Contributor: Gordon K. Klintworth
Tabes dorsalis is a manifestation of neurosyphilis. It is characterized by a degeneration of the dorsal columns of the spinal cord and of the sensory nerves of the trunk. Optic atrophy is also a feature. Patients manifest paroxyms of intense pain, incordination, disturbances of sensation, loss of reflexes. Trophic disturbances occur especially in the bones and joints.
The symptoms of congenital syphilis present 2-6 weeks after birth with rhinitis, maculopapular rash, and poor nutrition. Syphilitic interstitial keratitis is part of the Hutchinson triad (pegged teeth, neural deafness, interstitial keratitis). A self-limited interstitial keratitis is characteristic of congenital syphilis. This inflammatory reaction of the corneal stroma begins unilaterally with anterior uveitis and involvement of the corneal endothelium. Eventually it almost always affects both eyes. In 2 to 3 weeks pain, photophobia, and lacrimation are evident. Corneal edema and cellular infiltration of the stroma occur, and all layers are affected. The pupils become miotic. Corneal vascularization from the periphery form a "salmon patch." The inflammation subsides once the vessels meet. Empty blood vessels (ghost vessels) persist in the cornea. Complications include band keratopathy, keratoconus, and secondary glaucoma. Chorioretinits with the "salt-and-pepper" fundus may also occur. Other manifestations include saddle nose, splenomegaly, lymphadenopathy (epitrochlear nodes), saber tibia, scoliosis, and exostosis of the tibia and cranial bones. Some features of congenital syphilis become manifest between 5-20 years of age.
Treponema pallidum becomes disseminated hematogenously in secondary syphilis and the spirochete is found in high concentrations in cutaneous and mucosal lesions. An inflammatory reaction in which lymphocytes and plasma cells predominate may be granulomatous or non-granulmatous. The plasma cells tend to accumulate in a perivascular location. Necrosis is seldom found. Spirochetes can be identified with special stains (such as the Warthin-Starry stain).
Syphilis of the optic nerve occurs in secondary syphilis [syphilis - secondary] and tertiary syphilis [syphilis - teriary].. A granulomatous optic neuritis may develop in tertiary syphilis and optic atrophy is common in tabes dorsalis.
An Argyl-Robertson pupil is common in neurosyphilis. Gummas can involve the conjunctiva. Episclerits, scleritis, uveitis, retinal detachment and a pigmentary retinopathy (pseudo-retinitis pigmenosa) can occur.
Syphilis, including ocular syphilis is recognized complication of AIDS. Spirochetes spread hematogenously to the eye where they cause uveitis. Ocular syphilis can occur in hosts without any risk factors for AIDS.