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Ambika S, Lakshmi P. Infectious optic neuropathy (ION), how to recognise it and manage it. Eye (Lond) 2024; 38:2302-2311. [PMID: 38831116 PMCID: PMC11306351 DOI: 10.1038/s41433-024-03152-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/10/2024] [Accepted: 05/22/2024] [Indexed: 06/05/2024] Open
Abstract
Optic neuropathy can be of infectious or non-infectious/idiopathic aetiology. Many infectious organisms can cause optic neuropathy that can be of varied presentation including papillitis, retrobulbar optic neuritis, neuroretinitis, and optic perineuritis. Detailed history, ocular, systemic/neurologic examination along with appropriate laboratory evaluation can help clinicians to identify the infectious agent causing optic neuropathy. In spite of recent advanced techniques in serological testing and molecular diagnostics like polymerase chain reaction (PCR), the identification of these pathogens is still a diagnostic challenge. It is ideal to have an infectious disease (ID) consultant in the management team, as most of these infections are multisystem involving diseases. Most infectious agents can be effectively treated with specific antibiotics, with or without corticosteroid therapy, but visual recovery is highly variable and depends entirely on early diagnosis of the causative agent. This review article will provide an overview of common pathogens involved in ION and will describe their management paradigms.
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Affiliation(s)
- Selvakumar Ambika
- Department of Neuro-Ophthalmology, Sankara Nethralaya - A Unit of Medical Research Foundation, 18 College Road, Nungambakkam, Chennai, 600 006, India.
| | - Padma Lakshmi
- Department of Neuro-Ophthalmology, Sankara Nethralaya - A Unit of Medical Research Foundation, 18 College Road, Nungambakkam, Chennai, 600 006, India
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Makhoul J, Ben-Arie-Weintrob Y, Ben Ephraim Noyman D. Retinochoroiditis secondary to Rickettsia typhi infection: a case report. BMC Ophthalmol 2024; 24:111. [PMID: 38454387 PMCID: PMC10919007 DOI: 10.1186/s12886-024-03329-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/25/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND To report a case of unusual presentation of retinochoroiditis caused by Rickettsia typhi in a patient without prior uveitis. CASE PRESENTATION In this case, we describe a 24-year-old male soldier with no previous eye disease, who was referred to our ophthalmology department due to bilateral retinochoroiditis and vitritis. The patient initially presented with a paracentral scotoma in his right eye persisting for 7 days and scattered dark spots in his left eye for 2 days in June 2023. Preceding these ocular symptoms, he experienced a two-week episode of fever, headaches, night sweats, and rapid weight loss of 10 kg. A transient rash covered his body briefly. His mother had a history of recurrent eye inflammation. Physical examination revealed bilateral keratic precipitates on the lower corneal periphery, 1 + anterior vitreous cells, small retinal lesions and mild optic discs elevation. Fluorescein angiography indicated mild discs hyperfluorescence, and the clinically visible round punctate lesions on OCT showed inner retinal hyper-reflective lesion with a depth till outer plexiform layer possibly suggestive of a retinitis lesion. Laboratory tests were normal except thrombocytosis, elevated ESR, liver enzymes and ACE levels, with positive Rickettsia typhi serology tests. Rheumatology and infectious disease consultations ruled out autoimmune diseases, confirming Rickettsia typhi infection. Treatment included systemic doxycycline and prednisone, with improvement of visual acuity, ocular symptoms, OCT abnormalities and resolution of inflammation. Prednisone was discontinued, and after two months, additional improvement was seen clinically, with preserved retinal structures on OCT. CONCLUSION This study explores retinochoroiditis as a rare ocular presentation of Rickettsia typhi, an unusual infection in the Middle East. Previously reported ocular manifestations include conjunctivitis, vitritis, post infectious optic neuropathy and a few cases of uveitis. Ocular symptoms followed systemic illness, highlighting the need for awareness among clinicians. Diagnosis relies on seroconversion, with fluorescein angiography and OCT aiding in assessment. Empiric doxycycline and systemic corticosteroid therapy is recommended. Ocular symptoms resolved in two months. Awareness of these ocular manifestations is essential for timely diagnosis and management. Further research is needed to fully understand this aspect of murine typhus.
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Affiliation(s)
- Joanne Makhoul
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
- Rambam Health Care Campus, Haifa, Israel.
