scholarly journals Neurological findings in early syphilis: a comparison between HIV positive and negative patients

2013 ◽  
Vol 5 (4) ◽  
pp. 19 ◽  
Author(s):  
Alejandra González-Duarte ◽  
Zaira Medina López
Keyword(s):  
Venereal Disease ◽  
Age At Onset ◽  
Disease Onset ◽  
Clinical Findings ◽  
Hiv Positive ◽  
Ocular Involvement ◽  
Early Syphilis ◽  
Ocular Manifestations ◽  
Csf Pleocytosis ◽  
Hiv Negative

After a decade of steady decline, syphilis has reemerged within the past few years and it is seeping back into the HIV negative population. We describe herein 16 consecutive cases of neurosyphilis and compare its clinical characteristics. Of the 16 patients, 14 (87%) were men. Mean age at onset was 43 years old (range: 23-82). Twelve patients (75%) were HIV positive; stage was B2 in 2 patients, B3 and C2 in one patient each, and C3 in 8 patients. The clinical presentation was meningitis in 6 (40%), stroke in 3 (18%), ocular manifestations in 4 (27%), and psychiatric manifestations in 2 (13%) cases. Five additional patients had ocular involvement after a formal ophthalmologic examination. High venereal disease research laboratory test (VDRL) titers in serum and cerebrospinal fluid (CSF) were found. Patients in C3 stage of HIV had less CSF pleocytosis (<5 cells/mm3) than patients in earlier stages (P=0.018). Disease onset was earlier in patients older than 50 years old with HIV (P=0.049). We found that meningitis, ocular manifestations and stroke were the most common clinical findings in early syphilis. Moreover, stroke included the carotid and cerebrobasilar vascular territories. CSF VDRL continues to be a crucial test in all idiopathic cases of meningitis, stroke and uveitis, regardless of the HIV status or CSF pleocytosis. Except for less pleocytosis, there were no important differences between HIV positive and HIV negative patients.

scholarly journals The clinical spectrum of ocular bartonellosis: a retrospective study at a tertiary centre in Malaysia

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Michele Shi-Ying Tey ◽  
Gayathri Govindasamy ◽  
Francesca Martina Vendargon
Keyword(s):  
Hand Movement ◽  
Clinical Findings ◽  
Common Finding ◽  
Final Visit ◽  
Ocular Involvement ◽  
Exudative Retinal Detachment ◽  
Tertiary Centre ◽  
Ocular Manifestations ◽  
Ocular Findings ◽  
Clinical Records

Abstract Background Cat scratch disease (CSD) is a systemic illness caused by the gram-negative bacillus, Bartonella henselea, which can occasionally involve the ocular structures. The objective of this study is to evaluate the various clinical presentations of ocular bartonellosis at our institution. A retrospective review of the clinical records of 13 patients (23 eyes) with ocular manifestations of Bartonella infections over a 3-year period between January 2016 to December 2018 was undertaken at our institution. Results The diagnosis was made based on clinical findings and in addition, with the support of the evidence of Bartonella hensalae IgG and/or IgM. Small retinal white lesions were the most common ocular findings in this series of patients (82.6% of eyes, 76.9% of patients). Neuroretinitis was the second most common finding (47.8% of eyes, 69.2% of patients), followed by exudative retinal detachment involving the macula (34.8% of eyes, 53.8% of patients) and Parinaud’s oculoglandular syndrome (17.4% of eyes, 23.1% of patients). Other findings like isolated optic disc oedema without macular star (8.7% of eyes, 15.4% of patients) and vitritis (4.3% of eyes, 7.7% of patients) were also observed. Ten patients (76.9%) had bilateral ocular involvement. Most of the patients were young, immunocompetent and had systemic symptoms like fever prior to their ocular symptoms. The visual acuity (VA) at initial presentation ranged from 6/6 to hand movement (mean, 6/20), and at final visit 6/6 to 6/60, (mean, 6/9). 91.7% of patients were treated with antibiotics. Only 2 patients received oral corticosteroids together with antibiotics due to very poor vision on presentation. The visual prognosis of ocular bartonellosis is generally good with 16 (88.9%) of 23 eyes having VA of 6/12 or better at final follow-up visit. Conclusion Small foci of retinal white lesions were the most common manifestation of ocular bartonellosis in this series, followed by neuroretinitis, though an array of other ocular findings may also occur. Therefore, we should consider bartonella infection as a possible differential diagnosis in those patients.

