1
|
Reid GA, Halmagyi GM, Whyte C, McCluskey PJ. Ocular vs neurosyphilis. are they the same? A guide to investigation and management. Eye (Lond) 2024; 38:2337-2349. [PMID: 38914721 PMCID: PMC11306553 DOI: 10.1038/s41433-024-03150-w] [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: 02/26/2024] [Revised: 03/26/2024] [Accepted: 05/17/2024] [Indexed: 06/26/2024] Open
Abstract
This article reviews key concepts in the epidemiology, clinical features, diagnosis and management of ocular syphilis. It is not a systematic review or meta-analysis, but highlights the critical clinical features and investigations in patients with ocular syphilis. It reviews the overlap and interplay between ocular and neuro syphilis and provides practical guidance to diagnose and manage patients with ocular syphilis.
Collapse
Affiliation(s)
- Gerard A Reid
- Ophthalmology Department, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK.
- Save Sight Institute, University of Sydney, Specialty of Ophthalmology, Faculty of Medicine and Health, Sydney, NSW, Australia.
| | - Gabor Michael Halmagyi
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Central Clinical School, University of Sydney, Specialty of Neurology, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Claudia Whyte
- Department of Infectious Diseases Prince of Wales Hospital, Sydney, NSW, Australia
- Sydney Eye Hospital, Sydney, NSW, Australia
| | - Peter J McCluskey
- Save Sight Institute, University of Sydney, Specialty of Ophthalmology, Faculty of Medicine and Health, Sydney, NSW, Australia
- Sydney Eye Hospital, Sydney, NSW, Australia
- Department of Ophthalmology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| |
Collapse
|
2
|
Karami M, Gorgani-Firouzjaee T, Rostami-Mansour S, Shirafkan H. Prevalence of Ocular Toxoplasmosis in the General Population and Uveitis Patients: A Systematic Review and Meta-Analysis. Ocul Immunol Inflamm 2024; 32:1003-1016. [PMID: 37043543 DOI: 10.1080/09273948.2023.2190801] [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: 09/20/2022] [Revised: 02/19/2023] [Accepted: 03/09/2023] [Indexed: 04/13/2023]
Abstract
PURPOSE The present study aimed to estimate the global prevalence of ocular toxoplasmosis in the general population and patients with uveitis. METHODS Four electronic databases were searched and 130 studies for evaluating the prevalence of OT among the general population and uveitis patients were included. RESULTS The pooled prevalence of OT among the general population was estimated at 2% (95% CI, 2-3%; 762/486 051). The highest prevalence rate was observed in America 6% (95% CI, 1-11%). In uveitis patients, a prevalence rate of 9% (95% CI, 8-10%; 5668/88 006) was reported. The countries with a lower middle income had higher prevalence rates. The prevalence of OT in posterior uveitis 33% (95%CI, 24-42%) was substantially higher than in panuveitis 7% (95% CI, 5-8%). CONCLUSION Our results provide a new perspective on the prevalence of OT. Knowledge of international and regional patterns of disease is essential for the establishment of precise diagnostic protocols and control programs.
Collapse
Affiliation(s)
- Mohsen Karami
- Department of Mycology and Parasitology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Tahmineh Gorgani-Firouzjaee
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Sahar Rostami-Mansour
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Hoda Shirafkan
- Social Determinants of Health (SDH) Research Centre, Research Institute for Health, Babol University of Medical Sciences, Babol, Iran
| |
Collapse
|
3
|
de-la-Torre A, Mejía-Salgado G, Cifuentes-González C, Rojas-Carabali W, Cuevas M, García S, Rangel CM, Durán C, Pachón-Suárez DI, Bustamante-Arias A. Epidemiology, clinical features, and classification of 3,404 patients with uveitis: Colombian Uveitis Multicenter Study (COL-UVEA). Graefes Arch Clin Exp Ophthalmol 2024; 262:2601-2615. [PMID: 38446198 PMCID: PMC11271433 DOI: 10.1007/s00417-024-06422-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/09/2024] [Accepted: 02/17/2024] [Indexed: 03/07/2024] Open
Abstract
PURPOSE To describe the epidemiology, clinical features, and classification of uveitis in a large cohort of Colombian patients. METHODS Data were collected from seven ophthalmological referral centers in the four main cities in Colombia. The study included patients with a confirmed diagnosis of uveitis from January 2010 to December 2022. Information on demographics, ophthalmic examination findings, uveitis classification, and etiology was recorded. RESULTS The study reviewed 3,404 clinical records of patients with uveitis. The mean age at diagnosis was 41.1 (SD 19.0) years, and 54.2% of the patients were female. Overall, 1,341(39.4%) were infectious, 626 (18.4%) non-infectious, and four masquerade syndromes (0.1%). The most common types of uveitis were unilateral (66.7%), acute (48.3%), and non-granulomatous (83%). Anterior uveitis was the most common anatomical localization (49.5%), followed by posterior uveitis (22.9%), panuveitis (22.3%), and intermediate uveitis (5.2%). A diagnosis was established in 3,252 (95.5%) cases; idiopathic was the most common cause (27.7%), followed by toxoplasmosis (25.3%) and virus-associated uveitis (6.4%). The age group between 30 and 50 exhibited the highest frequency of uveitis. CONCLUSION This multicenter study comprehensively describes uveitis characteristics in Colombian patients, providing valuable insights into its demographic and clinical features. The study findings emphasize the need to continue updating the changing patterns of uveitis to improve diagnosis and treatment strategies for diseases associated with intraocular inflammation.
Collapse
Affiliation(s)
- Alejandra de-la-Torre
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 # 63C 69, Bogotá, Colombia.
| | - Germán Mejía-Salgado
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 # 63C 69, Bogotá, Colombia
| | - Carlos Cifuentes-González
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 # 63C 69, Bogotá, Colombia
| | - William Rojas-Carabali
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 # 63C 69, Bogotá, Colombia
| | - Miguel Cuevas
- Department of Ophthalmology, School of Medicine and Health Sciences, Universidad de Antioquia, Medellín, Colombia
| | - Sandra García
- Department of Ophthalmology, School of Medicine and Health Sciences, Universidad Pontificia Javeriana, Cali, Colombia
| | - Carlos M Rangel
- Department of Ophthalmology, School of Medicine and Health Sciences, FOSCAL, Centro Oftalmológico Virgilio Galvis, Universidad Industrial de Santander, Universidad Autónoma de Bucaramanga, Floridablanca, Santander, Colombia
| | - Claudia Durán
- Ocular Immunology and Uveitis Department, School of Medicine and Health Sciences, Universidad CES, Medellín, Colombia
| | - Diana Isabel Pachón-Suárez
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 # 63C 69, Bogotá, Colombia
| | | |
Collapse
|
4
|
Koller K, Matos Teixeira Fonseca K, Areco KN, Fernández-Zamora Y, Silva LMP, Casaroli-Marano RP, Coimbra CG, Muccioli C. Serum Vitamin D Levels as Biomarkers in Patients with Autoimmune Uveitis and their Possible Correlation with Disease Activity. Ocul Immunol Inflamm 2024; 32:628-635. [PMID: 36943728 DOI: 10.1080/09273948.2023.2184699] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 02/21/2023] [Indexed: 03/23/2023]
Abstract
This study investigated the correlation between serum vitamin D levels and intraocular inflammation in patients with autoimmune uveitis (AIU). We evaluated 67 patients with active and inactive AIU and measured their serum 25-hydroxyvitamin D [25(OH)D] concentration, sun exposure habits, number of relapses, and complications. Of the patients evaluated, 85% had significantly lower vitamin D levels, and patients with active uveitis had lower 25(OH)D levels than those with inactive uveitis. The odds of developing active uveitis decreased by 6% with each 1-unit increase in 25(OH)D. Patients with recurrent active AIU had significantly lower 25(OH)D serum levels than inactive forms, indicating that low vitamin D levels may alter the clinical course of intraocular inflammation in AIU. Additionally, the study found that a higher mean BMI increased the chances of an individual having active uveitis by 14%. These results suggest that serum vitamin D concentration could be a prognostic clinical biomarker in AIU.
Collapse
Affiliation(s)
- Karine Koller
- Department of Ophthalmology and Vision Sciences, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Kelsy N Areco
- Health Informatics Department, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Yuslay Fernández-Zamora
- Department of Ophthalmology and Vision Sciences, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Luci Meire Pereira Silva
- Department of Ophthalmology and Vision Sciences, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Ricardo Pedro Casaroli-Marano
- Department of Ophthalmology and Vision Sciences, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Department of Surgery and Hospital Clinic of Barcelona, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Cicero Galli Coimbra
- Laboratory of Neuroprotection and Neuropathology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Cristina Muccioli
- Department of Ophthalmology and Vision Sciences, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| |
Collapse
|
5
|
Fernández Zamora Y, Marinho PM, Dias JRO, Cabral T, Casoy J, Muccioli C, Nascimento H, Belfort R. Long-Term Low-Dose Pyrimethamine Use for the Prevention of Ocular Toxoplasmosis Recurrences: A Cohort Study. Ocul Immunol Inflamm 2024:1-6. [PMID: 38441575 DOI: 10.1080/09273948.2024.2321270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/15/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE To describe the effect of long-term, low-dose pyrimethamine for the prevention of ocular toxoplasmosis (OT) recurrences. METHODS Sixty-three consecutive patients with inactive ocular toxoplasmosis and positive toxoplasma IgG serology were included. Pyrimethamine (25 mg) + folinic acid (15 mg) were administered every other day (three times weekly) for 12 months. Eighteen patients received the treatment for an additional six months as part of an extension study. RESULTS Thirty-eight patients (60.3%, n = 63) were female; 38 (60.3%) had a previous history of recurrence and 37 (58.7%) had active OT within the preceding 12 months. Three (4.8%) patients had unilateral recurrences at 8, 12 and 18 months after starting intermittent pyrimethamine treatment. Five patients (7.9%) were discontinued due to hematological, renal and hepatic changes. Treatment was considered successful in 42 patients (84%). CONCLUSION Long-term, low-dose pyrimethamine can be considered as a treatment option for the prevention of ocular toxoplasmosis recurrence in selected patients, with only a few, mild and reversible systemic adverse events.
