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从水性液体中进行梅毒螺旋体检测在诊断HIV/AIDS患者眼部梅毒中的应用

Utility of Treponemal Testing from Aqueous Fluid in the Diagnosis of Ocular Syphilis in Patients with HIV/AIDS.

作者信息

Nair Nivedita, Sudharshan Sridharan, Anand Appakkudal R, Biswas Jyotirmay, Therese K Lily

机构信息

Department of Uvea, Sankara Nethralaya, Chennai, India.

L & T Microbiology Research Centre, Sankara Nethralaya, Chennai, India.

出版信息

Ocul Immunol Inflamm. 2022 Feb 17;30(2):444-450. doi: 10.1080/09273948.2020.1803362. Epub 2020 Oct 5.

Abstract

PURPOSE

Ocular syphilis is re-emerging globally especially in patients with human immunodeficiency virus (HIV). Atypical manifestations of ocular syphilis and/or other associated opportunistic infections often lead to a diagnostic dilemma. We evaluated the utility of aqueous humor (AH) hemagglutination assay (TPHA) titers in the diagnosis of ocular syphilis.

METHODS

Retrospective case series of five HIV positive patients with positive syphilis serology in whom AH sampling was performed. All patients had ocular manifestations suspicious of infectious etiology.

RESULTS

Panuveitis with/without retinitis was the commonest presentation. Along with blood investigations, polymerase chain reaction (PCR) testing from AH was done for (MTB), (HSV), (VZV), (CMV), and . In addition, serum antibody titers for Toxoplasma, rapid plasma reagin (RPR) and TPHA tests for syphilis were done. In patients with raised serum RPR/TPHA, aqueous TPHA titers were also assessed. Mean serum RPR titer was ≥ 1:32 and TPHA titer was ≥1:1280. Aqueous humor titers of TPHA was high in all patients (range ≥ 1:320 to ≥1:5120). Aqueous PCR was negative for all other infectious etiologies in four patients. In one patient, PCR-CMV was also positive, suggestive of a dual infection. Post-treatment with highly active antiretroviral therapy (HAART) and appropriate anti-syphilitic regime, complete resolution of lesions with corresponding fall in the serum RPR/TPHA titers were noted in all patients.

CONCLUSIONS

Ocular syphilis with atypical presentations is usually diagnosed based on a positive syphilis serology and by excluding other infectious causes. In the present study, we have shown an excellent correlation between raised AH TPHA titers with serological values and the clinical presentation. Considering the ease of collection of AH in contrast to vitreous fluids, the AH-TPHA assay could potentially be a valuable tool in the diagnosis of ocular syphilis.

摘要

目的

眼部梅毒在全球范围内再度出现,尤其是在人类免疫缺陷病毒(HIV)感染者中。眼部梅毒的非典型表现和/或其他相关机会性感染常常导致诊断困境。我们评估了房水(AH)血凝试验(TPHA)滴度在眼部梅毒诊断中的作用。

方法

对5例梅毒血清学阳性的HIV阳性患者进行回顾性病例系列研究,这些患者均进行了房水采样。所有患者均有可疑感染病因的眼部表现。

结果

伴有或不伴有视网膜炎的全葡萄膜炎是最常见的表现。除血液检查外,还对房水进行了聚合酶链反应(PCR)检测,以检测结核分枝杆菌(MTB)、单纯疱疹病毒(HSV)、水痘带状疱疹病毒(VZV)、巨细胞病毒(CMV)和梅毒螺旋体。此外,还进行了弓形虫血清抗体滴度、快速血浆反应素(RPR)检测以及梅毒的TPHA检测。在血清RPR/TPHA升高的患者中,也评估了房水TPHA滴度。血清RPR平均滴度≥1:32,TPHA滴度≥1:1280。所有患者的房水TPHA滴度均很高(范围≥1:320至≥1:5120)。4例患者的房水PCR检测对所有其他感染病因均为阴性。1例患者的PCR-CMV也呈阳性,提示双重感染。在接受高效抗逆转录病毒治疗(HAART)和适当的抗梅毒治疗后,所有患者的病变均完全消退,血清RPR/TPHA滴度相应下降。

结论

非典型表现的眼部梅毒通常根据梅毒血清学阳性并排除其他感染原因来诊断。在本研究中,我们已表明房水TPHA升高滴度与血清学值及临床表现之间具有良好的相关性。考虑到与玻璃体液相比,房水采集更容易,AH-TPHA检测可能是诊断眼部梅毒的一种有价值的工具。

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