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Moumen A, Belamlih H, Benabedlfedil Y, Derrou S, Lemhadi M, Safi S, El Guendouz F. Bacterial scleritis secondary to osteitis in a diabetic patient. J Fr Ophtalmol 2024; 47:103931. [PMID: 37666739 DOI: 10.1016/j.jfo.2023.08.002] [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: 06/04/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 09/06/2023]
Affiliation(s)
- A Moumen
- Endocrinology and Diabetology Department, Moulay Ismail Military Hospital of Meknes, Human pathology, Biomedicine and Environment Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fes, Morocco.
| | - H Belamlih
- Radiology Department, Moulay Ismail Military Hospital of Meknes, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fes, Morocco
| | - Y Benabedlfedil
- Endocrinology and Diabetology Department, Moulay Ismail Military Hospital of Meknes, Human pathology, Biomedicine and Environment Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fes, Morocco
| | - S Derrou
- Endocrinology and Diabetology Department, Moulay Ismail Military Hospital of Meknes, Human pathology, Biomedicine and Environment Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fes, Morocco
| | - M Lemhadi
- Ophthalmology Department, Moulay Ismail Military Hospital of Meknes, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fes, Morocco
| | - S Safi
- Endocrinology and Diabetology Department, Moulay Ismail Military Hospital of Meknes, Human pathology, Biomedicine and Environment Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fes, Morocco
| | - F El Guendouz
- Endocrinology and Diabetology Department, Moulay Ismail Military Hospital of Meknes, Human pathology, Biomedicine and Environment Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fes, Morocco
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Kreps EO, Jasim H, Mamtora S, Dick AD. ACUTE SYPHILITIC NECROTIZING RETINITIS ASSOCIATED WITH PLACOID CHORIORETINITIS IN AN IMMUNOCOMPETENT PATIENT. Retin Cases Brief Rep 2024; 18:152-154. [PMID: 36730930 DOI: 10.1097/icb.0000000000001361] [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: 02/04/2023]
Abstract
PURPOSE We report an atypical case of combined acute syphilitic necrotizing retinitis and a contiguous acute syphilitic posterior placoid chorioretinitis in an HIV-negative, immunocompetent patient. METHOD Observational case report. RESULTS A 56-year-old man presented with a one-week history of pain and blurred vision in the left eye. He also complained of left-sided hearing loss for several months. Ocular examination demonstrated a unilateral panuveitis with a yellowish placoid macular lesion involving the outer retina contiguous with an ovoid area of full-thickness retinitis extending temporally. Vitreal polymerase chain reaction analysis for HSV, CMV, VZV, and T. gondii were negative, but syphilis serology was reported as positive. An MRI of the head revealed bilateral enhancement along the facial nerves, more marked on the left side, consistent with syphilitic involvement. He was treated for neurosyphilis with a 14-day course of systemic procaine penicillin and oral probenecid. Oral prednisolone (1 mg/kg/day) was commenced 24 hours before initiating antibiotics to prevent Jarisch-Herxheimer reaction and treat his panuveitis. CONCLUSION To our knowledge, this is the first report of combined syphilitic necrotizing retinitis and acute syphilitic posterior placoid chorioretinitis occurring in continuity in the same eye. This case highlights the diversity of possible presentations of ocular syphilis, even in HIV-negative immunocompetent patients.
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Affiliation(s)
- Elke O Kreps
- Bristol Eye Hospital, University Hospitals Bristol and Weston, Bristol, United Kingdom
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
| | - Haneen Jasim
- Bristol Eye Hospital, University Hospitals Bristol and Weston, Bristol, United Kingdom
| | - Sunil Mamtora
- Bristol Eye Hospital, University Hospitals Bristol and Weston, Bristol, United Kingdom
| | - Andrew D Dick
- Bristol Eye Hospital, University Hospitals Bristol and Weston, Bristol, United Kingdom
- University College London, Institute of Ophthalmology, London, United Kingdom
- Academic Unit of Ophthalmology, Translational Health Sciences, University of Bristol, Bristol, United Kingdom; and
- NIHR Biomedical Research Centre of Ophthalmology, Moorfields Eye Hospital, London, United Kingdom
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Buchan J. Endophthalmitis rates and risk factors following intraocular surgeries: can we turn big-data benchmarks into patient benefit? Br J Ophthalmol 2024; 108:165-166. [PMID: 38164546 DOI: 10.1136/bjo-2023-324593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 09/17/2023] [Indexed: 01/03/2024]
Affiliation(s)
- John Buchan
- Clinical Research Department, London School of Hygiene and Tropical Medicine International Centre for Eye Health, London, UK
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Mejaddam A, Pircher A. AGGREGATIBACTER ENDOPHTHALMITIS IN A PATIENT WITH DENTOPHOBIA. Retin Cases Brief Rep 2024; 18:135-137. [PMID: 36007190 DOI: 10.1097/icb.0000000000001335] [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: 06/15/2023]
Abstract
PURPOSE To describe a rare case of unilateral, endogenous endophthalmitis caused by Aggregatibacter aphrophilus (HACEK group) confirmed in vitreous and blood cultures, in a patient with dentophobia. METHODS Case report. PATIENTS A seventy-five-year-old male patient with Type 2 diabetes, previous myocardial infarction, and pacemaker implantation. RESULTS Patient was observed with sudden loss of vision at the Department of Ophthalmology, Uppsala University. Initial diagnosis was posterior vitreous detachment and anterior uveitis, but progression of disease led to vitrectomy, which actually demonstrated endophthalmitis and growth of A. aphrophilus of the HACEK group. Aggregatibacter bacteremia and pacemaker endocarditis were also identified and dental examination confirmed growth of Aggregatibacter in the oral cavity. Intravitreal treatment with ceftazidime and vancomycin according to Endophthalmitis Vitrectomy Study protocol was administered with quick resolution of endophthalmitis. CONCLUSION Aggregatibacter endophthalmitis is a rare, but devastating cause of vision loss where immediate diagnosis may be delayed. Prompt diagnosis may be facilitated by a thorough medical history and early vitreous biopsy. Systemic investigation by an infectious disease specialist and multidisciplinary assessment are mandatory. Ophthalmologic treatment is effective with intravitreal injections of ceftazidime and vancomycin.
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Affiliation(s)
- Assem Mejaddam
- Department of Neuroscience/Ophthalmology, Uppsala University, Uppsala, Sweden
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Rahman EZ, Beck KD, Wong RW, Sohn JH, Diaz-Rohena RD, Harper CA. Bilateral Combined Rhegmatogenous and Tractional Retinal Detachments Due to Persistent High-Titer Syphilis. Ophthalmic Surg Lasers Imaging Retina 2024; 55:46-50. [PMID: 38189796 DOI: 10.3928/23258160-20231023-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
A 23-year-old man developed bilateral rhegmatogenous retinal detachments secondary to high-titer ocular syphilis. The patient's titer increased four-fold after completing a 14-day course of intravenous penicillin (IVP). He underwent bilateral pars plana vitrectomy with silicone oil fill in both eyes. In this article, the authors propose an updated treatment method for patients with advanced ocular syphilis that includes oral doxycycline for 30 days following 14 days of IVP to optimally minimize the patient's infectious burden. Following surgery and this new treatment regime, this patient's best-corrected visual acuity 10 weeks postoperatively measured 20/50 in the right eye and 20/30 in the left eye. This case highlights a rare but devastating complication of ocular syphilis. We suggest the addition of oral doxycycline to IVP for patients with syphilis titers ≥ 1:256, HIV co-infection, and presence of posterior retinitis. [Ophthalmic Surg Lasers Imaging Retina 2024;55:46-50.].
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Mirzania D, Zacks DN, Zhou Y, Huvard MJ. Clinical Characteristics and Visual Outcomes of Acute Syphilitic Posterior Placoid Chorioretinopathy. Ophthalmol Retina 2023; 7:1080-1086. [PMID: 37479085 DOI: 10.1016/j.oret.2023.07.014] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE To evaluate presenting features and visual outcomes in eyes with acute syphilitic posterior placoid chorioretinopathy (ASPPC). DESIGN Retrospective cohort study. SUBJECTS A total of 24 eyes of 17 adult patients with ASPPC. METHODS Chart review of patients with ASPPC who presented to the University of Michigan W. K. Kellogg Eye Center between January 1, 2012, and November 4, 2022. Demographic and clinical information, fundus photographs, fundus autofluorescence, and spectral-domain-OCT (SD-OCT) findings were reviewed. MAIN OUTCOME MEASURES Clinical characteristics and visual acuity (VA) on presentation and follow-up examination. RESULTS The median age was 46 (interquartile range [IQR], 38-51) years. At presentation, 20 (83.3%) eyes had subjectively decreased vision, with a median initial VA of 0.54 (IQR, 0.35-1.00) logarithm of the minimum angle of resolution (logMAR); at 45 days, median logMAR VA was 0.096 (IQR, 0.02-0.17). Initial VA was positively associated with posterior pole-sparing lesions (coefficient estimate [CE], -0.75; 95% confidence interval [CI], -1.38 to -0.12); P = 0.03), and negatively associated with ellipsoid zone (EZ) disruption (CE, 0.72; 95% CI, 0.03-1.42; P = 0.04), subfoveal EZ disruption (CE, 0.62; 95% CI, 0.02-1.23; P = 0.046), and initial hyperreflective foci on SD-OCT (CE, 0.66; 95% CI, 0.09-1.23; P = 0.03). Female eyes were more likely (hazard ratio [HR], 3.36; 95% CI, 1.07-10.6; P = 0.04), and eyes with optic nerve abnormality were less likely (HR, 0.34; 95% CI, 0.12-0.96; P = 0.04), to achieve a VA ≥ 20/40 (logMAR, 0.30). CONCLUSIONS This study of patients with ASPPC showed that symptomatic eyes had an improvement from a median VA of 20/69 on presentation to a median VA of 20/25 at 45 days. Female sex and absence of optic nerve involvement were associated with higher probability of achieving ≥ 20/40. These findings provide refined guidance for counseling patients who present with decreased vision due to ASPPC. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Delaram Mirzania
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, Michigan
| | - David N Zacks
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, Michigan
| | - Yunshu Zhou
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, Michigan
| | - Michael J Huvard
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, Michigan.