scholarly journals Clinical features and para-clinical findings of cryptococcal meningitis in the North of Iran during 2011-19

2021 ◽  
Author(s):  
Farhang Babamahmoodi ◽  
Kobra Gerizade firozjaii ◽  
Masoumeh Bayani ◽  
Tahereh Shokohi ◽  
Jamshid Yazdani ◽  
...  
Keyword(s):  
Length Of Hospital Stay ◽  
Signs And Symptoms ◽  
Underlying Disease ◽  
Clinical Findings ◽  
Hiv Positive ◽  
The North ◽  
Medication Consumption ◽  
Significant Difference ◽  
North Of Iran ◽  
Hiv Negative

Background and Purpose:Cryptococcalmeningitis (CM) is a serious fungal infection that especially affectspatients with human immunodeficiency virus (HIV). In this regard,the present retrospective study aimed to analyze the clinical and laboratory features and therapeutic outcomes of patients with CM admitted to two teaching referral centersin the north of Iran during 2011-19. Materials and Methods:This study was performed onall the hospitalized patients diagnosed with CM in two therapeutic centers of infectious diseases in the north of Iran. The required data,such as demographic characteristics and clinical and paraclinical features of patients, were extracted and entered in the information forms. Finally, the collected data were analyzed inSPSSsoftware(version16). Results:For the purpose of the study, records of 12confirmed CM patients were evaluatedin this research. Based on the results,75% of the patients were male. Moreover,the average age of the subjects was 40.33± 8.93 years old and 66.6%ofthem(n=8) were HIV-positive. Other underlying diseases among HIV-positive patients included infection with hepatitis C virus (25%) and a history of tuberculosis (25%). In total, threeHIV-negative patients suffered from Hodgkin lymphoma (25%), sarcoidosis (25%),and asthma (25%) and one patient (25%) had no underlying disease. Headache (75%), weakness,and fatigue (75%) were the most common symptoms among the participants. The cluster of differentiation 4count in all HIV-positive patients was less than 100 cells/μl. There was no significant difference between symptoms in HIV-positive and HIV-negative patients. Besides, no significant difference was observed between the groups of HIV-positive and HIV-negative patients regarding the period between the onset of symptoms and diagnosis of CM,the length of hospital stay,and the duration of antifungal medication consumption. In total,three patients (25%) expired,and six patients recovered. The CM recurred in two HIV-negative and oneHIV-positive subjects;the two HIV-negative patients were treated,whilethe HIV-positive patient expired due to this recurrence. Conclusion:Clinical features and cerebrospinal fluid parameters were not different in HIV-positive and HIV-negative participants. Despite the fact thatCM is not common in Iran, due to the increasing number of immunosuppressive patients, the differential diagnosis of CM should be considered for patients with signs and symptoms of infection in the central nervous system.

scholarly journals More than meets the eye: Monocular syphilis in an HIV-negative patient

2014 ◽  
Vol 1 (2) ◽  
pp. 29
Author(s):  
Nichole E Strickland ◽  
Amanda L. Strickland ◽  
Mark Feldman
Keyword(s):  
High Titer ◽  
Venereal Disease ◽  
Behavioral Changes ◽  
Abnormal Behavior ◽  
Penicillin G ◽  
Rapid Plasma Reagin ◽  
Immunodeficiency Virus ◽  
Csf Pleocytosis ◽  
Hiv 1 ◽  
Hiv Negative

A 50-year old heterosexual male presented with discomfort in his left eye and abnormal behavior. Physical examination showed a red eye suggestive of uveitis. He was found to have a reactive rapid plasma reagin (RPR) test in high titer and a cerebrospinal fluid (CSF) pleocytosis, with a reactive Venereal Disease Research Laboratory (VDRL) titer in the CSF. Testing for human immunodeficiency virus (HIV)-1 and HIV-2 was negative. He was diagnosed with ocular/neurosyphilis and treated with intravenous (IV) penicillin G for 14 days followed by an intramuscular injection of benzathine penicillin, with complete resolution of ocular findings and behavioral changes. This report illustrates an unusual presentation of ocular/neurosyphilis in an HIV-negative i

