1
|
Ferro Desideri L, Rosa R, Forte P, Manocchio R, Vagge A, Traverso CE, Nicolò M. Multimodal imaging for the management of Lyme-associated uveitis: A case report from an Italian tertiary center. Eur J Ophthalmol 2023; 33:NP58-NP64. [PMID: 36710514 DOI: 10.1177/11206721231154172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Lyme borreliosis may present with different systemic manifestations and also the ocular involvement may be difficult to diagnose because of its multifaceted presentation. Considering the growing incidence of Lyme disease in European countries, ophthalmologist should be trained to distinguish ocular borreliosis. CASE REPORT Several clinical presentations have been previously described, including uveitis, unilateral or bilateral chorioretinitis, keratitis, episcleritis, papillitis and ischemic optic neuropathy, retinal vasculitis and acute posterior multifocal placoid pigment epitheliopathy (APMPPE); however our case report showed a rare presentation with the presence of unilateral uveitis with vitreitis and multiple, patchy, yellowish lesions, in association with retinal vasculitis. This clinical picture was to be considered in differential diagnosis with ocular Toxoplasmosis. CONCLUSIONS The appropriate management of this patient was made possible by the combination of multimodal imaging and appropriate laboratory tests, representing the optimal process in the diagnostic and therapeutic pathway in high-risk patients for ocular Lyme disease.
Collapse
Affiliation(s)
- Lorenzo Ferro Desideri
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, Genoa, Italy
- Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili (DINOGMI), Università di Genova, Genova, Italy
| | - Raffaella Rosa
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, Genoa, Italy
- Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili (DINOGMI), Università di Genova, Genova, Italy
| | - Paolo Forte
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, Genoa, Italy
- Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili (DINOGMI), Università di Genova, Genova, Italy
| | - Riccardo Manocchio
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, Genoa, Italy
- Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili (DINOGMI), Università di Genova, Genova, Italy
| | - Aldo Vagge
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, Genoa, Italy
- Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili (DINOGMI), Università di Genova, Genova, Italy
| | - Carlo Enrico Traverso
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, Genoa, Italy
- Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili (DINOGMI), Università di Genova, Genova, Italy
| | - Massimo Nicolò
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, Genoa, Italy
- Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili (DINOGMI), Università di Genova, Genova, Italy
- Macula Onlus Foundation, Genoa, Italy
| |
Collapse
|
2
|
Maleki A, Anesi SD, Look-Why S, Manhapra A, Foster CS. Pediatric uveitis: A comprehensive review. Surv Ophthalmol 2021; 67:510-529. [PMID: 34181974 DOI: 10.1016/j.survophthal.2021.06.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 12/14/2022]
Abstract
Pediatric uveitis accounts for 5-10% of all uveitis. Uveitis in children differs from adult uveitis in that it is commonly asymptomatic and can become chronic and cause damage to ocular structures. The diagnosis might be delayed for multiple reasons, including the preverbal age and difficulties in examining young children. Pediatric uveitis may be infectious or noninfectious in etiology. The etiology of noninfectious uveitis is presumed to be autoimmune or autoinflammatory. The most common causes of uveitis in this age group are idiopathic and juvenile idiopathic arthritis-associated uveitis. The stepladder approach for the treatment of pediatric uveitis is based on expert opinion and algorithms proposed by multidisciplinary panels. Uveitis morbidities in pediatric patients include cataract, glaucoma, and amblyopia. Pediatric patients with uveitis should be frequently examined until remission is achieved. Once in remission, the interval between follow-up visits can be extended; however, it is recommended that even after remission the child should be seen every 8-12 weeks depending on the history of uveitis and the medications used. Close follow up is also necessary as uveitis can flare up during immunomodulatory therapy. It is crucial to measure the impact of uveitis, its treatment, and its complications on the child and the child's family. Visual acuity can be considered as an acceptable criterion for assessing visual function. Additionally, the number of cells in the anterior chamber can be a measure of disease activity. We review different aspects of pediatric uveitis. We discuss the mechanisms of noninfectious uveitis, including autoimmune and autoinflammatory etiologies, and the risks of developing uveitis in children with systemic rheumatologic diseases. We address the risk factors for developing morbidities, the Standardization of Uveitis Nomenclature (SUN) criteria for timing and anatomical classifications, and describe a stepladder approach in the treatment of pediatric uveitis based on expert opinion and algorithms proposed by multi-disciplinary panels. In this review article, We describe the most common entities for each type of anatomical classification and complications of uveitis for the pediatric population. Additionally, we address monitoring of children with uveitis and evaluation of Quality of Life.