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Nettleton WD, Kent JB, Lightheart K, Diesel JC. A Cluster of Ocular Syphilis Cases with a Common Sex Partner - Southwest Michigan, 2022. MMWR Morb Mortal Wkly Rep 2023; 72:1281-1287. [PMID: 37991986 PMCID: PMC10685383 DOI: 10.15585/mmwr.mm7247a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Untreated syphilis can lead to ocular syphilis, otosyphilis, and neurosyphilis, conditions resulting from Treponema pallidum infection of the eye, inner ear, or central nervous system. During March-July 2022, Michigan public health officials identified a cluster of ocular syphilis cases. The public health response included case investigation, partner notification, dissemination of health alerts, patient referral to a public health clinic for diagnosis and treatment, hospital care coordination, and specimen collection for T. pallidum molecular typing. Five cases occurred among southwest Michigan women, all of whom had the same male sex partner. The women were aged 40-60 years, HIV-negative, and identified as non-Hispanic White race; the disease was staged as early syphilis, and all patients were hospitalized and treated with intravenous penicillin. The common male sex partner was determined to have early latent syphilis and never developed ocular syphilis. No additional transmission was identified after the common male partner's treatment. Due to lack of genetic material in limited specimens, syphilis molecular typing was not possible. A common heterosexual partner in an ocular syphilis cluster has not been previously documented and suggests that an unidentified strain of T. pallidum might have been associated with increased risk for systemic manifestations of syphilis. A high index of clinical suspicion and thorough sexual history are critical to diagnosing ocular syphilis, otosyphilis, and neurosyphilis. Coordination of disease surveillance with disease intervention specialist investigation and treatment referral can interrupt syphilis transmission.
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Kase C, Boppré YT, Rocchetti TT, Yu MCZ, Fernandes AG, Hofling-Lima AL. Microbial keratitis in Sao Paulo, Brazil: a 10-year review of laboratory results, epidemiological features, and risk factors. Arq Bras Oftalmol 2023; 87:e202200660. [PMID: 37878874 DOI: 10.5935/0004-2749.2022-0060] [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] [Received: 03/17/2022] [Accepted: 12/20/2022] [Indexed: 10/27/2023] Open
Abstract
PURPOSE To study epidemiological data, laboratory results, and risk factors associated with microbial keratitis. METHODS We conducted a retrospective study of corneal sample cultures from patients with microbial keratitis from January 2010 to December 2019. Results were analyzed according to the etiological diagnosis of bacterial, mycotic, or parasitic infection and were associated with related risk factors. RESULTS We analyzed 4810 corneal samples from 4047 patients (mean age 47.79 ± 20.68 years; male 53.27%). The prevalence of bacterial, fungal, and Acanthamoeba infections were 69.80%, 7.31%, and 3.51%, respectively. The most frequently isolated bacteria were coagulase-negative Staphylococcus (CoNS) (45.14%), S. aureus (10.02%), Pseudomonas spp. (8.80%), and Corynebacterium spp. (6.21%). Among CoNS, the main agent was S. epidermidis (n=665). For mycotic keratitis, Fusarium spp. (35.42%) and Candida parapsilosis (16.07%) were the most common agents among filamentous and yeasts isolates, respectively. Contact lens use was associated with a positive culture for Acanthamoeba spp. (OR = 19.04; p < 0.001) and Pseudomonas spp. (OR = 3.20; p < 0.001). Previous ocular trauma was associated with positive fungal cultures (OR = 1.80; p = 0.007), while older age was associated with positive bacterial culture (OR = 1.76; p = 0.001). CONCLUSIONS Our findings demonstrated a higher positivity of corneal sample cultures for bacteria. Among those, CoNS was the most frequently identified, with S. epidermidis as the main agent. In fungal keratitis, Fusarium spp. was the most commonly isolated. Contact lens wearers had higher risks of positive cultures for Acanthamoeba spp. and Pseudomonas spp. Ocular trauma increased the risk of fungal infection, while older age increased the risk of bacterial infection.
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Affiliation(s)
- Camila Kase
- Department of Ophthalmology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Yasmin Tournier Boppré
- Department of Ophthalmology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Talita Trevizani Rocchetti
- Department of Ophthalmology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Maria Cecília Zorat Yu
- Department of Ophthalmology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Arthur Gustavo Fernandes
- Department of Ophthalmology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Ana Luisa Hofling-Lima
- Department of Ophthalmology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Rathinam SR, Kohila GJ, Gowri PC, Balagiri KS. Leptospiral uveitis- "Transition 'from epidemic to endemic form" difficulties in laboratory confirmations. Indian J Ophthalmol 2023; 71:3031-3038. [PMID: 37530277 PMCID: PMC10538821 DOI: 10.4103/ijo.ijo_61_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/02/2023] [Accepted: 05/29/2023] [Indexed: 08/03/2023] Open
Abstract
Purpose Leptospirosis is a waterborne zoonotic disease that primarily causes systemic illness, followed by uveitis. After heavy flooding in Madurai district, an epidemic outbreak of systemic and ocular leptospirosis occurred in 1994. Our data shows a transition to endemicity after each epidemic. Aim The aim of this study is to report the clinical signs, epidemic outbreaks, and persistent endemicity of leptospiral uveitis, as well as the diagnostic dilemmas associated with it. Methods A retrospective analysis of clinical signs was conducted using medical records of leptospiral uveitis patients over a period of 27 years (1994-2020) in a tertiary care eye hospital. The clinical workup of uveitis included a detailed clinical history, systemic, and ophthalmic examination. Microagglutination tests (MATs) was done at the Centers for Disease Control and Prevention (CDC) in Atlanta and later in our regional laboratory. Serum samples were collected from human systemic leptospirosis cases and a small group of animals in and around Madurai. Results The first epidemic outbreak resulted in 200 seropositive patients. Subsequent epidemic outbreaks occurred in 1997, 1998, 2001, 2005, and 2012, with Madurai experiencing multiple outbreaks. However, the disease remained endemic, with 25-50 patients being observed per year in between the peaks. Ocular examination revealed acute non-granulomatous uveitis (94.9%), pan uveitis (59.8%), vitreous inflammatory reaction (55.4%), retinal vasculitis (29.5%), disc hyperemia (20.9%), and hypopyon. (16.2%). New serovars emerged every year, resulting in decreased sensitivity of the MAT. Over time, the MAT started to miss diagnoses. Conclusion The persistent endemicity of leptospiral uveitis emphasizes the need for accessible diagnostic tests. The low performance of the MAT can be attributable to the use of an older panel. The incorporation of new isolates in the MAT by a national laboratory will improve the accuracy of diagnosis.
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Affiliation(s)
- SR. Rathinam
- Aravind Eye Hospital and PG. Institute of Ophthalmology, Aravind Medical Research Foundation, Madurai, Tamil Nadu, India
| | - G. Jeya Kohila
- Aravind Eye Hospital and PG. Institute of Ophthalmology, Aravind Medical Research Foundation, Madurai, Tamil Nadu, India
| | | | - KS. Balagiri
- Biostatistics, Aravind Medical Research Foundation, Madurai, Tamil Nadu, India
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Ling CJM, Zhang KY, Taubenslag KJ, Alexander N, Champ K, Murali N. The Mydriatic Red Eye as the Initial Presentation of Syphilis. J Emerg Med 2022; 63:296-299. [PMID: 36038437 DOI: 10.1016/j.jemermed.2022.05.019] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Syphilis is a sexually transmitted infection that has been increasing in prevalence since the early 2000s. Ocular involvement occurs in a minority of patients and must be in the differential diagnosis for patients who present with red eye and uveitis. CASE REPORT A 29-year-old woman presented to the emergency department with a painful, mydriatic red eye. Review of systems revealed a rash as well as a recent genital lesion and, on further questioning, she admitted to a history of intravenous drug use and high-risk sexual activity. Ophthalmology was consulted and the patient was diagnosed with bilateral uveitis. Serologic testing was positive for syphilis, and she was admitted and treated with intravenous penicillin, with resolution of her uveitis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Red eye is a common ocular symptom in patients presenting to the emergency department. The differential diagnosis of the red eye is broad and can range from benign etiologies, such as conjunctivitis, to life- and sight-threatening conditions, such as endogenous endophthalmitis. Systemic diseases such as syphilis may present with primarily ocular symptoms, and ocular syphilis must be identified and managed appropriately to prevent devastating sequelae.
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Affiliation(s)
- Carlthan J M Ling
- Department of Ophthalmology and Visual Sciences, University of Maryland Medical Center, Baltimore, Maryland
| | - Kevin Y Zhang
- Creighton University Medical School, Omaha, Nebraska
| | - Kenneth J Taubenslag
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Nicole Alexander
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kathryn Champ
- Department of Internal Medicine, University of Maryland Medical Center, Midtown Campus, Baltimore, Maryland
| | - Neeraja Murali
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
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Miyao Y, Nakagawa Y, Sato E, Suzuki Y. A Case of Post-cataract Surgery Endophthalmitis Successfully Treated with Conservative Therapy. Tokai J Exp Clin Med 2022; 47:75-78. [PMID: 35801552] [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] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/03/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Postoperative endophthalmitis after cataract surgery often requires emergency surgery if caused by an infection. However, early reoperation after the surgery put a heavy mental burden on the patient. Here we report a relatively mild case of postoperative endophthalmitis in which emergency surgery was avoided through careful observation including gram stain and culture test. CASE 87-year-old male. The patient had a sudden decrease in visual acuity on the 4th day after cataract surgery of the left eye performed at another hospital and visited his previous doctor on the following day. Postoperative endophthalmitis was suspected, so he was referred to our department on the same day. The inflammation was observed in the anterior segment of the left eye. The gram staining results for collected anterior aqueous humor were negative. The patient was followed up with continued medication and careful observation without undergoing emergency surgery. The inflammation of the anterior segment subsequently improved. The patient underwent a left vitrectomy three months later to remove residual vitreous opacity. CONCLUSION Postoperative endophthalmitis after cataract surgery is often indicated for emergency surgery, but there can be cases in which conservative therapy with thorough observation succeeds in retaining visual function.