Collapse
Affiliation(s)
- Yuslay Fernández Zamora
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Paula M Marinho
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Department of Ophthalmology, IPEPO - Vision Institute, São Paulo, Brazil
| | - João Rafael Oliveira Dias
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Thiago Cabral
- Department of Ophthalmology, IPEPO - Vision Institute, São Paulo, Brazil
- Department of Ophthalmology, Federal University of Espírito Santo, Vitória, Brazil
| | | | - Cristina Muccioli
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Heloisa Nascimento
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Department of Ophthalmology, IPEPO - Vision Institute, São Paulo, Brazil
| | - Rubens Belfort
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Department of Ophthalmology, IPEPO - Vision Institute, São Paulo, Brazil
| |
Collapse
|
6
|
Gentile P, Aldigeri R, Mastrofilippo V, Bolletta E, De Simone L, Gozzi F, Ragusa E, Ponti L, Adani C, Zanelli M, Belloni L, Bonacini M, Croci S, Zerbini A, De Maria M, Neri A, Vecchi M, Cappella M, Fastiggi M, De Fanti A, Citriniti G, Crescentini F, Galli E, Muratore F, Montepietra S, Contardi G, Massari M, Paci M, Facciolongo NC, Beltrami M, Cavallini GM, Salvarani C, Cimino L. Reggio Emilia (Northern Italy) Interdisciplinary Uveitis Clinic: What We Have Learned in the Last 20 Years. Ocul Immunol Inflamm 2024:1-11. [PMID: 38814046 DOI: 10.1080/09273948.2023.2296617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/13/2023] [Indexed: 05/31/2024]
Abstract
PURPOSE To analyze the referral patterns and the clinical and therapeutic features of patients diagnosed with uveitis in an Italian tertiary referral center to provide a comparison with previously published series from the same center. METHODS Retrospective retrieval of data on all new referrals to the Ocular Immunology Unit in Reggio Emilia (Italy) between November 2015 and April 2022 and comparison with previously published series from the same center. RESULTS Among the 1557 patients, the male-to-female ratio was 1:1.27. Anterior uveitis was the most common diagnosis (53.7%), followed by posterior (21.6%), pan- (18.5%), and intermediate (6.2%) uveitis. The most identifiable specific diagnoses were anterior herpetic uveitis (18.4%), Fuchs uveitis (12.8%), and tuberculosis (6.1%). Infectious etiologies were the most frequent (34.1%) and were more diffuse among non-Caucasian patients (p < 0.001), followed by systemic disease-associated uveitis (26.5%), and ocular-specific conditions (20%). Idiopathic uveitis accounted for 19.4% of cases. Fuchs uveitis presented the longest median diagnostic delay (21 months). Immunosuppressants were administered to 25.2% of patients. Antimetabolites, calcineurin inhibitors, and biologicals were prescribed to 18.4%, 3%, and 11.4% of cases, respectively. Compared to our previous reports, we observed a significant increase in foreign-born patients and in infectious uveitis, a decrease in idiopathic conditions, and an increasing use of non-biological and biological steroid-sparing drugs. CONCLUSIONS The patterns of uveitis in Italy have been changing over the last 20 years, very likely due to migration flows. Diagnostic improvements and a more widespread interdisciplinary approach could reduce the incidence of idiopathic uveitis as well as diagnostic delay.
Collapse
Affiliation(s)
- P Gentile
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - R Aldigeri
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - V Mastrofilippo
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - E Bolletta
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - L De Simone
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - F Gozzi
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - E Ragusa
- Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy
| | - L Ponti
- Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy
| | - C Adani
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Zanelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - L Belloni
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Bonacini
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - S Croci
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - A Zerbini
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M De Maria
- Ophthalmology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - A Neri
- Ophthalmology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Vecchi
- Ophthalmology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Cappella
- Pediatric Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Fastiggi
- Pediatric Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - A De Fanti
- Pediatrics Unit, Santa Maria Nuova Hospital, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - G Citriniti
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - F Crescentini
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - E Galli
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - F Muratore
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - S Montepietra
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - G Contardi
- Infectious Disease Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Massari
- Infectious Disease Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Paci
- Thoracic Surgery Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - N C Facciolongo
- Pulmonology Unit, Azienda USL di Reggio Emilia- IRCCS, Reggio Emilia, Italy
| | - M Beltrami
- Medicine and Gastroenterology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - G M Cavallini
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - C Salvarani
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - L Cimino
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
7
|
Barraquer-López D, Cifuentes-González C, Peña-Pulgar LF, Rojas-Carabali W, Villa-Piñeros J, de-la-Torre A. De Novo Uveitis in the Colombian Elderly Population: Characteristics and Comparison with Patients Under 60 Years of Age. Ocul Immunol Inflamm 2024; 32:71-78. [PMID: 36624966 DOI: 10.1080/09273948.2022.2155841] [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: 07/02/2022] [Accepted: 12/01/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE To describe the differences between de novo uveitis in elderly patients (≥60 years of age) and younger patients (< 60 years of age) in Colombia. METHODS Observational, analytic, cross-sectional study. RESULTS In the elderly group, idiopathic was the most common type of uveitis, followed by immune-mediated and infectious uveitis.No masquerade syndromes were diagnosed. Elderly patients had worse average visual acuities than young. Significant differences between both groups were observed in corneal edema, macular edema, cataract, glaucoma, and epiretinal membrane. Additionally, there were differences in the drugs used, such as topical hypotensive drugs, ocular lubricants, topical steroids, methotrexate, hydroxychloroquine, and adalimumab. CONCLUSION The present study demonstrated significant differences between elderly and young Colombian patients with de novo uveitis. The ophthalmologists should be aware of these patterns of presentation, which would help reach an adequate diagnosis and prevent complications based on the characteristics of each group.
Collapse
Affiliation(s)
- Doménico Barraquer-López
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - Carlos Cifuentes-González
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - Luisa Fernanda Peña-Pulgar
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - William Rojas-Carabali
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - Jerónimo Villa-Piñeros
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - Alejandra de-la-Torre
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| |
Collapse
|
8
|
Feitosa TF, Vilela VLR, Batista SP, Silva SS, Mota RA, Katzer F, Bartley PM. Genetic diversity of Toxoplasma gondii in goats and sheep from the Northeast Region of Brazil destined for human consumption. CURRENT RESEARCH IN PARASITOLOGY & VECTOR-BORNE DISEASES 2023; 5:100163. [PMID: 38196495 PMCID: PMC10775902 DOI: 10.1016/j.crpvbd.2023.100163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/16/2023] [Accepted: 12/05/2023] [Indexed: 01/11/2024]
Abstract
This study aimed to genotype isolates of Toxoplasma gondii obtained from samples of brain, diaphragm and heart of goats and sheep intended for human consumption in the State of Paraíba, Brazil. Tissue samples from 14 animals, goats (n = 5) and lambs (n = 9), were sourced from public slaughterhouses in seven cities and bio-assayed in mice. The brains of the mice were utilized for DNA extraction. Genotyping was carried out by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) using 10 markers (SAG1, SAG2, SAG3, BTUB, c22-8, PK1, GRA6, L358, c-29-2 and Apico). A total of 10 isolates were fully genotyped (i.e. at all loci), three from goats and seven from sheep, revealing five distinct genotypes: #13 (n = 4); #48 (n = 3); #57 (n = 1); #273 (n = 1); and one new genotype that had not been previously described. Genotype #13 is frequently found in the Northeast of Brazil and represents a clonal lineage circulating in this region and was the most prevalent genotype identified (n = 4). Moreover, in the present study genotypes #13, #48, #57, and #273 were documented for the first time in sheep from Brazil, and the novel genotype was isolated from a goat. Our findings align with previous studies on T. gondii from Brazil, where new genotypes are continuously being identified, highlighting a high level of genetic diversity of T. gondii isolates in the country.
Collapse
Affiliation(s)
- Thais Ferreira Feitosa
- Department of Veterinary Medicine, Federal Institute of Paraíba - IFPB, Sousa, Paraíba, ZC 58800-970, Brazil
| | - Vinícius Longo Ribeiro Vilela
- Department of Veterinary Medicine, Federal Institute of Paraíba - IFPB, Sousa, Paraíba, ZC 58800-970, Brazil
- Postgraduate Program in Science and Animal Health, Federal University of Campina Grande - UFCG, Patos, Paraíba, ZC 58708-110, Brazil
| | - Samira Pereira Batista
- Postgraduate Program in Science and Animal Health, Federal University of Campina Grande - UFCG, Patos, Paraíba, ZC 58708-110, Brazil
| | - Samara Santos Silva
- Department of Veterinary Medicine, Federal Rural University of Pernambuco - UFRPE, Recife, Pernambuco, ZC 52171-900, Brazil
| | - Rinaldo Aparecido Mota
- Department of Veterinary Medicine, Federal Rural University of Pernambuco - UFRPE, Recife, Pernambuco, ZC 52171-900, Brazil
| | - Frank Katzer
- Moredun Research Institute, Pentlands Science Park, Penicuik, EH26 0PZ, Scotland, United Kingdom
| | - Paul M. Bartley
- Moredun Research Institute, Pentlands Science Park, Penicuik, EH26 0PZ, Scotland, United Kingdom
| |
Collapse
|
9
|
Florez-Esparza G, Cifuentes-González C, Rojas-Carabali W, Mejía-Salgado G, Pineda-Sierra JS, Pardo-Pizza D, Lesley Cruz D, de-la-Torre A. Colombian Ocular Inflammatory Diseases Epidemiology Study (COIDES): Prevalence, Incidence, and Sociodemographic Characterization of Uveitis in Colombia, 2015-2020. Ocul Immunol Inflamm 2023:1-7. [PMID: 37972239 DOI: 10.1080/09273948.2023.2279681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE To describe the prevalence, incidence, and sociodemographic characteristics of uveitis in Colombia based on the National Health Registry of Colombia, the Integrated Social Protection Information System database (SISPRO). METHODS We performed a cross-sectional study using SISPRO. Along with the International Classification of Diseases, we were able to identify cases of general uveitis (GU), anterior (AU), and posterior uveitis (PU) from 2015 to 2019. For 2020, we used a statistical model for spatial data to predict the prevalence/incidence of the diseases and compared it to the data retrieved in SISPRO. RESULTS The average prevalence of GU was 14.66 cases per 100,000 inhabitants, while the average incidence rate of GU during the same period was 13.61 cases per 100,000 inhabitants per year. In 2020, there was a noticeable decrease in the incidence and prevalence of GU. Similar trends were observed when analyzing the incidence and prevalence of AU and PU separately. Females accounted for most reported cases, and there was a notable shift towards older age groups (over 50 years) for uveitis occurrence in males and females. Regions such as Bogotá, Antioquia, Valle del Cauca, and the Andean region had higher numbers of cases and a more significant disease burden. CONCLUSIONS Our study represents Colombia's first population-based characterization of GU, AU, and PU epidemiology. Our results highlight the importance of understanding disease patterns according to sociodemographic factors intrinsic to distinct geographic locations to design better preventive, diagnostic, and treatment approaches in the Colombian population.
Collapse
Affiliation(s)
- Gabriela Florez-Esparza
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Ophthalmology Interest Group, Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Carlos Cifuentes-González
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - William Rojas-Carabali
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Germán Mejía-Salgado
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Ophthalmology Interest Group, Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Juan Sebastián Pineda-Sierra
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Ophthalmology Interest Group, Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Daniella Pardo-Pizza
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Ophthalmology Interest Group, Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Danna Lesley Cruz
- Clinical Research Group, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Alejandra de-la-Torre
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Ophthalmology Interest Group, Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| |
Collapse
|
10
|
Silva MSF, Arantes TE, Moreto R, Smith JR, Furtado JM. Vision-related quality of life in patients treated for ocular syphilis. Sci Rep 2023; 13:13413. [PMID: 37591975 PMCID: PMC10435556 DOI: 10.1038/s41598-023-40289-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/08/2023] [Indexed: 08/19/2023] Open
Abstract
Multiple studies have showed negative impact of non-infectious uveitis on quality of life (QoL). Less is understood regarding life experiences in patients with infectious uveitis. We investigated vision-related QoL in individuals who had recovered from ocular syphilis. 32 adults treated for ocular syphilis at a uveitis service in Brazil completed the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25), and a comprehensive ophthalmic examination was performed. Medical records were reviewed to confirm resolution of ocular inflammation for 3 months pre-enrolment, and collect clinical data. The NEI VFQ-25 composite score was low overall (75.5 ± 19.8, mean ± standard deviation), and subscale scores varied from relative lows of 59.1 ± 39.6 (driving) and 60.9 ± 24.5 (mental health), to relative highs of 84.8 ± 21.8 (ocular) and 89.1 ± 21.0 (color vision). Adults aged over 40 years and those with a final visual acuity of 20/50 or worse had significantly lower mean composite and subscale scores. Other clinical characteristics-including gender, HIV co-infection, and type of uveitis-did not significantly influence scores. Our findings, taken in context with previous observations that prompt recognition achieves better vision outcomes, suggest early treatment may improve QoL after recovery from ocular syphilis.
