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Prevalence of uveitis: a retrospective study.

BACKGROUND: Uveitis is commonly seen in optometric practice, and anterior uveitis accounts for more than 75% of all uveitis. Uveitis may be the initial manifestation of an associated systemic disease process; and, with proper testing and diagnosis, the patient's ocular and systemic condition may be more effectively treated. METHODS: Retrospectively, 194 charts from a referral practice with a general diagnosis of uveitis, retinitis, or chorioretinal scar were reviewed to determine medical history, clinical findings, tests performed, and specific diagnoses obtained. RESULTS: The majority of cases, 87.6%, were anterior uveitis with more than half, 54.7%, presenting with undetermined etiology. Trauma was the cause of the next most common group of anterior uveitis patients, 21.8%, and accounted for 19.1% of all uveitis cases. Glaucomatocyclitic crisis was seen in 8 cases, 4.1%, while there were 7 patients with sarcoid disease, and 5 with ankylosing spondylitis or systemic lupus erythematosus. Posterior uveitis was the principle finding in 12.4% of cases with ocular histoplasmosis being most common. There were 4 cases of toxoplasmosis and 3 cases of pars planitis. CONCLUSIONS: Utilization of laboratory testing proved to be most valuable in the treatment and management of uveitis. Although there were fewer cases of pars planitis reported in our study in comparison to previous reports, the mix of cases of uveitis in our study was comparable to the work of others in the field. Accurate diagnosis of these cases is quite important since the treatment and prognosis for recovery is variable and different with its associated diseases.

Adolescent↗

[Ocular manifestations in HIV infected patients attending the department of ophthalmology of Universidade Federal de São Paulo].

PURPOSE: To evaluate ocular manifestations of HIV-infected patients. MATERIAL AND METHODS: A retrospective study of 1,100 HIV positive out patients in 3 years with a standard complete ophthalmological exam. RESULTS: Eight hundred and sixty nine (79%) of the 1,100 patients studied were male and 231 (21%) female. The most important risk factors were: male homosexuality in 303 cases (27.55%), heterosexuality in 272 (24.73%), endovenous drugs use in 168 (15.27%), and unknown cause in 246 (26.36%). Related to ocular complains, we found 432 (39.27%) patients with decreased visual acuity, 138 (12.55%) with visual hazy, 64 (5.82%) with ocular pain, 186 (16.9%) with inspecific complaints, and 235 (21.36%) with no complains. The most frequent ocular manifestations were: CMV retinitis in 246 (22.36%), cotton wool spots in 110 (10%), blepharitis in 51 (4.64%), and toxoplasmosis in 48 (4.36%). CONCLUSION: The increase of disease ratio was observed among heterosexual and females in this specific population. Patients with ocular complains were 79.42%. The most frequent ocular manifestations was CMV retinitis, in 246 (22.36%). We found also 10% of cotton wool spots.

Brazil↗

Ocular tissue absorption of clindamycin phosphate.

Clindamycin phosphate, a new semisynthetic antibiotic that is effective in the treatment of toxoplasmosis and of infections caused by Gram-positive bacteria, was found to be highly concentrated in the choroid, iris, and retina of the pigmented rabbit eye after a single intramuscular injection of 75 mg/kg. Drug levels considered adequate for the control of most ocular infections were detectable in the iris, choroid, and retina 24 hours after injection, at which time serum levels were negligible. Subconjunctival injection of clindamycin phosphate also produced sustained high levels of drug in the choroid, iris, and retina; but when 150 mg was injected in a volume of 1 ml, corneal edema and severe inflammation of the conjunctiva resulted. Lesser amounts (15 to 35 mg) injected subconjunctivally produced adequate ocular tissue levels without damage to the conjunctiva or cornea.

Absorption↗

[Pulmonary toxoplasmosis in patients with human immunodeficiency virus infection. 21 cases].