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Affiliation(s)
- Yosuke Miyao
- Department of Ophthalmology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
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Umazume A, Ohguro N, Okada AA, Namba K, Sonoda KH, Tsuruga H, Morita K, Goto H. Use of systemic corticosteroids in patients newly registered at a claims database with a diagnosis of non-infectious uveitis: results from a real-world claims database analysis. Jpn J Ophthalmol 2022; 66:394-404. [PMID: 35670922 DOI: 10.1007/s10384-022-00923-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/25/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the real-world dose of systemic corticosteroids in the treatment of non-infectious uveitis (NIU) in Japan. STUDY DESIGN A retrospective, observational study. METHODS Patients newly registered at the Japan Medical Data Center health insurance claims database with a diagnosis of NIU who received systemic corticosteroids were identified, and their systemic corticosteroid dose (prednisolone equivalent) was assessed over 12 months of treatment (data extraction period: January 2008 to May 2017). RESULTS The mean cumulative systemic corticosteroid dose in 12 months in 1641 new patients with NIU who received systemic corticosteroids was 593.7 mg. The mean systemic corticosteroid dose was highest at month 1 (10.7, 218.1, 16.7, and 23.0 mg/day in Behçet's disease [BD]-associated NIU [n = 19], Vogt-Koyanagi-Harada [VKH] disease-associated NIU [n = 49], sarcoidosis-associated NIU [n = 27], and "undifferentiated NIU" [NIU without specific primary disease information, n = 1545], respectively) and decreased over time. Systemic corticosteroids were prescribed at month 12 to 68.4%, 22.4%, 44.4%, and 5.6% of patients with BD-associated NIU, VKH disease-associated NIU, sarcoidosis-associated NIU, and undifferentiated NIU, respectively (mean dose, 6.0-14.3 mg/day). Multivariate regression analysis identified female sex, middle age (30 to < 40 years), VKH disease, and immunosuppressive agent use as background factors associated with higher systemic corticosteroid dose. CONCLUSIONS The systemic corticosteroid dose was highest at month 1 and decreased over time in all disease categories. This database research revealed that some patients with NIU continued being prescribed systemic corticosteroids for at least 1 year.
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Affiliation(s)
- Akihiko Umazume
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Nobuyuki Ohguro
- Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Annabelle A Okada
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Kenichi Namba
- Department of Ophthalmology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Koh-Hei Sonoda
- Department of Clinical Medicine, Kyushu University Faculty of Medical Sciences, Fukuoka, Japan
| | | | - Kazuo Morita
- AbbVie GK, 3-1-21 Shibaura, Minato-ku, 108-0023, Tokyo, Japan
| | - Hiroshi Goto
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
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Rangel CM, Parra MM, Corrales MI, Garcia D, Sánchez-Ávila R, Varón CL, Villareal E, Villarreal D, Tello A, Galvis V. ENDOPHTHALMITIS IN OPHTHALMOLOGICAL REFERRAL CENTRE IN COLOMBIA: AETIOLOGY AND MICROBIAL RESISTANCE. Cesk Slov Oftalmol 2022; 78:160-173. [PMID: 35922145 DOI: 10.31348/2022/19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
AIMS To describe the aetiology and microbial susceptibility profile of endophthalmitis cases treated at an ophthalmological referral centre in Colombia. MATERIAL AND METHODS A retrospective descriptive study was carried out with all endophthalmitis cases referred to the Fundación Oftalmológica de Santander FOSCAL (Floridablanca, Colombia) from 1 January 2012 to 31 December 2015. RESULTS 121 eyes of 121 patients were evaluated. 77.7% of them were male and the mean age was 42.9 years. Five of them (4.1%) corresponded to endogenous endophthalmitis, and 116 (95.9%) to exogenous endophthalmitis. Of the latter, 66.9% were associated with trauma (almost one-half of them associated with intraocular foreign body), and 29.5% with intraocular surgery. The most common isolated microorganisms in the exogenous endophthalmitis group corresponded to methicillin-resistant and methicillin-sensitive strains of Staphylococcus epidermidis and Staphylococcus aureus, which were mostly susceptible to imipenem, vancomycin and moxifloxacin and resistant to ceftazidime. CONCLUSION Endophthalmitis is a potentially sight-threatening condition, especially in cases of inadequate treatment. Therefore, antimicrobial therapy should be guided by vitreous humour culture to assure that the causative microorganism is susceptible to the selected agent. The results of our study lead us to propose vancomycin, moxifloxacin or imipenem as first-line antimicrobial options.
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Susiyanti M, Pambudy IM. Successful Treatment Bilateral Panuveitis with Multiple Systemic Infection in HIV/AIDS Patient: A Case Report. Acta Med Indones 2022; 54:120-123. [PMID: 35398833] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
There is an increasing number of HIV/AIDS patients in Indonesia, starting from <0.1% in 2010 to 0.4% in 2012, which warrants awareness of ocular manifestation in HIV. This might appear in 70-100% of patients with HIV. A 47 years old man came to the infection and immunology clinic with blurry vision on both eyes. He had been treated before but there was no clinical improvement. Examination showed both eyes had vitreous haziness. Visual acuity was 1/60 in both eyes with appearance of flare and cells within +3. Uveitis workup showed positive results for HIV, HSV and syphilis. Patient was given 100 mg of doxyciclin two times daily and fixed dose tablet which contains the combination of antiretroviral. Three months later, final acuity was 6/10 on the right eye and 6/18 on the left eye. Prompt diagnosis and treatment warrant good prognosis including multidisciplinary approach by ophthalmologist, clinical allergist and immunologist, and dermato-venerologist.
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Affiliation(s)
- Made Susiyanti
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
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Wang Y, Carion TW, Ebrahim AS, Sosne G, Berger EA. Adjunctive Thymosin Beta-4 Treatment Influences MΦ Effector Cell Function to Improve Disease Outcome in Pseudomonas aeruginosa-Induced Keratitis. Int J Mol Sci 2021; 22:ijms222011016. [PMID: 34681676 PMCID: PMC8537948 DOI: 10.3390/ijms222011016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
Abstract
Our previous work has shown that topical thymosin beta 4 (Tβ4) as an adjunct to ciprofloxacin treatment reduces inflammatory mediators and inflammatory cell infiltrates (neutrophils/PMN and macrophages/MΦ) while enhancing bacterial killing and wound healing pathway activation in an experimental model of P. aeruginosa-induced keratitis. This study aimed to mechanistically examine how Tβ4 influences MΦ function in particular, leading to reduced inflammation and enhanced host defense following P. aeruginosa-induced infection of the cornea. Flow cytometry was conducted to profile the phenotype of infiltrating MΦ after infection, while generation of reactive nitrogen species and markers of efferocytosis were detected to assess functional activity. In vitro studies were performed utilizing RAW 264.7 cells to verify and extend the in vivo findings. Tβ4 treatment decreases MΦ infiltration and regulates the activation state in response to infected corneas. MΦ functional data demonstrated that the adjunctive Tβ4 treatment group significantly downregulated reactive nitrogen species (RNS) production and efferocytotic activity. In addition, the in vitro studies showed that both Tβ4 alone and adjunctive Tβ4 treatment influenced MΦ cellular function following LPS stimulation. Collectively, these data provide further evidence that adjunctive Tβ4 + ciprofloxacin treatment offers a more efficacious option for treating bacterial keratitis. Not only does the adjunctive therapy address both the infectious pathogen and corneal wound healing response, but it also influences MΦ infiltration, activation, and function, as revealed by the current study.
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Dong LK, Shields RA, Subramanian S, Lee R, Wa CA, Ruby AJ, Hassan TS. FEATURES AND OUTCOMES OF EYES THAT UNDERWENT SURGICAL REPAIR OF RHEGMATOGENOUS RETINAL DETACHMENTS AFTER BEING TREATED FOR ACUTE ENDOPHTHALMITIS. Retina 2021; 41:1612-1617. [PMID: 33394997 DOI: 10.1097/iae.0000000000003091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/26/2022]
Abstract
PURPOSE To evaluate the etiology, clinical course, and outcomes of eyes that suffered postendophthalmitis rhegmatogenous retinal detachments. METHODS A retrospective, consecutive case series was conducted of patients managed at Associated Retinal Consultants P.C. from January 2013 to December 2019. Patients were identified as having had endophthalmitis by ICD-9/10 codes. Those with endophthalmitis and/or rhegmatogenous retinal detachment not managed at Associated Retinal Consultants from January were excluded. RESULTS Charts of 413 patients were reviewed and 19 met inclusion criteria. Incidence of rhegmatogenous retinal detachment following infectious endophthalmitis was 4.6%. The most common inciting events for endophthalmitis was intravitreal injection (9 of 19) and cataract surgery (7 of 19). Fifteen of 19 patients were treated with an injection of intravitreal antibiotics and 4 underwent immediate vitrectomy with antibiotic injection. Biopsy cultures were obtained in 18 of 19 patients and yielded positive growth in 12 (66.7%). Seventeen of the 19 eyes were operable. Final retinal reattachment rate was 88.2% (15 of 17). Mean final logMAR visual acuity was 1.58 (Snellen 20/765). Factors associated with worse final visual acuity after surgical repair included preceding intravitreal injection (P = 0.001), streptococcus species (P = 0.024), presence of proliferative vitreoretinopathy (P = 0.015), and use of silicone oil during primary rhegmatogenous retinal detachment repair (P = 0.010). CONCLUSION Rhegmatogenous retinal detachments following endophthalmitis occur infrequently. Although most eyes can be repaired surgically, visual outcomes are often poor, particularly in eyes that were infected with streptococcal species and had associated proliferative vitreoretinopathy.
