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Ambasta A, Kusumesh R, Ali M, Bhaskar G, Akanksha S, Pragya V. Causes of Vision Loss Associated with Dengue Fever in Bihar, India - A Case Series. Am J Trop Med Hyg 2024; 110:1172-1177. [PMID: 38697090 PMCID: PMC11154056 DOI: 10.4269/ajtmh.23-0524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 01/21/2024] [Indexed: 05/04/2024] Open
Abstract
The incidence and geographic distribution of dengue has increased dramatically in recent years across various parts of the world. Previously, ocular findings in dengue fever were considered rare. We report a spectrum of ocular manifestations presenting with vision loss in the last dengue epidemic in an eastern state of India. This is a retrospective interventional case series of patients with vision loss who were diagnosed with dengue eye disease in the 2022 epidemic. Systemic and ophthalmic examinations were completed on all patients and were analyzed. Fifteen patients had presented with vision loss. The mean age was 41.7 ± 10.8 years, and patients were mostly males. Three patients presented with panophthalmitis and orbital cellulitis. Eight patients were diagnosed with optic neuropathy. Four patients had macular involvement: macular chorioretinitis, macular subhyaloid hemorrhage, and macular hemorrhages in two patients. All patients with optic neuropathy gave a history of mild fever and had remained undiagnosed. The rest had been diagnosed with the more severe dengue hemorrhagic fever. Vision recovered partially or fully in patients with optic neuropathy and macular disease. No eye could be salvaged in any panophthalmitis patients. Thrombocytopenia (platelet count <100 × 109 per liter of blood) was significantly associated with ocular hemorrhage and panophthalmitis, but thrombocytopenia was not significantly seen in optic neuropathy. We conclude that optic neuropathy may be an underreported cause of vision loss in dengue fever. An eye examination is advocated in all patients with dengue eye disease.
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Affiliation(s)
- Anita Ambasta
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, India
| | - Rakhi Kusumesh
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, India
| | - Mobashir Ali
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, India
| | - Gyan Bhaskar
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, India
| | - Sinha Akanksha
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, India
| | - Varuni Pragya
- Jagadguru Sri Shivarathreeshwara Medical College, Mysore, India
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Karnam S, Huang Y, Nguyen N, Yeh S. Ophthalmic consequences of viral hemorrhagic fevers: Insights from the clinic and laboratory. FRONTIERS IN TROPICAL DISEASES 2023. [DOI: 10.3389/fitd.2023.1107786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Viral hemorrhagic fevers (VHFs) are a diverse group of RNA virus-mediated systemic diseases with significant morbidity and mortality and represent a significant public health concern. Given the high systemic morbidity and mortality in a number of these entities, delays in diagnosis can lead to downstream public health consequences. Many viral hemorrhagic fevers have ophthalmic manifestations and ophthalmologists thus play a key role in disease recognition and the management of ocular complications associated with specific hemorrhagic fevers. This review summarizes the key ophthalmic consequences of viral hemorrhagic fevers, viral disease pathogenesis, disease findings, and areas of unmet research need.
