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Hsu AY, Lin CJ, Hsia NY, Wang YH, Li JX, Chen HS, Wei JCC, Tsai YY. Reply to comment on "The risk assessment of uveitis after COVID-19 diagnosis by Wu et al. 2024". J Med Virol 2024; 96:e29636. [PMID: 38659371 DOI: 10.1002/jmv.29636] [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: 03/08/2024] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Alan Y Hsu
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Jing-Xing Li
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of General Medicine, China Medical University Hospital, Taichung, Taiwan
- Institute of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University, Taipei, Taiwan
| | - Huan-Sheng Chen
- An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
- Department of Nursing, Chung Shan Medical University, Taichung, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan
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Kamoi K, Uchimaru K, Tojo A, Watanabe T, Ohno-Matsui K. HTLV-1 uveitis and Graves' disease presenting with sudden onset of blurred vision. Lancet 2022; 399:60. [PMID: 34973718 DOI: 10.1016/s0140-6736(21)02442-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 08/23/2021] [Revised: 09/12/2021] [Accepted: 10/29/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Koju Kamoi
- Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Department of Haematology and Oncology, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
| | - Kaoru Uchimaru
- Department of Haematology and Oncology, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Medical Genome Sciences, Laboratory of Tumour Cell Biology, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
| | - Arinobu Tojo
- Department of Haematology and Oncology, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Toshiki Watanabe
- Department of Haematology and Oncology, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Practical Management of Medical Information, St Marianna University, Graduate School of Medicine, Tokyo, Japan
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Eghrari AO, Bishop RJ, Ross RD, Davis B, Larbelee J, Amegashie F, Dolo RF, Prakalapakorn SG, Gaisie C, Gargu C, Sosu Y, Sackor J, Cooper PZ, Wallace A, Nyain R, Gray M, Kamara F, Burkholder B, Brady CJ, Ray V, Tawse KL, Yeung I, Neaton JD, Higgs ES, Lane HC, Reilly C, Sneller MC, Fallah MP. Characterization of Ebola Virus-Associated Eye Disease. JAMA Netw Open 2021; 4:e2032216. [PMID: 33399856 PMCID: PMC7786253 DOI: 10.1001/jamanetworkopen.2020.32216] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Survivors of Ebola virus disease (EVD) may experience ocular sequelae. Comparison with antibody-negative individuals from the local population is required to characterize the disease. OBJECTIVE To assess features of ophthalmic disease specific to EVD. DESIGN, SETTING, AND PARTICIPANTS This baseline cross-sectional analysis of survivors of EVD and their close contacts was conducted within PREVAIL III, a 5-year, longitudinal cohort study. Participants who enrolled at John F. Kennedy Medical Center in Liberia, West Africa from June 2015 to March 2016 were included in this analysis. Close contacts were defined as household members or sex partners of survivors of EVD. Data were analyzed from July 2016 to July 2020. EXPOSURES All participants, both survivors and close contacts, underwent testing of IgG antibody levels against Ebola virus surface glycoprotein. MAIN OUTCOMES AND MEASURES Ocular symptoms, anterior and posterior ophthalmologic examination findings, and optical coherence tomography images were compared between antibody-positive survivors and antibody-negative close contacts. RESULTS A total of 564 antibody-positive survivors (320 [56.7%] female; mean [SD] age, 30.3 [14.0] years) and 635 antibody-negative close contacts (347 [54.6%] female; mean [SD] age, 25.8 [15.5] years) were enrolled in this study. Survivors were more likely to demonstrate color vision deficit (28.9% vs 19.0%, odds ratio [OR], 1.6; 95% CI, 1.2-2.1) and lower intraocular pressure (12.4 vs 13.5 mm Hg; mean difference, -1.2 mm Hg; 95% CI, -1.6 to -0.8 mm Hg) compared with close contacts. Dilated fundus examination revealed a higher percentage of vitreous cells (7.8% vs 0.5%; OR, 16.6; 95% CI, 5.0-55.2) and macular scars (4.6% vs 1.6%; OR, 2.8; 95% CI, 1.4-5.5) in survivors than in close contacts. Uveitis was present in 26.4% of survivors and 12.1% of close contacts (OR, 2.4; 95% CI, 1.8-3.2). Among all participants with uveitis, survivors were more likely than close contacts to have intermediate uveitis (34.2% vs 6.5% of all cases; OR, 7.8; 95% CI, 3.1-19.7) and had thicker mean central subfield thickness on optical coherence tomography (222 vs 212 μm; mean difference, 14.4 μm; 95% CI, 1.9-26.9 μm). CONCLUSIONS AND RELEVANCE In this cross-sectional study, survivors of EVD had a distinct spectrum of ocular and neuro-ophthalmologic findings compared with close contacts that potentially require medical and surgical treatment.
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Affiliation(s)
| | | | | | - Bionca Davis
- Division of Biostatistics, University of Minnesota, Minneapolis
| | | | | | | | | | | | - Catherine Gargu
- Partnership for Research on Ebola Virus in Liberia, Monrovia, Liberia
| | - Yassah Sosu
- Partnership for Research on Ebola Virus in Liberia, Monrovia, Liberia
| | - Jennie Sackor
- Partnership for Research on Ebola Virus in Liberia, Monrovia, Liberia
| | | | - Augustine Wallace
- Partnership for Research on Ebola Virus in Liberia, Monrovia, Liberia
| | - Ruth Nyain
- Partnership for Research on Ebola Virus in Liberia, Monrovia, Liberia
| | - Maima Gray
- Partnership for Research on Ebola Virus in Liberia, Monrovia, Liberia
| | - Famatta Kamara
- Partnership for Research on Ebola Virus in Liberia, Monrovia, Liberia
| | | | | | - Vincent Ray
- Department of Ophthalmology, California Pacific Medical Center, San Francisco
| | - Kirstin L. Tawse
- Department of Ophthalmology, Kaiser Permanente, Denver, Colorado
| | - Ian Yeung
- National Institutes of Health, Bethesda, Maryland
| | - James D. Neaton
- Division of Biostatistics, University of Minnesota, Minneapolis
| | | | | | - Cavan Reilly
- Division of Biostatistics, University of Minnesota, Minneapolis
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dos Santos HNV, Ferracioli-Oda E, Barbosa TS, Otani CSV, Tanaka T, da Silva LDCS, Lopes GDO, Doi A, Hirata CE, Yamamoto JH. Usefulness of aqueous and vitreous humor analysis in infectious uveitis. Clinics (Sao Paulo) 2020; 75:e1498. [PMID: 31994615 PMCID: PMC6970280 DOI: 10.6061/clinics/2020/e1498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [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] [Received: 08/16/2019] [Accepted: 11/21/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To evaluate the role of intraocular fluid analysis as a diagnostic aid for uveitis. METHODS Twenty-eight samples (27 patients including 3 HIV-infected patients) with active (n=24) or non-active (n=4) uveitis were submitted to aqueous (AH; n=12) or vitreous humor (VH) analysis (n=16). All samples were analyzed by quantitative PCR for herpes simplex virus (HSV), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV) and Toxoplasma gondii. RESULTS The positivity of the PCR in AH was 41.7% (5/12), with 50% (2/4) in immunocompetent and 67% (2/3) in HIV+ patients. The positivity of the PCR in VH was 31.2% (5/16), with 13% (1/8) in immunocompetent and 50% (4/8) in immunosuppressed HIV negative patients. The analysis was a determinant in the diagnostic definition in 58% of HA and 50% of VH. CONCLUSION Even in posterior uveitis, initial AH analysis may be helpful. A careful formulation of possible clinical diagnosis seems to increase the chance of intraocular sample analysis being meaningful.
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Affiliation(s)
- Helen Nazareth Veloso dos Santos
- Servico de Uveites, Departmento de Oftalmologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Eduardo Ferracioli-Oda
- Servico de Uveites, Departmento de Oftalmologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Thaisa Silveira Barbosa
- Servico de Uveites, Departmento de Oftalmologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Camila Sayuri Vicentini Otani
- Servico de Uveites, Departmento de Oftalmologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Tatiana Tanaka
- Servico de Uveites, Departmento de Oftalmologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Guilherme de Oliveira Lopes
- Secao de Citometria de Fluxo, Divisao do Laboratorio Central DLC, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Andre Doi
- Secao de Biologia Molecular, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Carlos Eduardo Hirata
- Servico de Uveites, Departmento de Oftalmologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Joyce Hisae Yamamoto
- Servico de Uveites, Departmento de Oftalmologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Gonzales JA, Hinterwirth A, Shantha J, Wang K, Zhong L, Cummings SL, Qian Y, Wilson MR, Acharya NR, Doan T. Association of Ocular Inflammation and Rubella Virus Persistence. JAMA Ophthalmol 2019; 137:435-438. [PMID: 30589932 PMCID: PMC6439711 DOI: 10.1001/jamaophthalmol.2018.6185] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 11/01/2018] [Indexed: 12/14/2022]
Abstract
Importance Metagenomic deep sequencing (MDS) demonstrates that persistent and active rubella virus (RV) infection is associated with Fuchs heterochromic iridocyclitis (FHI). Objective To assess the utility of MDS in identifying RV infection in patients with uveitis. Design, Setting, and Participants This case series assessed 6 patients diagnosed by MDS with RV-associated uveitis at a tertiary uveitis referral center in the United States. Exposures Prior RV infection. Main Outcomes and Measures Clinical examination findings, slitlamp photography, corneal confocal imaging, and infectious pathogen genome obtained from RNA sequencing. Results Six white men (age range, 36-61 years) were diagnosed with RV-associated uveitis by MDS. Three patients exhibited iris heterochromia associated with their uveitis in classic FHI fashion. The other 3 patients had less classic FHI features and exhibited anterior vitritis. Three patients had in vivo corneal confocal microscopy, with 2 demonstrating stellate keratic precipitates in addition to endothelial infiltration, spotlike holes, and enlarged intercellular boundaries. Of these 3 patients, 1 patient exhibited polymorphism and polymegathism of the endothelial cells. Conclusions and Relevance These findings suggest that persistent RV infection is associated with recurrent or chronic anterior or anterior-intermediate uveitis as well as corneal endothelial cell damage. Ophthalmologists should consider RV infection as a potential cause of hypertensive anterior and intermediate uveitis.