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Affiliation(s)
- Libing K Dong
- Central Michigan University College of Medicine, Mount Pleasant, Michigan
| | - Ryan A Shields
- Associated Retinal Consultants P.C., William Beaumont Hospital, Royal Oak, Michigan
| | - Sam Subramanian
- Ascension Macomb Oakland Hospital, Madison Heights, Michigan ; and
| | - Ramon Lee
- Associated Retinal Consultants P.C., William Beaumont Hospital, Royal Oak, Michigan
| | - Christianne A Wa
- Associated Retinal Consultants P.C., William Beaumont Hospital, Royal Oak, Michigan
| | - Alan J Ruby
- Associated Retinal Consultants P.C., William Beaumont Hospital, Royal Oak, Michigan
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Tarek S Hassan
- Associated Retinal Consultants P.C., William Beaumont Hospital, Royal Oak, Michigan
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
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Cheng Y, Wang C, Su G. Necrotizing retinitis in a patient with syphilis: A case report. Medicine (Baltimore) 2021; 100:e24452. [PMID: 33655916 PMCID: PMC7939152 DOI: 10.1097/md.0000000000024452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 01/06/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Ocular syphilis varies widely in presentation and should be considered in all patients with posterior uveitis. Necrotizing retinitis is a rare manifestation of ocular syphilis and mimics ARN. PATIENT CONCERNS We report a male patient who presented with bilateral dense vitritis obscuring fundus details similar to ARN, as a rare reported manifestation of syphilis, who was initially given intravitreal ganciclovir. DIAGNOSIS After the results for herpes viral PCR disclosed negative, the diagnosis of syphilitic necrotizing retinitis was made based on positive RPR. INTERVENTION AND OUTCOMES With the clinical diagnosis of ocular syphilis, treatment with intravenous penicillin was promptly initiated. His visual acuity improved to 20/100 in the right eye and still light perception in the left. Pars plana vitrectomy with silicon oil tamponade was performed in his left eye. LESSONS Ocular syphilis varies widely in presentation and should be considered in all patients with posterior uveitis. However, whenever ARN is clinically suspected, empiric treatment against herpetic viruses should be promptly administered while awaiting further infectious disease study results. Recognition of syphilitic retinitis and prompt initiation of intravenous penicillin is of critical important for clinicians.
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Yap A, Alshaikhi M, Evans K. Think about cats in acute vision loss. N Z Med J 2021; 134:96-98. [PMID: 33444310] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Cat-scratch disease (CSD) is a systemic illness caused by the gram-negative bacteria Bartonella henselae (B. henselae). Cats serve as the primary host reservoir for B. henselae, with cat fleas as the horizontal vector of transmission. It is transmitted to humans through close contact with cats and cat scratches and bites. We describe two cases of bilateral Bartonella neuroretinitis that were presented to Palmerston North Hospital Eye Clinic.
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Affiliation(s)
- Aaron Yap
- MBChB; Palmerston North Eye Department, MidCentral District Health Board
| | - Moaz Alshaikhi
- MBChB; Palmerston North Eye Department, MidCentral District Health Board
| | - Kay Evans
- MB., B.Chir., FRANZCO; Palmerston North Eye Department, MidCentral District Health Board
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19
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Gu X, Gao Y, Yan Y, Marks M, Zhu L, Lu H, Guan Z, Shi M, Ni L, Peng R, Zhao W, Wu J, Qi T, Lu S, Qian Y, Gong W, Zhou P. The importance of proper and prompt treatment of ocular syphilis: a lesson from permanent vision loss in 52 eyes. J Eur Acad Dermatol Venereol 2020; 34:1569-1578. [PMID: 32163642 PMCID: PMC7496700 DOI: 10.1111/jdv.16347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 02/25/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ocular involvement can occur at any stage of syphilis. Prompt diagnosis and proper treatment of ocular syphilis are vital to avoid long-term consequences. OBJECTIVES To describe the risk factors for ocular syphilis and clinical features of blindness caused by syphilis. METHODS We report risk factors for ocular syphilis amongst patients seen at the Shanghai Skin Disease Hospital between October 2009 and October 2017. We identify patients with ocular syphilis resulting in blindness and report the clinical characteristics, laboratory findings and treatment outcomes of these patients. RESULTS A total of 8310 new cases of syphilis were seen, of which 213 patients had ocular disease and 50 patients had blindness due to syphilis. Increasing age and higher RPR titres were associated with ocular involvement but there was no association with HIV status. Blindness in syphilis was restricted predominantly to patients with optic nerve involvement and not patients with isolated uveitis. Fifty patients (and a total of 67 eyes) met the WHO definition of blindness prior to treatment for syphilis. At the end of follow-up, vision had improved in 24 of 67 eyes (35.8%) after treatment. Successful treatment of uveitis was associated with the best improvement in visual acuity, whilst patient with underlying optic atrophy prior to treatment had the worst visual outcome. CONCLUSIONS Ocular involvement is an important manifestation of syphilis which may result in blindness. Our data demonstrate outcomes for ocular syphilis are poor if detected late; early recognition and diagnosis is therefore vital to avoid permanent visual loss.
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Affiliation(s)
- X. Gu
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Y. Gao
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Y. Yan
- Department of OphthalmologyRenji HospitalSchool of MedicineJiaotong UniversityShanghaiChina
| | - M. Marks
- Department of Clinical ResearchLondon School of Hygiene & Tropical MedicineLondonUK
| | - L. Zhu
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - H. Lu
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Z. Guan
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - M. Shi
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - L. Ni
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - R. Peng
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - W. Zhao
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - J. Wu
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - T. Qi
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - S. Lu
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Y. Qian
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - W. Gong
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - P. Zhou
- Sexually Transmitted Disease InstituteShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
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Abstract
RATIONALE Canaliculitis is a frequently overlooked and misdiagnosed disease. Concurrent corneal ulceration with canaliculitis is uncommon. We report such a case. PATIENT CONCERNS An 87-year-old woman complained of swelling and pain of the right eye after acute angle closure glaucoma attack. Slit-lamp examination was compatible with the features of infectious keratitis, and the cultures from corneal scrapings grew Streptococcus anginosus later. Hourly topical vancomycin (25 mg/ml) was instilled, then the corneal ulceration improved initially but became stationary after 1-week treatment. DIAGNOSIS Discharge from the upper punctum was noted subsequently and canalicular concretions were found through curettage. The cultures from canalicular discharge and concretions also revealed the presence of S. anginosus. Thus, infectious keratitis secondary to canaliculitis was diagnosed. INTERVENTIONS Canaliculotomy was performed to remove the large concretion and vancomycin was injected locally. OUTCOMES The corneal ulceration resolved after canaliculitis was appropriately treated. LESSONS Canaliculitis could be a reservoir for organisms that may make compromised corneas liable to infections. Only the appropriate diagnosis and aggressive treatment of canaliculitis leads to the eradication of associated corneal infections.
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Affiliation(s)
- Yu-Pu Chou
- Department of Education, Chang Gung Memorial Hospital, Linkou
- Department of Medicine, Mackay Medical College, New Taipei City
| | - Po-Han Yeh
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou
| | - Yueh-Ju Tsai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chieh-Hung Yen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou
| | - Ching-Hsi Hsiao
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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21
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Majumder PD, Mayilvakanam L, Palker AH, Sridharan S, Biswas J. Intravitreal sustained-release dexamethasone implant for the treatment of persistent cystoid macular edema in ocular syphilis. Indian J Ophthalmol 2019; 67:1487-1490. [PMID: 31436209 PMCID: PMC6727693 DOI: 10.4103/ijo.ijo_1795_18] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 04/09/2019] [Indexed: 12/20/2022] Open
Abstract
With a resurgence of syphilis with human immunodeficiency virus (HIV) infection in last few years, various ocular manifestations of syphilis have been described in literature. This case report described an HIV-positive patient on anti-retroviral therapy who was diagnosed and treated for posterior uveitis secondary to ocular syphilis in the recent past presented to our clinic with cystoid macular edema (CME). CME, which did not respond to periocular corticosteroid, resolved with intravitreal sustained release dexamethasone implant. There was a recurrence CME 9 months later and repeat injection of intravitreal implant showed complete resolution. A long-term follow-up did not reveal reactivation of the infection with intravitreal corticosteroid. Intravitreal sustained release dexamethasone implant can be an effective treatment for refractory CME in patients with regressed syphilitic uveitis.