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Chen YW, Hsieh TY, Lin CH, Chen HM, Lin CC, Chen HH. Association Between a History of Dengue Fever and the Risk of Systemic Autoimmune Rheumatic Diseases: A Nationwide, Population-Based Case-Control Study. Front Med (Lausanne) 2021; 8:738291. [PMID: 34805205 PMCID: PMC8597927 DOI: 10.3389/fmed.2021.738291] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/14/2021] [Indexed: 01/09/2023] Open
Abstract
Purpose: To determine the association between a history of clinically diagnosed dengue infection and the risk of systemic autoimmune rheumatic diseases (SARDs). Methods: Using claims data from the 1997-2013 Taiwanese National Health Insurance Research Database, we included 74,422 patients who were diagnosed with SARDs and 297,688 patients without SARDs who were matched (in a 1:4 ratio) for age, sex, year of SARDs index date, and city of residence. The associations between the development of SARDs and a history of dengue infection (International Classification of Diseases, Ninth Revision, Clinical Modification code 061) were investigated using conditional logistic regression analysis shown as odds ratios (ORs) with 95% confidence intervals (CIs) after adjusting for potential confounders. Results: We included 17,126 patients with systemic lupus erythematosus (SLE), 15,531 patients with Sjogren's syndrome (SS), 37,685 patients with rheumatoid arthritis (RA), 1,911 patients with systemic sclerosis (SSc), 1,277 patients with dermatomyositis (DM), and 892 patients with polymyositis (PM). SLE (OR, 4.55; 95% CI, 2.77-7.46; p <0.001) risk was significantly associated with a history of dengue infection. However, no statistically significant association was found between dengue infection and SS (OR, 1.41; 95% CI, 0.88-2.26; p = 0.155), RA (OR, 1.03; 95% CI, 0.70-1.50; p = 0.888), SSc (OR, 1.97; 95% CI, 0.38-10.29; p = 0.420), DM (OR, 0.54; 95% CI, 0.04-7.27; p = 0.641), or PM (OR, 2.08; 95% CI, 0.23-18.79; p = 0.513). Conclusion: This study revealed that a history of dengue infection was significantly associated with the risk of SLE, but not SS, RA, SSc, DM, or PM.
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Affiliation(s)
- Yun-Wen Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Tsu-Yi Hsieh
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan.,Department of Medical Education, Taichung Veterans General Hospital, Taichung City, Taiwan.,Ph.D. Program of Business, Feng Chia University, Taichung City, Taiwan.,School of Medicine, National Yang-Ming University, Taipei City, Taiwan
| | - Ching-Heng Lin
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung City, Taiwan.,Department of Medical Research, Taichung Veterans General Hospital, Taichung City, Taiwan.,Department of Healthcare Management, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan.,Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Hsian-Min Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung City, Taiwan.,Center for Quantitative Imaging in Medicine (CQUIM), Department of Medical Research, Taichung Veterans General Hospital, Taichung City, Taiwan.,Department of Computer Science and Information Engineering, National United University, Miaoli City, Taiwan.,Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, Chung Hsing University, Taichung City, Taiwan
| | - Chi-Chien Lin
- Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.,Center for Quantitative Imaging in Medicine (CQUIM), Department of Medical Research, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Hsin-Hua Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan.,School of Medicine, National Yang-Ming University, Taipei City, Taiwan.,Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung City, Taiwan.,Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, Chung Hsing University, Taichung City, Taiwan
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Feizi S, Meshksar A, Naderi A, Esfandiari H. Anterior Scleritis Manifesting After Coronavirus Disease 2019: A Report of Two Cases. Cornea 2021; 40:1204-1206. [PMID: 34351874 PMCID: PMC8330625 DOI: 10.1097/ico.0000000000002795] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/01/2021] [Accepted: 05/03/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE The purpose of this study was to report 2 patients with anterior scleritis manifesting after coronavirus disease 2019 (COVID-19). METHODS The patients with confirmed COVID-19 developed anterior scleritis after their systemic symptoms were markedly improved. A thorough systemic workup identified no underlying autoimmune diseases. Ocular characteristics and safety and efficacy of systemic immunosuppressive therapy were evaluated. RESULTS Case 1 was a 67-year-old woman who presented with necrotizing anterior scleritis in both eyes 3 weeks after the onset of COVID-19. One-week treatment with topical betamethasone and oral prednisolone (65 mg daily) did not result in improvement, so she was started on intravenous cyclophosphamide and subcutaneous adalimumab in addition to oral prednisolone. Necrotizing scleritis was gradually improved over 3 months. Case 2 was a 33-year-old man who presented with sectoral anterior scleritis in his right eye 2 weeks after the onset of COVID-19. He was started on topical betamethasone and oral prednisolone (85 mg daily). One week later, all signs and symptoms disappeared, and topical and oral corticosteroids were gradually tapered off over 2 weeks. There was no recurrence of respiratory symptoms or active scleritis in any cases after discontinuation of treatment. CONCLUSIONS These cases suggest that COVID-19 can be associated with anterior scleritis, which responds to immunosuppressive and biologic agents. Ophthalmologists should consider anterior scleritis in patients with COVID-19 who present with ocular pain and redness during the convalescent phase of the illness.