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Affiliation(s)
- John A. Gonzales
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
| | - Armin Hinterwirth
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Jessica Shantha
- Department of Ophthalmology, Emory University, Atlanta, Georgia
| | - Kaidi Wang
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
| | - Lina Zhong
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Susie L. Cummings
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Ying Qian
- Department of Ophthalmology, Kaiser Permanente, Oakland, California
| | - Michael R. Wilson
- Weill Institute for Neurosciences, University of California, San Francisco
- Department of Neurology, University of California, San Francisco
| | - Nisha R. Acharya
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
| | - Thuy Doan
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
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Avetisov SE, Surnina ZV, Troickaya NA, Pateyuk LS, Velieva IA, Gamidov AA, Sidamonidze AL. [Results of laser confocal microscopy of the cornea in viral uveitis (a preliminary report)]. Vestn Oftalmol 2019; 135:53-58. [PMID: 30830075 DOI: 10.17116/oftalma201913501153] [Citation(s) in RCA: 5] [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] [Indexed: 06/09/2023]
Abstract
UNLABELLED Herpesviruses involve neurotropic activity (they affect nerve cells) and have the ability to induce an immune response (a special tropism for immune tissue), which provides a valid reason for studying the possibilities of visualizing nerve fibers of the cornea and Langerhans cells (LC) in viral uveitis (with prospective applications in early diagnosis). PURPOSE To evaluate the results of laser corneal confocal microscopy (CCM) in viral uveitis of varying localization. MATERIAL AND METHODS The main study group included 23 patients (23 eyes) diagnosed with unilateral herpesviral uveitis (chorioretinitis), the patients' age varied from 18 to 79 years. The control group comprised 19 healthy volunteers (38 eyes) aged 20 to 75 years. In addition, the paired eyes of the main group patients were examined. In all patients, standard ophthalmologic examination was complemented with CCM performed on the HRT III device with a corneal module, followed by analysis of the course and structure of corneal nerve fibers (CNF) using copyrighted software Liner 1.2. CONCLUSION The preliminary results achieved in this study outline the prospects for further research on the state of cornea (in particular, changes in the course and structure of CNF, and the presence of dendritiform cells of Langerhans) with laser CCM in patients with uveitis of various etiologies. These morphological changes also has potential use as diagnostic markers of inflammation of the uveal tract. The main criteria for assessing the state of cornea in viral uveitis include the following: increased tortuosity of CNF, increase in the number and size of Langerhans cells. Further research - in particular, studying the integrated use of diagnostic methods necessary for the verification of viral uveitis, as well as detailed analysis of the history and clinical picture of the disease - is required to substantiate the inclusion of laser confocal microscopy method in the algorithm for the diagnosis of viral uveitis.
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Affiliation(s)
- S E Avetisov
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021; I.M. Sechenov First Moscow State Medical University, Department of Ophthalmology, 8-2 Trubetskaya St., Moscow, Russian Federation, 119991
| | - Z V Surnina
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - N A Troickaya
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - L S Pateyuk
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - I A Velieva
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - A A Gamidov
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - A L Sidamonidze
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
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Pohlmann D, Schlickeiser S, Metzner S, Lenglinger M, Winterhalter S, Pleyer U. Different composition of intraocular immune mediators in Posner-Schlossman-Syndrome and Fuchs' Uveitis. PLoS One 2018; 13:e0199301. [PMID: 29944680 PMCID: PMC6019249 DOI: 10.1371/journal.pone.0199301] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 02/06/2018] [Accepted: 06/05/2018] [Indexed: 12/14/2022] Open
Abstract
Posner-Schlossman-Syndrome (PSS) is clinically characterized by acute, recurrent, mild, unilateral uveitis anterior accompanied by elevated intraocular pressure (IOP). Fuchs´ Uveitis (FU) is a chronic, low-grade-inflammatory disorder, involving anterior uvea and vitreous. The clinical findings show remarkable similarities as well as differences. In our study, we determine the composition of immune mediators in aqueous humor of patients with PSS and FU and evaluate if immune mediators play a crucial role in specific viral intraocular inflammation and IOP rises. Aqueous humor samples from 81 uveitis patients (= eyes) presenting with either PSS or FU were collected at one time point. Local intraocular antibody synthesis to rubella virus was confirmed in 65 patients, whereas 16 were tested positively for human cytomegalovirus. Thirteen patients with PSS and 10 patients with FU were treated with glaucoma medications. Additionally, 11 cataract patients acted as control group. Immune mediator concentrations were measured by Bio-Plex Pro assay. We observed in both PSS (IFN-γ: 174.9 pg/mL; TNF-α: 25.1 pg/mL) and FU (IFN-γ: 25.4 pg/mL; TNF-α: 27.2 pg/mL) groups a significantly increased level of T-helper 1 immune mediators compared to controls (IFN-γ, TNF-α: 0 pg/mL) [median]. Notably, PSS patients (IL-1RA: 73.4 pg/mL; IL-8: 199.4 pg/mL; IL-10: 33.4 pg/mL; IP-10: 126350 pg/mL) showed a stronger and more active ocular inflammatory response, than FU patients (IL-1RA: 4.3 pg/mL; IL-8: 72.4 pg/mL; IL-10: 1.6 pg/mL; IP-10: 57400 pg/mL). Furthermore, a negative correlation between mediators and IOP was seen in the PSS group, potentially caused by acetazolamide-treatment. Our findings show that immune mediators play a crucial role in specific viral intraocular inflammation and influence IOP levels. Remarkable similarities but also significant differences of immune mediator concentrations are apparent in PSS compared to FU. High concentrations of IL-1RA, IL-8, IL-10, and IP-10 correlate with active inflammation in PSS, while FU may trigger chronic inflammation. Our data also substantiated a very similar composition of cytokines in those patients from the PSS group suffering from ocular hypertension and thus offers a potential explanation model for a negative correlation between mediators and IOP.
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Affiliation(s)
- Dominika Pohlmann
- Department of Ophthalmology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- * E-mail:
| | - Stephan Schlickeiser
- Institute of Medical Immunology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Sylvia Metzner
- Department of Ophthalmology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Matthias Lenglinger
- Department of Ophthalmology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sibylle Winterhalter
- Department of Ophthalmology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Uwe Pleyer
- Department of Ophthalmology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Imai A, Takase H, Imadome KI, Matsuda G, Ohnishi I, Yamamoto K, Kudo T, Tanaka Y, Maehara T, Miura O, Arai A. Development of Extranodal NK/T-cell Lymphoma Nasal Type in Cerebrum Following Epstein-Barr Virus-positive Uveitis. Intern Med 2017; 56:1409-1414. [PMID: 28566607 PMCID: PMC5498208 DOI: 10.2169/internalmedicine.56.7573] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 12/18/2022] Open
Abstract
A 74-year-old woman developed bilateral uveitis with high Epstein-Barr virus (EBV) DNA load in the vitreous fluid without lymphoma cells. Four years after the onset, T2-weighted contrast-enhanced MRI revealed hyperintense lesions in the right occipital and parietal lobe. A biopsy resulted in the diagnosis of extranodal NK/T-cell lymphoma nasal type (ENKL). The repeat region of LMP1, an EBV gene, detected in the brain lesion was identical to that detected in the vitreous fluid. ENKL of the central nervous system is quite rare, and the pathogenesis has not been determined. The lymphoma in this case might have been closely associated with the EBV-positive uveitis.
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Affiliation(s)
- Ayano Imai
- Department of Ophthalmology, Tokyo Medical and Dental University, Japan
| | - Hiroshi Takase
- Department of Ophthalmology, Tokyo Medical and Dental University, Japan
| | - Ken-Ichi Imadome
- Division of Advanced Medicine for Virus Infections, National Research Institute for Child Health and Development, Japan
| | - Go Matsuda
- Division of Advanced Medicine for Virus Infections, National Research Institute for Child Health and Development, Japan
| | - Iichiro Ohnishi
- Department of Comprehensive Pathology, Tokyo Medical and Dental University, Japan
| | - Kouhei Yamamoto
- Department of Comprehensive Pathology, Tokyo Medical and Dental University, Japan
| | - Takumi Kudo
- Department of Functional Neurosurgery, Tokyo Medical and Dental University, Japan
| | - Yoji Tanaka
- Department of Functional Neurosurgery, Tokyo Medical and Dental University, Japan
| | - Taketoshi Maehara
- Department of Functional Neurosurgery, Tokyo Medical and Dental University, Japan
| | - Osamu Miura
- Department of Hematology, Tokyo Medical and Dental University, Japan
| | - Ayako Arai
- Department of Hematology, Tokyo Medical and Dental University, Japan
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9
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Doan T, Wilson MR, Crawford ED, Chow ED, Khan LM, Knopp KA, O’Donovan BD, Xia D, Hacker JK, Stewart JM, Gonzales JA, Acharya NR, DeRisi JL. Illuminating uveitis: metagenomic deep sequencing identifies common and rare pathogens. Genome Med 2016; 8:90. [PMID: 27562436 PMCID: PMC4997733 DOI: 10.1186/s13073-016-0344-6] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [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: 05/28/2016] [Accepted: 08/05/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Ocular infections remain a major cause of blindness and morbidity worldwide. While prognosis is dependent on the timing and accuracy of diagnosis, the etiology remains elusive in ~50 % of presumed infectious uveitis cases. The objective of this study is to determine if unbiased metagenomic deep sequencing (MDS) can accurately detect pathogens in intraocular fluid samples of patients with uveitis. METHODS This is a proof-of-concept study, in which intraocular fluid samples were obtained from five subjects with known diagnoses, and one subject with bilateral chronic uveitis without a known etiology. Samples were subjected to MDS, and results were compared with those from conventional diagnostic tests. Pathogens were identified using a rapid computational pipeline to analyze the non-host sequences obtained from MDS. RESULTS Unbiased MDS of intraocular fluid produced results concordant with known diagnoses in subjects with (n = 4) and without (n = 1) uveitis. Samples positive for Cryptococcus neoformans, Toxoplasma gondii, and herpes simplex virus 1 as tested by a Clinical Laboratory Improvement Amendments-certified laboratory were correctly identified with MDS. Rubella virus was identified in one case of chronic bilateral idiopathic uveitis. The subject's strain was most closely related to a German rubella virus strain isolated in 1992, one year before he developed a fever and rash while living in Germany. The pattern and the number of viral identified mutations present in the patient's strain were consistent with long-term viral replication in the eye. CONCLUSIONS MDS can identify fungi, parasites, and DNA and RNA viruses in minute volumes of intraocular fluid samples. The identification of chronic intraocular rubella virus infection highlights the eye's role as a long-term pathogen reservoir, which has implications for virus eradication and emerging global epidemics.