Collapse
Affiliation(s)
- Milena Simões F Silva
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, 3900 Bandeirantes Avenue, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | | | - Renata Moreto
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, 3900 Bandeirantes Avenue, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Justine R Smith
- Flinders University College of Medicine and Public Health, Adelaide, Australia
| | - João M Furtado
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, 3900 Bandeirantes Avenue, Ribeirão Preto, São Paulo, 14049-900, Brazil.
| |
Collapse
|
11
|
Polanía D, Reyes-Guanes J, Rojas-Carabali W, Pardo-Pizza D, Barraquer-Lopez D, Cifuentes-González C, Neira-Segura N, de-la-Torre A. A new look into uveitis in Colombia: changes in distribution patterns and clinical characteristics over the last 25 years. Graefes Arch Clin Exp Ophthalmol 2023; 261:561-573. [PMID: 35994112 PMCID: PMC9836979 DOI: 10.1007/s00417-022-05796-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/20/2022] [Accepted: 08/01/2022] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To describe the distribution patterns and clinical characteristics of patients diagnosed with uveitis at a specialized uveitis center in Bogotá, Colombia, from 2013 to 2021 and compare these patterns with the previously reported between 1996 and 2006. METHODS We performed an observational descriptive cross-sectional study systematically reviewing clinical records of patients attending between 2013 and 2021. Data were analyzed and compared with previous reports. RESULTS Of the 489 patients with uveitis, 310 were females (63.4%). The mean age of onset was 38.7, with a range between 1 and 83 years. Bilateral (52.8%), anterior (45.8%), non-granulomatous (90.8%), and recurrent (47.6%) were the most common types of uveitis found in our population sample. The most common cause of uveitis in this study was idiopathic, followed by toxoplasmosis and HLA-B27 + associated uveitis, which differs from the previous Colombian study where ocular toxoplasmosis was the most frequent cause. This highlights a significant shift from infectious etiologies to more immune-mediated processes as the cause of uveitis in Colombia nowadays. CONCLUSION The results of this study provide a comparison between the clinical patterns of presentation of uveitis from 1996 to 2006 and the patterns observed from 2013 to 2021, enhancing awareness about the changing dynamics of uveitis in Colombia to guide a better understanding of the diagnosis, classification, and correlation with other systemic conditions of the disease.
Collapse
Affiliation(s)
- Diego Polanía
- Neuroscience Research Group (NEUROS), Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Bogotá, Colombia
- Ophthalmology Interest Group, Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Bogotá, Colombia
| | - Juliana Reyes-Guanes
- Neuroscience Research Group (NEUROS), Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Bogotá, Colombia
| | - William Rojas-Carabali
- Neuroscience Research Group (NEUROS), Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Bogotá, Colombia
| | - Daniella Pardo-Pizza
- Neuroscience Research Group (NEUROS), Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Bogotá, Colombia
- Ophthalmology Interest Group, Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Bogotá, Colombia
| | - Doménico Barraquer-Lopez
- Neuroscience Research Group (NEUROS), Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Bogotá, Colombia
- Ophthalmology Interest Group, Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Bogotá, Colombia
| | - Carlos Cifuentes-González
- Neuroscience Research Group (NEUROS), Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Bogotá, Colombia
| | - Natalia Neira-Segura
- Neuroscience Research Group (NEUROS), Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Bogotá, Colombia
| | - Alejandra de-la-Torre
- Neuroscience Research Group (NEUROS), Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Bogotá, Colombia.
- Ophthalmology Interest Group, Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Bogotá, Colombia.
| |
Collapse
|
12
|
Xu Y, Li J, Xu Y, Xia W, Mo X, Feng M, He F, Li S, Du F, Wang Q, Wu M. Case report: Visual acuity loss as a warning sign of ocular syphilis: A retrospective analysis of 17 cases. Front Med (Lausanne) 2022; 9:1037712. [PMID: 36325386 PMCID: PMC9621597 DOI: 10.3389/fmed.2022.1037712] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/23/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives To define the clinical features of ocular syphilis and analyze the cerebrospinal fluid (CSF) of ocular syphilis patients to determine the co-occurrence of neurosyphilis. Methods This was a retrospective study of 17 patients (23 eyes) with ocular syphilis admitted to the Fifth People's Hospital, Suzhou, China from September 2017 to December 2021. Clinical manifestations, laboratory tests, treatment, and clinical outcomes were analyzed, and a review was conducted. Results Eight males (12 eyes) and nine females (11 eyes) were enrolled. Mean patient age was 49.06 ± 3.47 years. The total manifestation time for ocular symptoms ranged from 10 days to 6 years. The cohort was comprised of three cases of early syphilis, four cases of late syphilis, and ten cases of unknown stage. The primary complaints were decreased visual acuity in 15 cases (21 eyes), ptosis in 1 case (1 eye), and loss of light perception in 1 case (1 eye). Cases were diagnosed as chorioretinitis in 7 cases (8 eyes), optic nerve retinitis in 4 cases (6 eyes), optic neuritis in 4 cases (7 eyes), and oculomotor nerve palsy in 1 case (1 eye), syphilitic stromal keratitis in 1 case (1 eye). Serum HIV antibody was positive in one case(Nos.2). All patients had reactive serum Treponema Pallidum Particle Agglutination (TPPA) and Toluidine Red Unheated Serum Test (TRUST). All patients underwent CSF examination. CSF white blood cell count was ≥5 × 106/L in 13 cases, CSF protein was >500 mg/L in 6 cases, TPPA was reactive in 15 cases, and TRUST was reactive in 5 cases. Eleven cases were also diagnosed with neurosyphilis. Patients were treated with either penicillin G sodium or ceftriaxone sodium. At time of discharge, 12 patients reported improved visual acuity. Abnormal serum or CSF examination improved in ten patients during the 6–12 month follow-up. Conclusion Visual acuity loss is a warning indicator of ocular syphilis. Ocular syphilis primarily manifests as posterior uveitis, involving the choroid, retina, and optic nerve, and often co-occurs with neurosyphilis. Effective treatment should be administered immediately to avoid irreversible visual impairment and other serious adverse outcomes.
Collapse
Affiliation(s)
- Yating Xu
- Department of Dermatology, The Fifth People's Hospital of Suzhou, The Affiliated Hospital of Infectious Diseases of Soochow University, Suzhou, Jiangsu, China
| | - Jingjing Li
- Department of Dermatology, The Fifth People's Hospital of Suzhou, The Affiliated Hospital of Infectious Diseases of Soochow University, Suzhou, Jiangsu, China
| | - Yuxuan Xu
- Department of Dermatology, The Fifth People's Hospital of Suzhou, The Affiliated Hospital of Infectious Diseases of Soochow University, Suzhou, Jiangsu, China
| | - Wei Xia
- Ophthalmology Department, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xingfan Mo
- Department of Dermatology, The Fifth People's Hospital of Suzhou, The Affiliated Hospital of Infectious Diseases of Soochow University, Suzhou, Jiangsu, China
| | - Mingzhi Feng
- Department of Dermatology, The Fifth People's Hospital of Suzhou, The Affiliated Hospital of Infectious Diseases of Soochow University, Suzhou, Jiangsu, China
| | - Fanghua He
- Department of Dermatology, The Fifth People's Hospital of Suzhou, The Affiliated Hospital of Infectious Diseases of Soochow University, Suzhou, Jiangsu, China
| | - Shanshan Li
- Department of Dermatology, The Fifth People's Hospital of Suzhou, The Affiliated Hospital of Infectious Diseases of Soochow University, Suzhou, Jiangsu, China
| | - Fangzhi Du
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
| | - Qianqiu Wang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
- *Correspondence: Qianqiu Wang
| | - Minzhi Wu
- Department of Dermatology, The Fifth People's Hospital of Suzhou, The Affiliated Hospital of Infectious Diseases of Soochow University, Suzhou, Jiangsu, China
- Minzhi Wu
| |
Collapse
|
13
|
de Pinho Queiroz R, Gontijo TM, dos Reis C, Zacarias LA, Santos HH, de Oliveira Machado D, Campos WR, Vasconcelos‐Santos DV. Trends in the clinical and epidemiological profiles of uveitis in Brazil. Clin Exp Ophthalmol 2022; 50:566-568. [DOI: 10.1111/ceo.14084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/11/2022] [Accepted: 04/15/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Rafael de Pinho Queiroz
- Departamento de Oftalmologia e Otorrinolaringologia e Laboratório de Ciências Visuais Faculdade de Medicina da Universidade Federal de Minas Gerais Belo Horizonte Brazil
- Hospital São Geraldo Hospital das Clínicas da Universidade Federal de Minas Gerais Belo Horizonte Brazil
- Programa de Pós‐graduação em Ciências da Saúde Infectologia e Medicina Tropical ‐ UFMG Belo Horizonte Brazil
| | - Tábata M. Gontijo
- Departamento de Oftalmologia e Otorrinolaringologia e Laboratório de Ciências Visuais Faculdade de Medicina da Universidade Federal de Minas Gerais Belo Horizonte Brazil
| | - Caroline dos Reis
- Departamento de Oftalmologia e Otorrinolaringologia e Laboratório de Ciências Visuais Faculdade de Medicina da Universidade Federal de Minas Gerais Belo Horizonte Brazil
| | - Laila A. Zacarias
- Departamento de Oftalmologia e Otorrinolaringologia e Laboratório de Ciências Visuais Faculdade de Medicina da Universidade Federal de Minas Gerais Belo Horizonte Brazil
- Hospital São Geraldo Hospital das Clínicas da Universidade Federal de Minas Gerais Belo Horizonte Brazil
| | - Helena H. Santos
- Departamento de Oftalmologia e Otorrinolaringologia e Laboratório de Ciências Visuais Faculdade de Medicina da Universidade Federal de Minas Gerais Belo Horizonte Brazil
- Hospital São Geraldo Hospital das Clínicas da Universidade Federal de Minas Gerais Belo Horizonte Brazil
| | - Danuza de Oliveira Machado
- Departamento de Oftalmologia e Otorrinolaringologia e Laboratório de Ciências Visuais Faculdade de Medicina da Universidade Federal de Minas Gerais Belo Horizonte Brazil
- Hospital São Geraldo Hospital das Clínicas da Universidade Federal de Minas Gerais Belo Horizonte Brazil
| | - Wesley R. Campos
- Departamento de Oftalmologia e Otorrinolaringologia e Laboratório de Ciências Visuais Faculdade de Medicina da Universidade Federal de Minas Gerais Belo Horizonte Brazil
- Hospital São Geraldo Hospital das Clínicas da Universidade Federal de Minas Gerais Belo Horizonte Brazil
| | - Daniel Vítor Vasconcelos‐Santos
- Departamento de Oftalmologia e Otorrinolaringologia e Laboratório de Ciências Visuais Faculdade de Medicina da Universidade Federal de Minas Gerais Belo Horizonte Brazil
- Hospital São Geraldo Hospital das Clínicas da Universidade Federal de Minas Gerais Belo Horizonte Brazil
- Programa de Pós‐graduação em Ciências da Saúde Infectologia e Medicina Tropical ‐ UFMG Belo Horizonte Brazil
| |
Collapse
|
14
|
Teo AYT, Betzler BK, Hua KLQ, Chen EJ, Gupta V, Agrawal R. Intermediate Uveitis: A Review. Ocul Immunol Inflamm 2022:1-20. [PMID: 35759636 DOI: 10.1080/09273948.2022.2070503] [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: 10/17/2022]
Abstract
PURPOSE This review aims to provide an update on the clinical presentation, etiologies, complications, and treatment options in intermediate uveitis (IU). METHODS Narrative literature review. RESULTS IU affects all age groups with no clear gender predominance and has varied etiologies including systemic illnesses and infectious diseases, or pars planitis. In some instances, IU may be the sole presentation of an underlying associated condition or disease. Management of IU and its complications include administration of corticosteroids, antimetabolites, T-cell inhibitors, and/or biologics, along with surgical interventions, with varying degrees of effectiveness across literature. In particular, increasing evidence of the safety and efficacy of immunomodulatory agents and biologics has seen greater adoption of these therapies in clinical practice. CONCLUSIONS IU is an anatomical description of uveitis, involving intraocular inflammation of the vitreous, peripheral retinal vasculature, and pars plana. Various treatment options for intermediate uveitis are currently used in practice.