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Moore SM, McAllister MA, Thomas TO. Rickettsia rickettsii infection as an unusual cause of pediatric retinitis: A case report. Am J Ophthalmol Case Rep 2022; 26:101566. [PMID: 35540704 PMCID: PMC9078999 DOI: 10.1016/j.ajoc.2022.101566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 03/21/2022] [Accepted: 04/25/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose To report a case of infectious pediatric retinitis attributed to Rocky Mountain spotted fever which is rarely reported in the United States. Observations A previously healthy 14-year-old male return traveler from Mexico was admitted to the pediatric ICU with septic shock and a diffuse rash. He subsequently complained of blurry vision and was found to have evidence of retinitis on exam. Infectious workup revealed high titers of rickettsial IgM and IgG antibodies. He was treated successfully with 14 days doxycycline and followed up in clinic with improvement in his visual complaints and retinitis. Conclusions and importance Rickettsioses are worldwide endemic zoonotic infections caused by Gram negative obligate intracellular bacteria and spread to humans by infected ticks. Rickettsial infections, including Rocky Mountain spotted fever caused by Rickettsia rickettsii, are a cause of infectious retinitis, and atypical and zoonotic infections should remain on the differential diagnosis for patients presenting with rash, systemic illness, and visual complaints, even if the patient's travel or exposure history do not immediately suggest a likely rickettsial infection. In general, the ocular manifestations of rickettsial infection improve with systemic doxycycline treatment of the underlying infection.
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Dixon MK, Dayton CL, Anstead GM. Parinaud's Oculoglandular Syndrome: A Case in an Adult with Flea-Borne Typhus and a Review. Trop Med Infect Dis 2020; 5:E126. [PMID: 32751142 PMCID: PMC7558689 DOI: 10.3390/tropicalmed5030126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/13/2020] [Accepted: 07/24/2020] [Indexed: 11/16/2022] Open
Abstract
Parinaud's oculoglandular syndrome (POGS) is defined as unilateral granulomatous conjunctivitis and facial lymphadenopathy. The aims of the current study are to describe a case of POGS with uveitis due to flea-borne typhus (FBT) and to present a diagnostic and therapeutic approach to POGS. The patient, a 38-year old man, presented with persistent unilateral eye pain, fever, rash, preauricular and submandibular lymphadenopathy, and laboratory findings of FBT: hyponatremia, elevated transaminase and lactate dehydrogenase levels, thrombocytopenia, and hypoalbuminemia. His condition rapidly improved after starting doxycycline. Soon after hospitalization, he was diagnosed with uveitis, which responded to topical prednisolone. To derive a diagnostic and empiric therapeutic approach to POGS, we reviewed the cases of POGS from its various causes since 1976 to discern epidemiologic clues and determine successful diagnostic techniques and therapies; we found multiple cases due to cat scratch disease (CSD; due to Bartonella henselae) (twelve), tularemia (ten), sporotrichosis (three), Rickettsia conorii (three), R. typhi/felis (two), and herpes simplex virus (two) and single cases due to tuberculosis, paracoccidioidomycosis, Yersinia enterocolitica, Pasteurella multocida, Chlamydia trachomatis, Epstein-Barr virus, and Nocardia brasiliensis. Preauricular lymphadenopathy is a common clinical clue for POGS and is unusual in viral and bacterial conjunctivitis. For POGS, the major etiological consideration is B. henselae, which is usually diagnosed by the indirect immunofluorescence serologic technique. Although CSD POGS is usually self-limited, oral azithromycin may hasten resolution. However, other possible etiologies of POGS may also arise from cat or cat flea contact: sporotrichosis, tularemia, Pasteurella multocida, or FBT. If there is no cat contact, other epidemiologic and clinical findings should be sought, because several of these conditions, such as tularemia, paracoccidioidomycosis, and tuberculosis, may have grave systemic complications. Although there are usually no long-term ocular sequelae if POGS is properly diagnosed, it still may cause prolonged ocular discomfort and require multiple physician contacts.
