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Ramanathan S, Fraser C, Curnow SR, Ghaly M, Leventer RJ, Lechner-Scott J, Henderson A, Reddel S, Dale RC, Brilot F. Uveitis and optic perineuritis in the context of myelin oligodendrocyte glycoprotein antibody seropositivity. Eur J Neurol 2019; 26:1137-e75. [PMID: 30748058 DOI: 10.1111/ene.13932] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 02/07/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Antibodies to myelin oligodendrocyte glycoprotein (MOG) have been identified in both children and adults with demyelination, with a strong association with bilateral or recurrent optic neuritis (ON). However, the full clinical spectrum of this newly described condition is unknown. We sought to describe non-ON inflammatory ophthalmological presentations such as uveitis and optic perineuritis in the context of MOG antibody seropositivity. METHODS Using a live cell-based assay analysed by flow cytometry, we identified seropositive patients referred for MOG antibody testing in Australasia between 2014 and 2017. We identified four MOG antibody-positive patients with non-ON inflammatory ophthalmological presentations and present their detailed clinical information in this case series. RESULTS Three patients had uveitis either in association with, or remote from, ON. One patient had optic perineuritis and peripheral ulcerative keratitis. We describe the presentation, examination, investigation findings and clinical course of these four patients. CONCLUSIONS Recognition of these novel clinical associations may expand the clinical spectrum of MOG antibody-associated presentations. An expedited diagnosis may guide the management of these complex patients.
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Affiliation(s)
- S Ramanathan
- Brain Autoimmunity Group, Kids Neuroscience Centre at Kids Research, The Children's Hospital, Westmead, New South Wales.,Sydney Medical School, University of Sydney, Sydney, New South Wales.,Department of Neurology, Westmead Hospital, Sydney, New South Wales
| | - C Fraser
- Save Sight Institute, University of Sydney, Sydney, New South Wales
| | - S R Curnow
- Department of Neurology, Royal Children's Hospital, Melbourne, Victoria
| | - M Ghaly
- University Hospital Geelong, Geelong, Victoria
| | - R J Leventer
- Department of Paediatrics, Royal Children's Hospital, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria
| | - J Lechner-Scott
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales.,Hunter Medical Research Institute, Faculty of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales
| | - A Henderson
- Department of Neurology, Westmead Hospital, Sydney, New South Wales.,Department of Ophthalmology, Westmead Hospital, Sydney, New South Wales
| | - S Reddel
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales.,Department of Neurology, Concord Repatriation General Hospital, Sydney, New South Wales
| | - R C Dale
- Brain Autoimmunity Group, Kids Neuroscience Centre at Kids Research, The Children's Hospital, Westmead, New South Wales.,Sydney Medical School, University of Sydney, Sydney, New South Wales.,Brain and Mind Centre, University of Sydney, Sydney, New South Wales.,TY Nelson Department of Neurology and Neurosurgery, Children's Hospital at Westmead, Sydney, New South Wales
| | - F Brilot
- Brain Autoimmunity Group, Kids Neuroscience Centre at Kids Research, The Children's Hospital, Westmead, New South Wales.,Sydney Medical School, University of Sydney, Sydney, New South Wales.,Brain and Mind Centre, University of Sydney, Sydney, New South Wales.,Applied Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
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Abstract
Over a four and a half month period, 1004 unselected routine faecal specimens from 815 patients were cultured for Aeromonas hydrophila. Forty-two specimens (4.2%) representing 38 patients were culture-positive. The study specimens also yielded Salmonella on 116 occasions, Shigella on seven, Campylobacter species on six and other bacterial pathogens on 17 occasions, respectively. Seven specimens had A hydrophila together with another bacterial pathogen. In only 19 of 38 patients (50%) was A hydrophila possibly associated with gastrointestinal symptoms. All the Aeromonas isolates were resistant to ampicillin but sensitive to gentamicin, piperacillin, mecillinam, chloramphenicol, ceftazidime and colistin.
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Abstract
The in vitro activity of ticarcillin, piperacillin, azlocillin and mezlocillin was determined against 403 clinical isolates. At MIC50, piperacillin was 2 to 8 times more active than the other three compounds against Pseudomonas, Escherichia coli, Proteus, Citrobacter, Acinetobacter and Salmonella species. Against Klebsiella, Enterobacter, Haemophilus, Bacteroides spp. and non-beta-lactamase producing Staphylococcus aureus the activity of piperacillin was similar to one or more of the most effective agents. However, azlocillin and mezlocillin were more active than piperacillin against enterococci. Ticarcillin was the least active in vitro. Despite these significant differences at MIC50 amongst the four compounds, they became much less discernible at MIC90, obviously due to beta-lactamase producing strains under study. The spectrum of activity of piperacillin encompasses those of azlocillin and mezlociLlin together except for Gram-positive organisms.
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