Collapse
Affiliation(s)
| | | | - Keith Low Qie Hua
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Singapore Eye Research Institute, Singapore.,Duke NUS Medical School, Singapore
| |
Collapse
|
15
|
Julian LK, Balfour G, Forgues RF, de Smet M, Suburo A. Uveitis Patterns and Severity: An Epidemiologic Study from a Tertiary Care Private Referral Center in Buenos Aires, Argentina. Ocul Immunol Inflamm 2022; 31:710-716. [PMID: 35404742 DOI: 10.1080/09273948.2022.2053546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To report uveitis' spectrum in a private practice cohort in the city of Buenos Aires, Argentina. METHODS Retrospective review at Instituto de la Visión (November 2011-October 2015). Standard demographics, ethnicity and Native American aboriginal ancestry were recorded. RESULTS Among 212 patients, median age 45 (6-97), 10% pediatric, 35% bilateral, 72% non-idiopathic, 36% infectious. Anterior uveitis presented in 50%, followed by posterior (32%), intermediate (9%) and panuveitis (8%). Frequent visits (≥ 6 per year) needed by 29%: posterior, non-idiopathic disease with 79% systemic immunosuppression requirement was their main presentation. Native American aboriginal ancestry was reported by 22.64% of the whole cohort and 37% of frequent visits' subgroup. CONCLUSIONS Unilateral, non-idiopathic, non-infectious anterior uveitis was the most frequent presentation, in agreement with reports coming from western developed cities. The multi-racial Argentinian population with specific Native American aboriginal ancestry might contribute to certain forms of posterior uveitis and their response to treatment.
Collapse
Affiliation(s)
- L. K. Julian
- Department of Ophthalmology, Instituto de la Visión, Buenos Aires, Argentina
- School of Biomedical Sciences, Austral University, Buenos Aires, Argentina
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - G. Balfour
- School of Biomedical Sciences, Austral University, Buenos Aires, Argentina
| | - R. F. Forgues
- Department of Ophthalmology, Instituto de la Visión, Buenos Aires, Argentina
| | - M.D. de Smet
- Department of Ophthalmology, MicroInvasive Ocular Surgery Center (MIOS), Lausanne, Switzerland
- Department of Ophthalmology, Leiden University, The Netherlands
| | - A. Suburo
- School of Biomedical Sciences, Austral University, Buenos Aires, Argentina
| |
Collapse
|
16
|
da Fonsêca MLG, Vianna RNG, Rocha ACH, Casella AMB, Cialdini A, Muccioli C, da Costa DS, Lucena DR, Vasconcelos-Santos DV, Morizot E, Castro E, Rodriguez EEC, Diligenti FT, Porto FBO, Nascimento H, Yanamoto JH, Oréfice JL, Muralha LRP, Carneiro LB, Finamor LPS, Frazão MAM, Motta M, Nobrega MJ, Zajdenweber ME, Moraes RT, Meirelles RL, Lemos SR, de Araújo WF. Birdshot retinochoroiditis in Brazil: a multicenter review of 40 patients. Int J Retina Vitreous 2022; 8:5. [PMID: 34996521 PMCID: PMC8740347 DOI: 10.1186/s40942-021-00353-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 12/27/2021] [Indexed: 11/21/2022] Open
Abstract
Background Birdshot retinochoroiditis (BRC) is a rare and chronic bilateral uveitis mostly found in Caucasians. As few data are available about the clinical course of BRC in Hispanic patients, we aimed to report the clinical findings and the evolution of BRC in Brazilian patients. Methods This retrospective cohort multicenter nationwide study was performed by analyzing the records of patients with BRC diagnoses from Brazilian ophthalmological centers from April 1995 to May 2020. Results Forty patients (80 eyes) with a diagnosis of BRC were evaluated. The mean age was 53 years, and there was no sex predominance. All tested patients (34/40) were positive for HLA-A29. The diagnosis of BRC was made following the Levinson et al. criteria, and all ancillary tests were performed to exclude differential diagnoses. Clinical signs and symptoms, such as complications and treatment, were described. Conclusions BRC evolution in Brazilian patients seems to have some peculiarities that diverge from the published literature available about Caucasians, as AS inflammation is higher in this population.
Collapse
Affiliation(s)
- Maria Luisa Gois da Fonsêca
- Retina and Vitreous Service, Federal Fluminense University (UFF), Marques do Parana Avenue 303 Centro, Niterói, RJ, 24033900, Brazil.
| | - Raul N G Vianna
- Retina and Vitreous Service, Federal Fluminense University (UFF), Marques do Parana Avenue 303 Centro, Niterói, RJ, 24033900, Brazil
| | - Anna C H Rocha
- Retina and Vitreous Service, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Antonio M B Casella
- Retina and Vitreous Service, Londrina State University (UEL), Londrina, PR, Brazil
| | - Arnaldo Cialdini
- Retina and Vitreous Service, Brazilian Center for Eye Surgery (CBCO), Goiânia, GO, Brazil
| | - Cristina Muccioli
- Retina and Vitreous Service, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Daniela S da Costa
- Retina and Vitreous Service, Federal Hospital of State Servers (SERVIDORES), Rio de Janeiro, RJ, Brazil
| | - Daniel R Lucena
- Retina and Vitreous Service, Escola Cearence de Oftalmologia, Fortaleza, CE, Brazil
| | | | - Eduardo Morizot
- Retina and Vitreous Service, Botafogo Polyclinic, Rio de Janeiro, RJ, Brazil
| | - Elaine Castro
- Retina and Vitreous Service, Federal Fluminense University (UFF), Marques do Parana Avenue 303 Centro, Niterói, RJ, 24033900, Brazil
| | - Ever E C Rodriguez
- Retina and Vitreous Service, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Felipe T Diligenti
- Retina and Vitreous Service, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | | | - Heloisa Nascimento
- Retina and Vitreous Service, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Joyce H Yanamoto
- Ophthalmology Department, Hospital das Clínicas, HCFMUSP (USP), São Paulo, SP, Brazil
| | | | | | | | - Luciana P S Finamor
- Retina and Vitreous Service, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Maria A M Frazão
- Department of Ophthalmology, "Santa Casa"of São Paulo, São Paulo, SP, Brazil
| | - Mario Motta
- Retina and Vitreous Service, Federal University of the State of the Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil
| | - Mario J Nobrega
- Retina and Vitreous Service, Hospital de Olhos Sadalla Amin Ghanem, Joinville, SC, Brazil
| | | | - Remo T Moraes
- Brazilian Institute of Ophthalmology (IBOL), Rio de Janeiro, RJ, Brazil
| | - Rodrigo L Meirelles
- Ophthalmology Department, Hospital das Clínicas, HCFMUSP (USP), São Paulo, SP, Brazil
| | - Sidney R Lemos
- Retina and Vitreous Service, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | | |
Collapse
|
17
|
Alli HD, Ally N, Mayet I, Dangor Z, Madhi SA. Global prevalence and clinical outcomes of tubercular uveitis: a systematic review and meta-analysis. Surv Ophthalmol 2021; 67:770-792. [PMID: 34626620 DOI: 10.1016/j.survophthal.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022]
Abstract
Tubercular uveitis (TBU) is an inflammation/infection of the eye secondary to Mycobacterium tuberculosis infection. The difficulty in making the diagnosis has resulted in variable prevalence and clinical response rates. We aimed to determine the global prevalence of TBU in uveitis patients stratified by TB high-burden countries (HBCs) and non-HBCs and by geographic regions and the clinical response of TBU to antitubercular treatment We performed a systematic review and meta-analysis of TBU studies published in PubMed, Scopus and EMBASE, up to June 30, 2020. A random effects model was used for all meta-analyses. Of 5,018 articles identified, 70 prevalence studies (65,607 uveitis and 3,166 TBU cases) and 18 clinical outcome studies (1,570 TBU cases; 1,304 responded to anti-tubercular therapy [ATT]) were analyzed. The overall weighted prevalence of TBU was 4.0% (95% CI, 3-5); in TB HBCs it was 7.0% (95% CI, 5-11), non-HBCs 3.0% (95% CI, 2-4), and sub-Saharan Africa 11.0% (95% CI, 8-15). The overall weighted clinical response was 82.0% (95% CI, 75-89). Despite the difficulty in diagnosing TBU, the prevalence is expectantly higher in HBCs, and sub-Saharan Africa and the clinical outcome is poor. Standardization of diagnostic criteria and ATT is warranted in future cohort studies.
Collapse
Affiliation(s)
- Hassan D Alli
- Division of Ophthalmology, St John Eye Hospital/Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
| | - Naseer Ally
- Division of Ophthalmology, St John Eye Hospital/Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Ismail Mayet
- Division of Ophthalmology, St John Eye Hospital/Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Ziyaad Dangor
- Department of Pediatrics, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Shabir A Madhi
- Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (VIDA), Faculty of Health Sciences, University of the Witwatersrand, South Africa
| |
Collapse
|
18
|
Fernández Zamora Y, Peixoto Finamor L, P Silva LM, Rodrigues DS, Casaroli-Marano RP, Muccioli C. Clinical features and management of presumed ocular tuberculosis: A long-term follow-up cohort study in a tertiary referral center in Brazil. Eur J Ophthalmol 2021; 32:2181-2188. [PMID: 34482752 DOI: 10.1177/11206721211044624] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the clinical features and management of presumed ocular tuberculosis (OTB). METHOD A prospective 3-year follow-up study of patients with ocular inflammation that performed Interferon-gamma release assay (IGRA) and tuberculin skin test (TST) was conducted in a tertiary referral center in Brazil. Patients with clinical signs highly suspect of OTB with a positive TST and/or IGRA with other causes ruled out were prescribed anti-tuberculosis therapy (ATT) during 9 months. Clinical features and treatment outcomes were recorded. RESULTS Seventy-two patients (mean age 48.3 ± 15.7 years) were included in the study, and most were female (65.3%, n = 47). Posterior uveitis (43.1%, n = 31) was the main clinical feature. Multifocal choroiditis (25%, n = 18) was the most common choroidal involvement. Concomitant oral prednisone (45.8%, n = 33) during ATT was associated with more recurrences (p = 0.04). A significant difference (p < 0.001) between initial and final best-corrected visual acuity after ATT conclusion was observed. Cure or remission was observed in 58 (85.3%) patients that completed follow-up (n = 68). CONCLUSION In our cohort some variation in demographics and ocular phenotypes of presumed OTB was observed. The high rates of cure or remission of our patients strongly support the ATT in presumed OTB. Oral corticosteroids during ATT were associated with higher recurrences rates.