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Affiliation(s)
- Thuy Doan
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA USA
| | - Michael R. Wilson
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA USA
- Department of Neurology, University of California San Francisco, San Francisco, CA USA
| | - Emily D. Crawford
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA USA
- Howard Hughes Medical Institute, Chevy Chase, MD USA
| | - Eric D. Chow
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA USA
| | - Lillian M. Khan
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA USA
| | - Kristeene A. Knopp
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA USA
| | - Brian D. O’Donovan
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA USA
| | - Dongxiang Xia
- California Department of Public Health, Richmond, CA USA
| | - Jill K. Hacker
- California Department of Public Health, Richmond, CA USA
| | - Jay M. Stewart
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA USA
| | - John A. Gonzales
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA USA
| | - Nisha R. Acharya
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA USA
| | - Joseph L. DeRisi
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA USA
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12
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Abstract
OBJECTIVE To analyse aqueous polymerase chain reaction (PCR) results in patients diagnosed with undifferentiated uveitis and determine prevalence of herpesviridae in non-uveitic patients undergoing routine cataract extraction. DESIGN Retrospective comparative case series and prospective cross-sectional study. SUBJECTS 72 patients with idiopathic uveitis and 57 surgical patients. METHODS Diagnostic aqueous paracentesis with PCR testing for 6 herpes viridae in uveitic patients. Anterior chamber paracentesis immediately pre-operative in the prospective arm, with PCR testing. RESULTS In the retrospective review we had a 47.2% positive PCR yield. Data analysis revealed a statistically significant correlation between a positive yield and being HIV+ (p=0.018); between an EBV+ yield and being HIV+ (p= 0.026) and a CMV+ result and being HIV+ (p=0.032). Posterior uveitis (p=0.014) and symptoms <30 days (p= 0.0014) had a statistically significant yield. In the prospective arm of the study: all 57 patients were HIV- and all aqueous samples were negative for the 6 herpesviridae. CONCLUSION We recommend PCR testing for Herpesviridae as a safe second line test for patients with undifferentiated uveitis. We were unable to establish prevalence and suggest that the idea of a commensal herpes virus is unlikely if the blood-ocular barrier is intact.
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Affiliation(s)
- Debbie Laaks
- Division of Ophthalmology, Department of Surgical Sciences, Faculty of Health Sciences, University of Stellenbosch, South Africa
| | - Derrick P Smit
- Division of Ophthalmology, Department of Surgical Sciences, Faculty of Health Sciences, University of Stellenbosch, South Africa
| | - Justin Harvey
- Center for Statistical Consultation, University of Stellenbosch, South Africa
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Rousseau A, Nasser G, Chiquet C, Barreau E, Gendron G, Kaswin G, M’Garrech M, Benoudiba F, Ducreux D, Labetoulle M. Diffusion tensor magnetic resonance imaging of trigeminal nerves in relapsing herpetic keratouveitis. PLoS One 2015; 10:e0122186. [PMID: 25830672 PMCID: PMC4382307 DOI: 10.1371/journal.pone.0122186] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 09/11/2014] [Accepted: 02/09/2015] [Indexed: 01/27/2023] Open
Abstract
Background Corneal hypoesthesia is the landmark of HSV and VZV keratitis and can lead to neurotrophic keratitis. Diffusion tensor imaging (DTI) is a new magnetic resonance imaging (MRI) derived technique, which offers possibilities to study axonal architecture. We aimed at assessing the potential impact of recurrent HSV or VZV-related keratitis on the axonal architecture of trigeminal nerves using DTI. Design Prospective non-interventional study. Participants Twelve patients and 24 controls. Methods DTI using MRI of the trigeminal fibers and corneal esthesiometry using the Cochet-Bonnet esthesiometer were acquired for patients affected by unilateral and recurrent HSV or VZV-related keratitis (3 months after the last corneal inflammatory event), and control subjects with no history of ocular or neuronal disease affecting the trigeminal pathways. Main Outcome Measures Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were compared between the 2 eyes of both patients and controls, and correlated with corneal esthesiometry. Results FA was lower in the trigeminal fibers ipsilateral to the affected eye compared to the non-affected side (0.39±0.02 versus 0.46±0.04, P=0.03). This difference was more important than the intra-individual variability observed in controls. Concomitantly, the asymmetry in ADC results was significantly correlated with the loss of corneal sensitivity in the affected eye. Conclusions Corneal hypoesthesia related to HSV and VZV keratitis is associated with persistent modifications in the architecture and functionality of the trigeminal fibers. These results add further explanation to the pathogenesis of HSV and VZV-induced neurotrophic keratitis, which may occur despite an apparent quiescence of the disease.
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Affiliation(s)
- Antoine Rousseau
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Ghaïdaa Nasser
- Department of Neuroradiology, Bicêtre Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Christophe Chiquet
- Department of Ophthalmology, Grenoble University Hospital, Grenoble, France
| | - Emmanuel Barreau
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Gael Gendron
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Godefroy Kaswin
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Mohamed M’Garrech
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Farida Benoudiba
- Department of Neuroradiology, Bicêtre Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Denis Ducreux
- Department of Neuroradiology, Bicêtre Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
- * E-mail: (ML); (DD)
| | - Marc Labetoulle
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
- * E-mail: (ML); (DD)
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Wohl DA, Kendall MA, Owens S, Holland G, Nokta M, Spector SA, Schrier R, Fiscus S, Davis M, Jacobson MA, Currier JS, Squires K, Alston-Smith B, Andersen J, Freeman WR, Higgins M, Torriani FJ. The Safety of Discontinuation of Maintenance Therapy for Cytomegalovirus (CMV) Retinitis and Incidence of Immune Recovery Uveitis Following Potent Antiretroviral Therapy. HIV Clinical Trials 2015; 6:136-46. [PMID: 16192248 DOI: 10.1310/4j65-4yx1-4et6-e5kr] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Reconstitution of immune function during potent antiretroviral therapy can prompt discontinuation of maintenance cytomegalovirus (CMV) therapy but has also been associated with sight-threatening inflammatory conditions including immune recovery uveitis (IRU). METHOD Patients with inactive CMV retinitis and a CD4+ cell count above 100/mm3, receiving CMV therapy and stable combination antiretroviral therapy, were assigned to one of two groups based on willingness to discontinue CMV therapy. RESULTS Thirty-eight participants were enrolled: 28 discontinued anti-CMV therapy (Group 1) and 10 continued CMV treatment (Group 2). Median on-study follow-up was 16 months. One Group 1 participant who experienced an increase in plasma HIV viral load and a decline in CD4+ cell count developed confirmed progression of CMV retinitis. Progression or reactivation CMV retinitis was not observed among Group 2. IRU was present at study entry in 3 participants. Six participants in Group 1 and 3 participants in Group 2 developed IRU on-study. CMV viremia was not detected in any participants, and urinary shedding of CMV was intermittent. CONCLUSION Recurrence of CMV retinitis following discontinuation of anti-CMV therapy among patients with antiretroviral-induced increases in CD4+ cell count was rare. However, IRU was common in both those who maintained and discontinued anti-CMV therapy.
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Affiliation(s)
- D A Wohl
- University of North Carolina, Chapel Hill, North Carolina 27516-7215, USA.
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15
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Burcea M, Avram CI, Stamate AC, Malciolu R, Oprea S, Zemba M. [Ocular hypertension in herpes simplex keratouveitis]. Oftalmologia 2014; 58:23-28. [PMID: 25842621] [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: 06/04/2023]
Abstract
The herpes simplex virus is one of the most common pathogens in humans, who are seropositive for the virus in 90% of the cases at the adult age. It determines reccurent infections in more than a third of the population and these infections depend on the immune response of the host. Ocular infections of newborns are due to the herpes simplex virus type 2, meanwhile type 1 is found predominantly at adults; almost all ocular structures can be affected. HSV-1 in the most frequent etiologic agent in infectious anterior uveitis (with the varicelo-zosterian virus) and it is responsible for 6-10% of all cases of anterior uveitis. More than half of the keratouveitides due to HSV will develop intraocular hypertension and open-angle secondary glaucoma, during reccurences and most of them will resolve after proper control of inflammation.
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Abstract
PURPOSE To provide population-based data on the risk, types, and outcomes of eye involvement in herpes zoster (HZ). METHODS A cohort study based on review of the medical records of patients in whom HZ was diagnosed between January 1, 1980, and December 31, 2007, was performed. Herpes zoster was confirmed by the presence of the typical rash and symptoms or by laboratory testing, and eye involvement was confirmed by ophthalmologists' evaluation. Information was collected on all eye diagnoses and on HZ eye-related visits, treatments, procedures, and outcomes. RESULTS Of the 2035 individuals with HZ in any dermatome, 184 (9.0%) had eye involvement. The mean age of the 184 was 62.6 years, and 5 cases occurred in patients younger than 21. Overall, 6.5% (12) were immunosuppressed at the time of the eye complications. The rate of increase in HZ eye involvement was 23% by decade from 1980 to 2007. Common eye complications were keratitis (n=144, 76.2%), uveitis/iritis (n=88, 46.6%), and conjunctivitis (n=67, 35.4%). Recurrent keratitis and recurrent iritis/uveitis occurred in 6.9% (13) and 7.4% (14), respectively. Outcomes included 6 patients (3.3%) with new vision decrements to 20/200 or worse. Two individuals had successful corneal transplants. Another 6 individuals (3.3%) had lid ptosis that affected vision, including 1 elderly woman with permanent unilateral tarsorrhaphy. Severe HZ eye pain was reported to be directly responsible for 1 unsuccessful suicide attempt. Acute retinal necrosis did not develop in any individual. A mean of 10.8 eye visits per patient with HZ and eye involvement was reported to continue for a mean of 308 days. CONCLUSION Eye complications are common and result in considerable health care use and permanent vision decrement in about 6.6% (6) of individuals with HZ eye involvement. Most health care use and long-term adverse outcomes occurred in patients in whom prevention of HZ with the zoster vaccine would be possible.
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Affiliation(s)
- Barbara P Yawn
- Department of Research, Olmsted Medical Center, Rochester, MN 55904, USA.
