Combined Intravitreal and Systemic Antibiotic Therapy in a Patient with Syphilitic Uveitis

Purpose: To report the novel use of combined intravitreal and systemic antibiotic therapy in a patient with syphilitic panuveitis and discuss the management of ocular syphilis.

Methods: Case report

Results: A 45-year old heterosexual male with human immunodeficiency virus (HIV) presented with 1 month of blurry vision in both eyes. Clinical examination revealed a bilateral panuveitis. The patient denied history of genital lesions or rash, but did complain of difficulty hearing bilaterally. Treponemal EIA was positive, the RPR titer greater than 1:512 dilution, and CSF VDRL 1:4. A diagnosis of neurosyphilis and ocular syphilis was made based on the clinical and laboratory findings. The patient was admitted for systemic intravenous antibiotic therapy, but was noted to have a penicillin allergy. Intravitreal ceftazidime was promptly administered bilaterally to achieve treponemacidal levels of antibiotic therapy. After penicillin desensitization protocol, the patient received 14 days of intravenous penicillin with clinical resolution.

Conclusions: There are increasing reports of ocular syphilis in the United States and delay in diagnosis and management can lead to severe visual impairment and blindness. We report the first case of adjunct intravitreal antibiotic therapy in a penicillin allergic patient. As ocular syphilis is a form of bacterial endophthalmitis, combination intravitreal and systemic antibiotics may be considered.     

Immunoblot and Polymerase Chain Reaction to Diagnose Ocular Syphilis and Neurosyphilis in HIV-positive and HIV-negative Patients

ABSTRACT

Purpose: To evaluate immunoblot (IB) and polymerase chain reaction (PCR) to diagnose ocular- and neurosyphilis.

Methods: Prospective cross-sectional study. Aqueous humor (AH) and cerebrospinal fluid (CSF) samples were tested for treponemal DNA or antibodies to treponemal antigens.

Results: Thirteen of 106 cases had positive syphilis serology of which 69.2% were HIV+ (median CD4+ = 181 cells/µL). Four cases met CDC criteria for neurosyphilis (3 confirmed, 1 probable) and 2 additional cases required neurosyphilis treatment according to UpToDate algorithms. All AH and CSF samples tested PCR negative. Five cases were CSF IB+ and 3 cases AH IB+. Using our classification, eight patients had confirmed neurosyphilis, one had probable neurosyphilis, three had confirmed ocular syphilis and nine had probable ocular syphilis.

Conclusion: Our findings suggest that IB of AH and CSF provides additional evidence to diagnose ocular and neurosyphilis and allows us to classify them as probable or confirmed.     

乙肝孕妇血清标志物模式与HBV-DNA载量及肝功能关系研究

目的探讨乙肝孕妇血清标志物模式、HBV-DNA载量及肝功能三者之间的关系,为孕期乙肝病毒感染情况的监控和乙肝病毒母婴传播的预防提供参考。方法选取2019年1月-11月在我院产检的767例乙肝表面抗原阳性孕妇的乙肝血清标志物模式、肝功能指标的丙氨酸氨基转移酶(alamine aminotransferase,ALT)及HBVDNA载量进行研究,探讨三者间的关系。结果HBsAg、HBeAg、HBcAb阳性组孕妇HBV-DNA阳性率及病毒载量均高于其余两组(P<0.05);ALT升高程度与HBV-DNA载量具有一定相关性(r=0.255,χ^2=80.150,P=0.000);HBeAg阳性组和HBeAg阴性组间HBV-DNA阳性率、ALT异常率差异均有统计学意义。结论HBV-M、HBV-DNA与肝功能之间有一定的相关性,大三阳孕妇中高病毒载量比例高,应加强乙肝孕妇孕期各项指标的监测,必要时进行干预治疗。     

Administration of intravenous benzylpenicillin in 13 infants born to mothers with syphilis infection: A case series

The incidence of syphilis infection among pregnant women is persistently high in Japan and in several developed countries. Here, we report the utility of intravenous benzylpenicillin in 13 infants born to mothers with syphilis infection. Because the recommended treatment (intramuscular benzathine benzylpenicillin) is not available in Japan, we intravenously administered benzylpenicillin for 10 days, which is used for treatment in high-risk cases. The administration of benzylpenicillin in low-risk infants resulted in an extended duration of parent-to-infant separation and increased the infants’ exposure to invasive procedures. Thus, establishing evidence of the adequacy of no-treatment follow-up in low-risk groups and introducing intramuscular injections of benzathine benzylpenicillin may improve the management of infants suspected with congenital syphilis in Japan.     

