한국의 매독 포도막염의 임상양상
Clinical Manifestations of Syphilitic Uveitis in the Korean Population
1
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
목적: 한국에서 매독 포도막염의 임상 양상을 조사해 보고자 한다. 대상과 방법: 2007년에서 2012년까지 부산 지역 3개, 3차 의료기관에서 확진된 매독 포도막염 환자 16명을 대상으로 후향적 의무기록분석을 시행하였다. 환자들은 혈청학적 검사를 통해 매독으로 진단되었으며 최대교정시력 및 세극등 검사, 안저 검사, 형광안저 혈관조영술 검사결과 및 어떠한 치료가 이루어졌는지 조사해 보았다. 결과: 매독 포도막염으로 진단받은 환자 중 남자는 12명, 여자는 4명이, 평균 나이는 51.16세였다. 비육아종성 전부 포도막염이 9안에서 관찰되었다. 후부 포도막염의 가장 흔한 양상은 유리체염으로 16안에서 관찰되었으며, 망막혈관염이 11안, 맥락망막염이 5안에서관찰되었다. 인체면역결핍바이러스 검사는 모두 음성 소견을 보였다. 15명에게 신경매독에 준하여 페니실린 또는 세프트리악손 항생제 치료를 시행하였다. 환자의 치료 전 평균 시력은 logMAR 시력으로 1.33 ± 1.1에서 치료 후 0.58 ± 068로 호전되었다. 결론: 한국의 매독 포도막염의 임상 양상은 외국의 보고와는 차이를 보였다. 매독 포도막염의 다양한 임상양상은 포도막염 환자의진단 시 매독 검사의 필요성을 보여준다. 매독 포도막염의 임상양상 및 치료 후 장기간 재발 및 합병증 발생에 대한 추가 연구가필요할 것으로 생각된다.
Abstract
Purpose: In recent, years, an increase of syphilis infections has become an issue in Korea as well as globally. Herein, we reporta recent clinical manifestation of syphilitic uveitis in a Korean population. Methods: Over a 5-year period (2007-2012), we collected and analyzed the medical records of 16 patients with syphilitic uveitisin three tertiary eye clinics in Pusan. Sixteen patients were confirmed to have syphilis based on serological tests. Retrospectivechart review was performed to determine the best corrected visual acuity, anterior and posterior segments, and treatment regimen,as well as ancillary test results including fluorescein angiogram (FAG). Results: Of the 16 patients, 12 were males and four were females. The mean age of the patients was 51.16 years. Non-granulomatousanterior uveitis was observed in nine eyes (47.4%). Vitritis was the most frequently observed posterior segment finding(16 eyes, 84.2%). Retinal vasculitis and chorioretinitis were found in 11 (57.9%) and five eyes (26.3%), respectively. All patientshad negative results in the serum HIV antibody test. Of the 16 patients, 15 were treated with penicillin or ceftriaxone dueto neurosyphilis. Mean visual acuity improved from 1.33 ± 1.1 to 0.58 ± 0.68 after treatment. Conclusions: Clinical manifestation of syphilitic uveitis in Korean patients is different from occurrences in Western countries. Ophthalmological findings of syphilitic uveitis are diverse; thus, serological testing for syphilis is recommended for all uveitispatients. Further research regarding long-term treatment, relapse of syphilitic uveitis, and complications is necessary.
참고문헌 (28)
- Goldsmith LA, "Fitzpatrick's Dermatology in General Medicine", pp.1955~1957 (2008), McGraw-Hill
- "Primary and secondary syphilis--United States, 2003-2004", MMWR Morb Mortal Wkly Rep, 55, pp.269~273 (2006)
- Herida M, "Epidemiology of sexually transmitted infections in France", Med Mal Infect, 35, pp.281~289 (2005)
- Parc CE, "Manifestations and treatment of ocular syphilis during an epidemic in France", Sex Transm Dis, 34, pp.553~556 (2007)
- Anshu A, "Syphilitic uveitis: an Asian perspective", Br J Ophthalmol, 92, pp.594~597 (2008)
- Gaudio PA, "Update on ocular syphilis", Curr Opin Ophthalmol, 17, pp.562~566 (2006)
- Baughn RE, "Secondary syphilitic lesions", Clin Microbiol Rev, 18, pp.205~216 (2005)
- Singh AE, "Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features", Clin Microbiol Rev, 12, pp.187~209 (1999)
- C. Stephen Foster, "Diagnosis and Treatment of Uveitis" (2002), WB Sounders CO.
- Barile GR, "Syphilis exposure in patients with uveitis", Ophthalmology, 104, pp.1605~1609 (1997)
- Tamesis RR, "Ocular syphilis", Ophthalmology, 97, pp.1281~1287 (1990)
- Drancourt M, "High prevalence of fastidious bacteria in 1520 cases of uveitis of unknown etiology", Medicine(Baltimore), 87, pp.167~176 (2008)
- Puech C, "Ocular manifestations of syphilis:recent cases over a 2.5-year period", Graefes Arch Clin Exp Ophthalmol, 248, pp.1623~1629 (2010)
- 백진옥, "최근 일반 건강인에서의 매독 유병률 경향: 서울지역 단일 기관에서의 연구", 대한피부과학회지, 49(02), pp.106~110 (2011), 대한피부과학회
- Marra CM, "Syphilis and human immunodeficiency virus: prevention and politics", Arch Neurol, 61, pp.1505~1508 (2004)
- Shalaby IA, "Syphilitic uveitis in human immunodeficiency virus-infected patients", Arch Ophthalmol, 115, pp.469~473 (1997)
- Tran TH, "Syphilitic uveitis in patients infected with human immunodeficiency virus", Graefes Arch Clin Exp Ophthalmol, 243, pp.863~869 (2005)
- Becerra LI, "Syphilitic uveitis in human immunodeficiency virus-infected and noninfected patients", Ophthalmology, 96, pp.1727~1730 (1989)
- Gass JD, "Acute syphilitic posterior placoid chorioretinitis", Ophthalmology, 97, pp.1288~1297 (1990)
- Wickremasinghe S, "Syphilitic punctate inner retinitis in immunocompetent gay men", Ophthalmology, 116, pp.1195~1200 (2009)
- Mendelsohn AD, "Syphilitic retinitis. A cause of necrotizing retinitis", Retina, 4, pp.221~224 (1984)
- Jay CA, "Treatment of neurosyphilis", Curr Treat Options Neurol, 8, pp.185~192 (2006)
- Shann S, "Treatment of neurosyphilis with ceftriaxone", Sex Transm Infect, 79, pp.415~416 (2003)
- Zhou P, "A study evaluating ceftriaxone as a treatment agent for primary and secondary syphilis in pregnancy", Sex Transm Dis, 32, pp.495~498 (2005)
- Steele RW, "Ceftriaxone therapy of meningitis and serious infections", Am J Med, 77, pp.50~53 (1984)
- Marra CM, "A pilot study evaluating ceftriaxone and penicillin G as treatment agents for neurosyphilis in human immunodeficiency virus-infected individuals", Clin Infect Dis, 30, pp.540~544 (2000)
- Augenbraun M, "Ceftriaxone therapy for syphilis:report from the emerging infections network", Clin Infect Dis, 29, pp.1337~1338 (1999)
- Dayan L, "Syphilis treatment: old and new", Expert Opin Pharmacother, 6, pp.2271~2280 (2005)