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Affiliation(s)
| | - Lakshmi Mayilvakanam
- Department of Uvea and Medical Retina, Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Amit H Palker
- Department of Uvea and Medical Retina, Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sudharshan Sridharan
- Department of Uvea, Medical and Vision Research Foundations, Chennai, Tamil Nadu, India
| | - Jyotirmay Biswas
- Department of Uvea, Medical and Vision Research Foundations, Chennai, Tamil Nadu, India
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22
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Prajna NV, Srinivasan M, Mascarenhas J, Lalitha P, Rajaraman R, McClintic SM, O'Brien KS, Ray KJ, Acharya NR, Lietman TM, Keenan JD. Visual Impairment in Fungal Versus Bacterial Corneal Ulcers 4 Years After Successful Antimicrobial Treatment. Am J Ophthalmol 2019; 204:124-129. [PMID: 30902692 PMCID: PMC8075352 DOI: 10.1016/j.ajo.2019.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 02/19/2019] [Accepted: 03/07/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare longitudinal outcomes of visual acuity after fungal corneal ulcers with those of bacterial ulcers. DESIGN Prospective cohort study. METHODS This study was conducted in a tertiary eye hospital in South India. The population consisted of 100 of 152 individuals whose fungal or bacterial keratitis had been diagnosed 4 years prior and had been enrolled in 1 of 2 concurrent randomized trials. Causative organisms of infectious keratitis were either bacterial or fungal. Presenting visual acuity consisted of best spectacle corrected visual acuity (BSCVA) and hard contact lens-corrected visual acuity (CLVA). RESULTS Fifty study participants with prior fungal keratitis and 50 with prior bacterial keratitis were enrolled. Four years after treatment for keratitis, participants' presenting vision in the better eye was worse than 20/60 for 12 individuals (24.0%) in the fungal group and 10 individuals (20.0%) in the bacterial group. Median BSCVA in the affected eye at the 4-year visit in the fungal group was similar to that in the bacterial group (Snellen equivalent, 20/32 for each), although vision worse than 20/400 was more common in the fungal ulcer group after spectacle correction (odds ratio [OR] 4.19; 95% confidence interval [CI], 1.11-15.8) and contact lens correction (OR, 5.74; 95% CI, 1.37-24.1). CONCLUSIONS In this South Indian population with a previous episode of fungal or bacterial keratitis, correctable bilateral visual impairment was common. Although long-term visual outcomes were, on average, similar between fungal and bacterial ulcers, fungal ulcers were more likely to produce severe visual impairment.
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Affiliation(s)
| | - Muthiah Srinivasan
- Department of Cornea and External Diseases, Aravind Eye Care System, Madurai, India
| | - Jeena Mascarenhas
- Department of Cornea and External Diseases, Aravind Eye Care System, Madurai, India
| | - Prajna Lalitha
- Department of Cornea and External Diseases, Aravind Eye Care System, Madurai, India; Department of Ocular Microbiology, Aravind Eye Care System, Madurai, India
| | - Revathi Rajaraman
- Department of Cornea and External Diseases, Aravind Eye Care System, Coimbatore, India
| | - Scott M McClintic
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA
| | - Kieran S O'Brien
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
| | - Kathryn J Ray
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
| | - Nisha R Acharya
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA; Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
| | - Thomas M Lietman
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA; Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Jeremy D Keenan
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA; Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA.
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Conrady CD, Feistmann JA, Roller AB, Boldt HC, Shakoor A. HEMORRHAGIC VASCULITIS AND RETINOPATHY HERALDING AS AN EARLY SIGN OF BACTERIAL ENDOPHTHALMITIS AFTER INTRAVITREAL INJECTION. Retin Cases Brief Rep 2019; 13:329-332. [PMID: 28594738 DOI: 10.1097/icb.0000000000000601] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 06/07/2023]
Abstract
PURPOSE To describe a case series of postintravitreal injection, bacterial endophthalmitis heralded by hemorrhagic retinal vasculitis. METHODS Observational case series of three patients with a history of intravitreal injections for age-related macular degeneration at a tertiary referral center who presented with vision changes and eye pain that were eventually found to have bacterial endophthalmitis. Clinical course was then followed. RESULTS All patients developed bacterial endophthalmitis and hemorrhagic retinal vasculitis. CONCLUSION These three cases highlight the importance of hemorrhagic retinal vasculitis as the presenting fundus finding of bacterial endophthalmitis and that this finding in a postinjection patient should be treated as endophthalmitis until proven otherwise.
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Affiliation(s)
- Christopher D Conrady
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Jonathan A Feistmann
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | | | - H Culver Boldt
- Department of Ophthalmology, University of Iowa, Iowa City, Iowa
| | - Akbar Shakoor
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
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Phillips S, Robbins A, Loader J, Hanger J, Booth R, Jelocnik M, Polkinghorne A, Timms P. Chlamydia pecorum gastrointestinal tract infection associations with urogenital tract infections in the koala (Phascolarctos cinereus). PLoS One 2018; 13:e0206471. [PMID: 30383822 PMCID: PMC6211709 DOI: 10.1371/journal.pone.0206471] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 10/12/2018] [Indexed: 11/21/2022] Open
Abstract
Background Chlamydia infects multiple sites within hosts, including the gastrointestinal tract (GIT). In certain hosts, gastrointestinal infection is linked to treatment avoidance and self-infection at disease susceptible sites. GIT C. pecorum has been detected in livestock and koalas, however GIT prevalence rates within the koala are yet to be established. Methods Paired conjunctival, urogenital and rectal samples from 33 koalas were screened for C. pecorum and C. pecorum plasmid using 16S rRNA and CDS5-specific quantitative PCR assays, respectively. Amplicon sequencing of 359 bp ompA fragment was used to identify site-specific genotypes. Results The overall C. pecorum prevalence collectively (healthy and clinically diseased koalas) was 51.5%, 57.6% and 42.4% in urogenital, conjunctival and gastrointestinal sites, respectively. Concurrent urogenital and rectal Chlamydia was identified in 14 koalas, with no cases of GIT only Chlamydia shedding. The ompA genotype G dominated the GIT positive samples, and genotypes A and E’ were dominant in urogenital tract (UGT) positive samples. Increases in C. pecorum plasmid per C. pecorum load (detected by PCR) showed clustering in the clinically diseased koala group (as assessed by scatter plot analysis). There was also a low correlation between plasmid positivity and C. pecorum infected animals at any site, with a prevalence of 47% UGT, 36% rectum and 40% faecal pellet. Conclusions GIT C. pecorum PCR positivity suggests that koala GIT C. pecorum infections are common and occur regularly in animals with concurrent genital tract infections. GIT dominant genotypes were identified and do not appear to be related to plasmid positivity. Preliminary results indicated a possible association between C. pecorum plasmid load and clinical UGT disease.
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Affiliation(s)
- Samuel Phillips
- Genecology Research Centre, Faculty of Science, Health, Education and Engineering, The University of the Sunshine Coast, Queensland, Australia
- * E-mail:
| | - Amy Robbins
- Genecology Research Centre, Faculty of Science, Health, Education and Engineering, The University of the Sunshine Coast, Queensland, Australia
- Endeavour Veterinary Ecology Pty Ltd, Toorbul, Australia
| | - Joanne Loader
- Endeavour Veterinary Ecology Pty Ltd, Toorbul, Australia
| | | | | | - Martina Jelocnik
- Animal Research Centre, Faculty of Science, Health, Education and Engineering, The University of the Sunshine Coast, Queensland, Australia
| | - Adam Polkinghorne
- Animal Research Centre, Faculty of Science, Health, Education and Engineering, The University of the Sunshine Coast, Queensland, Australia
| | - Peter Timms
- Genecology Research Centre, Faculty of Science, Health, Education and Engineering, The University of the Sunshine Coast, Queensland, Australia
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Courtright P, Rotondo LA, MacArthur C, Jones I, Weaver A, Negash BK, Olobio N, Binnawi K, Bush S, Abdala M, Haddad D, Bonfield A, Emerson P, Sarah V, Solomon AW. Strengthening the links between mapping, planning and global engagement for disease elimination: lessons learnt from trachoma. Br J Ophthalmol 2018; 102:1324-1327. [PMID: 29907634 PMCID: PMC6173819 DOI: 10.1136/bjophthalmol-2018-312476] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 05/20/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Trachoma is the leading infectious cause of blindness. Until recently, reliable data on the global extent of the disease, detailed plans for elimination, and government, donor and partner engagement were all inadequate. METHODS The trachoma community undertook a systematic, three-pronged strategy to map trachoma district by district, develop national-level trachoma elimination plans, and create a framework for governments, donors and partners to convene and coordinate in support of trachoma elimination. RESULT: There has been a frame-shift in internal and external perceptions of the global trachoma programme, from being an effort working towards disease control in focussed geographical areas, to one in the process of achieving worldwide disease elimination. Multiple factors contributed to the successful implementation of mapping, planning, and cross-sectional engagement of governments, partners and donors. CONCLUSIONS Elimination of trachoma is possible if the right combination of factors is in place. Planning for success is a critical first step. Some remaining challenges must still be addressed if the elimination targets are to be successfully attained.
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Affiliation(s)
- Paul Courtright
- Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | | | - Chad MacArthur
- Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Iain Jones
- Department for International Development, London, UK
| | - Angela Weaver
- United States Agency for International Development, Washington, DC, USA
| | | | | | - Kamal Binnawi
- Ministry of Health and Alneelain University, Khartoum, Sudan
| | | | - Mariamo Abdala
- Nacional Eye Care Program, Ministério da Saude de Mozambique, Maputo, Mozambique
| | | | | | - Paul Emerson
- International Trachoma Initiative, Atlanta, Georgia, USA
| | - Virginia Sarah
- International Coalition for Trachoma Control and The Fred Hollows Foundation, London, UK
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Abstract
RATIONALE Simultaneous presentation of peripheral infiltrates, which can be easily misidentified as satellite lesions, is rarely observed in patients with acute infectious keratitis. PATIENT CONCERNS A 70-year-old woman was referred to our clinic due to acute mucopurulent keratitis following application of a therapeutic soft contact lens for the treatment of epithelial defects caused by entrance of soil foreign bodies into the eye. The patient was diagnosed with Pseudomonas keratitis, following which she was treated with alternating administration of fourth-generation fluoroquinolone (Vigamox) and 5% fortified ceftazidime eyedrops every 2 hours. Although infectious keratitis rapidly improved, discrete catarrhal infiltrates at the corneolimbal junction (10- to 2-o'clock and 7- to 8-o'clock positions) were rapidly aggravated, forming bead-like stromal pustules inversely proportional to the extent of Pseudomonas keratitis. DIAGNOSIS Acute exacerbation of staphylococcal catarrhal infiltration associated with treatment for Pseudomonas aeruginosa keratitis. INTERVENTIONS Addition of 1% prednisone acetate eyedrops (Pred Forte) four times per day. OUTCOMES Dramatic improvement was observed at the sites of catarrhal infiltration without recurrence of infectious keratitis. LESSONS Clinicians should thus remain aware of the risk for co-occurring non-infectious, immune-related keratitis, as treatment for infectious keratitis may induce significant aggravation of non-infectious keratitis.