OBJECTIVES: Assess expression of pulmonary toxoplasmosis, the second most frequent localization after brain, in patients infected with the human immunodeficiency virus (HIV). METHODS: Twenty-one HIV-infected patients (18M, 3F) were admitted for pulmonary toxoplasmosis between September 1987 and February 1995. Mode of HIV transmission was unprotected homosexual sexual activity (n = 16), intravenous drug abuse (n = 3) and transfusion (n = 2). RESULTS: Isolated pulmonary toxoplasmosis was found in 11 patients. In 10 patients pulmonary toxoplasmosis was associated with cerebral (n = 4), bone marrow (n = 2), ocular (n = 1) and multifocal (n = 3) localizations. Seven patients were admitted for acute pulmonary distress. Fever (reported for 20 patients) and nonproductive cough (reported for 16 patients) were the most common clinical symptoms. Chest roentgenogram revealed bilateral pulmonary infiltrates in 16 (76%) patients. Mean absolute CD4 count was 25 +/- 57 (range 0-110). Serologic evidence of past infection was observed in 18 patients. Serology tests were not done for two patients and negative for one. Two patients presented co-infection with Pneumocystis carinii. Fourteen patients had elevated serum lactic dehydrogenase (LDH) concentration. Among those, 4 patients whose LDH concentration was elevated more than ten fold died of respiratory distress. Patients received pyrimethamine and sulfadiazine (n = 13) or clindamycin (n = 8). Seven patients died during the first month after diagnosis was made. For the other patients, mean survival was 8 months. No relapse of toxoplasmosis was observed. All the patients took a secondary prophylaxis. CONCLUSION: No difference between patient with isolated pulmonary toxoplasmosis and patients with associated extra-pulmonary localization was noted for clinical, biological, radiological presentations and outcome.

AIDS-Related Opportunistic Infections↗

Ocular manifestations in pediatric patients with acquired immunodeficiency syndrome.

Forty pediatric patients seropositive for human immunodeficiency virus antibody and conforming to Centers for Disease Control, Atlanta, Ga, case definition of acquired immunodeficiency syndrome underwent ophthalmic examinations to evaluate prospectively the incidence, type, and natural history of ocular involvement in pediatric acquired immunodeficiency syndrome. A total of 87 examinations were performed on the patient population throughout the course of the study. Twenty percent had ocular findings, including two cases of cytomegalovirus retinitis, one case of isolated retinal cotton-wool spots, one case of toxoplasmosis retinochoroiditis, and three cases of external infections of adnexal structures. One patient had unusual peripheral retinal findings. The incidence of ocular manifestations in pediatric acquired immunodeficiency syndrome is considerably less than reported in several adult series. However, we recommend ophthalmic screening in all pediatric patients with acquired immunodeficiency syndrome with encephalopathy or disseminated opportunistic infections, or when symptoms suggest ophthalmic involvement.

Acquired Immunodeficiency Syndrome↗

Trovafloxacin is active against Toxoplasma gondii.

Drugs currently used for treatment of toxoplasmosis in pregnant women, congenital infections, immunocompromised patients, and patients with the ocular disease are not always effective or may be dangerous to use; therefore, there is a need for more-effective and less-toxic drugs. Recently, we examined a group of fluoroquinolones for in vitro and in vivo activities against Toxoplasma gondii. Among those examined in vitro (ciprofloxacin, fleroxacin, ofloxacin, temafloxacin, and trovafloxacin), only trovafloxacin significantly inhibited intracellular replication of T. gondii without significant toxicity for host cells. In a murine model of acute toxoplasmosis, 100 or 200 mg of trovafloxacin per kg of body weight per day for 10 days protected 100% of infected mice against death. A dose of 50 mg/kg/day protected 90% of the mice, and a dose of 25 mg/kg/day effected prolongation of time to death. The other fluoroquinolones did not have such in vivo activities. These results indicate that trovafloxacin may be useful for treatment of toxoplasmosis in humans.

Animals↗

Epidemiological considerations about retinal opportunistic infections in HIV-infected patients in France.

PURPOSE: To evaluate the evolution of the epidemiology of retinal opportunistic infections in HIV-infected patients from 1994 to 1997 and to assess the effect of HAART initiated in 1996. MATERIALS AND METHODS: Epidemiological prospective study using the data collected during ocular examinations of HIV-infected patients conducted in a single referral center specialized in HIV infection. RESULTS: From 1995 to 1997, the total number of examined HIV-infected patients and the incidence of retinitis related to CMV, VZV, tuberculosis, and toxoplasmosis decreased. The incidence of CMV retinitis, which was by far the most frequent ocular infection, fell from 6.2% to 1.2%. COMMENTS: The dramatic decrease in retinal opportunistic infections since 1996 may be related to the use of HAART. However, a close follow-up is still justified due to the increasing occurrence of resistance to protease inhibitors.

AIDS-Related Opportunistic Infections↗

[Infectious myopathies].

Infectious myopathies are rare acquired affections which have, generally, a good prognostic. Many types of viral infections can cause transient inflammatory myopathies. HIV myopathy may be present early in the HIV infection, but more often it is a complication of fully developed AIDS. Influenza virus myositis tend to be more severe in adults than in children. Group B coxsackie virus has been isolated from striated muscle of patients with epidemic myalgia. Parasitic infections of muscle include trichinosis, toxoplasmosis, and cysticercosis. Trichinosis is the most frequent parasitic myositis. The ocular, lingual or pharyngeal weakness and/or hypereosinophilia suggest the diagnosis. Pyomyositis, is a located zone of suppuration of muscle due to staphylococcus in 90% of the cases. It is a common occurrence in tropical climates, but has been recognized increasingly in temperate climates.