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17
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Yasunaga JI, Matsuoka M. [HTLV-1: Recent topics in epidemiologic, basic and clinical research]. Uirusu 2013; 63:165-174. [PMID: 25366051 DOI: 10.2222/jsv.63.165] [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: 06/04/2023]
Abstract
Human T-cell leukemia virus type 1 (HTLV-1) belongs to Delta Retorviridae, and induces a malignancy of CD4+CD25+ T-cells, adult T-cell leukemia (ATL), and several chronic inflammatory diseases, such as HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) and HTLV-1 uveitis. A nationwide survey of HTLV-1-infected subjects, which was recently conducted by Japanese government, revealed that the numbers of HTLV-1 carriers and patients with HTLV-1-associated diseases have not decreased much over the last two decades in Japan. In contrast, novel findings on HTLV-1 dynamics in vivo and molecular mechanisms of its pathogenesis are accumulating by detailed analysis of newly identified viral and cellular factors, novel technologies such as next-generation sequencing, and appropriate animal models for HTLV-1 research. In this review, we summarize the recent progress of HTLV-1 research.
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18
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Li J, Ang M, Cheung CMG, Vania M, Chan ASY, Waduthantri S, Yang H, Chee SP. Aqueous cytokine changes associated with Posner-Schlossman syndrome with and without human cytomegalovirus. PLoS One 2012; 7:e44453. [PMID: 23028541 PMCID: PMC3441587 DOI: 10.1371/journal.pone.0044453] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [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: 05/02/2012] [Accepted: 08/03/2012] [Indexed: 12/14/2022] Open
Abstract
AIM To study the differences in aqueous cytokines in Posner-Schlossman Syndrome (PSS) patients with and without human cytomegalovirus (CMV) DNA in the aqueous humor. METHODS This is a prospective study. Fifty-three uveitis patients with clinical signs of PSS were enrolled and aqueous humor samples were collected. Fourteen PSS patients were positive of CMV DNA in the aqueous by polymerase chain reaction (PCR) analysis. These eyes were negative of common ocular pathogens such as herpes simplex virus, varicella-zoster virus, rubella virus and toxoplasma. Twenty-five otherwise healthy cataract patients were enrolled as controls. Cytokine concentration was measured by a magnetic color-bead-based multiplex assay and analyzed using statistical and classification approaches. RESULTS The average age of 53 PSS patients was 48.74±13.43 years (yrs) (mean ± standard deviation) and 66.3±15.0 yrs for the controls. The median CMV viral DNA copy number was 26000/mL aqueous (range 1400 to 85000 copies/mL) in 14 CMV positive patients as determined by quantitative PCR. PSS aqueous had significantly higher Interleukin (IL)-8 (CXCL8), monocyte chemotactic protein-1 (CCL2), macrophage inhibitory protein 1-β (CCL4), granulocyte colony-stimulating factor (GCSF) and transforming growth factor-β (TGF-β) levels than controls after adjusted by age and gender. IL-2, IL-12, tumor necrosis factor-α (TNF-α) and interferon-α (IFN-α) levels were significantly lower in PSS aqueous than controls. No difference between CMV positive PSS and CMV negative PSS aqueous was observed. Over 97% of PSS samples were distinguished from controls by elevated CXCL10 (>500 ng/mL), CXCL8 (>30 ng/mL) and CCL2 (>60 ng/mL) levels. CONCLUSION PSS eyes were characterized by elevated aqueous chemokine concentration. The presence of CMV viral DNA was not associated with significant change of the type of cytokine expression in PSS patients.
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Affiliation(s)
- Jing Li
- Department of Ophthalmology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Ocular Inflammation Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Marcus Ang
- Department of Ophthalmology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Ocular Inflammation and Immunology Services, Singapore National Eye Centre, Singapore, Singapore
| | - Chui Ming Gemmy Cheung
- Ocular Inflammation and Immunology Services, Singapore National Eye Centre, Singapore, Singapore
| | - Maya Vania
- Department of Ophthalmology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Anita Sook Yee Chan
- Department of Ophthalmology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Ocular Inflammation and Immunology Services, Singapore National Eye Centre, Singapore, Singapore
- Department of Pathology, Singapore General Hospital, Singapore, Singapore
| | - Samanthila Waduthantri
- Department of Ophthalmology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Ocular Inflammation and Immunology Services, Singapore National Eye Centre, Singapore, Singapore
| | - Henry Yang
- Cancer Science Institute of Singapore, Singapore, Singapore
| | - Soon Phaik Chee
- Department of Ophthalmology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Ocular Inflammation and Immunology Services, Singapore National Eye Centre, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- * E-mail:
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Abstract
PURPOSE Herpes stromal keratitis is a serious condition and the most frequent cause of unilateral blindness. The real-time PCR is an accurate and fast diagnostic method for an analysis of infectious agents causing keratitis and keratouveitis. The aim of the study was to assess the relationship between clinical symptoms, treatment efficacy monitoring and viral quantity in corneal swabs determined by quantitative real-time PCR method. The real-time PCR method was used as well for the detection of other viral eye pathogens. METHODS A total of 212 patients (136 men and 76 women) suspect of having herpes simplex virus (HSV) keratitis or keratouveitis were included in the study. The detection and quantitative analysis of the viral DNA were performed using the EliGene HSV1 RT kit, and the result was correlated with the clinical picture of the disease. The patients were routinely treated with acyclovir applied locally or, alternatively, in systemic administration. In a case of acyclovir treatment resistant keratitis, the patients were treated with local ganciclovir (Virgan gel ophth 0.15%). RESULTS A total of 636 analyses of the viral DNA were performed; 85 patients were positive for HSV1 (198 detected). There were 16 acyclovir resistant cases of keratitis (14%). CONCLUSIONS The real-time PCR appears as a fast and accurate method for an exact identification of the viral DNA in patients with herpes stromal keratitis. The introduction of the quantification is important for the treatment evaluation and for the specification of a so-called acyclovir resistant keratitis. A long-term systemic administration in maintenance doses may lead to the resistance and repeated, frequent relapses of the disease.
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Affiliation(s)
- Zuzana Hlinomazová
- Department of Ophthalmology, University Hospital Brno, Brno, Czech Republic
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Turno-Krecicka A, Misiuk-Hojlo M, Grzybowski A, Oficjalska-Młynczak J, Jakubowska-Kopacz M, Jurowska-Liput J. Early vitrectomy and diagnostic testing in severe infectious posterior uveitis and endophthalmitis. Med Sci Monit 2010; 16:CR296-CR300. [PMID: 20512093] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND To determine the therapeutic and diagnostic value of vitreoretinal surgery in various types of severe viral retinitis and endogenous endophthalmitis. MATERIAL/METHODS Pars plana vitrectomy with silicon-oil tamponade was performed on 12 eyes (12 patients) with severe viral retinitis and endogenous endophthalmitis. The mean age of the patients was 35.2 years (range, 18-56 years). Investigations consisted of chest radiography, RT 23, serology (for toxoplasmosis, cytomegalovirus, herpes simplex virus, and human immunodeficiency virus), and routine blood tests and urinalysis. Examination of vitreous samples consisted of polymerase chain reaction for cytomegalovirus, herpes simplex virus, and Mycobacterium tuberculosis, and cultures for fungi and bacteria. The results were analyzed 7 days and 6 months after surgery. RESULTS Analysis of vitreous samples showed cytomegalovirus in 3 patients, herpes simplex virus in 2, tuberculosis in 2, and Candida albicans in 5. All patients had improvement in visual acuity and severity of clinical signs seven days after surgery and in 10 cases after long-term follow-up. Final visual acuity was compromised by chronic macular edema, postinflammatory macular scarring, optic atrophy, subcapsular cataract formation, and capsular opacification after cataract surgery. CONCLUSIONS Modern laboratory tests are useful for quick and accurate diagnosis of atypical cases of severe infectious posterior uveitis. Early pars plana vitrectomy with silicon oil tamponade is valuable in diagnosing and treating severe infectious posterior uveitis and endophthalmitis.
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Affiliation(s)
- Aliza Jap
- Division of Ophthalmology, Changi General Hospital, 2 Simei Street 3, Singapore
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Magdei C, Cuşnir V, Bârcâ L. [Epstein Barr and cytomegaloviruses in ocular pathology]. Oftalmologia 2010; 54:23-28. [PMID: 20540365] [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
Epstein-Barr virus (EBV) and Citomegalovirus (CMV) are Herpesviridae family representative and presents a real danger for human. A very high infect risk of population farther the danger The ocular pathology induced by them can affect all media and tunics of optic analyzer. An etiologic differentiation is necessary for the mentioned viruses induced diseases. The etiologic differentiation has like purpose the enforcement of an effective and optimal antiviral and immunomodulating therapy.
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Affiliation(s)
- Corina Magdei
- Spitalul Clinic Republican Pentru Copii "Emilian Coţaga"
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Kozner P, Rozsypal H, Machala L, Filous A, Brozek B. [Two types of CMV ocular complications in patients with HIV infection]. Klin Mikrobiol Infekc Lek 2009; 15:180-182. [PMID: 19916157] [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: 05/28/2023]
Abstract
CMV retinitis is the most serious ocular complication of AIDS. Introduction of the combination antiretroviral therapy markedly reduced the occurrence of CMV retinitis, on the other hand it brought a new ocular complication - CMV uveitis. CMV uveitis is an immunopathological inflammatory reaction associated with the immune reconstitution inflammatory syndrome, which is a side effect of successfully initiated cART. These two forms of CMV ocular complications differ in pathogenesis, symptomatology and therapy. The CMV retinitis is treated with anti-CMV virostatics whereas the therapy of CMV uveitis is based on attenuation of the inflammatory reaction by administration of corticosteroids. The optimal prevention of both complications is an early initiation of cART before the CD4+ T lymphocytes drop below 200/microl.
