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Souza GM, Finamor LP, Belfort R. Neuroretinitis: A Rare Manifestation of Acute Ocular Toxoplasmosis in a Child. Ophthalmol Retina 2024; 8:48. [PMID: 37943205 DOI: 10.1016/j.oret.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Guilherme Macedo Souza
- Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil
| | - Luciana Peixoto Finamor
- Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil
| | - Rubens Belfort
- Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil; Instituto Paulista de Estudos e Pesquisas em Oftalmologia, IPEPO, Vision Institute, São Paulo, São Paulo, Brazil
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Fernández-Zamora Y, Finamor LP, Silva LMP, S Rodrigues D, Casaroli-Marano RP, Muccioli C. Role of Interferon-Gamma Release Assay for the Diagnosis and Clinical Follow up in Ocular Tuberculosis. Ocul Immunol Inflamm 2023; 31:304-311. [PMID: 35081020 DOI: 10.1080/09273948.2022.2027459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To assess the performance of interferon-gamma release assay (IGRA) associated with tuberculosis skin test (TST) for ocular tuberculosis (OTB) diagnosis and therapeutic decision making. METHOD One hundred and ninety-one patients with ocular inflammation were prospectively followed-up. Patients with clinical signs highly suspected of OTB, TST≥10 mm, and/or IGRA≥0.35 IU/mL received antitubercular therapy (ATT). Sensitivity (Se), specificity (Sp), and area under the curve (AUC) were assessed. RESULTS Seventy-two (37.7%) patients received ATT for presumed OTB. Combining TST and IGRA had Se=89.6%, Sp=99.2%, and AUC (0.98) significantly higher compared to TST (0.85, Z=6.3, p<.001) or IGRA (0.95, Z=2.5, p=.01). Prior history of corticosteroids or immunosuppressant with concomitantly oral prednisone and baseline IGRA> 2.0 IU/mL was associated significantly with more recurrences in ATT patients (p=.01) . CONCLUSION Considering TST and IGRA together was more effective in assessing OTB diagnosis. The real value of the IGRA test to predict recurrences needs further studies.
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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.,Department of Surgery, School of Medicine & Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Luciana Peixoto Finamor
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Luci Meire P Silva
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Denise S Rodrigues
- Laboratory of Immunology, Instituto Clemente Ferreira (ICF), São Paulo, Brazil
| | - Ricardo P Casaroli-Marano
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), 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 Science, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Fernández Zamora Y, Finamor LP, Silva LMP, Rodrigues DS, Casaroli-Marano RP, Muccioli C. Current Practices in Ocular Tuberculosis: A Survey of Brazilian Specialists. Ocul Immunol Inflamm 2019; 28:256-261. [PMID: 30806119 DOI: 10.1080/09273948.2018.1563705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To describe the approach of Brazilian specialists in the diagnosis and treatment of tuberculosis-associated uveitis (TBU).Methods: Members of the Brazilian Uveitis Society received an electronic invitation to participate in an online questionnaire.Results: Of the 169 invited specialists, 78 answered the questionnaire. Specialists evaluated 5.6 patients with TBU annually. Tuberculin skin test (TST, 81%) was primarily used for diagnosis. Patients with presumed TBU should always be tested for syphilis and HIV according to 51 (88%) and 47 (81%) of respondents, respectively. Chest computed tomography (CT, 72%) was preferable to chest radiography (CXR) for diagnosis. A positive TST (81%) and CXR (60%) were the main indicators of anti-tuberculous therapy, with 34%, 39%, and 14% of specialists treating for 6, 9, and 12 months, respectively.Conclusions: TST remains the preferred method for TBU diagnosis and prompt treatment by Brazilian specialists, though there is no consensus regarding disease treatment and management.
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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
| | - Luciana Peixoto Finamor
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Luci Meire P Silva
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Denise S Rodrigues
- Laboratory of Immunology, Instituto Clemente Ferreira (ICF), São Paulo, Brazil
| | - Ricardo P Casaroli-Marano
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), 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 Science, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Abstract
PURPOSE To analyze clinical findings of ocular tuberculosis and its epidemiological features. METHODS Were reviewed clinical files of patients who attended the Ophthalmology-Uveitis and AIDS sector of UNIFESP-EPM, São Paulo, Brazil between January 1999 and July 2002 and had a diagnosis of ocular tuberculosis. Patients who had Mantoux test higher than 10 mm, epidemiological history of tuberculosis and ocular findings that improved after specific treatment were included. RESULTS Seventeen medical files were analyzed, of those, 12 (70.6%) were females. The mean age was 54 (24-84) years. The average time between symptoms and diagnosis was 100 days. Ocular findings at the first interview were multiple but most were at the anterior segment of the eye and 41% of patients who had clinical findings that suggested tuberculosis other than ocular. Situations as glaucoma, retinal detachment and vitreous hemorrhage were responsible for reduction of visual acuity. CONCLUSIONS Ocular tuberculosis showed a low prevalence but important visual loosing morbidity. The multiplicity of clinical findings is responsible for the delay of diagnosis.
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Affiliation(s)
- Luciana Peixoto Finamor
- Vision Institute, Federal University of São Paulo, Rua Botucatu 824, São Paulo, Brazil 04023062
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Dimantas MA, Finamor LP, Ewert V, Nakanami C, Muccioli C. [Cytomegalovirus retinitis in pediatric patients with AIDS receiving highly active antiretrovirus therapy]. Rev Assoc Med Bras (1992) 2004; 50:320-3. [PMID: 15499487 DOI: 10.1590/s0104-42302004000300042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND To describe three cases of cytomegalovirus retinitis occurring in HIV-infected children taking protease inhibitors combined with transcriptase inhibitors (HAART). METHODS Three cases of HIV-infected children taking highly active antiretrovirus therapy (HAART) underwent an ocular examination at a university referral center-UNIFESP. RESULTS The average age was 6 years (10 months to 13 years old), and all of them were C3 (CDC-Atlanta-EUA 1994). Median CD4 cell count and plasma HIV RNA were 67 cells/mm3 (43-98 cells/mm3) and 190.000 copies/ml (53.600-460.000 copies/ml). The three patients presented HAART failure and all of them were treated with anti-CMV agents without success. CONCLUSION The unprecedented benefits resulting from highly active antiretroviral therapy (HAART) have been well described. However, treatment failure has become increasingly complex, because of the aggressive forms of opportunistic diseases like CMV retinitis, despite anti-CMV agents. Prompt diagnosis and treatment are essential to minimize the risk of long-term loss of vision for these infected children.
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Affiliation(s)
- Maria Angélica Dimantas
- Departamento de Oftalmologia, Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP.
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Ewert V, Finamor LP, Dimantas MA, Muccioli C. Neovascularização retiniana secundária a obstrução vascular em retinocoroidite por toxoplasmose em paciente HIV positivo: relato de caso. Arq Bras Oftalmol 2004. [DOI: 10.1590/s0004-27492004000400019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Finamor LP, Dimantas MAP, Campos VED, Prata Jr. JA, Muccioli C. Efeitos da injeção subtenoniana posterior de corticóide em pacientes com uveíte. Arq Bras Oftalmol 2003. [DOI: 10.1590/s0004-27492003000300006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Finamor LP, Dimantas MAP, Campos VED, Muccioli C. Glaucoma persistente secundário à injeção subtenoniana posterior de acetato de triancinolona (Kenalog®): relato de casos. Arq Bras Oftalmol 2003. [DOI: 10.1590/s0004-27492003000200019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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