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Affiliation(s)
- A Donnio
- Service d'Ophtalmologie, Centre Hospitalier Universitaire de Fort de France, Hopital Pierre Zobda-Quitman, Fort de France Cedex, Martinique - France (French West Indies)
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Zhu J, Jiang Y, Shi Y, Zheng B, Xu Z, Jia W. Clinical manifestations and treatment outcomes of syphilitic uveitis in HIV-negative patients in China: A retrospective case study. Medicine (Baltimore) 2017; 96:e8376. [PMID: 29069031 PMCID: PMC5671864 DOI: 10.1097/md.0000000000008376] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Syphilitic chorioretinitis should be included in differential diagnosis of any form of ocular inflammation. A significantly higher proportion of human immunodeficiency virus (HIV)-positive patients with ocular syphilis as compared to HIV-negative cases have been reported in published studies. However, the clinical signs and symptoms are more insidious in HIV-negative patients who are easily misdiagnosed. We report a series of cases of ocular syphilis and describe the clinical manifestations and treatment outcomes of syphilitic chorioretinitis in HIV-negative patients in China.This was a retrospective case series study. The clinical records of patients with syphilis chorioretinitis were reviewed. Demographic information and findings of fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), and spectral domain optical coherence tomography (SD-OCT) were analyzed. All patients received the standard treatment. Ophthalmology examination and laboratory evaluation were repeated every 3 months. All changes were recorded. The treatment was considered successful if the patients had no inflammation in both eyes and rapid plasma reagin titer was negative after therapy.The study examined 41 eyes of 28 HIV-negative patients. The main complaints were blurry vision, floaters, and visual field defect. Twenty-seven eyes presented with panuveitis, and all had posterior involvement, including uveitis, vasculitis, chorioretinitis, and optic neuritis. The most common manifestations were uveitis and retinal vasculitis. Disc hyperfluorescence and persistent dark spots were the most common findings on FFA and ICGA. The ill-defined inner segment/outer segment junction was the most frequent manifestation on SD-OCT. Patients were diagnosed with syphilitic uveitis based on positive serological tests. Best-corrected visual acuity (BCVA) was improved in 34 eyes after treatment. Eleven patients were misdiagnosed before serological tests were performed. The delay in treatment led to long-standing cystoid macular edema and optic neuropathy, which were associated with poor BCVA (P = .037).The common manifestations of syphilitic chorioretinitis were uveitis, retinal vasculitis, and optic neuritis. Further diagnosis should be prompted by FFA, ICGA, and SD-OCT when ocular manifestation is suspected. The standard treatment for neurosyphilis was effective. If patients are presumed to be in low-risk groups such as HIV-negative, delays in diagnosis, and therapy may be likely. It is necessary to reiterate the importance of including syphilis uveitis as a differential diagnosis for any form of ocular inflammations, especially posterior uveitis and optic neuropathy.
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Affiliation(s)
- Jiang Zhu
- Department of Ophthalmology, The Affiliated Guangren Hospital of Xi’an Jiaotong University College of Medicine
| | - Yuan Jiang
- Department of Ophthalmology, The Affiliated Guangren Hospital of Xi’an Jiaotong University College of Medicine
| | - Yewen Shi
- Department of Ophthalmology, The Affiliated Guangren Hospital of Xi’an Jiaotong University College of Medicine
- Department of Otorhinolaryngology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Bo Zheng
- Department of Ophthalmology, The Affiliated Guangren Hospital of Xi’an Jiaotong University College of Medicine
| | - Zhiguo Xu
- Department of Ophthalmology, The Affiliated Guangren Hospital of Xi’an Jiaotong University College of Medicine
| | - Wei Jia
- Department of Ophthalmology, The Affiliated Guangren Hospital of Xi’an Jiaotong University College of Medicine
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Tsuboi M, Nishijima T, Yashiro S, Teruya K, Kikuchi Y, Katai N, Gatanaga H, Oka S. Time to development of ocular syphilis after syphilis infection. J Infect Chemother 2017; 24:75-77. [PMID: 28958728 DOI: 10.1016/j.jiac.2017.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 07/26/2017] [Accepted: 08/12/2017] [Indexed: 11/18/2022]
Abstract
To provide an estimate of the incubation period of ocular syphilis based on serology using both clinical data and stored serum samples, we retrospectively reviewed patients with HIV-1 infection who presented with ocular syphilis between August 1997 and July 2015 in a tertiary hospital in Japan. The incubation period of ocular syphilis was defined as the time from syphilis infection to the development of ocular symptoms due to ocular syphilis. During the study period, 20 patients were diagnosed with ocular syphilis and 8 patients were enrolled in the present study. All patients were Japanese men who have sex with men with a median age of 46 years (IQR 41.5-53.5). The median CD4 count was 668.5/μL (IQR 567.8-734.3) and 5 of the 8 patients had HIV-1 viral load of less than 50 copies/mL. All study patients presented to our clinic because of the development of ocular symptoms, and they did not have any other symptoms compatible with primary, secondary, or tertiary syphilis. The median time between syphilis infection and development of ocular symptoms was 11 months (IQR 4-19, range 2.5-45). Seven out of eight (87.5%) cases developed ocular syphilis within 2 years of syphilis infection. Ocular syphilis should be suspected even in patients with early syphilis who present with ocular symptoms. Moreover, routine serologic screening for syphilis among patients with HIV-1 infection is critical for prevention of irreversible visual loss in ocular syphilis cases.
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Affiliation(s)
- Motoyuki Tsuboi
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Takeshi Nishijima
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Shigeko Yashiro
- Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Katsuji Teruya
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoshimi Kikuchi
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Naomichi Katai
- Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroyuki Gatanaga
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan; Center for AIDS Research, Kumamoto University, Kumamoto, Japan
| | - Shinichi Oka
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan; Center for AIDS Research, Kumamoto University, Kumamoto, Japan
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Farid S, Sohail MR. Ocular Bartonellosis. Mayo Clin Proc 2017; 92:1319-1320. [PMID: 28778273 DOI: 10.1016/j.mayocp.2017.06.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 06/20/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Saira Farid
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN.
| | - M Rizwan Sohail
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
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Wood EH, Powers MA, Moshfeghi DM. Spontaneous Globe Rupture Due to Rapidly Evolving Endogenous Hypermucoid Klebsiella Pneumoniae Endophthalmitis. Ophthalmic Surg Lasers Imaging Retina 2017; 48:600-601. [PMID: 28728189 DOI: 10.3928/23258160-20170630-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/01/2017] [Indexed: 11/20/2022]
Abstract
In this retrospective report, the authors describe a rare case of spontaneous globe rupture from Klebsiella pneumoniae endophthalmitis in a middle-aged man with poorly controlled type 2 diabetes mellitus. There have been only four previously reported cases of spontaneous globe rupture from endophthalmitis. Out of the now five reported cases, all have been due to endogenous endophthalmitis, four have been due to gram-negative bacteria, and three have been due to K. pneumoniae. K. pneumoniae, especially the hypermucoid variant with a protective polysaccharide capsule, is an emerging pathogen with remarkable virulence. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:600-601.].
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Naik AU, Gadewar SB. 360 Degree Deep Corneal Vascularization In A Case Of Endophthalmitis With Corneal Abscess. J Ayub Med Coll Abbottabad 2017; 29:368. [PMID: 28718272] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Chen KJ, Chen YP, Chao AN, Wang NK, Wu WC, Lai CC, Chen TL. Prevention of Evisceration or Enucleation in Endogenous Bacterial Panophthalmitis with No Light Perception and Scleral Abscess. PLoS One 2017; 12:e0169603. [PMID: 28056067 PMCID: PMC5215906 DOI: 10.1371/journal.pone.0169603] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 12/19/2016] [Indexed: 11/20/2022] Open
Abstract
Panophthalmitis is the most extensive ocular involvement in endophthalmitis with inflammation in periocular tissues. Severe inflammation of the anterior and posterior segments is frequently accompanied by corneal opacity, scleral abscess, and perforation or rupture. Enucleation or evisceration was the only remaining viable treatment option when all options to salvage the eye had been exhausted. The purpose of this retrospective study is to examine the outcomes of patients with endogenous bacterial panophthalmitis, no light perception and scleral abscess who were treated with multiple intravitreal and periocular injections of antibiotics and dexamethasone. Evaluation included spreading of infection to contiguous or remote sites, following evisceration or enucleation, and sympathetic ophthalmia. Eighteen patients were diagnosed with EBP, with liver abscesses in eight patients, retroperitoneal infection in four, pneumonia in two, infective endocarditis in one, cellulitis in one, drug abuse in one, and mycotic pseudoaneurysm in one. Culture results were positive for Klebsiella pneumoniae in 12 patients, Streptococcus spp. in three, Pseudomonas aeruginosa in one, Escherichia coli in one, and Staphylococcus aureus in one. The average number of periocular injections was 2.2, and the average number of intravitreal injections was 5.8. No eye required evisceration or enucleation and developed the spreading of infection to contiguous or remote sites during the follow-up. No sympathetic ophthalmia was observed in the fellow eye of all patients. Prevention of evisceration or enucleation in patients with EBP, NLP and scleral abscess can be achieved by multiple intravitreal and periocular injections of antibiotics and dexamethasone.
