Treponema pallidum in the vitreous tap

Abstract number: 1733_414

Müller M., Ewert I., Hansmann F., Tiemann C., Hagedorn H., Roider J., Hoerauf H., Laqua H., Solbach W.

Background: Syphilis of the eye still poses a clinical challenge due the chameleonic behaviour of the disease. As the serodiagnosis has significant limitations, the direct detection of Treponema pallidum (TP) in the vitreous of the eye represents a desirable diagnostic tool.

Methods: Real-time polymerase chain reaction (PCR) for the detection of TP was applied in specimens from diagnostic vitrectomies of 2 patients with acute chorioretinitis. Qualitative verification of TP by real-time PCR and melting point analysis according a modified protocol was ruled out. Patients underwent complete serological work-up (TP antibodies, immunoblot, antilipoidal antibodies), ophthalmologic examination with fundus photographs, fluorescein angiography, antibiotic treatment and follow-up.

Results: In 2 cases of acute chorioretinitis of unknown origin, real-time PCR of vitreous specimens of both patients provided evidence of TP and was 100% specific. Initial diagnosis of presumed viral retinitis was ruled out by PCR of vitreous specimen. Patients were treated with systemic antibiotics and showed prompt improvement in visual function and resolution of fundus lesions.

Conclusions: In cases of acute chorioretinitis the use of PCR-based assays of vitreous specimens in the diagnostic evaluation of patients is advisable. With real-time PCR, detection of TP in the vitreous was possible and delivered a sensitive, quick and inexpensive answer in a disease rather difficult to assess. Although syphilitic chorioretinitis is a rare disease, PCR should include search for TP, as diagnostic dilemmas prolong definitive treatment in a sight threatening disease.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Location: ICC, Munich, Germany
Presentation type:
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