Early symptomatic neurosyphilis and ocular syphilis: A comparative study between HIV-positive and HIV-negative patients.

OBJECTIVES: Since the 2000s, there has been an increase in prevalence of neurosyphilis (NS) and ocular syphilis (OS). As data about symptomatic NS/OS is limited, this study aims to assess the characteristics of symptomatic NS/OS, according to HIV status. METHODS: We compared the clinical and biological presentation of early symptomatic NS/OS and its outcome in HIV-positive and HIV-negative patients. RESULTS: Ninety-six patients (93% men, 49% HIV-positive) were included from 2000 to 2016 in two centers, with 67 (69%) having OS, 15 (16%) NS, and 14 (14%) both. HIV-positive patients were younger (P=0.006) and more likely to be males having sex with males (P=0.00048) or to have a history of syphilis (P=0.01). Among 81 OS, there were 43 posterior uveitis (57%), and bilateral involvement was more common in HIV-positive patients (62% versus 38%, P=0.045). Among 29 NS there were 21 cases of cranial nerve involvement (72%), seven meningitis (24%) and 11 paresthesia (38%). Involvement of the VIIIth cranial nerve was the most common (16 cases). Treponemal tests were more commonly found positive in cerebrospinal fluid in HIV-positive patients (88% versus 76%, P=0.04). Visual acuity (VA) always improved after treatment (initial VA logMAR 0.8±0.8 versus 0.1±0.1 at 3 months), but 32% and 18% of the patients still had neurological or ocular impairment respectively six and 12 months after treatment. Non-treponemal serological reversion was observed in 43/50 patients (88%) at six months. CONCLUSION: HIV infection has no consequence on the outcome of NS and OS. Sequelae are common, emphasizing the importance of prevention, and screening, and questioning enhanced treatment.

[Severe pseudouveitis associated with moxifloxacin therapy]. / Pseudo-uvéite sévère associée à l'utilisation de moxifloxacine.

INTRODUCTION: Moxifloxacin is an antibiotic of the fluoroquinolone class, marketed in France since 2002. It is used primarily in the treatment of bacterial sinusitis and acute exacerbations of chronic bronchitis. The purpose of this study is to report a possible severe ocular side effect following the systemic use of moxifloxacin. PATIENT AND METHODS: Case report of a patient who presented with the appearance of a severe acute uveitis after being treated with systemic moxifloxacin. Eleven days after initiation of moxifloxacin treatment, the patient developed simultaneous bilateral eye pain, pigment dispersion and diffuse iris transillumination. This case was further complicated by ocular hypertension. Etiologic investigations for other causes of the uveitis were negative. In particular, an anterior chamber tap was performed and PCR for herpes viruses (HSV, VZV, EBV, CMV) was negative. DISCUSSION: Drug-induced uveitis is relatively rare. The relationship between systemic fluoroquinolone treatment and the occurrence of uveitis has been considered "possible", according to World Health Organization criteria, in a recent retrospective analysis of 40 case reports. Moxifloxacin was suspected in 25 of these cases. The presence of both iris transillumination and pigment dispersion appears specific to the uveitis in question. CONCLUSION: It appears that practitioners prescribing moxifloxacin and ophthalmologists should be informed of this possible adverse effect, so that it may be quickly recognized, managed and reported.

Risk factors for prolonged treatment of lymph node tuberculosis.

Lymph node tuberculosis (LNTB) is the most frequent form of extra-pulmonary tuberculosis (TB). Randomised, controlled trials have convincingly demonstrated that 6 months of chemotherapy is sufficient for most drug-susceptible LNTB. We performed a retrospective, multicentric study from 1997 to 2010 to describe factors associated with prolonged anti-tuberculosis treatment in patients with LNTB. Of 126 patients diagnosed with LNTB, 22 (17.5%) were human immunodeficiency virus (HIV) infected. The median treatment duration was 9 months (interquartile range, 6-12). Treatment was significantly longer in patients with HIV (P < 0.01), additional sites of TB (P < 0.01) or weight loss (P = 0.04). Factors independently associated with excessively lengthy treatment were HIV co-infection and the presence of other TB foci.