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Affiliation(s)
- Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tayouan, Taiwan
- * E-mail:
| | - Yen-Po Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tayouan, Taiwan
| | - An-Ning Chao
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tayouan, Taiwan
| | - Nan-Kai Wang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tayouan, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tayouan, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tayouan, Taiwan
| | - Tun-Lu Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tayouan, Taiwan
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Hongyok T, Leelaprute W. Corneal Ulcer Leading to Evisceration or Enucleation in a Tertiary Eye Care Center in Thailand: Clinical and Microbiological Characteristics. J Med Assoc Thai 2016; 99 Suppl 2:S116-S122. [PMID: 27266225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Very severe corneal infection can lead to permanent visual loss, and there is still inadequate knowledge about these severe cases. OBJECTIVE To identify clinical and microbiological characteristics of corneal ulcers resulting in evisceration or enucleation in a tertiary eye care center in Thailand. MATERIAL AND METHOD A retrospective chart review was performed of all patients who required evisceration or enucleation due to corneal ulcer at Rajavithi Hospital, Bangkok, Thailand between October 2008 and September 2013. RESULTS One hundred patients who underwent evisceration or enucleation as a result of corneal ulcer were included in the study. The mean age of the patients was 56.5 ± 12 years, most cases were referred from other hospitals (93%), and 13% of patients were diabetic. At presentation, visual acuity was worse than 5/200 in almost all cases (98%), and trauma (66%), especially by organic substances (36%), was the most common cause. Most cases had full thickness infiltration (81%) with mean size of 6.6 ± 2 mm. Corneal perforation was found in 18% of patients at presentation, and 60% of corneal scraping cultures were positive. Bacteria were the most common pathogens (65%), leading by Pseudomonas aeruginosa (10 cases), and the most common fungus was Fusarium spp. (7 cases). Secondary glaucoma (39%) and corneal perforation (25%) were the main ocular complications. Over half of the patients (52%) needed therapeutic or tectonic surgical intervention during admission. Following evisceration (94%) or enucleation (6%), 23 cases had wound complications that required further surgical treatment. Bacterial infection was found to increase the risk of wound complications more than infection by other pathogen groups (40.9%, p = 0.013). CONCLUSION Despite aggressive medical and surgical treatments, very severe corneal ulcers at referral can lead to loss of an eye. Bacterial infection, especially by Pseudomonas aeruginosa, following eye trauma was the most common cause. Evisceration in bacterial corneal ulcers had greater wound complications than ulcers infected by other pathogens.
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Tangpagasit W, Reanpinyawat T. Outcome of Urgent Penetrating Keratoplasty for Corneal Ulcer at Thammasat University Hospital. J Med Assoc Thai 2016; 99:71-76. [PMID: 27455827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To determine the eye integrity preservation after urgent penetrating keratoplasty (PKP) for corneal ulcer at Thammasat University Hospital. MATERIAL AND METHOD A retrospective review of patients who underwent urgent PKP between September 2005 and January 2015 was conducted. Demographic data, predisposing factors, organisms, indication for surgery, time of urgent corneal graft registry, and preservation rate of eye integrity were analyzed. RESULTS Fifty-five patients (55 eyes) registered for urgent corneal graft registry from eye bank and 22 eyes underwent urgent PKP There were 14 males (63.6%) and 8 females (36.4%). A mean age was 55.9±15.4 years. The most common predisposing factor was ocular trauma in 11 eyes (50.0%) and the most common indication for surgery was severe corneal ulcer in 11 eyes (50.0%). The mean time of urgent corneal graft registiy was 22.1±1 7.2 days (3-70 days). The present study could preserve eye integrity in post urgent PKP in 18 eyes (81.8%). Other 4 eyes (18.2%) could not preserve the eye integrity. In 33 eyes who did not underwent urgent PKP 20 eyes (60.6%) could preserve eye integrity, 10 eyes (30.3%) underwent primary evisceration and 3 eyes (9.1%) underwent primary enucleation due to extensive ocular infection. CONCLUSION Urgent PKP of corneal ulcer could provide satisfactory in eye integrity preservation.
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Miyamura Y, Sotozono C, Higashihara H, Hoshi S, Kinoshita S. [Severe Ocular Infection in Elderly Patients with Dementia: a Case Study]. Nippon Ganka Gakkai Zasshi 2015; 119:863-867. [PMID: 26817134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
UNLABELLED Purpose : To report 3 cases of severe ocular infection in elderly patients with dementia. CASE REPORTS Case 1 involved a 75-year-old man who presented after his wife noticed hyperemia and discharge in his right eye. Corneal infection with perforation was found. Wife-administered antibiotics healed the infection within 1 month. Case 2 involved a 97-year-old man who was referred to us after nursing-home staff members noticed redness and discharge in his right eye. Severe corneal infection with hypopyon was found. Following systemic and topical and antibiotics' administration by the nursing-home staff, the infectious keratitis healed within 2 weeks. Case 3 involved an 80-year-old woman referred to us from another clinic due to persistent epithelial defect in her left eye. Since the defect was accompanied by anterior uveitis and vitreous opacity, we suspected bacterial endophthalmitis. Following systemic and topical antibiotics' administration by family members, signs of infection diminished within 3 weeks. In all 3 cases, medical examination was difficult, topical eye-drop instillation by the patients themselves was impossible. CONCLUSIONS In elderly dementia patients, cognizance of infection, medical examination, and treatment are difficult. Support by family members or nursing-home staff is necessary to obtain improved outcomes.
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Chiba T, Yoneyama S, Nakagomi T, Takahashi H, Iijima H. [A Case of Metastatic Endophthalmitis Resulting from Liver Abscess Complicated with Pyogenic Ventriculitis via Optic Nerve]. Nippon Ganka Gakkai Zasshi 2015; 119:686-692. [PMID: 26571629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Intracranial extension of infection via the optic nerve is a rare but serious complication of bacterial endophthalmitis. CASE A 79-year-old women was hospitalized complaining of right eyelid swelling, severe hyperemia and purulent conjunctival discharge in the right eye. Although the fundus was invisible due to cataract, right endophthalmitis of unknown origin was suggested by pus in the anterior chamber and brain computed tomography (CT) findings showing nasal scleral rupture and orbital cellulitis. Systemic examination revealed pyogenic liver abscess and percutaneous drainage of abscess disclosed Klebsiella pneumoniae, which was also isolated from conjunctival discharge. Because diffusion-weighted magnetic resonance imaging (MRI) findings demonstrated right optic neuritis and ventriculitis, enucleation of her right eye was performed based on the diagnosis of pyogenic ventriculitis via the optic nerve. Klebsiella pneumoniae was detected in both stumps of the transected right optic nerve. Despite intensive anti-bacterial treatment, she died of acute respiratory distress syndrome 46 days after hospitalization. CONCLUSION Severe bacterial endophthalmitis may cause intracranial infection via the optic nerve.
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Pollett S, McMullan B, Lam VWT, Qureshi C, Kok J. A 68-year-old type 2 diabetic man of Korean ethnicity with fever, abdominal pain, and right eye visual disturbance. Clin Infect Dis 2015; 60:611; answer 664-5. [PMID: 25617417 DOI: 10.1093/cid/ciu928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Advanced purulent corneal ulcer, as well as abscess, is a serious vision-threatening condition notable for its fulminant course and possible loss of the eye due to endophthalmitis. Its leading causes, pathogenesis, and classifications are described and analyzed in this paper.
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Affiliation(s)
- Evg A Kasparova
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - Evg A Kasparova
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russian Federation, 119021
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Zegrí I, Mingo Santos S, García-Pavía P. Endophthalmitis and a Heart Murmur. Rev Esp Cardiol (Engl Ed) 2015; 68:804. [PMID: 25743770 DOI: 10.1016/j.rec.2014.10.017] [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] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 10/03/2014] [Indexed: 06/04/2023]
Affiliation(s)
- Isabel Zegrí
- Departamento de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | - Susana Mingo Santos
- Departamento de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Pablo García-Pavía
- Departamento de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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Antequera P, Garcia-Conca V, Martín-González C, Ortiz-de-la-Tabla V. Multidrug resistant Fusarium keratitis. Arch Soc Esp Oftalmol 2015; 90:382-384. [PMID: 25443198 DOI: 10.1016/j.oftal.2014.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/26/2014] [Accepted: 04/08/2014] [Indexed: 06/04/2023]
Abstract
CASE REPORT We report a case of keratitis in a female contact lens wearer, who developed a deep corneal abscess. The culture of a corneal biopsy scraping was positive for multiresistant Fusarium solani. The patient has a complicated clinical course and failed to respond to local and systemic antifungal treatment, requiring eye enucleation. CONCLUSION Fusarium keratitis may progress to severe endophthalmitis. Clinical suspicion is paramount in order to start antifungal therapy without delay. Therapy is complex due to the high resistance of this organism to usual antifungal drugs.
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Affiliation(s)
- P Antequera
- Servicio de Microbiología, Hospital Universitario San Juan, Alicante, España
| | - V Garcia-Conca
- Servicio de Oftalmología, Hospital Universitario San Juan, Alicante, España
| | - C Martín-González
- Servicio de Microbiología, Hospital Universitario San Juan, Alicante, España
| | - V Ortiz-de-la-Tabla
- Servicio de Microbiología, Hospital Universitario San Juan, Alicante, España.