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Affiliation(s)
- Pavel Kozner
- Eye Department, The Faculty Hospital Na Bulovce, Prague, Czech Republic
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Matos K, Muccioli C, Belfort Junior R, Rizzo LV. Correlation between clinical diagnosis and PCR analysis of serum, aqueous, and vitreous samples in patients with inflammatory eye disease. Arq Bras Oftalmol 2008; 70:109-14. [PMID: 17505729 DOI: 10.1590/s0004-27492007000100020] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [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: 09/14/2005] [Accepted: 07/25/2006] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To study the applicability (sensitivity, specificity) of polymerase chain reaction (PCR) tests in the detection of cytomegalovirus (CMV), herpes virus (HSV) and varicella zoster (VZV), Epstein-Barr virus (EBV), Mycobacterium sp and Toxoplasma gondii in the diagnosis of patients with or without AIDS, with presumably infectious uveitis, using serum, aqueous humor and vitreous humor samples. METHODS Twenty individuals with uveitis of presumed infectious origin were evaluated. Sixteen of them had AIDS, four were immunocompetent individuals. We also evaluated 4 normal controls who underwent vitrectomy surgery. Clinical evaluation of the patients was performed together by three clinicians. PCR evaluations of the serum, aqueous, and vitreous humor were performed in a masked fashion by the laboratory staff. RESULTS Twelve patients had a clinical diagnosis of CMV retinitis. Of these 6 (50%) had a positive PCR for CMV in the vitreous, three (25%) had a positive PCR for CMV in the serum, and none were positive in the aqueous. Five patients had a clinical diagnosis of acute retinal necrosis (ARN). Three (60%) of these had positive PCR for HSV/VZV in the vitreous. One of these patients had a positive PCR reaction for both EBV and HSV/VZV in the vitreous samples. One patient with cutaneous herpes zoster had a positive PCR reaction for HSV/VZV in the serum. Four patients had a presumed diagnosis of ocular toxoplasmosis, one patient (25%) had a positive PCR for Toxoplasma gondii in the serum, 3 (75%) had positive results in the aqueous, and 2 (50%) had positive results in the vitreous. One patient with presumed ocular tuberculosis had a positive PCR reaction both in the serum and in the vitreous samples. Finally, none of the four control individuals revealed any positive PCR reaction. CONCLUSION PCR is an auxiliary diagnostic procedure that should be evaluated together with ophthalmological aspects of the patient.
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Affiliation(s)
- Kimble Matos
- Setor de Uveite e AIDS, Universidade Federal de São Paulo, Rua Pintassilgo 480, São Paulo, SP, CEP 04514-032, Brazil.
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Westeneng AC, Rothova A, de Boer JH, de Groot-Mijnes JDF. Infectious uveitis in immunocompromised patients and the diagnostic value of polymerase chain reaction and Goldmann-Witmer coefficient in aqueous analysis. Am J Ophthalmol 2007; 144:781-5. [PMID: 17707328 DOI: 10.1016/j.ajo.2007.06.034] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [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: 01/02/2007] [Revised: 06/24/2007] [Accepted: 06/26/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE To establish the causes of uveitis in immunocompromised patients and to determine the contribution of polymerase chain reaction (PCR) and Goldmann-Witmer coefficient (GWC) analysis of aqueous humor in patients with an infectious etiology. DESIGN Retrospective case series of 56 consecutive immunocompromised patients with uveitis. METHODS All patients underwent full ophthalmologic examination and laboratory blood analysis for uveitis. Aqueous humor analyses were performed using PCR and GWC for cytomegalovirus (CMV), herpes simplex virus (HSV), varicella zoster virus (VZV), and Toxoplasma gondii. RESULTS Of 56 immunocompromised patients, 43 (77%), all posterior and panuveitis, had intraocular infections. Twenty-one (49%) had CMV, three (7%) had VZV, 11 (26%) had T. gondii, six (14%) had Treponema pallidum, and one (2%) each had Aspergillus and Candida. In AIDS patients, CMV was the most common cause. A strong correlation between AIDS and ocular syphilis was also observed (P = .007). In nonAIDS immunocompromised patients, T. gondii was most frequently detected. Twenty-seven patients were examined by both PCR and GWC; five (18.5%) were positive by both assays, 15 (55.5%) were positive by PCR alone and seven (26%) by GWC alone. Viral infections were detected by PCR in 16 of 17 (94%) cases; T. gondii in four of 10 (40%) patients. Using GWC, a viral infection was diagnosed in three of 17 (18%) and T. gondii in nine of 10 (90%) cases. CONCLUSIONS In immunocompromised patients, PCR is superior in diagnosing viral infections. Analysis of intraocular antibody production played a decisive role in the diagnosis of ocular toxoplasmosis.
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Milikan JCM, Kinchington PR, Baarsma GS, Kuijpers RWAM, Osterhaus ADME, Verjans GMGM. Identification of viral antigens recognized by ocular infiltrating T cells from patients with varicella zoster virus-induced uveitis. Invest Ophthalmol Vis Sci 2007; 48:3689-97. [PMID: 17652740 DOI: 10.1167/iovs.07-0020] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [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: 11/24/2022] Open
Abstract
PURPOSE Varicella zoster virus (VZV) is a common cause of infectious uveitis associated with an intraocular inflammatory response involving virus-specific T cells. In the current study, the functional characteristics and the antigen specificity of VZV-reactive T cells recovered from intraocular fluid (IOF) samples of five patients with VZV were determined. METHODS B-cell lines were infected with a comprehensive panel of recombinant vaccinia viruses expressing 11 individual VZV open reading frames (ORFs), or alternatively pulsed with the corresponding peptides to generate antigen-presenting cells (APCs). T-cell responsiveness of the IOF-derived VZV-specific T cells toward APCs was monitored by interferon (IFN)-gamma enzyme-linked immunosorbent spot-forming assays on bulk T-cell cultures and subsequently T-cell clones (TCCs). The cytokine-secretion profile and cytotoxicity of the VZV-specific TCCs was determined by ELISA and flow cytometry, respectively. RESULTS T-cell reactivity to VZV proteins encoded by ORF4, -10, -14, -18, -29, -31, -61, -62, -63, -67, and -68 was demonstrated, but specificity varied individually. T-cell epitopes on ORF62 and -68 were delineated. The TCCs secreted IFNgamma, but relatively low levels of interleukin-4 and -5, in response to VZV antigen-expressing APCs. The TCCs induced antigen-specific cytotoxic T-cell activity. CONCLUSIONS The results suggest that the intraocular VZV-specific T-cell response in the patients with VZV analyzed is directed to a broad spectrum of VZV antigens, including the latency-associated VZV proteins from ORFs 4, 29, 63, and particularly ORF62. This local T-cell response was in part mediated by cytotoxic CD4(+) T cells with a Th1/0-like effector memory phenotype.
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Nakano EM, Kuchembuck M, Nakano K, Oliveira M, Alvarenga LS, Portellinha W. [LASIK interface fluid accumulation caused by glaucoma associated with herpetic keratouveitis: case report]. Arq Bras Oftalmol 2007; 70:165-7. [PMID: 17505741 DOI: 10.1590/s0004-27492007000100032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 04/04/2005] [Accepted: 05/02/2006] [Indexed: 11/22/2022] Open
Abstract
Herpes simplex virus infection is a frequent cause of intraocular inflammation or anterior uveitis. Ocular hypertension is a common feature in herpetic keratouveitis. We describe a fluid accumulation and flap displacement in late postoperative period (28 months) of LASIK associated with ocular hypertension caused by herpetic keratouveitis. This finding supports the theory that flap attachment after LASIK is only partial and the virtual space remains indefinitely. The presence of ocular hypertension may lead to corneal edema and fluid accumulation in the interface.
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Affiliation(s)
- Eliane Mayumi Nakano
- Departamento de Oftalmologia, Universidade Federal de São Paulo, Rua Vergueiro 2087, São Paulo, SP, CEP 04101-000, Brazil
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Abstract
In the early 1980s, the first human retrovirus, human T-cell leukemia virus type I (HTLV-I), was isolated and its characterization opened up the new field of human viral oncology. Adult T-cell leukemia/lymphoma (ATLL), which is associated with HTLV-I, is characterized clinically by the appearance of characteristic flower cells, a rapid clinical course, occasional skin lesions, lymphadenopathy and hepatosplenomegaly. Severe opportunistic infections are occasionally accompanied. In addition, HTLV-I infection is associated with autoimmune and reactive disorders, such as HTLV-I-associated myelopathy and uveitis, and is also related to immunodeficient infectious diseases. Pathological findings of ATLL in the lymph nodes, skin, liver and other organs have been described. Common histological features are a diffuse proliferation of atypical lymphoid cells that vary in size and shape. In addition to ATLL, non-neoplastic organopathies have been documented in many organs, such as the central nerve system, lung, skin, lymph nodes and gastrointestinal tract. To clarify the HTLV-I-associated diseases, it is important to understand the pathological variations.
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Affiliation(s)
- Koichi Ohshima
- Department of Pathology, School of Medicine, Kurume University, Asahimati 67, Kurume 830-0011, Japan.
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Maslin J, Bigaillon C, Froussard F, Enouf V, Nicand E. Acute bilateral uveitis associated with an active human herpesvirus-6 infection. J Infect 2007; 54:e237-40. [PMID: 17303245 DOI: 10.1016/j.jinf.2006.12.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [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: 09/26/2006] [Revised: 11/14/2006] [Accepted: 12/24/2006] [Indexed: 11/25/2022]
Abstract
Human herpesvirus 6 (HHV-6), which is usually responsible for exanthem subitum in children, can reactivate from its latent form after primary infection. It has been implicated in hepatitis, pneumonitis, retinitis and severe infections of the central nervous system in both immunosuppressed and immunocompetent patients. However, involvement of HHV-6 in these infections has not yet been clearly demonstrated. We report the case of a patient presenting a bilateral uveitis from whom HHV-6 was isolated in both aqueous fluid and cerebrospinal fluid (CSF). No other pathogenic agents were found. Diagnosis by polymerase chain reaction (PCR) followed by sequencing of part of the genome revealed the presence of HHV-6 in both aqueous fluid and CSF. Serum IgM and IgG HHV-6 antibodies were significantly elevated in two successive examinations by immunofluorescence. Patient recovery following antiviral therapy suggested that a protocol based on foscarnet followed by ganciclovir was effective. HHV-6 may be responsible for uveo-meningitis. Diagnosis by PCR analysis is essential to identify HHV-6 and to initiate a specific antiviral therapy as fast as possible.
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Affiliation(s)
- Jérôme Maslin
- Laboratoire de Biologie Médicale, Groupement Médico Chirurgical Bouffard, SP Armées, Djibouti.