Collapse
Affiliation(s)
- Arash Maleki
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA; The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
| | - Stephen D Anesi
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA; The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
| | - Sydney Look-Why
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA; The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
| | - Ambika Manhapra
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA; The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA; The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA; Harvard Medical School, Department of Ophthalmology, Boston, MA, USA.
| |
Collapse
|
3
|
Rebman AW, Yang T, Aucott JN, Mihm EA, West SK. Contrast Sensitivity Loss in Patients With Posttreatment Lyme Disease. Transl Vis Sci Technol 2021; 10:27. [PMID: 34003960 PMCID: PMC7995915 DOI: 10.1167/tvst.10.3.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Posttreatment Lyme disease (PTLD) is marked by neurologic symptoms, cognitive impairment, and significant symptom burden, including fatigue and ocular complaints. The purpose of this study was to determine whether contrast sensitivity (CS) is altered in patients with PTLD compared with healthy controls and, second, whether CS is associated with cognitive and/or neurologic deficits. Methods CS was measured using a Pelli-Robson chart with forced-choice procedures, and the total number of letters read was recorded for each eye. CS impairment was defined for age <60 years as logCS of 1.80 (36 letters or fewer) and for those age ≥60 years as logCS of 1.65 (33 letters or fewer). Participants self-administered a questionnaire to assess presence of ocular symptoms and underwent a neurologic exam and battery of neurocognitive tests. Results CS impairment was associated with an increased odds of being in the PTLD group that was 2.6 times as high as those without CS impairment (odds ratio, 2.6; 95% confidence interval, 1.3-5.2). Neither cases nor controls had significant distance acuity impairment. CS impairment was not associated with any of the ocular complaints in cases but was borderline associated with neurologic abnormalities and cognitive impairment. Conclusions CS impairment in patients with PTLD is linked to signs of cognitive and neurologic impairment and may be a marker of illness severity. Translational Relevance Further investigation into the value of testing CS impairment in PTLD cases is warranted, especially if it is an indicator of cognitive or neurologic manifestations.
Collapse
Affiliation(s)
- Alison W Rebman
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ting Yang
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John N Aucott
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erica A Mihm
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sheila K West
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
4
|
Havuz E, Güdül Havuz S. Lyme disease atypically presenting with a singular symptom: Unilateral chorioretinitis. Eur J Ophthalmol 2020; 31:NP151-NP156. [PMID: 32998513 DOI: 10.1177/1120672120962055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Lyme disease, caused by Borrelia burgdorferi, is a spirochetal disease. Lyme disease-related ocular findings may also provide important clues. Ocular involvement is most commonly seen as uveitis, chorioretinitis, conjunctivitis, keratitis, episcleritis, papillitis, panuveitis, ischemic optic neuropathy, papilledema, and retinal vasculitis. CASE A 27-year-old male patient was admitted with a history of fatigue, malaise, and sudden loss of vision in his left eye for 3 days. The best visual acuity was found 20/20 in the right eye and 20/400 in the left eye. Fluorescein fundus angiography showed no pathological findings in the right eye; but hyperfluorescence that was compatible with choroiditis foci was seen in the left eye. Optical coherence tomography (OCT) showed choroidal thickening in the left eye compared to the right eye. Lyme IgM antibody was found to be positive, explaining choroiditis etiology, while IgG values were found to be negative. Western blot verification test was positive. The patient was treated with 2 × 100 mg doxycycline (21 days) with a diagnosis of Lyme disease, prednol 1 mg/kg/day (10 days) for choroiditis. Omeprazole tablets were given 1 × 1 during the period of cortisone intake. On the third day of treatment, visual acuity increased to 20/200 and continued to increase until reaching 20/20 in the second week. CONCLUSIONS Lyme disease is rare, but must be kept in mind when investigating the etiology of chorioretinitis and retinal vasculitis. The patient reported here is, to our knowledge, the second case reported in literature that shows atypical clinic for Lyme disease with unilateral chorioretinitis without Erythema chronicum migrans (ECM).