Bacterial Infections↗

Toxoplasma antibodies in clinically suspected cases of toxoplasmosis.

One hundred and seven cases, 35 males and 72 females aging from 3 months to 32 years old were divided into 4 groups: ocular, neurological, cases with abortion and cases having Down's syndrome. 47 apparently healthy individuals were taken as control. All were serologically tested for Toxoplasma antibodies using IFAT and ELSA for detection of IgG. The positive cases as well as cases below one year old were tested by ELISA IgM for the detection of acute or congenital toxoplasmosis. Toxoplasma antibodies (IgG) were found in 28 (26%) and 43 cases (40%) by IFAT and ELISA respectively. ELISA IgM was positive in 12 (20%) out of 60 serum samples. Two cases (11%) among 27 patients below one year old positive. Statistical significance was reported concerning the positive cases in the ocular group as well as patients with abortions. Results revealed that ELISA is more sensitive and specific than IFAT.

Adolescent↗

Auditory and visual defects resulting from symptomatic and subclinical congenital cytomegaloviral and toxoplasma infections.

Sensorineural hearing loss was present in ten of 59 (17%) patients with congenital cytomegalovirus (CMV) infection (three of eight born with symptomatic and seven of 51 born with subclinical infection). The defect was bilateral in eight, moderate to profound in eight, and of progressive nature in two. Hearing loss did not occur in 21 patients with natal CMV infection nor in seven of 12 patients with congenital toxoplasmosis. Histopathologic and immunofluorescent studies of the inner ear in two of three neonates who died with severe infection revealed that viral antigens were widely distributed in cochlear structures. Eye pathology was associated only with congenital Toxoplasma (nine of 12) and CMV (seven of 43) infections. Visual impairments were more prominent and severe in those born with symptomatic infections, exclusively so with CMV. However, ocular defects, in particular chorioretinitis, developed after birth in five of eight patients born with asymptomatic congenital toxoplasmosis. These data firmly establish clinically inapparent congenital CMV infection as a major public health problem and confirm the fact that congenital toxoplasmosis may be associated with late-appearing, debilitating chorioretinitis.

Audiometry↗

Parasitic infections of the central nervous system.

The authors give a comprehensive review of the epidemiology, clinical presentations, diagnosis and current therapy of parasitic infections with CNS manifestations in both the normal and immunocompromised host. These include toxoplasmosis, malaria, amebiasis, neurocystcersosis, hydatid disease, and trichinosis. Additional sections cover disseminated strongyloidiasis, eosinophilic meningitis, visceral and ocular larva migrans, schistosomiasis, and cerebral paragonimiasis. Emphasis is on the neurologic complications of these diseases and their presentations in populations at increased risk for acquiring or reactivating these infections.

Acquired Immunodeficiency Syndrome↗

Punctate inner choroidopathy and its differential diagnosis.

The diagnosis of chorioretinal diseases largely depends on their clinical presentation rather than etiologic or systemic investigations. We report on a patient whose examination revealed a peculiar fundus pattern, almost completely different from disorders such as multifocal choroiditis, presumed ocular histoplasmosis, myopic degeneration, acute multifocal placoid pigment epitheliopathy, vitiliginous chorioretinitis, and punctate outer retinal toxoplasmosis. It resembled punctate inner choroidopathy, described by Watzke in 1984.

Adult↗

Hereditary and congenital factors in inflammations of the uveal tract.

The discovery of associations between HLA antigens and particular diseases has provided an explanation for some racial differences in the incidence of uveitis. Acute anterior uveitis is strongly associated with HLA B27 and this hereditary influence has been substantiated by evidence of familial cases. HLA B5 occurs more frequently in Japanese patients with Behçet's disease and HLA BW22J and HLA DWa are associated with the Vogt-Koyanagi-Harada disease. HLA B7 and HLA DRW2 occur more frequently in patients with presumed ocular histoplasmosis. Some possible explanations for these associations are discussed. Syphilis, cytomegalic inclusion disease, and toxoplasmosis can all produce a congenital form of uveitis.

Acute Disease↗

Endogenous uveitis in children.