P30 Extra-ocular manifestations of children with sarcoid-like uveitis

Rheumatology ◽  
2019 ◽  
Vol 58 (Supplement_4) ◽  
Author(s):  
Abhay Shivpuri ◽  
Ameenat Lola Solebo ◽  
Harry Petrushkin ◽  
Emily Kalms ◽  
Eesha Gokhale ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Conflicts Of Interest ◽  
Age At Onset ◽  
Ocular Involvement ◽  
Close Monitoring ◽  
Mild Phenotype ◽  
Systemic Involvement ◽  
Ocular Sarcoidosis ◽  
Ocular Manifestations ◽  
Systemic Manifestations

Abstract Background Paediatric sarcoidosis represents a spectrum of disease. Early onset sarcoidosis & Blau syndrome associated with NOD2 mutations are characterized by fever, rash, arthritis & organomegaly. Later onset sarcoidosis has wider organ involvement (lungs, kidneys, lachrymal & extra-ocular glands). Both presentations may lead to long term complications due to end-stage organ damage. Ocular sarcoidosis has a well described uveitis phenotype. We aim to describe a retrospective cohort of children with sarcoid-like uveitis & their systemic manifestations at time of study; compare cohort of patients fulfilling IWOS criteria for ocular sarcoidosis versus who did not; and describe their management in retrospective cohort. Methods We performed a retrospective case review of all children currently followed at GOSH with ocular sarcoidosis phenotype with uveitis (ophthalmologist definition based on IWOS, or diagnosis of idiopathic uveitis with raised ACE level at least once. We collected demographics & all extra-ocular involvement described in sarcoidosis. Results n = 52; 27/52 males. Median age at onset of uveitis 4.20 years (1.41-15.16). 49/52 bilateral uveitis. 27/52 (50%) <8years age at onset & 2/6 NOD 2 + belonged to this group. Median ACE 68 U/L at presentation (0-90U/L). Median maximum ACE 74 (14-420). NOD2 tested in 12 patients: 6+ , 6- . 1/6 positive patient had Blau phenotype. Ethnicity: African 12/52, asian 11/52, caucasian 14/52, unknown 15/52. Uveitis: Anterior 17/52(32.6%), Anterior+Intermediate 1/52, intermediate 5/52(9.6%) , posterior 2/52, panuveitis 25/52(48%), undocumented 2/52. ANA positive (>1:80) in 15/47 (32%). Systemic involvement (n = 52): arthritis 29%, liver 29%, lymphadenopathy 19%, renal 16%, lungs 15.3%, skin 17.3%, spleen 7.7%, glands 1.9%. Patients as per adult IWOS criteria: Definite 12/52, Presumed 6/52, Probable7/52 and Not fulfilling – 27/52. Systemic involvement in patients not fulfilling IWOS criteria (27/52) – renal 14.8%, arthritis 22.2%, hilar or peripheral lymphadenopathy 0 %, skin involvement 7.4%, lung 18.5%, splenomegaly 3.7%. Comparing IWOS fulfilling (25) with the ones who did not (27) – systemic involvement consistently less common in the ones NOT fulfilling but only reaches statistical significance difference for involvement. Lymphadenopathy and skin (p < 0.001 and p < 0.050 respectively). Suggesting that paediatric age group cannot be classified as per the adult IWOS ocular sarcoidosis criteria and needs early systemic screening. Medications used to treat uveitis and/or extra-ocular manifestations: methotrexate alone 25%, methotrexate + adalimumab 21.1%, mycophenolate mofetil 9.61%, only systemic steroids 3.8%. 9 patients- no systemic medications at any time during their disease. Conclusion Most sarcoid-like uveitis patients had at least one systemic involvement. 51.9% patients did not fulfil the IWOS ocular sarcoidosis criteria, still had systemic involvement. Hilar lymphadenopathy criteria cannot be applied to the paediatric population, peripheral more common. ACE not a sensitive biomarker to predict sarcoidosis. 17.3 % had mild phenotype & required no treatment. This study demonstrates the importance of close monitoring for systemic manifestations & highlights good clinical response to steroids, MTX, MMF and anti-TNF. Conflicts of Interest The authors declare no conflicts of interest.