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Affiliation(s)
- Sepehr Feizi
- Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran; and
| | - Aidin Meshksar
- Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran; and
| | - Ali Naderi
- Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran; and
| | - Hamed Esfandiari
- Department of Ophthalmology, Olmsted Medical Center, Rochester, MN
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Vijitha VS, Dave TV, Murthy SI, Ali MJ, Dave VP, Pappuru RR, Narayanan R. Severe ocular and adnexal complications in dengue hemorrhagic fever: A report of 29 eyes. Indian J Ophthalmol 2021; 69:617-622. [PMID: 33595487 PMCID: PMC7942086 DOI: 10.4103/ijo.ijo_1588_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose: To describe a series of sight-threatening ocular and adnexal involvement associated with dengue hemorrhagic fever and their treatment options. Methods: Retrospective, interventional, non-comparative case series. Medical records of patients who presented with ocular symptoms attributed to dengue hemorrhagic fever were reviewed. Demography, presenting features, and treatment outcomes were recorded. Outcome measures assessed included globe salvage, vision salvage, and visual improvement. The outcome was deemed as favorable if vision salvage was possible and unfavorable if the vision was lost. Results: Twenty-nine eyes of 23 patients were included. Bilateral ocular involvement was seen in 6 (26%) patients. The mean age was 37.62 ± 18.68 years (range: 14 to 81 years). Coexistent diabetes mellitus and enteric fever were present in three patients. History of blood transfusion was present in nine (40%) and thrombocytopenia in eight (35%) patients at the time of presentation with ocular complaints. Presenting features included endophthalmitis in 11 (38%), panophthalmitis in 10 (35%), orbital cellulitis with panophthalmitis in four (14%), isolated corneal or scleral melt in three (10%), and orbital hemorrhage with panophthalmitis in one (3%) patient. Globe salvage was achieved in 21/29 eyes (72.4%), vision salvage in 6/29 eyes (20.68%), and improvement in visual acuity was noted in 5/29 eyes (17.24%). Logistic regression analysis revealed no significant effect of any clinical-microbiological factors on globe salvage, vision salvage, and visual improvement. However, visual improvement and globe salvage were possible in eyes that underwent early endoscopic vitrectomy. Conclusion: Dengue fever can present with sight-threatening ocular and adnexal inflammation resulting in endophthalmitis and panophthalmitis, orbital cellulitis, corneal and scleral melt, and orbital hemorrhage. Early vitrectomy may improve vision and globe salvage in cases with significant vitritis.
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Affiliation(s)
- V S Vijitha
- Ophthalmic Plastic Surgery Service, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Tarjani Vivek Dave
- Ophthalmic Plastic Surgery Service, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | | | - Mohammad Javed Ali
- Ophthalmic Plastic Surgery Service, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Vivek Pravin Dave
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rajeev Reddy Pappuru
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Raja Narayanan
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
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Goyal M, Murthy SI. Infectious Scleritis due to Methicillin-resistant Staphylococcus Aureus after Dengue Viral Fever. Ocul Immunol Inflamm 2021; 30:1544-1546. [PMID: 33830847 DOI: 10.1080/09273948.2021.1900877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: Dengue fever is a severe mosquito-borne disease which can present with various severe ocular manifestations. We aim to report a case of infectious scleritis in dengue fever, occurring due to Methicillin-resistant Staphylococcus aureus (MRSA), managed with intravenous Teicoplanin.Methods: Case report.Results: A 23-year-old woman with recent hospitalization for dengue fever presented with severe pain and a nodular scleral lesion. She was initially diagnosed with immune-mediated scleritis, but as the condition worsened, she underwent scleral scraping which subsequently grew MRSA. She was initially started on topical vancomycin eye drops and topical linezolid but there was further worsening. Therapy was switched to intravenous Teicoplanin which resulted in rapid resolution of the condition.Conclusion: To the best of our knowledge, this is the first reported case of infectious scleritis in association with dengue fever due to MRSA.