Collapse
Affiliation(s)
- Erol Havuz
- Department of Ophthalmology, University of Health Sciences, SUAM Samsun Hospital, Samsun, Turkey
| | | |
Collapse
|
5
|
Madugundu AK, Muthusamy B, Sreenivasamurthy SK, Bhavani C, Sharma J, Kumar B, Murthy KR, Ravikumar R, Pandey A. A Next-Generation Sequencing-Based Molecular Approach to Characterize a Tick Vector in Lyme Disease. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2019; 22:565-574. [PMID: 30106352 DOI: 10.1089/omi.2018.0089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Next-generation sequencing approaches have revolutionized genomic medicine and enabled rapid diagnosis for several diseases. These approaches are widely used for pathogen detection in several infectious diseases. Lyme disease is a tick-borne infectious disease, which affects multiple organs. The causative organism is a spirochete, Borrelia burgdorferi, which is transmitted by ticks. Lyme disease can be treated easily if detected early, but its diagnosis is often delayed or is incorrect leading to a chronic debilitating condition. Current confirmatory diagnostic tests for Lyme disease rely on detection of antigens derived from B. burgdorferi, which are prone to both false positives and false negatives. Instead of focusing only on the human host for the diagnosis of Lyme disease, one could also attempt to identify the vector (tick) and the causative organism carried by the tick. Since all ticks do not transmit Lyme disease, it can be informative to accurately identify the tick from the site of bite, which is often observed by the patient and discarded. However, identifying ticks based on morphology alone requires a trained operator and can still be incorrect. Thus, we decided to take a molecular approach by sequencing DNA and RNA from a tick collected from an individual bitten by the tick. Using next-generation sequencing, we confirmed the identity of the tick as a dog tick, Dermacentor variabilis, and did not identify any pathogenic bacterial sequences, including Borrelia species. Despite the limited availability of nucleotide sequences for many types of ticks, our approach correctly identified the tick species. This proof-of-principle study demonstrates the potential of next-generation sequencing in the diagnosis of tick-borne infections, which can also be extended to other zoonotic diseases.
Collapse
Affiliation(s)
- Anil K Madugundu
- 1 Manipal Academy of Higher Education (MAHE) , Manipal, Karnataka, India .,2 Institute of Bioinformatics , International Technology Park, Bangalore, Karnataka, India .,3 McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Babylakshmi Muthusamy
- 1 Manipal Academy of Higher Education (MAHE) , Manipal, Karnataka, India .,2 Institute of Bioinformatics , International Technology Park, Bangalore, Karnataka, India
| | - Sreelakshmi K Sreenivasamurthy
- 1 Manipal Academy of Higher Education (MAHE) , Manipal, Karnataka, India .,2 Institute of Bioinformatics , International Technology Park, Bangalore, Karnataka, India .,3 McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland.,4 National Institute of Mental Health and Neurosciences , Bangalore, Karnataka, India
| | - Chandra Bhavani
- 2 Institute of Bioinformatics , International Technology Park, Bangalore, Karnataka, India
| | - Jyoti Sharma
- 1 Manipal Academy of Higher Education (MAHE) , Manipal, Karnataka, India .,2 Institute of Bioinformatics , International Technology Park, Bangalore, Karnataka, India
| | - Bankatesh Kumar
- 4 National Institute of Mental Health and Neurosciences , Bangalore, Karnataka, India
| | - Krishna R Murthy
- 1 Manipal Academy of Higher Education (MAHE) , Manipal, Karnataka, India .,2 Institute of Bioinformatics , International Technology Park, Bangalore, Karnataka, India .,5 Vittala International Institute of Ophthalmology , Bangalore, Karnataka, India
| | - Raju Ravikumar
- 4 National Institute of Mental Health and Neurosciences , Bangalore, Karnataka, India
| | - Akhilesh Pandey