Collapse
Affiliation(s)
- Yuslay Fernández Zamora
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
| | - Luciana Peixoto Finamor
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
| | - Luci Meire P Silva
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
| | | | - Ricardo P Casaroli-Marano
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, São Paulo, Brazil.,Department of Surgery, School of Medicine & Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Cristina Muccioli
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
| |
Collapse
|
19
|
Furtado JM, Simões M, Vasconcelos-Santos D, Oliver GF, Tyagi M, Nascimento H, Gordon DL, Smith JR. Ocular syphilis. Surv Ophthalmol 2021; 67:440-462. [PMID: 34147542 DOI: 10.1016/j.survophthal.2021.06.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 01/01/2023]
Abstract
Multiple studies around the world suggest that syphilis is re-emerging. Ocular syphilis - with a wide range of presentations, most of which are subtypes of uveitis - has become an increasingly common cause of ocular inflammation over the past 20 years. Its rising incidence, diagnostic complexity, and manifestations that have only recently been characterized make ocular syphilis relevant from the public health, clinical, and scientific perspectives. We review the demographics, epidemiology, clinical features, ocular imaging findings, diagnosis, and medical management of this condition.
Collapse
Affiliation(s)
- João M Furtado
- Divisão de Oftalmologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.
| | - Milena Simões
- Divisão de Oftalmologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Daniel Vasconcelos-Santos
- Departamento de Oftalmologia e Otorrinolaringologia, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Genevieve F Oliver
- Flinders University College of Medicine and Public Health, Adelaide, Australia
| | - Mudit Tyagi
- Ocular Inflammation and Immunology Services, LV Prasad Eye Institute, Hyderabad, India
| | - Heloisa Nascimento
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil; Instituto Paulista de Estudos e Pesquisas em Oftalmologia-IPEPO, São Paulo, Brazil
| | - David L Gordon
- Flinders University College of Medicine and Public Health, Adelaide, Australia; SA Pathology, Microbiology and Infectious Diseases, Flinders Medical Centre, Bedford Park, South Australia
| | - Justine R Smith
- Flinders University College of Medicine and Public Health, Adelaide, Australia
| |
Collapse
|
20
|
Neves LM, Haefeli LM, Hopker LM, Ejzenbaum F, Moraes do Nascimento H, Aikawa N, Hilario MO, Magalhães CS, Terreri MT, Sztajnbok F, Silva C, Rossetto JD. Monitoring and Treatment of Juvenile Idiopathic Arthritis-associated Uveitis: Brazilian Evidence-based Practice Guidelines. Ocul Immunol Inflamm 2021; 30:1384-1398. [PMID: 33826468 DOI: 10.1080/09273948.2021.1876886] [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: 10/21/2022]
Abstract
Purpose: To present a national guideline for ophthalmologic care and surveillance of juvenile idiopathic arthritis-associated uveitis (JIA-uveitis).Methods: Review article based on medical literature and the experience of an Expert Committee composed of members of the Brazilian Society of Pediatric Ophthalmology/Brazilian Council of Ophthalmology and the Brazilian Society of Pediatrics/Brazilian Society of Rheumatology. Studies with a high level of evidence were selected by searching the PubMed/Medline database. The final document was approved by the experts.Results: The main recommendations are that children/adolescents with JIA should undergo screening according to their risk factors. Ophthalmological checkups should also consider ocular inflammation and therapy. Topical glucocorticoids should be the first line of therapy, with systemic glucocorticoids acting as bridge treatments in severe uveitis. Methotrexate should be the first-line systemic therapy and anti-tumor necrosis factor (anti-TNF alpha) the second for uncontrolled uveitis.Conclusions: This evidence-based guideline for JIA-uveitis will be useful for both ophthalmology and rheumatology practice.
Collapse
Affiliation(s)
- L M Neves
- Ophthalmology Department, Instituto Nacional De Saúde Da Mulher, Da Criança E Do Adolescente Fernandes Figueira- Fundação Oswaldo Cruz, Rio De Janeiro, RJ, Brazil.,Brazilian Society of Pediatric Ophthalmology (SBOP), Sao Paulo/SP, Brazil.,Brazilian Council of Ophthalmology (CBO), Sao Paulo/SP, Brazil
| | - L M Haefeli
- Ophthalmology Department, Instituto Nacional De Saúde Da Mulher, Da Criança E Do Adolescente Fernandes Figueira- Fundação Oswaldo Cruz, Rio De Janeiro, RJ, Brazil.,Brazilian Society of Pediatric Ophthalmology (SBOP), Sao Paulo/SP, Brazil.,Brazilian Council of Ophthalmology (CBO), Sao Paulo/SP, Brazil
| | - L M Hopker
- Brazilian Society of Pediatric Ophthalmology (SBOP), Sao Paulo/SP, Brazil.,Brazilian Council of Ophthalmology (CBO), Sao Paulo/SP, Brazil.,Ophthalmology Department, Hospital De Olhos Do Paraná, Curitiba/PR, Brazil.,Brazilian Society of Pediatrics (SBP), Rio de Janeiro/RJ, Brazil
| | - F Ejzenbaum
- Brazilian Society of Pediatric Ophthalmology (SBOP), Sao Paulo/SP, Brazil.,Brazilian Council of Ophthalmology (CBO), Sao Paulo/SP, Brazil.,Brazilian Society of Pediatrics (SBP), Rio de Janeiro/RJ, Brazil.,Ophthalmology Department, Santa Casa De Misericórdia De São Paulo Sao Paulo/SP, Brazil
| | - H Moraes do Nascimento
- Brazilian Council of Ophthalmology (CBO), Sao Paulo/SP, Brazil.,Ophthalmology and Visual Science Department, Federal University of Sao Paulo - UNIFESP, São Paulo, SP, Brazil
| | - N Aikawa
- Brazilian Society of Pediatrics (SBP), Rio de Janeiro/RJ, Brazil.,Pediatric Rheumatology Unit, Children's Institute, Hospital Das Clinicas HCFMUSP, Faculdade De Medicina, Universidade De Sao Paulo, SP, Brazil.,Brazilian Society of Rheumatology (SBR), Sao Paulo/SP, Brazil
| | - M O Hilario
- Brazilian Society of Pediatrics (SBP), Rio de Janeiro/RJ, Brazil.,Brazilian Society of Rheumatology (SBR), Sao Paulo/SP, Brazil.,Pediatric Department, Santa Casa De Misericórdia De Porto Alegre, Porto Alegre/RS, Brazil
| | - C S Magalhães
- Brazilian Society of Pediatrics (SBP), Rio de Janeiro/RJ, Brazil.,Brazilian Society of Rheumatology (SBR), Sao Paulo/SP, Brazil.,Pediatric Rheumatology Division, São Paulo State University (UNESP), Botucatu/SP, Brazil
| | - M T Terreri
- Brazilian Society of Pediatrics (SBP), Rio de Janeiro/RJ, Brazil.,Brazilian Society of Rheumatology (SBR), Sao Paulo/SP, Brazil.,Pediatric Rheumatology Unit, Federal University of São Paulo - UNIFESP, São Paulo/SP, Brazil
| | - F Sztajnbok
- Brazilian Society of Pediatrics (SBP), Rio de Janeiro/RJ, Brazil.,Brazilian Society of Rheumatology (SBR), Sao Paulo/SP, Brazil.,Pediatric Department, Instituto De Puericultura E Pediatria Martagão Gesteira - IPPMG/Federal University of Rio De Janeiro - UFRJ - Rio De Janeiro/RJ, Brazil
| | - Caa Silva
- Brazilian Society of Pediatrics (SBP), Rio de Janeiro/RJ, Brazil.,Pediatric Rheumatology Unit, Children's Institute, Hospital Das Clinicas HCFMUSP, Faculdade De Medicina, Universidade De Sao Paulo, SP, Brazil.,Brazilian Society of Rheumatology (SBR), Sao Paulo/SP, Brazil
| | - J D Rossetto
- Brazilian Society of Pediatric Ophthalmology (SBOP), Sao Paulo/SP, Brazil.,Brazilian Council of Ophthalmology (CBO), Sao Paulo/SP, Brazil.,Brazilian Society of Pediatrics (SBP), Rio de Janeiro/RJ, Brazil.,Ophthalmology and Visual Science Department, Federal University of Sao Paulo - UNIFESP, São Paulo, SP, Brazil.,Pediatric Department, Instituto De Puericultura E Pediatria Martagão Gesteira - IPPMG/Federal University of Rio De Janeiro - UFRJ - Rio De Janeiro/RJ, Brazil
| |
Collapse
|
21
|
Radosavljevic A, Agarwal M, Chee SP, Zierhut M. Epidemiology of Viral Induced Anterior Uveitis. Ocul Immunol Inflamm 2021; 30:297-309. [PMID: 33617392 DOI: 10.1080/09273948.2020.1853177] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: Viral agents are the most common cause of infectious anterior uveitis worldwide. The purpose of this review is to analyze the frequency, gender and racial differences of viral anterior uveitis (VAU) in various populations.Methods: Systematized literature review of epidemiological reports of VAU cited in PubMed, EMBASE and the Cochrane Library database published until June 30th, 2020.Results: A total of 12 clinical studies on epidemiology of definite VAU and 36 clinical studies of presumed VAU were identified. Members of Herpesviridae family represent the most common causes of VAU. Other less frequently reported causes, such as rubella and endemic viruses (HTLV-1, Chikungunya, Dengue, Ebola, Zika virus) were also analyzed.Conclusion: HSV, VZV are prevalent worldwide. CMV is more frequent in Asia, and rubella in the West. However, due to globalization and air travel, HTLV-1, Chikungunya, Dengue and Ebola may become important causes of VAU across the world.
