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Diagnosis of Treponema pallidum in vitreous samples using real time polymerase chain reaction
  1. M S Rajan1,
  2. P Pantelidis2,
  3. C Y W Tong3,
  4. G L French3,
  5. E M Graham4,
  6. M R Stanford4
  1. 1Medical Eye Unit, St Thomas’s Hospital, London, UK
  2. 2Pan-pathology Molecular Diagnostic Laboratory, St Thomas’s Hospital, London, UK
  3. 3Department of Infection, St Thomas’s Hospital, London, UK
  4. 4Medical Eye Unit, St Thomas’s Hospital, London, UK
  1. Correspondence to: Dr E M Graham FRCP, Medical Eye Unit, St Thomas’s Hospital, Lambeth Palace Road, London SE1 7EH, UK; elizabeth.graham{at}gstt.nhs.uk

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We describe a real time polymerase chain reaction (PCR) technique for the detection of treponemal DNA in the vitreous of patients with suspected syphilitic uveitis.

Case 1

A 41 year old white homosexual male presented with a 1 week history of pain, redness, and reduced visual acuity in the right eye. There was a recent history of mouth ulcers and skin rashes involving the left lower limb. Corrected Snellen visual acuities were 6/60 and 6/6 in the right and left eyes respectively. In the right eye there were 4+ cells in the anterior chamber and vitreous. The right optic disc was swollen with patchy retinitis involving the inferior quadrants. The left eye was normal. Treponema specific serology tests, total antibody enzyme immunoassay assay (EIA) and Treponema pallidum particle agglutination test (TPPA) were strongly positive. Rapid plasma reagin (RPR) titre was 1:512, consistent with active treponemal infection. Subsequent cerebrospinal fluid analysis was also positive for both RPR and TPPA, …

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