrospinal Fluid / microbiology*
  • Eye Infections, Bacterial / complications*
  • Eye Infections, Bacterial / diagnosis
  • Eye Infections, Bacterial / microbiology
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Neurosyphilis / cerebrospinal fluid*
  • Neurosyphilis / complications
  • Neurosyphilis / microbiology
  • Retrospective Studies
  • Syphilis / diagnosis*
  • Syphilis / epidemiology
  • Treponema pallidum / immunology*
  • Uveitis / complications*
  • Uveitis / diagnosis
  • Uveitis / microbiology

Substances

  • Antibodies, Bacterial