Endogenous uveitis, with its ocular sequalae, accounts for a significant number of blind children in the world today. Even though these children are asymptomatic by ophthalmic history, they usually present with ocular pathology compatible with chronic intraocular inflammation. Although loss of vision is invariably due to cataract formation, fluorescein angiogram, binocular indirect ophthalmoloscopy, and fundus contact lens examination often reveal pathology of the optic nerve and retina, accounting for a significant degree of visual loss. While actual etiologic agents are usually not identified in the majority of children, toxoplasmosis, sarcoidosis, and childhood arthropathies occur with such high frequency that mention is made of these diseases. Conventional surgical procedures for ocular sequalae such as cataract and glaucoma, are known to yield poor results. Corticosteroids administered either topically, periocularly, or systemically appear to be of value in the treatment of these diseases, although control studies have not been done. Efforts to lessen the visual morbidity in these children should begin by a cross-fertilization of information between primary care physicians, pediatricians, and ophthalmologists.

Adrenal Cortex Hormones↗

Toxoplasmosis.

Toxoplasma gondii is a protozoan parasite that infects up to a third of the world's population. Infection is mainly acquired by ingestion of food or water that is contaminated with oocysts shed by cats or by eating undercooked or raw meat containing tissue cysts. Primary infection is usually subclinical but in some patients cervical lymphadenopathy or ocular disease can be present. Infection acquired during pregnancy may cause severe damage to the fetus. In immunocompromised patients, reactivation of latent disease can cause life-threatening encephalitis. Diagnosis of toxoplasmosis can be established by direct detection of the parasite or by serological techniques. The most commonly used therapeutic regimen, and probably the most effective, is the combination of pyrimethamine with sulfadiazine and folinic acid. This Seminar provides an overview and update on management of patients with acute infection, pregnant women who acquire infection during gestation, fetuses or infants who are congenitally infected, those with ocular disease, and immunocompromised individuals. Controversy about the effectiveness of primary and secondary prevention in pregnant women is discussed. Important topics of current and future research are presented.

Animals↗

Association between prenatal treatment and clinical manifestations of congenital toxoplasmosis in infancy: a cohort study in 13 European centres.

AIM: To determine the effectiveness of prenatal treatment for clinical manifestations of congenital toxoplasmosis. METHODS: We prospectively identified 255 live-born infants with congenital toxoplasmosis using prenatal or neonatal screening. We determined the effect of prenatal treatment on the risks of intracranial or ocular lesions in infancy, accounting for gestational age at maternal seroconversion. RESULTS: Prenatal treatment within 4 wk of seroconversion reduced the risk of intracranial lesions compared with no treatment (odds ratio, OR 0.28; 95% CI: 0.08-0.75), but there was no significant effect when initiated after 4 wk (OR 0.76; 95% CI: 0.35-1.59; overall p-value 0.19). Compared to spiramycin alone, no treatment doubled the risk of intracranial lesions (OR 2.33; 95% CI: 1.04-5.50), but the risk did not differ with pyrimethamine-sulphonamide treatment (overall p-value 0.52). There was no consistent relationship between the type or timing of treatment and the risk of ocular lesions. Gestational age at maternal seroconversion was inversely associated with the risk of intracranial but not ocular lesions. CONCLUSION: Only early versus no prenatal treatment for intracranial lesions showed a statistically significant benefit. A large randomized controlled trial and/or meta-analysis of individual patient data from cohort studies is required to confirm these findings.

Adult↗

[Cytomegalovirus retinitis and ocular complications in AIDS patients in Togo].

BACKGROUND: Cytomegalovirus retinitis seems to be an uncommon complication in African AIDS patients. This study was conducted in 200 patients in order to evaluate AIDS eye related complications with specific focus to cytomegalovirus retinitis. MATERIAL AND METHODS: During a period of 20 months, 200 patients (83 men and 117 women) presenting WHO AIDS case definition diagnosis were enrolled for a complete ocular examination comprising external, anterior segment and retinal fundus and fluorescein angiographic examination. RESULTS: For the whole, 200 patients underwent ocular examinations; of them 121 (60.5%) developed ocular complications. The most frequent complications were cotton wool spots (25.5%), cytomegalovirus (CMV) retinitis (21.5%), retinal hemorrhage (6%), papilloedema (3%), chorioretinal toxoplasmosis (3%), peripheral retinal vascularitis (2. 5%), herpes zoster ophthalmicus (2%). Among those with CMV retinitis, bilateral lesions were found in 30 cases, and unilateral ones in 13 cases. Poor vision was associated with the presence of CMV retinitis in 88% of cases. Death occurred in a mean range of 22 days after the "presumed" diagnosis of CMV retinitis. CONCLUSION: Cytomegalovirus retinitis represents the second ocular complication in AIDS patients in this study. Poor visual outcome was associated in 88% of cases. These results demonstrate that in some west African countries, CMV retinitis may be a common complication in AIDS patients.

AIDS-Related Opportunistic Infections↗