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Matsuda H, Hayashi K, Meguro M, Saruta T. A case report of progressive multifocal leukoencephalopathy in a human T-cell lymphotropic virus type 1-infected hemodialytic patient. Ther Apher Dial 2006; 10:291-5. [PMID: 16817797 DOI: 10.1111/j.1744-9987.2006.00371.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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
We experienced a case manifesting progressive multifocal leukoencephalopathy (PML) in a hemodialytic patient with hepatitis C virus-induced liver cirrhosis and human T-cell lymphotropic virus type-1 (HTLV-1)-associated uveitis. A 57-year-old male patient had received chronic hemodialysis therapy for 10 years, during which he received multiple blood transfusions and HTLV-1-associated uveitis developed. He complained of visual disturbance and disorientation. Brain CT scan showed diffuse and multifocal low density areas in occipital and temporal lobes, with gray matter relatively spared. MRI imaging showed high intensity lesions in the same areas. Cerebrospinal fluid culture was negative, but using nested PCR, rearranged regulatory region of JC virus DNA was detected. His consciousness level gradually deteriorated and complete paraplegia developed. Seven months after admission, he died of pneumonia. An autopsy confirmed the diagnosis of PML. Notably, mononuclear cell infiltration, gliosis and demyelinating lesions but no nuclear inclusion bodies were observed in the thoracic cord, which suggested HTLV-1-associated myelopathy. Because JC virus is activated under immunocompromised conditions, precipitating factors in this case appear multifactorial; depressed immune system induced by chronic hemodialysis as well as blood-borne hepatitis C virus/HTLV-1 infection might contribute to the activation of dormant JC virus and the development of florid clinical manifestation of PML.
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Affiliation(s)
- Hiroto Matsuda
- Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
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Garweg JG, Wanner D, Sarra GM, Altwegg M, Loosli H, Kodjikian L, Halberstadt M. The diagnostic yield of vitrectomy specimen analysis in chronic idiopathic endogenous uveitis. Eur J Ophthalmol 2006; 16:588-94. [PMID: 16952099 DOI: 10.1177/112067210601600414] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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: 11/17/2022]
Abstract
PURPOSE The low diagnostic yield of vitrectomy specimen analysis in chronic idiopathic uveitis (CIU) has been related to the complex nature of the underlying disease and to methodologic and tissue immanent factors in older studies. In an attempt to evaluate the impact of recently acquired analytic methods, the authors assessed the current diagnostic yield in CIU. METHODS Retrospective analysis of consecutive vitrectomy specimens from patients with chronic endogenous uveitis (n = 56) in whom extensive systemic workup had not revealed a specific diagnosis (idiopathic) and medical treatment had not resulted in a satisfying clinical situation. Patients with acute postoperative endophthalmitis served a basis for methodologic comparison (Group 2; n = 21). RESULTS In CIU, a specific diagnosis provided in 17.9% and a specific diagnosis excluded in 21.4%. In 60.7% the laboratory investigations were inconclusive. In postoperative endophthalmitis, microbiological culture established the infectious agent in 47.6%. In six of eight randomly selected cases, eubacterial PCR identified bacterial DNA confirming the culture results in three, remaining negative in two with a positive culture and being positive in three no growth specimens. A double negative result never occurred, suggesting a very high detection rate, when both tests were applied. CONCLUSIONS The diagnostic yield of vitrectomy specimen analysis has not been improved by currently routinely applied methods in recent years in contrast to the significantly improved sensitivity of combined standardized culture and PCR analysis in endophthalmitis. Consequently, the low diagnostic yield in CIU has to be attributed to insufficient understanding of the underlying pathophysiologic mechanisms.
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Affiliation(s)
- J G Garweg
- Swiss Eye Institute, Gossetstrasse 43, CH-3084 Wabern, Switzerland.
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32
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Teplinskaia LE, Filichkina NS. [Hyper-IGE reactions in uveitis and their immunomodulation with cytokine-containing agents]. Vestn Oftalmol 2006; 122:33-5. [PMID: 17217200] [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: 05/13/2023]
Abstract
Examination of 73 patients with primary, active uveitis of various etiology established a high frequency (78%) of IgE hyperconcentrations particularly among patients with viral uveitis (95%) and in the presence of systemic diseases (65.2%). The correlations between IgE and some values of T, humoral immunity, and cytokines support the multiple factors of the immunopathogenesis of uveitis. Combined treatment with local instillations of autocytokines and superlymph provided a high immunomodulating effect. The established IgE hyperproduction in uveitis may be a reflection of either rapidly progressive allergy or an allergic background and serve as a pathogenetic rationale for the use of antihistamines and immunotherapy with cytokine-containing agents.
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Terrada C, Fisson S, De Kozak Y, Kaddouri M, Lehoang P, Klatzmann D, Salomon BL, Bodaghi B. Regulatory T cells control uveoretinitis induced by pathogenic Th1 cells reacting to a specific retinal neoantigen. J Immunol 2006; 176:7171-9. [PMID: 16751360 DOI: 10.4049/jimmunol.176.12.7171] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In many clinical cases, uveitis develops secondary to an infection. This could result from peripheral activation followed by ocular penetration and reactivation of T cells specific for microbial Ags expressed in the retina. To gain insights into the pathophysiology of uveitis, we developed a new mouse model based on stable retinal expression of influenza virus hemagglutinin (HA) neoantigen by adeno-associated virus-mediated gene transfer. One month thereafter, we adoptively transferred HA-specific T cells, which were activated in vitro or in vivo. Intraocular inflammation was clinically and histologically observed in all animals within 15 days. The ocular infiltrate was composed mostly of macrophages and HA-specific T cells with a proinflammatory cytokine profile. Depletion of CD4(+)CD25(+) regulatory T cells exacerbated the disease, whereas HA-specific CD4(+)CD25(+) T cells given i.v. controlled the disease. This novel model should allow to better study the pathophysiology and therapeutic of uveitis.
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MESH Headings
- Animals
- Antigens, Viral/biosynthesis
- Antigens, Viral/genetics
- Cell Movement/genetics
- Cell Movement/immunology
- Cytokines/biosynthesis
- Dependovirus/genetics
- Dependovirus/immunology
- Epitopes, T-Lymphocyte/genetics
- Epitopes, T-Lymphocyte/immunology
- Female
- Genetic Vectors/administration & dosage
- Hemagglutinin Glycoproteins, Influenza Virus/administration & dosage
- Hemagglutinin Glycoproteins, Influenza Virus/biosynthesis
- Hemagglutinin Glycoproteins, Influenza Virus/genetics
- Hemagglutinin Glycoproteins, Influenza Virus/immunology
- Mice
- Mice, Inbred BALB C
- Mice, Transgenic
- Radiation Chimera
- Receptors, Antigen, T-Cell/genetics
- Receptors, Antigen, T-Cell/immunology
- Retina/immunology
- Retina/pathology
- Retina/virology
- Retinitis/immunology
- Retinitis/pathology
- Retinitis/prevention & control
- Retinitis/virology
- T-Lymphocytes, Regulatory/immunology
- T-Lymphocytes, Regulatory/metabolism
- T-Lymphocytes, Regulatory/transplantation
- T-Lymphocytes, Regulatory/virology
- Th1 Cells/immunology
- Th1 Cells/pathology
- Th1 Cells/virology
- Uveitis/immunology
- Uveitis/pathology
- Uveitis/prevention & control
- Uveitis/virology
- Vitreous Body/immunology
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Affiliation(s)
- Céline Terrada
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7087 , Hôpital de la Pitié-Salpêtrière, Paris, France
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Milikan JCM, Kuijpers RWAM, Baarsma GS, Osterhaus ADME, Verjans GMGM. Characterization of the varicella zoster virus (VZV)-specific intra-ocular T-cell response in patients with VZV-induced uveitis. Exp Eye Res 2006; 83:69-75. [PMID: 16530754 DOI: 10.1016/j.exer.2005.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 08/16/2005] [Revised: 10/31/2005] [Accepted: 11/05/2005] [Indexed: 11/18/2022]
Abstract
Varicella zoster virus (VZV) is a well-known cause of infectious uveitis. The aim of this study was to characterize the VZV-specific T-cell response in eyes of patients with VZV-induced uveitis. T-cell lines (TCL) were generated by mitogenic stimulation of intra-ocular fluid (IOF) samples obtained from eight patients with VZV-induced uveitis. Two patients with herpes simplex virus (HSV)-induced uveitis were included as disease controls. Characterization of individual T-cells in the TCL was performed by stimulating the TCL with mock, HSV-1 and VZV antigen pulsed autologous B cells and subsequent flow cytometric analyses. Virus specificity and phenotype of the T-cells were identified by simultaneous detection of intracellular gamma interferon and cell surface markers CD4, CD8, CD3 or T-cell receptor (TCR) beta chain variable region (TCRBV) usage. The TCL obtained from patients with HSV-1-induced uveitis contained higher numbers of T-cells reactive to HSV-1 compared to VZV. VZV-specific T-cells were detected in all TCL of the patients diagnosed with VZV-induced uveitis. Four out of six TCL obtained from patients with VZV-induced uveitis that were assayed for both viruses, contained higher numbers of T-cells reactive to VZV compared to HSV-1. Detailed analyses of the TCL of two patients demonstrated that the VZV reactivity within the assayed TCL was dominated by T-cells expressing one specific TCRBV gene. The data implicate that VZV-reactive T-cells infiltrate and participate in the local inflammatory response in eyes of patients with VZV-induced uveitis.
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Affiliation(s)
- Johannes C M Milikan
- Institute of Virology, Erasmus Medical Center, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
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35
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Abstract
AIMS To describe the cases of opportunistic posterior uveal infection diagnosed in renal transplant recipients at a single center over a 10-year period. METHODS The study involved 1156 patients who underwent renal transplantation. Five of the recipients were diagnosed with posterior uveal infection. The specific diagnoses were acute retinal necrosis (two cases), cytomegalovirus retinitis (one case), nocardial chorioretinitis (one case), or tuberculoid granuloma (one case). RESULTS The five patients were aged 27 to 55 years, and the interval from renal transplantation to uveal infection ranged from 7 months to 16 years. All patients were receiving immunosuppressive treatment at the time of the posterior uveal infection. Acute retinal necrosis was diagnosed in cases I and II at 2 and 3 years after transplantation, respectively. In both cases, fundus examination revealed moderate vitritis and yellow-white lesions representing confluent retinitis. In case III (cytomegalovirus retinitis), 7 months after transplantation the patient developed extensive hemorrhage and confluent white exudates, periphlebitis, and perivascular sheathing in the right eye. In case IV, culture of a fine-needle aspirate from a well-demarcated, white-yellow, elevated choroidal lesion in the superotemporal region of the macula revealed nocardial infection. Fundus examination of the right eye of case V revealed a small, hypopigmented choroidal lesion superior to the optic disc. The lesion was identified as a choroidal tuberculoid granuloma. CONCLUSIONS Opportunistic chorioretinal infections can occur at any time after renal transplantation. So it is important that every kidney recipient undergo regular ophthalmic examinations throughout his or her lifetime.