Collapse
Affiliation(s)
| | - Mamta Agarwal
- Uveitis & Cornea Services, Sankara Nethralaya, Chennai, India
| | - Soon Phaik Chee
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Duke-NUS Medical School, Singapore
| | - Manfred Zierhut
- Centre for Ophthalmology, University Tubingen, Tubingen, Germany
| |
Collapse
|
22
|
Frequency and visual outcomes of ocular toxoplasmosis in an adult Brazilian population. Sci Rep 2021; 11:3420. [PMID: 33564078 PMCID: PMC7873183 DOI: 10.1038/s41598-021-83051-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 01/27/2021] [Indexed: 11/09/2022] Open
Abstract
Although ocular toxoplasmosis is a leading cause of posterior uveitis worldwide, there is scarce information about the real-life frequency of ocular lesions, visual outcomes, and risk factors for poor prognosis. We conducted a community-based cross-sectional study with 721 adults living in Cássia dos Coqueiros, Southeast Brazil, consisted of visual acuity measurement, dilated ocular examination, a risk-factor questionnaire, and peripheral blood collection for anti-T. gondii serology. Presumed toxoplasmic lesions were recorded on video and analyzed by experienced and masked ophthalmologists. Ocular toxoplasmosis was determined if at least one suspected lesion was appointed by two graders in the presence of positive anti-T. gondii serology. Forty-eight eyes (n = 42 participants; 6.7% among those with positive anti-T. gondii serology) with ocular toxoplasmosis were found. Most lesions were single (n = 28; 58.3%), peripheral (n = 34; 77.1%) and unilateral (85.7% of participants); no active lesions were found. Older age was associated with lesions larger than one-disc diameter (p = 0.047), and lower social stratum (OR: 2.89; CI 1.2-6.97; p = 0.018) was associated with the presence of toxoplasmic lesions. Although there were no differences in visual acuity between participants and eyes with or without ocular lesions (p > 0.05), unilateral blindness associated with ocular toxoplasmosis was identified in a reduced number of individuals.
Collapse
|
23
|
Arruda S, Vieira BR, Garcia DM, Araújo M, Simões M, Moreto R, Rodrigues MW, Belfort R, Smith JR, Furtado JM. Clinical manifestations and visual outcomes associated with ocular toxoplasmosis in a Brazilian population. Sci Rep 2021; 11:3137. [PMID: 33542439 PMCID: PMC7862362 DOI: 10.1038/s41598-021-82830-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/21/2021] [Indexed: 11/09/2022] Open
Abstract
Ocular toxoplasmosis is the leading cause of posterior uveitis worldwide. We conducted an observational study of 262 consecutive individuals (n = 344 eyes) with ocular toxoplasmosis who were followed over a 34-month period. Most subjects were T. gondii IgG + /IgM- (n = 242; 92.4%; 317 eyes), and 140 eyes (40.7%) had active lesions. For eyes in which retinal lesions were active at recruitment and best-corrected visual acuity (BCVA) could be measured (n = 133), 21.0% (n = 28) remained blind (BCVA below 20/400) after inflammation resolved. In these eyes, atypical ocular toxoplasmosis (OR 4.99; 95% CI 1.14–22.85; p = 0.0330), macular lesion (OR 9.95; 95% CI 2.45–47.15; p = 0.0019) and any complication (OR 10.26; 95% CI 3.82–30.67; p < 0.0001) were associated with BCVA below 20/200. For eyes with only inactive lesions at recruitment and BCVA measured (n = 178), 28.1% (n = 50) were blind. In these eyes, having at least one lesion larger than one disc-diameter (OR 6.30; 95% CI 2.28–22.46; p = 0.0013) and macular lesion (OR 5.69; 95% CI 2.53–13.54; p < 0.0001) were associated with BCVA below 20/200. Older age (OR 1.02; 95% CI 1.00–1.05; p = 0.0493) and active disease at presentation (OR 4.74; 95% CI 1.95–12.91; p = 0.0011) were associated with recurrences. Additional clinical attention should be directed towards patients with risk factors for poor visual outcome.
Collapse
Affiliation(s)
- Sigrid Arruda
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Barbara R Vieira
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Denny M Garcia
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Michelle Araújo
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Milena Simões
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Renata Moreto
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Murilo W Rodrigues
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Rubens Belfort
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Justine R Smith
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - João M Furtado
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil.
| |
Collapse
|
24
|
Moro JC, Moreira NM. Clinico-epidemiological and sociodemographic profile of HIV/AIDS patients who are co-infected with Toxoplasma gondii in the border region of Brazil. AN ACAD BRAS CIENC 2020; 92:e20200293. [PMID: 33237145 DOI: 10.1590/0001-3765202020200293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/14/2020] [Indexed: 11/21/2022] Open
Abstract
The present study assessed clinico-epidemiological and sociodemographic characteristics and risk factors for human immunodeficiency virus (HIV) in patients who were co-infected with T. gondii in the border region of Brazil. HIV-positive patients who were attended by the Expert Assistance Service in Foz do Iguaçu city were assessed using a questionnaire and medical records. Of the 332 patients with HIV/autoimmune deficiency syndrome (AIDS) who were evaluated, 111 had serology for toxoplasmosis, which could be attributed to the location of the city (i.e., border region) and tourism that encourages the intense flow of people. Toxoplasmosis infection was prevalent among patients who were 18-60 years old, had education up to the 4th grade of elementary school, ate raw vegetables from home, handled soil without gloves, drank untreated water, and allowed street cats to enter their homes. These findings contribute to assessments of the toxoplasmosis profile of HIV/AIDS patients who have a high rate of toxoplasmosis. The results may contribute to improving public health, especially in border regions with characteristics that are similar to this study. Effective measures need to be implemented to control morbidity and mortality that are associated with HIV/AIDS and toxoplasmosis in the evaluated population.
Collapse
Affiliation(s)
- Janielle C Moro
- State University of Western of Paraná (UNIOESTE), Program of Postgraduate Public Health in the Border Region, Tarquínio Joslin dos Santos Avenue, 1300, 85870-650 Foz do Iguaçu, PR, Brazil
| | - Neide M Moreira
- State University of Western of Paraná (UNIOESTE), Program of Postgraduate Public Health in the Border Region, Tarquínio Joslin dos Santos Avenue, 1300, 85870-650 Foz do Iguaçu, PR, Brazil
| |
Collapse
|
25
|
Bozkurt E, Muhafiz E, Sengul D, Uçak T, Atum M. Can the CRP/albumin Ratio be Used as a New Indicator of Activation in Patients with Uveitis? Ocul Immunol Inflamm 2020; 29:1017-1022. [PMID: 32125910 DOI: 10.1080/09273948.2020.1714061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose: To evaluate whether the C-reactive protein (CRP)/albumin ratio (CAR) in patients with uveitis during an attack is a marker that can give information about the activity, severity and prognosis of the disease.Methods: This study included 35 patients with an uveitis attack and 35 healthy volunteers. The localization and severity of uveitis were recorded. Patients' complete blood count (CBC) during the attack, CRP, CAR, erythrocyte sedimentation rate(ESR), neutrophil/lymphocyte ratio(NLR), and platelet/lymphocyte ratio(PLR) were recorded.Results: The mean age was 34.1 ± 12.5 years for the 35 uveitis cases and 30.1 ± 4.1 years for the healthy volunteers. CRP and CAR were significantly higher in uveitis patients (p = .015 and 0.011, respectively). While CRP and CAR were significantly higher in severe anterior uveitis than mild anterior uveitis (p = .036 and 0.022, respectively), only CAR was significantly higher in severe posterior and panuveitis than mild ones(p = .017).Conclusion: CAR may be an important parameter in determining the activation of the uveitis.
Collapse
Affiliation(s)
- Erdinç Bozkurt
- Faculty of Medicine, Department of Ophthalmology, Kafkas University, Kars, Türkiye
| | - Ersin Muhafiz
- Faculty of Medicine, Department of Ophthalmology, Kafkas University, Kars, Türkiye
| | - Dilek Sengul
- Faculty of Medicine, Department of Ophthalmology, Kafkas University, Kars, Türkiye
| | - Turgay Uçak
- Department of Ophthalmology, Mengücek Training and Research Hospital, Erzincan, Türkiye
| | - Mahmut Atum
- Department of Ophthalmology, Sakarya Training and Research Hospital, Sakarya, Türkiye
| |
Collapse
|
26
|
Kunimi K, Usui Y, Tsubota K, Mitsuhashi R, Umazume A, Kezuka T, Sakai J, Goto H. Changes in Etiology of Uveitis in a Single Center in Japan. Ocul Immunol Inflamm 2020; 29:976-981. [PMID: 32068467 DOI: 10.1080/09273948.2019.1709649] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose: We investigated the changes in etiology of uveitis at the Uveitis Clinic of Tokyo Medical University Hospital in recent years.Methods: Medical records of patients with uveitis diagnosed between 2011 and 2017 (Group A) and between 2001 and 2007 (Group B) were reviewed.Results: 1,587 patients in group A and 1,507 patients in group B were analyzed. For noninfectious uveitis, frequencies of Vogt-Koyanagi-Harada disease, intraocular lymphoma (IOL) and iridocyclitis in young girls increased, while those of sarcoidosis and Behçet's disease decreased in the recent era. For infectious uveitis, herpetic iridocyclitis, ocular toxoplasmosis, ocular syphilis, and bacterial endophthalmitis increased, while acute retinal necrosis and ocular toxocariasis decreased. Unclassified uveitis decreased, whereas infectious uveitis and IOL increased due to the availability of new diagnostic tests.Conclusion: Etiologies of uveitis have changed over the years. Further development of novel tests and diagnostic criteria would increase definitive diagnosis for unclassified uveitis. (147/150 words).
Collapse
Affiliation(s)
- Keiko Kunimi
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Yoshihiko Usui
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Kinya Tsubota
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | | | - Akihiko Umazume
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Takeshi Kezuka
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Junichi Sakai
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Hiroshi Goto
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| |
Collapse
|
27
|
dos Santos HNV, Ferracioli-Oda E, Barbosa TS, Otani CSV, Tanaka T, da Silva LDCS, Lopes GDO, Doi A, Hirata CE, Yamamoto JH. Usefulness of aqueous and vitreous humor analysis in infectious uveitis. Clinics (Sao Paulo) 2020; 75:e1498. [PMID: 31994615 PMCID: PMC6970280 DOI: 10.6061/clinics/2020/e1498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/21/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To evaluate the role of intraocular fluid analysis as a diagnostic aid for uveitis. METHODS Twenty-eight samples (27 patients including 3 HIV-infected patients) with active (n=24) or non-active (n=4) uveitis were submitted to aqueous (AH; n=12) or vitreous humor (VH) analysis (n=16). All samples were analyzed by quantitative PCR for herpes simplex virus (HSV), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV) and Toxoplasma gondii. RESULTS The positivity of the PCR in AH was 41.7% (5/12), with 50% (2/4) in immunocompetent and 67% (2/3) in HIV+ patients. The positivity of the PCR in VH was 31.2% (5/16), with 13% (1/8) in immunocompetent and 50% (4/8) in immunosuppressed HIV negative patients. The analysis was a determinant in the diagnostic definition in 58% of HA and 50% of VH. CONCLUSION Even in posterior uveitis, initial AH analysis may be helpful. A careful formulation of possible clinical diagnosis seems to increase the chance of intraocular sample analysis being meaningful.