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Affiliation(s)
- Mallika Goyal
- Retina-Vitreous & Uvetis Service, Apollo Health City, Hyderabad, India
| | - Somasheila I Murthy
- Cornea Service, The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
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Abstract
PURPOSE OF REVIEW There are an increasing number of publications related to dengue ophthalmic manifestations and multimodality imaging related to dengue. This review summarizes the current literature, describe ocular manifestations, current using of ocular imaging/investigations, and management of ocular dengue. RECENT FINDINGS Ocular manifestations of dengue can be present in many stages of dengue fever including after the resolution of systemic disease. Most cases of ocular dengue will exhibit an improvement in vision spontaneously over time. Multimodal imaging such as optical coherence tomography, optical coherence tomography angiography, near-infrared imaging, and microperimetry plays an important role in the diagnosis, follow-up, quantitative measure, and help to understand the disease progression. SUMMARY Dengue fever can lead to a variety of ocular manifestations. The mechanisms underlying dengue-related ocular complications remain unclear. Immune-mediated mechanisms and direct viral invasion are thought to play an important role. Ophthalmologists should carefully assess patients with dengue-related ophthalmic disease because some patients may have poor visual acuity and exhibit refractoriness to treatment. Treatment with systemic corticosteroids may benefit those patients with poor presenting visual acuity, progressive ocular symptoms, and lesions involving the optic nerve and/or threatening the macula.
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da Silva PAN, Ito CRM, Barbosa MS, de Oliveira Santos M, Carneiro LC. Arboviruses (chikungunya, dengue, and Zika) associated with ophthalmic changes: a focus on aqueous fluid and vitreous humor. Eur J Clin Microbiol Infect Dis 2019; 39:827-833. [PMID: 31863236 DOI: 10.1007/s10096-019-03792-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/04/2019] [Indexed: 01/22/2023]
Abstract
The aim of this study was to conduct a bibliographic survey and correlates the presence of arboviroses in the eyeball with the main eye changes presented by the population under study. This study is a systematic review of journals and indexed articles, carried out between January 2019 and June 2019, in which there was a query in the Pubmed/Medline and Scielo databases without temporal restriction. In addition to the aforementioned databases, the Brazilian Association of Organ Transplantation Association database, which provides epidemiological data on organ and tissue transplants in Brazil, was used as a research source. The Midwest region contributed to the increase in the number of organ transplants in Brazil. The number of corneal transplants in Brazil surpassed the number of organ transplants by four times. Several ophthalmic changes associated with Chikungunya, Dengue, and Zika virus infections have been diagnosed; however, few studies have identified the presence of the virus in the eyeball. Arboviruses are of great relevance to public health due to a number of factors, ranging from the diversity of infectious agents involved and the plurality of clinical manifestations because the absence of efficient laboratory support, leading to delayed disease confirmation due to lack of differential diagnostics available. Added to these difficulties is the lack of specific therapy, leaving only the symptomatic control of clinical manifestations as the only treatment option. However, the manifestations are directly associated with the decreased quality of vision and consequently the quality of life of patients.
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Affiliation(s)
- Paulo Alex Neves da Silva
- Instituto de Patologia Tropical e Saúde Pública, Departamento de Biotecnologia, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Célia Regina Malveste Ito
- Instituto de Patologia Tropical e Saúde Pública, Departamento de Biotecnologia, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Mônica Santiago Barbosa
- Instituto de Patologia Tropical e Saúde Pública, Departamento de Biotecnologia, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Mônica de Oliveira Santos
- Instituto de Patologia Tropical e Saúde Pública, Departamento de Biotecnologia, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Lilian Carla Carneiro
- Instituto de Patologia Tropical e Saúde Pública, Departamento de Biotecnologia, Universidade Federal de Goiás, Goiânia, Goiás, Brazil.
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