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Affiliation(s)
- Y A Akova
- Baskent University Faculty of Medicine, Ankara Hospital, Ankara, Turkey.
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Balba GP, Kumar PN, James AN, Malani A, Palestine AG, Welch JN, Timpone JG. Ocular syphilis in HIV-positive patients receiving highly active antiretroviral therapy. Am J Med 2006; 119:448.e21-5. [PMID: 16651059 DOI: 10.1016/j.amjmed.2005.11.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2005] [Revised: 11/04/2005] [Accepted: 11/04/2005] [Indexed: 11/16/2022]
Abstract
BACKGROUND From October 2001 to October 2002, we have observed a surprisingly high incidence of ocular syphilis in human immunodeficiency virus-positive (HIV+) patients receiving highly active antiretroviral therapy at our clinic. METHODS We conducted a retrospective chart and patient database review. RESULTS From 1997 to 2002, 455 patients in our clinic were screened for syphilis; 320 were screened from 2001 to 2002; 7.3% of patients (33/455) were diagnosed with syphilis. During the past year, syphilis was diagnosed in 7.5% of patients (24/320), of whom 13% (3/24) had ocular syphilis. We estimate the prevalence of ocular syphilis in HIV+ patients on highly active antiretroviral therapy screened for syphilis to be 9% (3/33). Presenting symptoms included blurred vision, loss of vision, central scotomas, and bilateral ocular involvement. The most common ocular manifestation of syphilis was posterior chamber uveitis; one patient also had a retinal detachment. All patients demonstrated reactive rapid plasma reagin and fluorescent treponemal antibody absorption test results, cerebrospinal fluid pleocytosis, and elevated total protein. Each patient received a 21-day course of intravenous penicillin G (24 million units daily) with improvement of visual symptoms. CONCLUSION Our data demonstrate an unexpectedly high incidence of ocular syphilis in our HIV+ patients receiving highly active antiretroviral therapy during the past year. A diagnosis of ocular syphilis should be considered in any HIV+ patient who presents with visual symptoms, irrespective of the patient's CD4 count.
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Affiliation(s)
- Gayle P Balba
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA.
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Yukawa E, Urano T, Nakahara M, Miyata K, Matsuura T, Taketani F, Hara Y, Mochizuki M. Pattern-reversal visual evoked potentials in patients with human T-lymphotropic virus type 1 uveitis. Curr Eye Res 2006; 31:37-42. [PMID: 16421018 DOI: 10.1080/02713680500479509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 10/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the possible injury in the optic pathway by measuring P100 peak latency of pattern-reversal visual evoked potentials (PVEPs) in patients with human T-lymphotropic virus type 1 uveitis (HU). METHODS The P100 peak latency of PVEP was measured during the period without macular abnormalities observed by fluorescein angiography in 23 patients (46 eyes) with HU and 24 patients (48 eyes) with Vogt-Koyanagi-Harada disease (VKH) with a corrected visual acuity of 20/25 or more. To determine the normal upper limit of P100 peak latency, PVEPs were measured in 31 normal subjects (31 eyes). In addition, in the HU patients, the serum anti-HTLV-1 antibody titer was measured by particle agglutination assay within 3 months of PVEP recording, and the period of HU was retrospectively surveyed. RESULTS Delayed latency was observed in 4 (7 eyes) of the 23 patients (46 eyes) with HU but none of the 24 patients (48 eyes) with VKH. All four patients with delayed latency showed a serum anti-HTLV-1 antibody titer of more than x4000. The HU period in the HU patients was 0.2-14.0 years, and the HU periods in the four patients with delayed latency were 0.8, 2.7, 4.2, and 14.0 years, respectively. CONCLUSIONS We measured pattern-reversal visual evoked potentials and observed delayed P100 peak latency in 7 of the 46 eyes in 4 (17.4%) of the 23 HU patients. This suggests injury in the optic pathway including the optic nerve by HTLV-1 in some patients with HU. In the future, consideration should also be given to the possible development of optic neuropathy due to HTLV-1.
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De Groot-Mijnes JDF, Rothova A, Van Loon AM, Schuller M, Ten Dam-Van Loon NH, De Boer JH, Schuurman R, Weersink AJL. Polymerase chain reaction and Goldmann-Witmer coefficient analysis are complimentary for the diagnosis of infectious uveitis. Am J Ophthalmol 2006; 141:313-8. [PMID: 16458686 DOI: 10.1016/j.ajo.2005.09.017] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.1] [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: 06/03/2005] [Revised: 09/13/2005] [Accepted: 09/13/2005] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine the relative contribution of the analysis of intraocular antibody production and the polymerase chain reaction (PCR) in aqueous humor (AH) to the diagnosis of infectious uveitis. DESIGN Retrospective case-control study. METHODS Paired AH and serum samples from 230 patients suspected of infectious uveitis were examined for intraocular antibody production against herpes simplex virus (HSV), varicella zoster virus (VZV), and Toxoplasma gondii by calculating the Goldmann-Witmer coefficient (GWC). In addition, AH samples were investigated by real-time PCR to determine the presence of microbial DNA. RESULTS Positive results were obtained in 54 cases (23%): 13 HSV (24%), 16 VZV (30%), and 25 T gondii (46%). Of these, 23 (43%) were positive for both GWC and PCR, 26 (48%) only for GWC, and 5 (9%) only for PCR. With PCR as the sole diagnostic approach, a correct diagnosis of the infectious etiology would have been missed in 34% of cases for the herpes viruses and in 64% for T gondii. Analysis of the relationship between a positive laboratory diagnosis and the time of sampling after onset of ocular disease demonstrated that intraocular antibody production was found throughout the course of the diseases. Viral DNA was more readily detected early in infection. In contrast, T gondii nucleic acid was not detected until 3 weeks after onset of ocular disease. CONCLUSIONS Analysis of intraocular antibody production contributed considerably to the etiological diagnosis of infectious uveitis, most notably of ocular toxoplasmosis early after onset of disease. Therefore, both PCR and GWC determination might be performed for comprehensive diagnosis of intraocular infections.
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MESH Headings
- Animals
- Antibodies, Protozoan/analysis
- Antibodies, Viral/analysis
- Aqueous Humor/immunology
- Aqueous Humor/parasitology
- Aqueous Humor/virology
- Case-Control Studies
- DNA, Protozoan/analysis
- DNA, Viral/analysis
- Enzyme-Linked Immunosorbent Assay/methods
- Eye Infections, Parasitic/diagnosis
- Eye Infections, Parasitic/parasitology
- Eye Infections, Viral/diagnosis
- Eye Infections, Viral/virology
- Herpesvirus 3, Human/genetics
- Herpesvirus 3, Human/immunology
- Humans
- Polymerase Chain Reaction/methods
- Retrospective Studies
- Simplexvirus/genetics
- Simplexvirus/immunology
- Toxoplasma/genetics
- Toxoplasma/immunology
- Uveitis/diagnosis
- Uveitis/parasitology
- Uveitis/virology
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Affiliation(s)
- Jolanda D F De Groot-Mijnes
- Department of Virology, Eijkman-Winkler Center, and F.C. Donders Institute of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Schrier RD, Song MK, Smith IL, Karavellas MP, Bartsch DU, Torriani FJ, Garcia CR, Freeman WR. INTRAOCULAR VIRAL AND IMMUNE PATHOGENESIS OF IMMUNE RECOVERY UVEITIS IN PATIENTS WITH HEALED CYTOMEGALOVIRUS RETINITIS. Retina 2006; 26:165-9. [PMID: 16467672 DOI: 10.1097/00006982-200602000-00007] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [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: 11/26/2022]
Abstract
PURPOSE To investigate immune and viral contributions to the pathogenesis of immune recovery uveitis (IRU), which presents as vitritis, macular edema, or formation of epiretinal membranes, and develops in patients with acquired immunodeficiency syndrome (AIDS) who experienced cytomegalovirus (CMV) retinitis before antiretroviral treatment (ART) induced immune reconstitution. METHODS Aqueous and vitreous fluids from patients with IRU, active CMV retinitis, and control human immunodeficiency virus (HIV)-negative, noninflamed eyes were compared for presence of cytokines IL-6, IL12, interferon gamma using enzyme-linked immunosorbent assay techniques, and CMV DNA (by polymerase chain reaction). RESULTS IRU eyes (11 patients, 18 samples) had the highest levels of IL-12 (median 48 pg/mL), moderate levels of IL-6 (median 146 pg/mL), and low but significant interferon gamma (median 15 pg/mL), compared to controls (P < 0.01). All uveitis eyes tested (9/9) were CMV DNA negative. In contrast, active CMV retinitis eyes were CMV DNA positive, had higher levels of IL-6 (median 349 pg/mL) (25 patients, 41 samples) than both control (P = 0.0001) and uveitis eyes (P = 0.048), similar levels of interferon gamma (median 27 pg/mL) to uveitis eyes, but less IL-12 (median 0 pg/mL) than uveitis eyes. CONCLUSIONS Inflammatory IRU can be differentiated from active CMV retinitis by the presence of IL-12, less IL-6, and absence of detectable CMV replication.
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Affiliation(s)
- Rachel D Schrier
- Division of Infectious Diseases, Department of Pathology, University of California-San Diego, UCSD Medical Center, MC 8416, 200 W. Arbor Drive, San Diego, CA 92103-8416, USA.