Collapse
Affiliation(s)
- Helen Nazareth Veloso dos Santos
- Servico de Uveites, Departmento de Oftalmologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Eduardo Ferracioli-Oda
- Servico de Uveites, Departmento de Oftalmologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Thaisa Silveira Barbosa
- Servico de Uveites, Departmento de Oftalmologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Camila Sayuri Vicentini Otani
- Servico de Uveites, Departmento de Oftalmologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Tatiana Tanaka
- Servico de Uveites, Departmento de Oftalmologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Guilherme de Oliveira Lopes
- Secao de Citometria de Fluxo, Divisao do Laboratorio Central DLC, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Andre Doi
- Secao de Biologia Molecular, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Carlos Eduardo Hirata
- Servico de Uveites, Departmento de Oftalmologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Joyce Hisae Yamamoto
- Servico de Uveites, Departmento de Oftalmologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| |
Collapse
|
28
|
Zagora SL, Cornish EE, Symes RJ, Younan C, Sammel A, Wakefield D, McCluskey P. Inflammatory eye and rheumatic disease. Int J Rheum Dis 2019; 22:2091-2095. [PMID: 31797538 DOI: 10.1111/1756-185x.13714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 09/05/2019] [Accepted: 09/05/2019] [Indexed: 01/27/2023]
Affiliation(s)
- Sophia L Zagora
- Uveitis Unit, Sydney Eye Hospital, Sydney, NSW, Australia.,Save Sight Institute & Discipline of Ophthalmology, The University of Sydney, Sydney, NSW, Australia
| | - Elisa E Cornish
- Uveitis Unit, Sydney Eye Hospital, Sydney, NSW, Australia.,Save Sight Institute & Discipline of Ophthalmology, The University of Sydney, Sydney, NSW, Australia
| | - Richard J Symes
- Uveitis Unit, Sydney Eye Hospital, Sydney, NSW, Australia.,Save Sight Institute & Discipline of Ophthalmology, The University of Sydney, Sydney, NSW, Australia
| | - Christine Younan
- Uveitis Unit, Sydney Eye Hospital, Sydney, NSW, Australia.,Save Sight Institute & Discipline of Ophthalmology, The University of Sydney, Sydney, NSW, Australia
| | - Anthony Sammel
- Save Sight Institute & Discipline of Ophthalmology, The University of Sydney, Sydney, NSW, Australia.,Rheumatology Department, Prince of Wales Hospital and Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Denis Wakefield
- Immunology Department, University of New South Wales, Sydney, NSW, Australia
| | - Peter McCluskey
- Uveitis Unit, Sydney Eye Hospital, Sydney, NSW, Australia.,Save Sight Institute & Discipline of Ophthalmology, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
29
|
Abstract
OBJECTIVE Uveitis is the most common ophthalmological finding in the practice of rheumatology and clinical immunology. The condition is frequently idiopathic but about 60 causes of uveitis have been described. Our aim was to analyze the clinical patterns and etiologies of uveitis in a tertiary referral center. METHODS The records of 912 consecutive patients referred to the department of internal medicine (Lyon University Hospital, Lyon, France) for the diagnostic work-up of uveitis were examined. Demographic, clinical, anatomical, and etiological features of uveitis were analyzed. RESULTS The mean age at onset was 48.8 years; 59.8% of the patients were women and 78.2% were Caucasians. Anterior uveitis was the most common type of uveitis (40.6%), followed by panuveitis (31.7%), posterior (18.75%) and intermediate uveitis (9%). 46.9% of the patients had idiopathic uveitis. The most common etiologies were systemic diseases (37.3%), such as sarcoidosis (17.1%), HLA-B27-related uveitis and/or spondyloarthritis (12.5%), and tuberculosis (7.5%). CONCLUSION We describe one of the largest cohorts of consecutive uveitis patients referred to a department of internal medicine. The high percentage of uveitis associated with underlying (systemic) diseases highlights the need for a multidisciplinary approach, in order to reduce the diagnostic delay.
Collapse
|
30
|
Marquezan MC, Nascimento H, Dalbem D, Muccioli C, Belfort R. Vogt-Koyanagi-Harada Syndrome in Brazilian Children. Ocul Immunol Inflamm 2019; 28:402-408. [DOI: 10.1080/09273948.2019.1588982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Maria Carolina Marquezan
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, UNIFESP, Sao Paulo, Brazil
| | - Heloisa Nascimento
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, UNIFESP, Sao Paulo, Brazil
| | - Daniele Dalbem
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, UNIFESP, Sao Paulo, Brazil
| | - Cristina Muccioli
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, UNIFESP, Sao Paulo, Brazil
| | - Rubens Belfort
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, UNIFESP, Sao Paulo, Brazil
| |
Collapse
|
31
|
Casoy J, Nascimento H, Silva LMP, Fernández-Zamora Y, Muccioli C, Dias JRDO, Nóbrega MJ, Nóbrega HAJ, Zummo J, Belfort R. Effectiveness of Treatments for Ocular Toxoplasmosis. Ocul Immunol Inflamm 2019; 28:249-255. [PMID: 30806556 DOI: 10.1080/09273948.2019.1569242] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To evaluate the effectiveness of treatments for ocular toxoplasmosis (OT).Methods: A review of charts was conducted from patients who experienced an active episode of OT treated at the Federal University of São Paulo and associated sites. OT charts were reviewed to determine treatment effectiveness based on clinical judgment, taking clinical course and outcome into consideration in addition to change in best-corrected visual acuity. Treatment emergent adverse events (TEAEs) were used to assess safety.Results: Overall, 451/1200 patient charts met the inclusion criteria. The most commonly prescribed treatment was trimethoprim + sulfamethoxazole (52.3%) followed by pyrimethamine + sulfadiazine (28%). Treatment was successful in 96.9% of patients. Irrespective of the treatment, active lesions were resolved in 63.9% of patients within 6 weeks. Vision improved in 56.3% of patients. The incidence of TEAEs was low (10%).Conclusions: All treatments were effective for active episodes of OT, with few side effects.
Collapse
Affiliation(s)
- Julio Casoy
- R&D Department, Inclinica, Wayne, Pennsylvania, USA
| | - Heloisa Nascimento
- Department of Ophthalmology and Visual Sciences of the Federal University of São Paulo, , São Paulo, Brazil.,Instituto da Visão, São Paulo, Brazil
| | - Luci Meire P Silva
- Department of Ophthalmology and Visual Sciences of the Federal University of São Paulo, , São Paulo, Brazil
| | - Yuslay Fernández-Zamora
- Department of Ophthalmology and Visual Sciences of the Federal University of São Paulo, , São Paulo, Brazil
| | - Cristina Muccioli
- Department of Ophthalmology and Visual Sciences of the Federal University of São Paulo, , São Paulo, Brazil
| | | | - Mário Junqueira Nóbrega
- Sadalla Amin Ghanem Eye Hospital, Joinville, Santa Catarina, Brazil.,Ophthalmology Department , University of Joinville, Santa Catarina, Brazil
| | | | - Jacqueline Zummo
- Department of Health Sciences, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Rubens Belfort
- Department of Ophthalmology and Visual Sciences of the Federal University of São Paulo, , São Paulo, Brazil.,Instituto da Visão, São Paulo, Brazil
| |
Collapse
|
32
|
Clinical Manifestations and Ophthalmic Outcomes of Ocular Syphilis at a Time of Re-Emergence of the Systemic Infection. Sci Rep 2018; 8:12071. [PMID: 30104765 PMCID: PMC6089995 DOI: 10.1038/s41598-018-30559-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 07/26/2018] [Indexed: 01/20/2023] Open
Abstract
Recent reports from different world regions suggest ocular syphilis is re-emerging, in parallel with an increasing incidence of the systemic infection globally. We conducted a large observational study of 127 persons consecutively treated for ocular syphilis at public medical centers in Brazil over a 2.5-year period ending July 2015. Of 104 individuals serologically tested for human immunodeficiency virus (HIV), 34.6% were positive. Ophthalmological evaluations included measurement of Snellen visual acuity and intraocular pressure, and assessment of inflammation by slit lamp examination and dilated posterior eye examination. Involvements in 214 eyes were anterior (6.1%), intermediate (8.4%), posterior (76.2%) and pan- (8.4%) uveitis, and scleritis (0.9%). Multiple anterior and posterior eye complications were observed, including cataract in the anterior eye (incidence rate, 0.18/eye-year) and epiretinal membrane in the posterior eye (incidence rate, 0.09/eye-year); incidence rates of reduction in best-corrected visual acuity to ≤20/50 and ≤20/200 were 0.10 and 0.06/eye-year, respectively. Rates of complications and visual acuity loss did not differ significantly between HIV- positive and negative individuals. In an era of re-emergence, syphilis has ocular complications that may compromise vision, despite treatment with appropriate anti-microbial drugs.
Collapse
|
33
|
Souto FMS, Giampietro BV, Takiuti JT, Campos LMA, Hirata CE, Yamamoto JH. Clinical features of paediatric uveitis at a tertiary referral centre in São Paulo, SP, Brazil. Br J Ophthalmol 2018; 103:bjophthalmol-2018-312313. [PMID: 29907630 DOI: 10.1136/bjophthalmol-2018-312313] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 06/02/2018] [Indexed: 11/04/2022]
Abstract
AIMS To analyse the clinical features, systemic associations, treatment and visual outcomes of uveitis in children from a referral centre in São Paulo, Brazil. METHODS Clinical records of patients under 16 years old who attended the Uveitis Service, Hospital das Clinicas, Faculdadede Medicina, Universidade de São PauloFMUSP, between April and September 2017, were reviewed retrospectively. Patients with incomplete medical records, previous ocular trauma, or less than six6 months of follow-up were excluded. RESULTS Thirty-nine children (25 female/14 male) were included. There was predominance of bilateral (89.7%), asymptomatic (56.4%) and recurrent/chronic cases (84.6%). The mean age at study inclusion was 10.7±3.4 years (range 3-16 years). Improvement or preservation of visual acuity (VA) was observed in 27 patients (84%); VA was not informed in 8 patients. Patients were referred early to tertiary centre (55% within 6 months of uveitis diagnosis). Anterior uveitis was the most common involvement (46%), followed by intermediate uveitis (26%). Juvenile idiopathic arthritis (JIA)-associated uveitis (41%) and immune-mediated intermediate uveitis (25.6%) were the principal non-infectious conditions; ocular toxoplasmosis (7.7%) and toxocariasis (5.1%) were the most common infectious conditions. Ocular complications were observed at first visit in 46% of patients and in 90% during final evaluation. Oral prednisone, immunosuppressive therapy (IMT) and/or biologic agents were used in all non-infectious conditions (32 children, 82%); IMT and/or biologic agents were used in all patients with JIA-associated uveitis and in 50% of patients with immune-mediated intermediate uveitis. CONCLUSION Paediatric patients with uveitis are referred early to this centre and, although severe, adequate management with systemic IMT may preserve VA.
Collapse
Affiliation(s)
| | | | - Julia Thiemi Takiuti
- Department of Ophthalmology, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Lucia Maria Arruda Campos
- Pediatric Rheumatology Unit, Pediatric Department, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carlos Eduardo Hirata
- Department of Ophthalmology, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Joyce Hisae Yamamoto
- Department of Ophthalmology, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
34
|
Lee JH, Mi H, Lim R, Ho SL, Lim WK, Teoh SC, Agrawal R. Ocular Autoimmune Systemic Inflammatory Infectious Study - Report 3: Posterior and Panuveitis. Ocul Immunol Inflamm 2017; 27:89-98. [PMID: 28991501 DOI: 10.1080/09273948.2017.1358377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To report the pattern of posterior and panuveitis at a tertiary referral center in Singapore. METHODS Subgroup retrospective analysis of 334 new posterior and panuveitis cases, from the Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS) database. Descriptive analysis was performed and visual outcome and complications were reported. RESULTS The etiology for posterior uveitis and panuveitis was infectious in 162 patients (48.5%), non-infectious in 144 patients (43.1%), and idiopathic in 28 patients (8.4%). More patients with bilateral disease had a non-infectious etiology (n = 82, 50.9%) (p = 0.012). The most common complication was epiretinal membrane (n = 20, 12.3%) for the infectious group and cystoid macular edema (n = 12, 8.3%) for the non-infectious group. CONCLUSIONS The proportion of etiologies in our cohort varies from other studies. Understanding the variations and demographic associations allows the diagnosis and management of posterior and panuveitis to be further improved.