探讨高危孕妇胎盘植入的临床危险因素及MRI价值征象

目的探讨高危孕妇胎盘植入的临床危险因素及MRI价值征象。方法91例高危孕妇,年龄23~44岁、平均年龄32岁;孕周27~38.5周、平均孕周36.2周;分别分析临床资料及MRI宫内征象1)胎盘异常增厚及胎盘内T2WI低信号带;2)胎盘与肌层分界线不连续或中断;3)子宫肌层变薄及局部膨隆。最终诊断结果均经手术及病理证实。采用卡方检验比较临床高危因素及MRI宫内征象在总体胎盘植入与对照组间以及MRI宫内征象在胎盘植入组内的统计学差异。结果41/91例为胎盘植入,其中26例浅植入(胎盘粘连)、13例胎盘深植入、2例胎盘穿透,余50例阴性。临床资料剖宫产和/或流产史次数大于等于2次、前置胎盘以及上述MRI宫内征象在总体胎盘植入组间均具有统计学差异(P<0.05)。其中胎盘T2WI低信号带(P=0.015)、胎盘与肌层分界线不连续或中断(P=0.007)、子宫肌层变薄(P=0.000)及局部膨隆(P=0.006)在胎盘植入组内具有统计学差异。结论剖宫产和/或流产史次数大于等于2次及前置胎盘是高危孕妇胎盘植入的临床危险因素。上述MRI宫内征象均为高危孕妇胎盘植入的价值征象。其中胎盘与肌层分界线不连续或中断,是胎盘浅植入的敏感征象。除胎盘异常增厚外,余下MRI宫内价值征象出现越多,提示胎盘植入越深,危险性越大。     

HBV感染免疫耐受期孕妇分娩前后 临床指标及细胞因子水平变化特征

[摘要]　目的　分析HBV感染免疫耐受期孕妇分娩前后临床指标及细胞因子水平的变化规律，比较分娩后不同ALT水平组孕妇血清细胞因子水平差异。方法　选择2015年1月—2017年12月就诊于首都医科大学附属北京佑安医院的HBV感染免疫耐受期孕妇52例，妊娠28周给予替比夫定（telbivudine, LdT）抗病毒干预，分别于LdT干预前（基线）、分娩前（2周）及分娩后（6周）进行生化、血清学及病毒学检测，同步留取相应时间点外周血标本进行细胞因子检测，并分析分娩前后临床指标及细胞因子水平的变化特征。结果　52例患者分娩后6周ALT水平均值明显高于LdT干预前和分娩前，其中ALT≥2倍正常值上限（upper limit of normal, ULN）者达28.8%（15/52例）；与LdT干预前相比，分娩前HBV DNA水平显著下降，平均降幅达（3.68±0.79） lg IU/ml；HBsAg和HBeAg水平在分娩前后无明显变化。与分娩后ALT＜2倍ULN组相比，ALT≥2倍ULN组的IFN-γ水平在LdT干预前呈低水平表达，分娩后呈高水平表达，差异均有统计学意义（Z=2.284，P=0.022；Z=2.223，P=0.026）；2组间IL-2、IL-4、IL-6、IL-10、TNF-α在LdT干预前、分娩前及分娩后均无明显差异。结论　HBV感染免疫耐受期孕妇分娩后部分患者ALT明显升高，结合分娩前后细胞因子的动态变化，提示分娩后可能出现免疫功能增强并打破机体对HBV的免疫耐受，这或许有利于分娩后的抗病毒治疗，但仍须要进一步深入的研究。