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Affiliation(s)
- M. Kevin Dixon
- Baylor Scott & White Clinic, 800 Scott & White Drive, College Station, TX 77845, USA;
| | - Christopher L. Dayton
- Division of Critical Care, Department of Medicine, University of Texas Health, San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA;
| | - Gregory M. Anstead
- Medical Service, South Texas Veterans Health Care System, San Antonio, TX 78229, USA
- Division of Infectious Diseases, Department of Medicine, University of Texas Health, San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
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Situ BA, Streit SJ, Tran TC, Nomura JH, Bababeygy SR, Rodger DC. Two cases of uveitis associated with severe transaminitis during a Rickettsia typhi outbreak in Los Angeles County. Am J Ophthalmol Case Rep 2020; 19:100813. [PMID: 32715155 PMCID: PMC7374180 DOI: 10.1016/j.ajoc.2020.100813] [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] [Received: 05/13/2019] [Revised: 04/07/2020] [Accepted: 06/29/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To report the clinical presentation, multimodal imaging, and management of two patients with Rickettsia typhi infection who presented with transaminitis and bilateral uveitis. Observations We report two cases of murine typhus-associated uveitis in the setting of a Rickettsia typhi outbreak in Los Angeles County. In case 1, a 29-year-old Hispanic female presented with scotoma of the right eye and bilateral floaters after 2 weeks of persistent fevers, maculopapular rash, and arthralgia. Clinical examination and optical coherence tomography (OCT) revealed vitreous cell and scattered white spots in both eyes at the level of the inner retina, and a cotton wool spot inferiorly in the left eye. Multiple hyperautofluorescent spots were seen on widefield fundus autofluorescence (FAF). Retinal vascular leakage and optic disc hyperfluorescence were visualized on widefield fluorescein angiography (FA). These findings were concerning for a white dot syndrome (WDS). The patient was started on oral prednisone 30 mg daily. Serologic testing during the convalescent phase returned positive for R. typhi infection and she was started on doxycycline. 3 weeks later, she reported complete resolution of scotoma and significant improvement of bilateral floaters. In the second case, a 42-year-old Hispanic male presented with sudden bilateral increased floaters and blurry vision after 12 days of persistent fever and headache. Clinical examination revealed trace flare with 1+ cell in the anterior chamber, 1+ vitreous cell, and multiple white dots in both eyes at the level of the inner retina. FAF showed scattered hyperautofluorescent spots in both eyes. FA demonstrated late retinal vascular leakage with bilateral hyperfluorescent optic discs. He was started on oral prednisone 40mg, prednisolone acetate 1% drops, and cyclopentolate 1% drops daily. 2 weeks later, serologic titers returned positive for murine typhus and he was started on doxycycline with gradual taper off of steroids. He subsequently had complete resolution of floaters, blurry vision, and the inner retinal white spots. Conclusions and Importance Murine typhus-associated uveitis may present with scotoma and increased floaters in the setting of persistent fevers and transaminitis, with pre- or inner retinal white spots seen on fundus examination. Ophthalmologists may aid in prompt diagnosis and initiation of antibiotic therapy, which can shorten the course of the disease and in turn, reduce the risk of severe complications.
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Affiliation(s)
- Betty A Situ
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA, USA
| | - Susan J Streit
- Kaiser Permanente Los Angeles Medical Center, 4867 W. Sunset Blvd., Los Angeles, CA, USA
| | - Timothy C Tran
- Kaiser Permanente Los Angeles Medical Center, 4867 W. Sunset Blvd., Los Angeles, CA, USA
| | - Jim H Nomura
- Kaiser Permanente Los Angeles Medical Center, 4867 W. Sunset Blvd., Los Angeles, CA, USA
| | - Simon R Bababeygy
- Kaiser Permanente Los Angeles Medical Center, 4867 W. Sunset Blvd., Los Angeles, CA, USA
| | - Damien C Rodger
- Kaiser Permanente Los Angeles Medical Center, 4867 W. Sunset Blvd., Los Angeles, CA, USA
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Kahloun R, Abroug N, Ksiaa I, Mahmoud A, Zeghidi H, Zaouali S, Khairallah M. Infectious optic neuropathies: a clinical update. Eye Brain 2015; 7:59-81. [PMID: 28539795 PMCID: PMC5398737 DOI: 10.2147/eb.s69173] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Different forms of optic neuropathy causing visual impairment of varying severity have been reported in association with a wide variety of infectious agents. Proper clinical diagnosis of any of these infectious conditions is based on epidemiological data, history, systemic symptoms and signs, and the pattern of ocular findings. Diagnosis is confirmed by serologic testing and polymerase chain reaction in selected cases. Treatment of infectious optic neuropathies involves the use of specific anti-infectious drugs and corticosteroids to suppress the associated inflammatory reaction. The visual prognosis is generally good, but persistent severe vision loss with optic atrophy can occur. This review presents optic neuropathies caused by specific viral, bacterial, parasitic, and fungal diseases.
