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. 2022 Jun 27;2(2):mtsi.v2i2.2021.181.
doi: 10.48327/mtsi.v2i2.2021.181. eCollection 2022 Jun 30.

[Ocular syphilis associated to HIV: A report of 2 patients treated in Marrakech, Morocco]

[Article in French]
Hajar El Fouar  1 , Khadija Danaoui  1 , Fatima Ihbibane  1 , Noura Tassi  1
Affiliations

[Ocular syphilis associated to HIV: A report of 2 patients treated in Marrakech, Morocco]

[Article in French]
Hajar El Fouar et al. Med Trop Sante Int. .

Abstract
in English, French

Introduction: Syphilis is a sexually transmitted disease. All organs might be affected, but ocular syphilis occurs only in 0.6 percent of patients. A resurgence of syphilis cases has been observed for several years in many countries, especially in HIV-infected subjects. These patients often present with concomitant primary and secondary lesions or extensive presentations of syphilis.

Case reports: We report 2 patients with syphilitic uveitis diagnosed and treated at the department of infectious diseases at the University hospital of Marrakech. Ocular involvement was inaugural in both HIV patients. Each had a specific treatment, but none had a complete recovery of visual function; the first patient was treated by ceftriaxone and the second one was treated by penicillin.

Conclusion: Syphilis must be discussed in all patients diagnosed with uveitis or papillitis. The diagnosis should be suspected in cases of eye inflammation even in the absence of favourable clinical presentation or anamnesis. Search for HIV co-infection should be systematic. Although not evidence-based, prompt therapy may lead to functional recovery. Ceftriaxone could be a suitable alternative to penicillin in the treatment of early syphilis in HIV-infected patients. This treatment has a concomitant effectiveness even for asymptomatic forms of neurosyphilis. Ocular syphilis is a form of neurosyphilis and requires neurosyphilis therapy regardless of when it develops after primary infection.Conventional syphilis staging is of little use in understanding ocular syphilis. Co-infection between HIV and ocular syphilis is common, but does not affect response to a neurosyphilis regimen of penicillin in the short term.

Introduction: Une recrudescence des cas de syphilis est observée depuis plusieurs années dans de nombreux pays, surtout en ce qui concerne les sujets infectés par le VIH. Ces patients se présentent souvent avec des lésions simultanées de syphilis primaire et secondaire, ou bien avec des formes étendues de syphilis.

Observations: Nous rapportons 2 observations d'uvéite syphilitique prises en charge au service de Maladies infectieuses du Centre hospitalier universitaire Mohammed VI de Marrakech. La syphilis oculaire était inaugurale chez les 2 patients séropositifs. Malheureusement, aucun d'eux n'a bénéficié d'une récupération ophtalmologique complète.

Conclusion: Devant toute uvéite ou papillite, il faut évoquer une infection syphilitique, d'autant que l'incidence de cette maladie est en augmentation depuis une dizaine d'années. Le traitement de la syphilis oculaire est mal codifié mais permet parfois une récupération fonctionnelle complète, s'il est précoce et adapté. La ceftriaxone pourrait être une alternative thérapeutique efficace à la pénicilline G dans le traitement de la syphilis précoce chez les individus infectés par le VIH.

Keywords: Ceftriaxone; HIV; Hospital; Maghreb; Morocco; Neurosyphilis; Northern Africa; Papillitis; Penicillin G; Uveitis.

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Figures

Figure 1
Figure 1
Échographie mode B objectivant une hyalite droite avec décollement de rétine en V. Collection Dr El Fouar, CHU Mohammed VI, Marrakech, Maroc. B-Mode ultrasound objectifying a right hyalitis with V-retinal detachment. Collection Dr El Fouar, CHU Mohammed VI, Marrakech, Morocco.
Figure 2
Figure 2
Échographie mode B objectivant une hyalite gauche avec décollement de rétine total gauche. Collection Dr El Fouar, CHU Mohammed VI, Marrakech, Maroc. B-Mode ultrasound objectifying a left hyalitis with total retinal detachment. Collection Dr El Fouar, CHU Mohammed VI, Marrakech, Morocco.
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