syphilitic keratopathy
Introduction
Introduction to syphilitic keratopathy Syphilis is a chronic sexually transmitted disease (STD) caused by Treponema pallidum. Congenital syphilis occurs mainly through sexual contact and transmission to the next generation through the placenta. Syphilis can invade many organs and tissues of the human body, such as skin, mucous membrane, cardiovascular system, nervous system, etc., which is extremely harmful. In the early stage, it mainly invades the skin mucosa, and in the late stage, it mainly attacks the cardiovascular and nervous systems. The eye can cause a variety of damage, such as conjunctivitis, keratitis, scleritis, uveitis, chorioretinitis, optic neuritis, strabismus, ptosis, pupillary abnormalities. basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of transmission: sexual contact, blood transmission Complications: total uveitis
Cause
Causes of syphilitic keratopathy
(1) Causes of the disease
Treponema pallidum (TP), also known as P. pallidum, (0.18 ~ 0.2) m × (5 ~ 15) m, 6 ~ 20 spiral, pitch 1m, is the pathogen causing human syphilis, natural infection is limited to human Syphilis can be divided into two types: congenital and acquired. The former is transmitted from the mother through the placenta to the fetus, and the latter is transmitted through sexual contact.
(two) pathogenesis
It may be that infected TP is caused by epithelial or limbal blood vessels; it is more likely to be infected with TP during embryonic or acquired, spreading to the cornea with blood, sensitizing corneal tissue, and TP antigen or toxin present in other parts of the body again with blood When the flow reaches the sensitized cornea, it develops due to local antigen-antibody allergy or antigen-antibody-complement reaction.
Prevention
Syphilitic keratopathy prevention
(1) All suspected patients should be examined and tested for syphilis serum in order to detect new patients early and treat them promptly.
(2) Patients with syphilis must be forced to undergo isolation treatment. The patient's clothing and supplies, such as towels, clothes, razors, tableware, bedding, etc., should be strictly disinfected under the guidance of medical personnel to eliminate the source of infection.
(3) Tracking the patient's sexual partners, including patient self-reports and medical personnel visits, finding all sexual contact persons, conducting preventive examinations, tracking observations and performing necessary treatments. The spouse is absolutely forbidden to have sex before the cure.
Complication
Complications of syphilitic keratopathy Complications, uveitis
More complicated with uveitis. Uveitis refers to inflammation of the iris, ciliary body, and choroid; the blood supply to the iris and ciliary body is the same as the iris ring, so the two are often inflamed at the same time, and are collectively called iridocyclitis. If the choroid is also inflamed at the same time, it is called uveitis. Uveitis is an eye disease that occurs mostly in young adults. It has a wide variety of causes and the cause is quite complicated. Improper treatment can lead to blindness.
Symptom
Symptoms of syphilitic keratopathy common symptoms deafness edema saddle nose angle cleft palate
1. Congenital syphilitic keratitis with simultaneous or sequential onset of both eyes (weeks to weeks), clinically divided into 4 phases:
(1) Initial stage: The symptoms are not obvious. The slit lamp can be seen in the peripheral part of the upper cornea. The matrix is foggy and turbid, mild edema, and a small amount of fine corneal metaphyseal, which develops into the stage after 1 to 2 weeks.
(2) Progression period: the irritation symptoms are obvious, more than 50% of the peripheral parts of the cornea are limited, the scaly vasospasm inflammatory infiltration, affecting the deep layer of the matrix, and then developing toward the center and the whole week, the cornea is frosted glassy, with a brush Neovascularization grows into the keratome, often accompanied by iridocyclitis, which enters the peak period after a few weeks.
(3) Peak period: the whole corneal stroma is turbid, the superficial matrix is densely covered with new blood vessels, the surface layer is shoulder-like across the limbus, the deep layer is brush-like, the broom-like shape enters the lamina, the cornea is dark red, and the intraocular condition is not seen. 2 to 4 months.
(4) Degenerative period: The inflammation slowly decreases. From the peripheral part, the epithelial layer and the shallow stromal layer gradually clear, but the middle and deep stromal layers are still turbid. The diffuse cloud and vascular shadows can exist for life, and the cornea can be seen in the posterior cornea. , mesh or membranous glass-like stripes, which lasted for months to 2 years.
Congenital syphilis in addition to corneal stroma inflammation, often combined with saddle nose, Hutchinson teeth, soft cleft palate, angular cleft palate, forehead bulging, saber-shaped humerus, neurological deafness and other congenital syphilis signs, at present, the disease is extremely rare in China.
2. Acquired syphilitic parenchymatous keratitis The keratitis caused by acquired syphilis is clinically divided into: incubation period (stage 1), generalized stage (stage 2) and late stage (stage 3). Acquired keratitis is more common in the general stage, but also in the late stage, but rare, the inflammatory response is lighter than congenital syphilitic keratitis, often invading the cornea, a benign trend, with anterior uveitis, patients Older, with a history of syphilis, serum Kang-Fahrenheit reaction.
Examine
Examination of syphilitic keratopathy
1. Rapid plasma reagin (RPR) test is an improved method of VDRL test. Plasma can be used. The principle is to adsorb VDRL antigen with untreated medicinal carbon particles (3~5m in diameter). When the reacting hormone in the serum to be tested is combined, a black agglomerate is formed, which can be recognized by the naked eye, and does not need to be observed by a low power microscope. The test is carried out in a reaction circle (inner diameter of 18 mm) of a special paper card, and the test has high sensitivity and certainity. Specific, economical, convenient, fast, suitable for large-scale screening and qualitative or semi-quantitative.
2. Cerebrospinal fluid examination can be used for neurosyphilis.
3. Histopathological examination Biopsy can sometimes find Treponema pallidum in tissues, which is often stained with silver stains. However, after staining, the bacteria are easily confused with elastic fibers. Special immunofluorescence or immunoperoxidase staining can be used, but specimens cannot be freezing.
4. Dark-field microscopy, Phase I, Phase II syphilis and early congenital syphilis should be examined by dark-field microscopy of Treponema pallidum in lesions. Positive persons should see pathogens with regular spiral motion, and dark-field examination is simple. Fast and accurate, a skin lesion can only be judged to be negative after three consecutive examinations. Dark-field microscopy is not suitable for damage to the oral mucosa, because the syphilis spirochete seen under the microscope cannot be in the mouth. Non-pathogenic spirochete difference, should pay attention to the examination of the anterior skin lesions can not be used externally, or use antibiotic-containing saline as the carrier liquid for examination, the dead syphilis in the specimen can be directly or indirectly immunofluorescent staining or immunoperoxide Identification by enzyme staining.
5. Serological examination is taken from the Kang-Fahrenheit reaction lesions. The optical microscope is used to examine the spirochetes, aqueous humor, vitreous materials, direct staining of fluorescein-labeled antibodies, and fluorescence microscopy for the spirochetes.
Diagnosis
Diagnosis and diagnosis of syphilitic keratopathy
According to the ocular and corneal manifestations combined with the full physical signs, history of sexual disorder, patients or children with a history of parental sexual history and other preliminary diagnosis.