scholarly journals Vasculitis Retinae- A Rare Presentation of SLE

2019 ◽  
Vol 10 (2) ◽  
pp. 179-182
Author(s):  
Sanwar Hossain ◽  
Titus Leonard Guda ◽  
Forhad Chowdhury ◽  
Md Somir Hossain ◽  
Mehran Hossain ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Keratoconjunctivitis Sicca ◽  
Normal Population ◽  
Systemic Disease ◽  
Disease Onset ◽  
Retinal Vasculitis ◽  
Ocular Involvement ◽  
Rare Presentation ◽  
Medical College ◽  
Ocular Manifestations

Systemic lupus erythematosus (SLE) is a rare complex autoimmune disease characterized by autoantibody  formation against double strand DNA and antinuclear antibody (ANA), complement activation, and  deposition of immune complexes in tissues and organs. In normal population only 0.03% suffer from SLE,  among them 90% are female between the age of 20 to 30 yrs. SLE can involve any region of the visual  system. Although ocular manifestations are not part of the classification criteria for SLE but retinal involvement is the most common intraocular lesion observed in up to one-third of SLE patients. The most  common extra ocular lesion is keratoconjunctivitis sicca. Ocular manifestations are rarely reported at the  time of disease onset, but are usually associated with active generalized systemic disease. Due to low  frequency of SLE and only one third of them have ocular involvement, so reports about retinal vasculitis  are very rare. But fortunately a case of Vasculitis retinae due to SLE was admitted in Anwer Khan Modern  Medical College & Hospital on 04/12/2018 Anwer Khan Modern Medical College Journal Vol. 10, No. 2: July 2019, P 179-182

scholarly journals Impact of MMP2 rs243865 and MMP3 rs3025058 Polymorphisms on Clinical Findings in Alzheimer’s Disease Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Vladimira Durmanova ◽  
Juraj Javor ◽  
Zuzana Parnicka ◽  
Gabriel Minarik ◽  
Agata Ocenasova ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Age At Onset ◽  
Disease Onset ◽  
Gene Promoter ◽  
Clinical Findings ◽  
Control Group ◽  
Promoter Polymorphisms ◽  
Pcr Rflp ◽  
The Central Nervous System

Alzheimer’s disease (AD) is a chronic neurodegenerative disease of the central nervous system with higher prevalence in elderly people. Despite numerous research studies, the etiopathogenesis of AD remains unclear. Matrix metalloproteinases (MMPs) are endopeptidases involved in the cleavage of extracellular matrix proteins and basement membrane compounds. In the brain, the pathological role of MMPs includes the disruption of the blood-brain barrier leading to the induction of neuroinflammation. Among various MMPs, MMP-2 and MMP-3 belong to candidate molecules related to AD pathology. In our study, we aimed to evaluate the association of MMP2 rs243865 and MMP3 rs3025058 polymorphisms with AD susceptibility and their influence on age at onset and MoCA score in patients from Slovakia. Both MMP gene promoter polymorphisms were genotyped in 171 AD patients and 308 controls by the PCR-RFLP method. No statistically significant differences in the distribution of MMP2 rs243865 (-1306 C>T) and MMP3 rs3025058 (-1171 5A>6A) alleles/genotypes were found between AD patients and the control group. However, correlation with clinical findings revealed later age at disease onset in MMP2 rs243865 CC carriers in the dominant model as compared to T allele carriers (CC vs. CT+TT: 78.44 ± 6.28 vs. 76.36 ± 6.39 , p = 0.036 ). The results of MMP3 rs3025058 analysis revealed that 5A/6A carriers in the overdominant model tended to have earlier age at disease onset as compared to other MMP3 genotype carriers (5A/6A vs. 5A/5A+6A/6A: 76.61 ± 5.88 vs. 78.57 ± 6.79 , p = 0.045 ). In conclusion, our results suggest that MMP2 rs243865 and MMP3 rs3025058 promoter polymorphisms may have influence on age at onset in AD patients.

scholarly journals Accessing HIV care may lead to earlier ascertainment of comorbidities in health care clients in Khayelitsha, Cape Town

2021 ◽  
Vol 1 (12) ◽  
pp. e0000031
Author(s):  
Richard Osei-Yeboah ◽  
Tsaone Tamuhla ◽  
Olina Ngwenya ◽  
Nicki Tiffin
Keyword(s):  
South Africa ◽  
Health Care ◽  
Maternal Care ◽  
Disease Onset ◽  
Cape Town ◽  
Public Health Care ◽  
Hiv Care ◽  
Hiv Positive ◽  
Health Care Planning ◽  
Hiv Negative

