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Mitchell JL, MacDougall L, Dobromylskyj MJ, Smith K, Stavinohova R, Gunn-Moore DA, Hope JC, Scurrell E. Ocular mycobacterial lesions in cats. Vet Pathol 2022; 59:792-805. [PMID: 35587045 PMCID: PMC9358306 DOI: 10.1177/03009858221098431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ocular mycobacterial infections are an under-recognized cause of morbidity in the
domestic cat. This study aimed to explore the distribution, histopathological
appearance, and severity of feline ocular mycobacterial lesions, and to
characterize the immune cell population with immunohistochemistry. Routine
histological staining with hematoxylin and eosin, and Masson’s trichrome, was
performed to identify ocular lesions and assign an inflammation score based on
the number of cells present. Acid-fast bacilli were detected with Ziehl-Neelsen,
and immunohistochemistry for ionized calcium-binding adaptor protein-1 (Iba1),
calprotectin, cluster of differentiation 3 (CD3), and Pax5 was undertaken on
formalin-fixed paraffin-embedded tissue samples from 24 cases of ocular
mycobacteriosis. Posterior or panuveitis with concurrent retinitis was
identified in 20/24 cases (83%), with retinal detachment in 16/20 (80%) of these
cases. Choroidal lesions had the highest median inflammation score.
Ziehl-Neelsen-positive organisms were detected in 20/24 cases (83%), with the
highest prevalence of acid-fast bacilli detected in choroidal lesions (16/20,
80%). Lesions were typically granulomatous to pyogranulomatous, characterized by
abundant numbers of Iba1-positive macrophages, followed by calprotectin-positive
granulocytes and monocytes, fewer T cells, and rarer B cells. However, where
iritis was identified, inflammation was typically lymphoplasmacytic (11/16
cases, 69%). Where diagnostic testing was performed, tuberculosis (ie, infection
with Mycobacterium bovis, Mycobacterium
microti, or a nonspeciated Mycobacterium
tuberculosis-complex pathogen) was diagnosed in 20/22 cats (91%),
with Mycobacterium lepraemurium infection identified in the
other 2/22 cats (9%). These results suggest the choroid is the primary site of
lesion development in most cases of feline ocular mycobacteriosis, and
inflammatory changes are associated with the presence of mycobacteria localized
to ocular tissues.
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Affiliation(s)
| | | | | | - Ken Smith
- Royal Veterinary College, Hatfield, UK
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2
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Mitchell JL, Ganis L, Blacklock BT, Petrushkin H, Hope JC, Gunn-Moore DA. Ocular Tuberculosis: More than 'Of Mice and Men'. Ocul Immunol Inflamm 2022; 30:34-38. [PMID: 32946291 DOI: 10.1080/09273948.2020.1797116] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Tuberculosis (TB), caused by infection with members of the Mycobacterium tuberculosis-complex, is one of the oldest known infectious disease entities, resulting in the death of millions of humans each year. It also results in a substantial degree of morbidity and mortality in animal species. Extrapulmonary TB is well recognized in humans, and the eye is one site that can be affected. Studies seeking to understand ocular TB have often relied on animal models; however, these have their limitations and may not truly reflect what happens in humans. We wish to raise awareness among ophthalmologists and vision scientists of naturally occurring cases of ocular TB in animals, namely cattle and domestic cats, and the possibilities of gaining further understanding of this presentation of TB by adopting a collaborative approach. This will hopefully improve outcomes for both human and animal patients.