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Abstract
AIMS To describe ocular syphilis presentations to a tertiary referral eye hospital over a 5-year period and to document HIV coinfection frequency. METHODS A retrospective chart review was conducted of consecutive ocular syphilis presentations to Sydney Eye Hospital from 2007 to 2012. Inclusion criteria were positive syphilis serology, ocular inflammation on clinical examination and appropriate syphilis treatment. Outcome measures were clinical features at presentation and best-corrected visual acuity (BCVA) at interval follow-up. RESULTS Thirty-seven eyes of 25 patients were included in the series. Patients were predominantly male (92.0%, p<0.05) with mean age 43.7±14.0 years. Eight (32.0%) patients had confirmed HIV coinfection, three newly diagnosed with HIV. Twelve (32.4%) eyes demonstrated anterior segment involvement with anterior uveitis. Twenty-five (67.6%) eyes demonstrated posterior segment involvement, including panuveitis, acute syphilitic posterior placoid chorioretinitis, retinitis, necrotising retinitis, punctate retinitis and optic neuritis. There was a significant improvement in BCVA for involved eyes (p<0.05) at 1 month and 2-3 months follow-up. CONCLUSIONS The clinical findings of 37 eyes with ocular syphilis demonstrated a broad spectrum of clinical manifestations. Rates of HIV coinfection were high, with patients exhibiting both anterior and posterior segment inflammation. Visual outcome improved following syphilis treatment.
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Affiliation(s)
- Luke C Northey
- Save Sight Institute, Discipline of Ophthalmology, Sydney Eye Hospital Campus, The University of Sydney, Sydney, Australia
| | - Simon E Skalicky
- Save Sight Institute, Discipline of Ophthalmology, Sydney Eye Hospital Campus, The University of Sydney, Sydney, Australia
| | - Avinash Gurbaxani
- Save Sight Institute, Discipline of Ophthalmology, Sydney Eye Hospital Campus, The University of Sydney, Sydney, Australia
| | - Peter J McCluskey
- Save Sight Institute, Discipline of Ophthalmology, Sydney Eye Hospital Campus, The University of Sydney, Sydney, Australia
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Abstract
A 67-year-old man was transported to our hospital and diagnosed with pneumococcal meningitis. We immediately administered ceftriaxone and vancomycin according to the guidelines, but did not administer dexamethasone to him because he had been previously administered antibiotics. His left eye became complicated by endogenous endophthalmitis on the next day, which resulted in blindness, although his meningitis rapidly ameliorated. In comparison to other patients who have been reported to recover from complications with endophthalmitis after the combination therapy of antibiotics, corticosteroids and vitreous surgery, we consider that this patient's poor visual outcome may have been caused by severe inflammation or the breakdown of the blood ocular barrier due to the action of S. pneumoniae. Corticosteroids may be able to successfully treat such inflammation or disruption of the blood ocular barrier.
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Affiliation(s)
- Teruhiko Sekiguchi
- Department of Neurology and Neurological Science, Graduate School, Tokyo Medical and Dental University, Japan
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Promelle V, Bennai D, Drimbea A, Milazzo S, Bremond-Gignac D. Cellulites orbitaires atypiques d’origine non sinusienne de l’enfant : à propos de quatre cas. J Fr Ophtalmol 2014; 37:149-54. [PMID: 24239218 DOI: 10.1016/j.jfo.2013.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 08/26/2013] [Accepted: 08/29/2013] [Indexed: 11/28/2022]
Affiliation(s)
- V Promelle
- Centre d'ophtalmologie Saint-Victor, CHU d'Amiens, 354, boulevard de Beauvillé, 80000 Amiens, France.
| | - D Bennai
- Centre d'ophtalmologie Saint-Victor, CHU d'Amiens, 354, boulevard de Beauvillé, 80000 Amiens, France
| | - A Drimbea
- Centre d'ophtalmologie Saint-Victor, CHU d'Amiens, 354, boulevard de Beauvillé, 80000 Amiens, France
| | - S Milazzo
- Centre d'ophtalmologie Saint-Victor, CHU d'Amiens, 354, boulevard de Beauvillé, 80000 Amiens, France
| | - D Bremond-Gignac
- Centre d'ophtalmologie Saint-Victor, CHU d'Amiens, 354, boulevard de Beauvillé, 80000 Amiens, France
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Affiliation(s)
- Wallace J Brownlee
- Department of Neurology, Auckland District Health Board, Auckland, New Zealand.
| | - Veronica M Playle
- Department of General Medicine, Auckland District Health Board, Auckland, New Zealand
| | | | - Neil E Anderson
- Department of Neurology, Auckland District Health Board, Auckland, New Zealand
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46
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Mattila JS, Holopainen J. [Keratitis associated with contact lens wear]. Duodecim 2013; 129:1901-1907. [PMID: 24187781] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Keratitis is a rare complication associated with contact lens wear, always presenting a threat to the patient's vision. In most cases the patients seek medical care for a painful, reddened eye that is watering or produces discharge. In most cases a light-colored lesion staining with fluorescein is seen on the cornea. The most common causative organism is Pseudomonas aeruginosa. Representative culture specimens from the cornea and conjunctiva as well as from the contact lens are important in respect of directing the treatment. Even if the inflammation can in most cases be treated, keratitis always leaves a scar on the cornea and may require further surgical interventions to restore patients vision.
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Agrawal RV, Teoh SC, Yong V. Bilateral endogenous endophthalmitis associated with methicillin sensitive Staphylococcus aureus (MSSA) related tenosynovitis: case report. Ocul Immunol Inflamm 2012; 20:224-6. [PMID: 22512341 DOI: 10.3109/09273948.2012.676702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Endogenous endophthalmitis is a rare, devastating intraocular infection associated with poor outcome often from late diagnosis. We present a case report of acute onset bilateral endogenous endophthalmitis caused by Methicillin Sensitive Staphylococcus Aureus causing tenosynovitis of carpometacarpal joint in a 64 year old man with Type II Diabetes Mellitus. To the best of our knowledge, this is the first case report of endogenous endophthalmitis following tenosynovitis. This case also highlights the fact that prompt diagnosis and treatment is the key for good outcome.
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48
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Tucker JD, Li JZ, Robbins GK, Davis BT, Lobo AM, Kunkel J, Papaliodis GN, Durand ML, Felsenstein D. Ocular syphilis among HIV-infected patients: a systematic analysis of the literature. Sex Transm Infect 2011; 87:4-8. [PMID: 20798396 PMCID: PMC3103105 DOI: 10.1136/sti.2010.043042] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Ocular syphilis among HIV-infected patients continues to be a problem in the highly active antiretroviral therapy (HAART) era. However, outside of case reports or small case series, little is known about the clinical, laboratory, and treatment outcomes of these patients. Objective To examine the literature on HIV-infected patients and determine the results of treatment. METHODS Systematic review of cases series and case reports among HIV-infected individuals with ocular syphilis. Reviews, languages other than English and pre-1980 reports were excluded. The effect of CD4 count and virological suppression on clinical manifestations and diagnostic laboratory values was evaluated. RESULTS A total of 101 HIV-infected individuals in case series and case reports were identified. Ocular syphilis led to the HIV diagnosis in 52% of cases, including patients with CD4 count >200 cells/mm(3). Posterior uveitis was significantly more common in individuals with CD4 count <200 cells/mm(3) (p = 0.002). Three patients with confirmed ocular syphilis had negative non-treponemal tests. Ninety-seven per cent of patients with visual impairment improved following intravenous penicillin or ceftriaxone. CONCLUSIONS Non-treponemal tests may be negative in HIV-infected patients with ocular syphilis. Ocular syphilis remains an important clinical manifestation that can lead to initial HIV diagnosis.
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Affiliation(s)
- Joseph D Tucker
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRJ-504, Boston 02114, USA.
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Our A, Kano K, Kuwayama Y. [Risk factors for visual outcome after bleb-related infection]. Nippon Ganka Gakkai Zasshi 2010; 114:598-603. [PMID: 20681255] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE To investigate risk factors for visual impairment following bleb-related infection after trabeculectomy with mitomycin C. METHODS We retrospectively reviewed 31 cases of bleb-related infection at Osaka Koseinenkin hospital from 2004 to 2007. RESULTS Twelve cases of blebitis and 19 cases of bleb-related endophthalmitis were studied. According to the stage of infection, each patient was continued to be treated following a previously decided treatment strategy. Fifteen patients underwent pars plana vitrctomy. Two patients with blebitis progressed to endopthalmitis. Visual acuity in seven eyes (22.6%) decreased by two or more lines following infection. Risk factors for visual impairments following bleb-related infections were recurrence of infection (p = 0.022), negative Seidel tests (p = 0.0056), aphakia (p = 0.045), avitreous (p = 0.00070), positive Streptococcus species (p = 0.029), and prolonged inflammation (p = 0.014). CONCLUSIONS Recurrence of infection, negative Seidel tests, aphakia and avitreous are risk factors for visual impairment following bleb-related infection after trabeculectomy.
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Affiliation(s)
- Atsushi Our
- Department of Ophthalmology, Hoshigaoka Koseinenkin Hospital, 4-8-1 Hoshigaoka, Hirakata-shi 573-8511, Japan.
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Boĭko EV, Chepur SV, Pozniak AL, Nuralova IV, Suetov AA, Mal'tsev DS, Ageev VS, Shestaev AI. [The specific features of a structural lesion in the ocular posterior segment in experimental chlamydial infection]. Vestn Oftalmol 2010; 126:27-32. [PMID: 20645572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The investigation was undertaken to study changes in the structure of the vitreoretinal complex in experimental chlamydial infection. Six rabbits were inoculated with Ch. pneumonia (6 eyes) and Ch. trachomatis (6 eyes) via instillations, subconjunctivally and intravitreally. Clinical and pathomorphological study was conducted during 128 days, by using immunohistochemical techniques. All modes of inoculation resulted in the development of an intraocular infectious process as uveitis, choriorenitis, and vitreitis (endophthalmitis) of varying degrees--from subclinical to severe. Immunohistochemical study revealed the pathogen in the structures of the ocular posterior segment and in venous blood in all cases. When locally inoculated, chlamydial infection becomes disseminated, by afflicting the ocular posterior segment, no matter what the mode of inoculation is applied. The clinical picture of the lesion widely varies from subclinical manifestations to a severe process.
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