Successful antiretroviral rollout in South Africa has greatly increased the health of the HIV-positive population, and morbidity and mortality in PLHIV can increasingly be attributed to comorbidities rather than HIV/AIDS directly. Understanding this disease burden can inform health care planning for a growing population of ageing PLHIV. Anonymized routine administrative health data were analysed for all adults who accessed public health care in 2016–2017 in Khayelitsha subdistrict (Cape Town, South Africa). Selected comorbidities and age of ascertainment for comorbidities were described for all HIV-positive and HIV-negative healthcare clients, as well as for a subset of women who accessed maternal care. There were 172 937 adult individuals with a median age of 37 (IQR:30–48) years in the virtual cohort, of whom 48% (83 162) were HIV-positive. Median age of ascertainment for each comorbidity was lower in HIV-positive compared to HIV-negative healthcare clients, except in the case of tuberculosis. A subset of women who previously accessed maternal care, however, showed much smaller differences in the median age of comorbidity ascertainment between the group of HIV-positive and HIV-negative health care clients, except in the case of chronic kidney disease (CKD). Both HIV-positive individuals and women who link to maternal care undergo routine point-of-care screening for common diseases at younger ages, and this analysis suggests that this may lead to earlier diagnosis of common comorbidities in these groups. Exceptions include CKD, in which age of ascertainment appears lower in PLHIV than HIV-negative groups in all analyses suggesting that age of disease onset may indeed be earlier; and tuberculosis for which age of incidence has previously been shown to vary according to HIV status.

scholarly journals 1359. Reported Neurologic, Ocular, and Otic Manifestations among Syphilis Cases — 16 States, 2019

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S766-S766
Author(s):  
David A Jackson ◽  
Robert McDonald ◽  
Hillard Weinstock ◽  
Elizabeth Torrone
Keyword(s):  
Clinical Manifestation ◽  
Clinical Manifestations ◽  
The United States ◽  
Hiv Status ◽  
Permanent Disability ◽  
Early Syphilis ◽  
Ocular Manifestations ◽  
Late Syphilis ◽  
Hiv Negative ◽  
Complete Reporting

Abstract Background Syphilis can cause neurologic, ocular, or otic manifestations at any stage, possibly resulting in permanent disability or even death. In 2018, CDC began collecting clinical manifestation data for syphilis cases reported through the National Notifiable Diseases Surveillance System (NNDSS). We present the first estimates of the prevalence of neurologic, ocular, and otic manifestations among syphilis cases in the United States. Methods We reviewed NNDSS data to identify jurisdictions (states + DC) who reported ≥ 70% of their syphilis cases with clinical manifestation data (considered to have “complete reporting”) in 2019. Among these jurisdictions, we determined the prevalence of neurologic, ocular, and otic manifestations (combining verified, likely, and possible clinical manifestations together), stratified by HIV status and by syphilis stage (Unknown/late syphilis vs. Early syphilis [Primary, Secondary, and Early non primary non secondary syphilis]). Results In 2019, 16 states had complete reporting for neurologic, otic, and ocular manifestations. Of the 41,216 syphilis cases reported in these jurisdictions, clinical manifestations were infrequently reported: neurologic (n=445, 1.1%), ocular (n=461, 1.1%), and otic (n=166, 0.4%). Prevalence was higher among HIV-infected persons compared to HIV-negative persons for neurologic (1.4% vs. 0.9%) and ocular manifestations (1.3% vs 1.0%) but was similar for otic manifestations (0.4% vs 0.4%). Prevalence was higher among persons diagnosed with Unknown/late syphilis compared to Early syphilis for neurologic (1.6% vs 0.8%) and ocular manifestations (1.6% vs 0.9%) but similar for otic manifestations (0.5% vs 0.4%); however, 49.4% of cases reported with ≥ 1 of these clinical manifestations were diagnosed with Early syphilis. Conclusion The prevalence of neurologic, ocular, and otic manifestations was low among syphilis cases, but case data likely underestimate the true burden given potential underreporting. The frequency of clinical manifestations, including among HIV-negative persons and persons diagnosed with Early syphilis, emphasizes the importance of evaluating all syphilis cases for clinical signs or symptoms regardless of stage or HIV status. Disclosures All Authors: No reported disclosures

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