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Affiliation(s)
- Jordan L Mitchell
- Royal (Dick) School of Veterinary Studies and the Roslin Institute, The University of Edinburgh, Midlothian, UK
| | - Laura Ganis
- Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - Benjamin T Blacklock
- Royal (Dick) School of Veterinary Studies and the Roslin Institute, The University of Edinburgh, Midlothian, UK
| | - Harry Petrushkin
- Moorfields Eye Hospital Foundation Trust, Uveitis and Scleritis Service, London, UK.,Rheumatology Department, Great Ormond Street Hospital, London, UK
| | - Jayne C Hope
- Royal (Dick) School of Veterinary Studies and the Roslin Institute, The University of Edinburgh, Midlothian, UK
| | - Danièlle A Gunn-Moore
- Royal (Dick) School of Veterinary Studies and the Roslin Institute, The University of Edinburgh, Midlothian, UK
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3
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Agarwal A, Aggarwal K, Pichi F, Meng T, Munk MR, Bazgain K, Bansal R, Agrawal R, Gupta V. Clinical and Multimodal Imaging Clues in Differentiating Between Tuberculomas and Sarcoid Choroidal Granulomas. Am J Ophthalmol 2021; 226:42-55. [PMID: 33529591 DOI: 10.1016/j.ajo.2021.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare the differences among clinical, demographic, and multimodal imaging features of choroidal granulomas associated with tuberculosis and sarcoidosis. DESIGN Retrospective comparative case series. METHODS Clinical features and fundus imaging, including fluorescein and indocyanine green angiography and optical coherence tomography of patients with tuberculomas and sarcoid choroidal granulomas seen at 3 tertiary care centers, were reviewed. The differences among clinical appearances, including morphology of the lesions (size, shape, extent), vascularity, and multimodal imaging features, were compared. Repeated logistic regression measurements with a multilevel random effects model was used to assess characteristics of individual granulomas that could predict the underlying cause. RESULTS The study included 47 eyes of 38 patients (22 with tuberculomas and 16 with sarcoid granulomas; total of 138 granulomas). Patients with tuberculomas were significantly younger (33.8 ± 10.1 vs. 48.6 ± 14.3 years, respectively; P = .002), but no sex differences were observed. In comparison with sarcoid granulomas, tuberculomas were solitary (P <.001), intense yellow, lobulated, full thickness, and located in the perivascular region (all P <.001); they were also larger (16.01 ± 9.7 mm2 vs. 2.7 ± 4.5 mm2, respectively; P <.001) and were vascularized (P <.001). Sarcoid granulomas were associated with retinal vasculitis (P = .003) and disc hyperfluorescence (P <.001). Logistic regression showed that multiple granulomas were associated with sarcoidosis (odds ratio [OR]: 3.5; 95% confidence interval: 1.8-6.9; P <.001). Granulomas larger than 6.45 mm2 had the highest area under the receiver operating curves (0.94) for differentiating tuberculomas from sarcoid granulomas. CONCLUSIONS Tuberculomas and sarcoid choroidal granulomas have various clinical and imaging features that help differentiate between the 2 entities with high predictability and can supplement immunological and radiological tests in a diagnosis.
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Mölzer C, Heissigerova J, Wilson HM, Kuffova L, Forrester JV. Immune Privilege: The Microbiome and Uveitis. Front Immunol 2021; 11:608377. [PMID: 33569055 PMCID: PMC7868421 DOI: 10.3389/fimmu.2020.608377] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/04/2020] [Indexed: 02/03/2023] Open
Abstract
Immune privilege (IP), a term introduced to explain the unpredicted acceptance of allogeneic grafts by the eye and the brain, is considered a unique property of these tissues. However, immune responses are modified by the tissue in which they occur, most of which possess IP to some degree. The eye therefore displays a spectrum of IP because it comprises several tissues. IP as originally conceived can only apply to the retina as it contains few tissue-resident bone-marrow derived myeloid cells and is immunologically shielded by a sophisticated barrier – an inner vascular and an outer epithelial barrier at the retinal pigment epithelium. The vascular barrier comprises the vascular endothelium and the glia limitans. Immune cells do not cross the blood-retinal barrier (BRB) despite two-way transport of interstitial fluid, governed by tissue oncotic pressure. The BRB, and the blood-brain barrier (BBB) mature in the neonatal period under signals from the expanding microbiome and by 18 months are fully established. However, the adult eye is susceptible to intraocular inflammation (uveitis; frequency ~200/100,000 population). Uveitis involving the retinal parenchyma (posterior uveitis, PU) breaches IP, while IP is essentially irrelevant in inflammation involving the ocular chambers, uveal tract and ocular coats (anterior/intermediate uveitis/sclerouveitis, AU). Infections cause ~50% cases of AU and PU but infection may also underlie the pathogenesis of immune-mediated “non-infectious” uveitis. Dysbiosis accompanies the commonest form, HLA-B27–associated AU, while latent infections underlie BRB breakdown in PU. This review considers the pathogenesis of uveitis in the context of IP, infection, environment, and the microbiome.