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Affiliation(s)
- Rim Kahloun
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Nesrine Abroug
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Anis Mahmoud
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Hatem Zeghidi
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sonia Zaouali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Espino Barros Palau A, Morgan ML, Lee AG. Bilateral optic atrophy in endemic typhus. Can J Ophthalmol 2014; 49:e90-2. [PMID: 25103667 DOI: 10.1016/j.jcjo.2014.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 04/08/2014] [Accepted: 04/09/2014] [Indexed: 11/17/2022]
MESH Headings
- Anti-Bacterial Agents/therapeutic use
- Antibodies, Bacterial/blood
- Doxycycline/therapeutic use
- Eye Infections, Bacterial/diagnosis
- Eye Infections, Bacterial/drug therapy
- Eye Infections, Bacterial/microbiology
- Fluorescein Angiography
- Humans
- Immunoglobulin G/blood
- Immunoglobulin M/blood
- Male
- Middle Aged
- Optic Atrophy/diagnosis
- Optic Atrophy/drug therapy
- Optic Atrophy/microbiology
- Rickettsia typhi/immunology
- Rickettsia typhi/isolation & purification
- Typhus, Endemic Flea-Borne/diagnosis
- Typhus, Endemic Flea-Borne/drug therapy
- Typhus, Endemic Flea-Borne/microbiology
- Vision, Low/diagnosis
- Vision, Low/drug therapy
- Vision, Low/microbiology
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Affiliation(s)
| | | | - Andrew G Lee
- Houston Methodist Hospital, Houston; Baylor College of Medicine, Houston; Cornell Medical College, Houston; University of Texas Medical Branch, Galveston; University of Texas M.D. Anderson Cancer Center, Houston, Tex.; University of Iowa Hospitals and Clinics, Iowa City, Iowa.
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Loussaief C, Toumi A, Ben Brahim H, Aouam A, Kairallah M, Chakroun M. [Macrophage activation syndrome: rare complication of murine typhus]. ACTA ACUST UNITED AC 2014; 62:55-6. [PMID: 24461392 DOI: 10.1016/j.patbio.2013.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 10/02/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Typhi is one of the rickettsial species endemic in the Mediterranean countries and is associated with the zoonotic infection of murine typhus, which may have a complicated course especially in adult patients. The association with macrophage activation syndrome (MAS) has rarely been reported in the medical literature. CASE REPORT We describe a case of murine typhus in a diabetic woman complicated with MAS, who was effectively treated with cyclin and parenteral immunoglobulin. CONCLUSION The murine typhus can be exceptionally complicated with SAM. This infection should be suspected in front of the discovery of SAM.
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Affiliation(s)
- C Loussaief
- Service des maladies infectieuses, hôpital Fattouma Bourguiba, 5019 Monastir, Tunisie.
| | - A Toumi
- Service des maladies infectieuses, hôpital Fattouma Bourguiba, 5019 Monastir, Tunisie
| | - H Ben Brahim
- Service des maladies infectieuses, hôpital Fattouma Bourguiba, 5019 Monastir, Tunisie
| | - A Aouam
- Service des maladies infectieuses, hôpital Fattouma Bourguiba, 5019 Monastir, Tunisie
| | - M Kairallah
- Service d'ophtalmologie, hôpital Fattouma Bourguiba, 5019 Monastir, Tunisie
| | - M Chakroun
- Service des maladies infectieuses, hôpital Fattouma Bourguiba, 5019 Monastir, Tunisie
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Al-Zubidi N, Spitze A, Yalamanchili S, Lee AG. Neuro-ophthalmology Annual Review. ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2013; 2:42-56. [PMID: 26107867 DOI: 10.1097/apo.0b013e3182782e64] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To provide a clinical update of the neuro-ophthalmology literature over the last twelve months. DESIGN This is an annual review of current literature from August 1, 2011 to August 1, 2012. METHODS The authors conducted a one year English language neuro-ophthalmology literature search using PubMed from August 1, 2011 to August 1, 2012 using the following search terms: pupil abnormalities, eye movements, diseases of muscle and musculoskeletal junction, optic nerve disorders, optic neuritis and multiple sclerosis, chiasm and posterior primary visual pathway lesions, increased intracranial pressure and related entities, tumors (e.g., meningioma) and aneurysm affecting the visual pathways, vascular diseases, higher visual functions, advances in neuroimaging, and miscellaneous topics in neuro-ophthalmology. The authors included original articles, review articles, and case reports, which revealed the new aspects and updates in neuro-ophthalmology. Letters to the editor, unpublished work, and abstracts were not included in this annual literature review. We propose to update the practicing clinical ophthalmologist on the most clinically relevant literature from the past year. However, this review is not meant to be all-inclusive and highlights only the literature most applicable to the practicing clinical ophthalmologist. RESULTS We reviewed the literature over the past year in neuro-ophthalmology of potential interest and relevance to the comprehensive ophthalmologist. CONCLUSION This annual review provides a brief update on a number of neuroophthalmic conditions that might be of interest to the practicing clinical ophthalmologist.
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Affiliation(s)
- Nagham Al-Zubidi
- From the *Department of Ophthalmology, The Methodist Hospital, Houston, TX; †Department of Ophthalmology and Visual Science, Robert Cizik Eye Clinic, The University of Texas-Houston Medical School, Houston, TX; ‡Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, Houston, TX; §Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa; ¶Department ofOphthalmology, Baylor College of Medicine, Houston, Texas; and ∥Departmentof Ophthalmology, The University of Texas Medical Branch, Galveston, TX
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