- 3 McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland.,6 Department of Biological Chemistry, Johns Hopkins University School of Medicine , Baltimore, Maryland.,7 Department of Oncology, Johns Hopkins University School of Medicine , Baltimore, Maryland.,8 Department of Pathology, Johns Hopkins University School of Medicine , Baltimore, Maryland
| |
Collapse
|
6
|
Škiljić D, Gustavsson M, Dotevall L, Norrsell K, Grönlund MA. Ophthalmological findings in neuroborreliosis - a prospective study performed in western Sweden. Acta Ophthalmol 2019; 97:44-52. [PMID: 30146785 DOI: 10.1111/aos.13884] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 07/02/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate and follow-up ophthalmological findings in individuals diagnosed with neuroborreliosis, confirmed by cerebrospinal fluid (CSF) analysis. METHODS Twenty-four individuals (13 males), mean age 43.5 ± 18.2 years, with strong clinical suspicion of neuroborreliosis, were referred to the Department of Ophthalmology by the Department of Infectious Diseases at Sahlgrenska University Hospital, Gothenburg, Sweden. All subjects underwent serological and CSF analysis. A structured history taking and a detailed ophthalmological examination were performed prospectively. RESULTS Diagnosis for neuroborreliosis was confirmed as definite in 16, possible in two and negative in four individuals, while two had unknown diagnosis. The majority (n = 14/18) with definite and possible diagnoses had ophthalmological symptoms and/or findings either in history or at examination. The most common findings were visual disturbance, diplopia, red eyes, photophobia, facial palsy with palpebral diastasis, strabismus and sixth nerve palsy. The number of symptoms and findings was correlated with immunoglobulin G (IgG)/IgM in CSF (r = 0.6, p = 0.009/0.016; Spearman's correlation). All subjects improved, except one with initially fulminant papilloedema, who still suffered from optic disc atrophy and affected visual fields at the last follow-up. CONCLUSION The majority of patients diagnosed with neuroborreliosis had ophthalmological symptoms and/or findings. Facial palsy with palpebral diastasis was a common finding. Onset of diplopia and/or sixth nerve affection may be a first sign of neuroborreliosis. Number of ophthalmological findings was correlated with the CSF antibody titre. Ticks are becoming more widespread and abundant, resulting in a higher incidence of neuroborreliosis. Hence, the knowledge of ophthalmological symptoms and findings is of great importance.
Collapse
Affiliation(s)
- Dragana Škiljić
- Department of Ophthalmology; Sahlgrenska University Hospital; Mölndal Sweden
- Department of Clinical Neuroscience; Institute of Neuroscience and Physiology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Martin Gustavsson
- Department of Clinical Neuroscience; Institute of Neuroscience and Physiology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Leif Dotevall
- Department of Communicable Disease Control; Region Västra Götaland; Gothenburg Sweden
- Department of Infectious Diseases; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Kerstin Norrsell
- Department of Clinical Neuroscience; Institute of Neuroscience and Physiology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Marita Andersson Grönlund
- Department of Ophthalmology; Sahlgrenska University Hospital; Mölndal Sweden
- Department of Clinical Neuroscience; Institute of Neuroscience and Physiology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| |
Collapse
|
7
|
Raja H, Starr MR, Bakri SJ. Ocular manifestations of tick-borne diseases. Surv Ophthalmol 2016; 61:726-744. [DOI: 10.1016/j.survophthal.2016.03.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 11/29/2022]
|
8
|
Mattéi J, Pélissier P, Richard O, Manoli P, Girod JP, Cazorla C, Bru JP, Stéphan JL. Uvéites de Lyme : à propos de 2 observations. Arch Pediatr 2011; 18:49-53. [DOI: 10.1016/j.arcped.2010.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Revised: 05/12/2010] [Accepted: 10/08/2010] [Indexed: 10/18/2022]
|
9
|
|