Augenbeteiligung bei venerischer Syphilis – Update

Zusammenfassung

Syphilis ist eine bakterielle Infektionskrankheit, die durch die Spirochäte Treponema pallidum übertragen wird. Die Zahl von Neuerkrankungen ist in den letzten Jahren kontinuierlich gestiegen. Die Augenbeteiligung ist eine wohl unterschätzte Manifestation der Syphilis, die gehäuft bei HIV-positiven Patienten auftritt. Obschon praktisch jeder Teil der Augen im Rahmen einer Syphilis betroffen sein kann, tritt sie häufig mit einer posterioren oder Panuveitis auf. Eine besonders typische Verlaufsform ist die akute syphilitische plakoide Chorioretinitis, mit typischen Charakteristika in der multimodalen Bildgebung. Bei dem Verdacht auf eine Syphilis sind treponemenspezifische und nicht treponemenspezifische serologische diagnostische Tests angezeigt. Bei frühzeitigem Einsatz einer antibiotischen Therapie (primär mit Penicillin) werden oft gute Ergebnisse hinsichtlich Morphologie und Visus erzielt. Additive Kortikosteroide sollten verlaufsorientiert und erst nach dem Beginn der Antibiotikatherapie verwendet werden.

Abstract

Syphilis is a bacterial infectious disease transmitted by the spirochaete Treponema pallidum. The rate of infection has increased during the last decade. Ocular syphilis is an underestimated presentation of the disease, and it is increased in HIV-positive patients. Even though every part of the eye may be affected, syphilis most commonly occurs with posterior or panuveitis. A distinctive pattern is acute syphilitic placoid chorioretinitis, with typical features in multimodal imaging. If syphilis is suspected, specific and nonspecific Treponema pallidum serological diagnostic tests are mandatory. Clinical outcome, or morphology and vision are commonly improved if antibiotic therapy (penicillin is the drug of choice) is instituted early. Additional corticosteroids are carefully applied according to individual need, and should be initiated after the start of antibiotics.

Schlüsselwörter

Syphilis - Uveitis - Infektiologie - intraokulare Entzündungen

Key words

syphilis - uveitis - infectious diseases - intraocular inflammation

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