Collapse
Affiliation(s)
- Joanne H Lee
- a Yong Loo Lin School of Medicine , National University of Singapore , Singapore , Singapore
| | - Helen Mi
- b National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore , Singapore
| | - Rachel Lim
- c Singapore National Eye Centre , Singapore , Singapore
| | - Su Ling Ho
- b National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore , Singapore
| | - Wee Kiak Lim
- b National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore , Singapore.,d Eagle Eye Center , Mount Elizabeth Novena Hospital , Singapore , Singapore
| | - Stephen C Teoh
- b National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore , Singapore.,d Eagle Eye Center , Mount Elizabeth Novena Hospital , Singapore , Singapore
| | - Rupesh Agrawal
- a Yong Loo Lin School of Medicine , National University of Singapore , Singapore , Singapore.,b National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore , Singapore
| |
Collapse
|
35
|
Okafor LO, Hewins P, Murray PI, Denniston AK. Tubulointerstitial nephritis and uveitis (TINU) syndrome: a systematic review of its epidemiology, demographics and risk factors. Orphanet J Rare Dis 2017; 12:128. [PMID: 28709457 PMCID: PMC5513333 DOI: 10.1186/s13023-017-0677-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 06/19/2017] [Indexed: 01/22/2023] Open
Abstract
Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare oculorenal inflammatory condition that was first described in 1975. In 2001 a major review identified 133 cases in the world literature and proposed key diagnostic criteria for the condition. Although acknowledged as rare, the limited data available prevented reliable estimates of the prevalence of the condition, and hampered elucidation of the relationship between genetic and environmental factors that contribute to its pathogenesis.In this review we have performed a systematic search on the epidemiology, demographics and proposed risk factors for TINU. Estimates of prevalence based on studies that explicitly report TINU cases suggest that it is diagnosed in 0.2-2% of patients attending specialist uveitis services, with variation reflecting a number of factors including level of diagnostic certainty required. The prevalence of uveitis in patients with tubulointerstitial nephritis (TIN) may be higher than currently recognised, particularly in the paediatric population.The prevalence of TINU is higher in younger age groups and there is a female preponderance although this gender effect appears weaker than suggested by early studies. Although important genetic contributions have been proposed, the small size of studies and variation between reports currently preclude identification of a 'pro-TINU' haplotype. Drugs and infections have been proposed as the leading acquired risk factors for the development of TINU; whilst the small size of TINU cohorts and issues of study design limit interpretation of many studies. Larger datasets from the renal literature suggest that the majority of these cases are precipitated by a drug-induced hypersensitivity reaction; however in many ophthalmic cases no clear precipitant is identified.
Collapse
Affiliation(s)
- Linda O. Okafor
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Birmingham & Midland Eye Centre, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Peter Hewins
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Translational Medicine, Centre for Rare Diseases, Birmingham Health Partners, Birmingham, UK
| | - Philip I. Murray
- Birmingham & Midland Eye Centre, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
- Institute of Inflammation and Ageing, Academic Unit of Ophthalmology, University of Birmingham, Birmingham, B15 2WB UK
| | - Alastair K. Denniston
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Translational Medicine, Centre for Rare Diseases, Birmingham Health Partners, Birmingham, UK
- Institute of Inflammation and Ageing, Academic Unit of Ophthalmology, University of Birmingham, Birmingham, B15 2WB UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| |
Collapse
|
36
|
Uveitis in childhood-onset systemic lupus erythematosus patients: a multicenter survey. Clin Rheumatol 2017; 36:547-553. [PMID: 28070763 DOI: 10.1007/s10067-016-3534-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/27/2016] [Accepted: 12/29/2016] [Indexed: 02/07/2023]
Abstract
The aim of this study is to assess uveitis prevalence in a large cohort of childhood-onset systemic lupus erythematosus (cSLE) patients. A retrospective multicenter cohort study including 852 cSLE patients was performed in ten pediatric rheumatology centers (Brazilian cSLE group). An investigator meeting was held and all participants received database training. Uveitis was diagnosed through clinical assessment by the uveitis expert ophthalmologist of each center. Patients with and without uveitis were assessed for lupus clinical/laboratory features and treatments. Uveitis was observed in 7/852 cSLE patients (0.8%). Two of them had ocular complications: cataract and irreversible blindness in one patient and retinal ischemia with subsequent neovascularization and unilateral blindness in another. Uveitis was identified within the first 6 months of cSLE diagnosis in 6/7 patients (86%). Comparison of a subgroup of cSLE patients with (n = 7) and without uveitis (n = 73) and similar length of disease duration showed that patients with uveitis had increased SLEDAI-2K score (19 vs. 6; p < 0.01). In addition, fever (71 vs. 12%; p < 0.01), lymphadenopathy (29 vs. 1.4%; p = 0.02), arthritis (43 vs. 7%; p = 0.02), and use of intravenous methylprednisolone (71 vs. 22%; p = 0.01) were higher in cSLE patients with uveitis, as compared to those without this manifestation, respectively. Presence of fever was significantly associated with uveitis, independently of SLEDAI scores or use of intravenous methylprednisolone pulses, as shown by adjusted regression analysis (adjusted prevalence ratio 35.7, 95% CI 2.4-519.6; p < 0.01). Uveitis was a rare and initial manifestation of active cSLE patients. Early recognition is essential due to the possibility of irreversible blindness.
Collapse
|
37
|
Roizenblatt M, Fares N, Nascimento H, Novais EA, Muccioli C, Belfort R. Asymptomatic Progression of Ocular Behçet's Disease. Ophthalmic Surg Lasers Imaging Retina 2017; 48:18-35. [PMID: 28060390 DOI: 10.3928/23258160-20161219-03] [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: 09/14/2016] [Accepted: 10/10/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To emphasize the importance of auxiliary exams to detect progression of ocular Behçet's disease (BD) in asymptomatic patients. PATIENTS AND METHODS This was a retrospective review of the clinical records of a consecutive series of patients with BD and asymptomatic visual deterioration, imaged on fundus photograph (FP), visual field (VF), fluorescein angiography (FA), and optical coherence tomography (OCT). RESULTS Patients presented with no clinical findings or with mild inflammation on ophthalmic examination. However, during follow-up, VF examination indicated a progressive enlargement of previously visualized scotomas. On FA, the authors detected leakage and ischemia. On OCT, there was macular anatomical disruption, and the FP showed areas of atrophic retina. CONCLUSION In patients with ocular BD, the visual acuity deterioration may be asymptomatic and progressive. This should justify the importance of early and sequential ancillary exams in the management of BD patients to detect subclinical ocular involvement. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:18-25.].
Collapse
|
38
|
Chen EJ, Bin Ismail MA, Mi H, Ho SL, Lim WK, Teoh SC, Agrawal R. Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS) - Report 1: Epidemiology and Classification. Ocul Immunol Inflamm 2016; 26:732-746. [PMID: 27918224 DOI: 10.1080/09273948.2016.1249376] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To report the epidemiology and classification of ocular inflammation at a tertiary eye care center in Singapore. METHODS Retrospective cohort study of the clinical records of consecutive new cases from the Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS) database from 2004-2015. RESULTS A total of 2200 patients were studied from the OASIS database. The most common anatomic diagnosis was anterior uveitis (55.9%), posterior uveitis (17.5%), panuveitis (9.6%), and intermediate uveitis (4.7%). In addition, scleritis (6.1%), keratouveitis (2.8%), retinal vasculitis (2.2%), and episcleritis (1.2%) were observed. Etiology was established in 65.1%, with 35.2% of patients associated with non-infectious etiologies. The most common etiologies found were presumed tuberculosis (7.2%), followed by cytomegalovirus infection (6.9%), herpetic infection (6.3%), HLA-B27-associated anterior uveitis (4.2%), and ankylosing spondylitis (3.8%). CONCLUSIONS The pattern of ocular inflammation in Singapore has similarities with both Western and Asian populations. Anterior uveitis was the most common, with non-infectious etiologies being slightly more common than infectious etiologies.
Collapse
Affiliation(s)
- Elizabeth J Chen
- a Yong Loo Lin School of Medicine , National University of Singapore , Singapore
| | | | - Helen Mi
- b National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore
| | - Su Ling Ho
- b National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore
| | - Wee Kiak Lim
- b National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore.,c Eagle Eye Center , Mount Elizabeth Novena Hospital , Singapore
| | - Stephen C Teoh
- b National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore.,c Eagle Eye Center , Mount Elizabeth Novena Hospital , Singapore
| | - Rupesh Agrawal
- a Yong Loo Lin School of Medicine , National University of Singapore , Singapore.,b National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore
| |
Collapse
|
39
|
Yalçındağ FN, Özdal PC, Özyazgan Y, Batıoğlu F, Tugal-Tutkun I. Demographic and Clinical Characteristics of Uveitis in Turkey: The First National Registry Report. Ocul Immunol Inflamm 2016; 26:17-26. [PMID: 27467500 DOI: 10.1080/09273948.2016.1196714] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To describe the demographic and clinical profiles of uveitis patients seen at secondary and tertiary care centers in Turkey. METHODS A nationwide web-based registry of patients with uveitis was initiated in November 2008. We analyzed data from a single baseline registry-enrollment visit. RESULTS In 33 centers, 6967 eyes of 4863 consecutive patients were registered. The mean age at presentation was 36.6 ± 15.7 (1-92) years; 51.3% were male. Behçet disease was the leading diagnosis (24.9%), followed by ankylosing spondylitis and/or HLA-B27-associated anterior uveitis (9.7%), toxoplasmosis (7.1%), Fuchs uveitis (6.3%), and presumed herpetic anterior uveitis (6.0%). Visual acuity was 0.1 or worse in 22% of eyes. The most common ocular complications were posterior synechiae (16.2%) and cataract formation (16.2%). CONCLUSIONS Behçet disease is still the most common non-infectious etiology in Turkish uveitis patients, while ocular toxoplasmosis and herpetic anterior uveitis are the most common infectious uveitic entities.
Collapse
Affiliation(s)
- F Nilüfer Yalçındağ
- a Department of Ophthalmology , Ankara University, Faculty of Medicine , Ankara , Turkey
| | - Pınar C Özdal
- b Ulucanlar Eye Research and Training Hospital , Ankara , Turkey
| | - Yılmaz Özyazgan
- c Department of Ophthalmology , Istanbul University, Cerrahpasa Faculty of Medicine , Istanbul , Turkey
| | - Figen Batıoğlu
- a Department of Ophthalmology , Ankara University, Faculty of Medicine , Ankara , Turkey
| | - Ilknur Tugal-Tutkun
- d Department of Ophthalmology , Istanbul University, Istanbul Faculty of Medicine , Istanbul , Turkey
| | | |
Collapse
|