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Affiliation(s)
- Christine Mölzer
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Jarmila Heissigerova
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Heather M Wilson
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Lucia Kuffova
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom.,Eye Clinic, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - John V Forrester
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
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Marchese A, Agarwal AK, Erba S, Scialdone A, Miserocchi E, Bandello F, Introini U, Jampol LM, Casalino G. Placoid lesions of the retina: progress in multimodal imaging and clinical perspective. Br J Ophthalmol 2021; 106:14-25. [PMID: 33468489 DOI: 10.1136/bjophthalmol-2020-318337] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 12/17/2022]
Abstract
Placoid lesions of the retina may be secondary to a wide spectrum of acquired inflammatory conditions that have been reported as single entities with different presentation and clinical course. These conditions include acute posterior multifocal placoid pigment epitheliopathy, persistent placoid maculopathy, serpiginous choroiditis, serpiginous-like choroiditis, relentless placoid chorioretinitis and acute syphilitic posterior placoid chorioretinitis. In this article, we will group these conditions under the name of 'placoids'. The recognition of the specific condition may be challenging in clinical practice, often resulting in diagnostic and therapeutic delay. Given the complex nature of placoids and their similarities, a systematic approach including differentiating between infectious and non-infectious aetiologies increases the chance of reaching the correct diagnosis. Detailed history and comprehensive clinical examination are the first steps to formulate a diagnostic hypothesis that should be corroborated by multimodal imaging and appropriate investigations. The advent of multimodal imaging has made it possible to extensively study placoids and revealed a constellation of specific findings that may help clinicians in the diagnostic process. The treatment of the conditions other than syphilis is complex and sometimes challenging. Our article is aimed at giving an overview of the individual entities associated with placoids and discussing the differential diagnosis. A practical and systematic approach is then proposed.
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Affiliation(s)
- Alessandro Marchese
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Aniruddha Kishandutt Agarwal
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Stefano Erba
- Oftalmico Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Elisabetta Miserocchi
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Ugo Introini
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Lee M Jampol
- Department of Ophthalmology, Northwestern University, Chicago, Illinois, USA
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Patel A, Kelgaonkar A, Kaza H, Tyagi M, Murthy S, Pathengay A, Basu S. Recent Advances in Diagnosis and Treatment of Infectious Uveitis Prevalent in Asia-Pacific Region. Asia Pac J Ophthalmol (Phila) 2021; 10:99-108. [PMID: 33512831 DOI: 10.1097/apo.0000000000000367] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT The role of infections in intraocular inflammation is being increasingly recognized across the world. The Asia-Pacific region, being the single largest and most populous geographical entity on the planet, is home to a wide variety of such infections. Not surprisingly, there has been an explosion in the literature on infectious uveitis emerging from Asia-Pacific countries. In this review, we have covered recent advances in the diagnosis, treatment, and pathogenesis of common forms of infectious uveitis from the Asia-Pacific region. Much of the literature is focussed on the diagnosis of these infections by clinical criteria and laboratory investigations. There has also been an increased emphasis on the application of newer modes of ocular imaging and understanding pathomechanisms of ocular inflammation in these infections. Together this research has significantly improved our understanding of the diagnosis and management of infectious uveitis.
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Affiliation(s)
- Anamika Patel
- Uveitis services, L V Prasad Eye Institute, GMR Varalakshmi Campus, Vishakhapatnam, India
| | - Anup Kelgaonkar
- Uveitis services, L V Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, India
| | - Hrishikesh Kaza
- Uveitis services, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India
| | - Mudit Tyagi
- Uveitis services, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India
| | - Somasheila Murthy
- Uveitis services, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India
| | - Avinash Pathengay
- Uveitis services, L V Prasad Eye Institute, GMR Varalakshmi Campus, Vishakhapatnam, India
| | - Soumyava Basu
- Uveitis services, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India
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Insights into the molecular pathogenesis of ocular tuberculosis. Tuberculosis (Edinb) 2020; 126:102018. [PMID: 33202350 DOI: 10.1016/j.tube.2020.102018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 11/23/2022]
Abstract
Unclear pathogenic mechanisms underlying the ocular tuberculosis (OTB) has resulted in perplexity related to the diagnosis and management of the disease. Developments in experimental research and innovations in molecular diagnostics have recently provided a new understanding of disease pathogenesis and natural history. The current review focuses on the new insights into OTB pathogenesis, derived from in vivo and in vitro studies on Mycobacterium tuberculosis dissemination and localization into the eye, in combination with histopathological studies on chorioretinal tissue and vascular network. Advances in the knowledge of OTB have influenced disease management in the clinical setting and lead to reconsideration of the role of existing treatments and suggesting potential new therapeutic approaches.
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