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40
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Affiliation(s)
- Laura K Green
- Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
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41
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Abstract
PURPOSE To assess whether the results of microbial and cytological investigations of vitreous biopsy specimens are useful in the management of patients with intraocular inflammation. METHOD A retrospective review of the medical records of 59 consecutive patients from consulting rooms, outpatient clinics and inpatient consultation who underwent intravitreal sampling between January 1997 and December 2003. Results of the biopsies were examined to determine if they altered management of the patient. RESULTS The clinical diagnosis was correct in 37 of 59 patients (62.7%) with ocular inflammation. The organism was identified in 50% (7/14) of vitreous biopsies in patients with postoperative endophthalmitis. Of patients with endogenous bacterial endophthalmitis 16.7% (1/6) had the diagnosis confirmed by vitreous tap and 83.3% (5/6) had positive cultures from other sites that provided the diagnosis. Of the fungal endophthalmitis 80% (4/5) grew the fungus from the vitreous biopsy. Viral polymerase chain reaction identified the causative organism in 87.5% (7/8) of patients with clinical diagnosis of viral infection. 30.8% (4/13) vitreous biopsies in patients with clinically suspected masquerade syndromes were diagnosed as lymphoma. Vitreous biopsy results altered management significantly in seven (11.9%) patients. These patients included toxoplasmosis that was thought to be viral retinitis; malignant melanoma thought to be fungal endophthalmitis; chronic inflammation secondary to retinal detachment that was thought to be a neoplasm; three patients with infective endophthalmitis thought to be idiopathic uveitis and a patient with known lung carcinoma thought to have metastases who had lymphoma. In 67.8% (40/59) the vitreous sample helped to either confirm the diagnosis or exclude an infective cause. Complications from vitrectomy were hypotony (1/29) and retinal detachment (1/29). CONCLUSION Clinical diagnosis based on examination findings and vitreous biopsy is highly accurate. Vitreous sampling altered the management of seven of 59 patients. Vitreous biopsy is a safe and useful method for diagnosing and excluding malignancy and infection in patients with ocular inflammation. Viral polymerase chain reaction is highly sensitive and accurate. The sensitivity of microbiological culture techniques for bacteria and fungi limits their usefulness.
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Affiliation(s)
- Harkiran Manku
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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Imaizumi M, Tatewaki SY, Kimoto KI, Takaki Y, Nakatsuka K, Furushima M, Matsumoto CS, Choshi T. DISAPPEARANCE OF PUNCTA AFTER UVEITIS IN AN EYE WITH FUNDUS ALBIPUNCTATUS. Retina 2005; 25:1096-8. [PMID: 16340543 DOI: 10.1097/00006982-200512000-00021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Masamoto Imaizumi
- Department of Ophthalmology, Oita Prefectural Hospital, Oita University Faculty of Medicine, Hasama-machi, Oita, Japan.
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Streho M, Delair E, Abad S, Sablé-Fourtassou R, Blanche P, Monnet D, Brion MC, Brezin AP, Dhote R. Uvéite et thyroïdite associée à HTLV-1. Rev Med Interne 2005; 26:894-6. [PMID: 16146665 DOI: 10.1016/j.revmed.2005.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 04/06/2005] [Accepted: 07/11/2005] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The oncovirus HTLV-1 is aetiologically associated with uveitis and autoimmune thyroiditis in endemic areas. The association of uveitis with autoimmune thyroiditis in HTLV-1 carriers is less common moreover in non-endemic area. EXEGESE We report two original cases of simultaneous uveitis and autoimmune thyroiditis in HTLV-1 carriers, without other disease due to HTLV-1. The visual outcome was favorable in both cases. CONCLUSION A significant correlation exists between hyperthyroidism, uveitis and HTLV-1, but still needs to be confirmed. The autoimmune or immune mediated mecanism of HTLV-1 may be involved in the uveitis and the thyroidits.
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Affiliation(s)
- M Streho
- Service de médecine interne, hôpital Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France
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Brasnu E, Wechsler B, Bron A, Charlotte F, Bliefeld P, Lehoang P, Marcelin AG, Bodaghi B. Efficacy of interferon-alpha for the treatment of Kaposi's sarcoma herpesvirus-associated uveitis. Am J Ophthalmol 2005; 140:746-8. [PMID: 16226536 DOI: 10.1016/j.ajo.2005.04.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 11/01/2004] [Revised: 04/10/2005] [Accepted: 04/11/2005] [Indexed: 12/15/2022]
Abstract
PURPOSE To report cases of uveitis that are associated with human herpesvirus-8 (HHV-8) and the impact of interferon-alpha therapy on their visual outcome. DESIGN Interventional case reports. METHODS Extensive examination was performed in patients with chronic and severe uveitis to exclude a viral cause that requires specific therapy. After histopathologic, molecular, and/or serologic confirmation of HHV-8 uveitis, interferon-alpha2a therapy (3 millions IU/d, 3 days per week, subcutaneously) was initiated. RESULTS Two patients of Mediterranean origin were included. HHV-8 serologic result was positive in both cases. Histopathologic examination of conjunctival biopsy specimens confirmed Kaposi's sarcoma in the second case, and quantitative polymerase chain reaction identified HHV-8 DNA in the biopsy specimen. Disease was controlled by interferon-alpha2a in both cases, but maintenance therapy was mandatory to prevent relapses. CONCLUSION HHV-8-associated uveitis is a rare condition in immunocompetent hosts. Severe and chronic conditions may require antiviral and immunomodulatory therapies. Interferon alpha seems to be a good candidate and may be proposed in these cases.
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Affiliation(s)
- Emmanuelle Brasnu
- Department of Ophthalmology, University of Paris VI, Pitie-Salpêtrière Hospital, Paris, France
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Krichevskaia GI, Andzhelov VO, Katargina LA, Starikova AV, Denisova EV, Zvonarev AI, Kuliakina MN, Tsutskiridze NG. [Reactivation of persistent herpes virus infection as a factor of endogenous uveitis in children]. Vestn Oftalmol 2005; 121:22-4. [PMID: 15881151] [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: 05/02/2023]
Abstract
Two hundred and fifty-five children with endogenous uveitis, aged 2 months to 15 years, were examined. 73-93% of children were chronically infected by different viruses of the human herpes group; mycoplasmal past-infection was detected in only 13% of them and Chlamydia past-infection _ in 3.7% of them. Herpes simplex virus of type 1 reactivated reliably more often versus other types of Herpesviridae. Reactivation of cytomegalovirus infection prevailed in mothers who gave birth to children with intrauterine uveitis. A prolonged active replication of herpes virus was primarily observed in children with a Suppressed cell antiviral immunity component. Uveitis in such children was notable for a severe clinical course and trend towards often relapses.
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46
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Abstract
PURPOSE OF REVIEW The virology, pathophysiology, and treatment of the varicella zoster virus (VZV) have been investigated for many years now. Infection with VZV has different ramifications for people of different ages and immune status. The various aspects of VZV disease make it difficult to treat. Selected aspects of VZV disease that pertain to ocular disease are presented. RECENT FINDINGS The risk factors for VZV disease in the different age spectrums and with concomitant immunodeficiencies have been further clarified. Studies suggest that the VZV may persist for prolonged periods on the cornea after herpes zoster ophthalmicus (HZO). Herpes Simplex Virus (HSV) or VZV may cause many cases of idiopathic uveitis with sectoral iris atrophy. The different patterns of retinal disease caused by VZV may relate to the immune status. Systemic antiviral medications for herpes zoster should be instituted within 72 hours of the rash but could be used later. Systemic antivirals combined with systemic corticosteroids improve the early quality of life in HZ patients. Postherpetic neuralgia is not prevented by early systemic antivirals or corticosteroids. Present systemic antivirals are all effective, but Famvir offers the best dosing schedule. The VZV vaccine is effective but there are some issues that suggest the need for a different vaccination regimen. SUMMARY Further research must be performed on the clinical and therapeutic aspects of the VZV disease. Although both the vaccine and systemic antivirals have brought tremendous improvements, the disease persists. Therapy lessens but does not eliminate many of the complications. The disease may manifest in unpredictable patterns in this era of vaccination.
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47
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Abstract
Since the introduction of West Nile virus in the Western Hemisphere in 1999, the incidence of human infection has increased dramatically. As this virus spreads westward across the United States, ophthalmologists should be aware of this presently uncommon but important condition. Systemic features of West Nile virus infection are well characterized; however, the ophthalmic presentations are not widely known. Intraocular involvement with West Nile virus infection was first described in February 2003, and a variety of ophthalmic manifestations have since been recognized. A complete survey of the systemic and intraocular manifestations of West Nile virus infection relevant to the ophthalmologist is presented.
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Affiliation(s)
- Seema Garg
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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48
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Mathur R, Lim WK, Chan CC, Chee SP. Reactive iris lymphoid proliferation presenting as the AIDS-defining event in an HIV patient with systemic lymphoma. AIDS 2004; 18:2215-6. [PMID: 15577661 DOI: 10.1097/00002030-200411050-00020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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49
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Abstract
Enterovirus uveitis (EU) is a new infant eye disease that was first observed in 1980. Three distinct subtypes of human echoviruses, EV19/K, EV11/A and EV11/B, caused five hospital outbreaks of EU in different Siberian cities in 1980-1989, affecting approximately 750 children, predominantly below 1 year of age. Sporadic EU cases were also retrospectively diagnosed in other regions of Russia and in different countries of the Former Soviet Union. The illness was characterised by rapid iris destruction and severe complications, including cataract and glaucoma. The disease has been a subject of intensive studies and was reproduced in lower primates after intraocular inoculation of isolated enterovirus strains. Importantly, prototype EV11 and EV19 strains did not induce notable disease in experimental monkeys. Some of the EU-causing strains were shown to be similar phylogenetically and in their pathogenetic properties to the enterovirus strains associated with multisystem hemorrhagic disease of newborns. In this review we present a summary of the vast epidemiological, virological, clinical and experimental data on this new form of ophthalmic infection.
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Affiliation(s)
- Vasilii A Lashkevich
- Chumakov Institute of Poliomyelitis and Viral Encephalitides RAMS, Moscow, Russia.
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50
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Abstract
Viral eye diseases are common and associated with different well-known forms of uveitis. However, experimental models and clinical observations have led to an infectious, in particular a viral etiology in different autoimmune conditions. The use of molecular techniques is particularly informative, not only to characterize the previously well-known subgroup of presumed viral uveitis, but also to define the role of these agents or emerging viruses in atypical forms of autoimmune uveitis resistant to conventional therapy. PCR detection of viral DNA in patients with uveitis is a rapid, sensitive and accurate procedure. Therefore, aqueous humor could be analyzed when uveitis is unresponsive to anti-inflammatory molecules, in order to exclude a viral condition and dramatically modify the therapeutic management. Several new viral entities have recently been identified such as cytomegalovirus-associated chronic anterior uveitis and non-necrotizing herpetic retinopathies in immunocompetent hosts. Systemic antiviral drugs should be proposed rapidly in order to control viral replication before the use of corticosteroids. Maintenance therapy based on low-dose antivirals can reduce the rate of recurrence and should be considered.
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Affiliation(s)
- B Bodaghi
- Service d'Ophtalmologie, Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris.
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