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Hosseini SM, Baghi M, Astaneh MA, Motamed Shariati M. Fulminant endogenous endophthalmitis caused by Brucella melitensis, a case report. Clin Case Rep 2023; 11:e8200. [PMID: 38028096 PMCID: PMC10643306 DOI: 10.1002/ccr3.8200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 10/17/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
Key Clinical Message Ocular brucellosis is a potential cause of endogenous endophthalmitis in endemic areas, which can be associated with sight-threatening complications. Abstract To report a patient with unusual fulminant endogenous endophthalmitis due to Brucella melitensis. A 25-year-old woman with a history of fever and right shoulder pain from 4 months ago and a positive Wright test presented with acute panuveitis in her right eye. All laboratory tests were unremarkable except for the positive polymerase chain reaction (PCR) test of the vitreous sample for B. melitensis. Despite the therapeutic efforts, including multiple vitreoretinal surgeries, and intravitreal and systemic antibiotics, the patient's final follow-up examination after 6 months revealed hand motion vision, hypotonia, and pre-phthisis bulbi status. The fellow eye was entirely normal. Brucella endogenous endophthalmitis can be fulminant and result in poor visual outcomes. It is suggested to consider ocular brucellosis as a potential cause of endogenous endophthalmitis in endemic areas.
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Affiliation(s)
| | - Mohammad Baghi
- Eye Research CenterMashhad University of Medical SciencesMashhadIran
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Evlice O, Çeviker SA, Filik A, Ağın A. Ocular Involvement of Brucellosis: A Pooled Analysis Study. Ocul Immunol Inflamm 2023; 31:1677-1686. [PMID: 36638336 DOI: 10.1080/09273948.2022.2164727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 12/29/2022] [Indexed: 01/15/2023]
Abstract
AIM Brucellosis may affect the eye to varying degrees. The aim of this study was to investigate the ocular involvement of brucellosis and highlight key points. MATERIAL AND METHODS Published literature in English language on the ocular involvement of brucellosis within last 30 years was evaluated. The PubMed international database was screened using certain keywords. RESULTS The study included 27 publications evaluating a total of 159 cases. The most common types of ocular involvement were uveitis (52.2%) and conjunctivitis (17.6%). Most cases had concomitant systemic brucellosis (27.7%), and the most commonly used diagnostic method was a serological test (92.4%). Of all the patients, 37.1% recovered with sequelae. CONCLUSION Brucellosis may cause a wide range of ophthalmic manifestations, and an overlooked or late diagnosis may also lead to the development of sequelae or loss of vision. A routine ophthalmologic examination should be performed in all patients with systemic brucellosis.
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Affiliation(s)
- Oğuz Evlice
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Kutahya Health Sciences University, Kütahya, Turkey
| | - Sevil Alkan Çeviker
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Armağan Filik
- Department of Ophthalmology, Patnos State Hospital, Ağrı, Turkey
| | - Abdullah Ağın
- Department of Ophthalmology, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey
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Ma C, Li H, Lu S, Li X, Wang S, Wang W. Ocular Lesions in Brucella Infection: A Review of the Literature. Infect Drug Resist 2022; 15:7601-7617. [PMID: 36579126 PMCID: PMC9791996 DOI: 10.2147/idr.s394497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Ocular lesions due to Brucella infection are uncommon and easily overlooked in clinical management, but must be differentiated from non-infectious eye diseases and treated promptly to protect the patient's vision. We reviewed the relevant literature and identified 47 patients with ocular complications of Brucella infection. Among them, 28 showed ocular neuropathy, 15 presented with uveitis, and four patients displayed other ocular symptoms. Ocular symptoms accompanying Brucella infection require prompt diagnosis and treatment. The main methods of diagnosis are intraocular fluid tests and blood tests. Early diagnosis and treatment with suitable antibiotics are central to protecting the patient's vision. Notably, in terms of mechanism of injury, Brucella infection is chronic and cannot be eliminated by phagocytes, and can cause damage to the eye by inducing autoimmune reactions, antigen-antibody complex production, release of endogenous and exogenous toxins, and bacterial production of septic thrombi in the tissues. In this review, we summarize the ocular symptoms, diagnosis, treatment and prognosis of Brucella infection, and discuss the mechanisms of Brucella in ocular lesions, providing a reference for the diagnosis and treatment of Brucella ocular lesions.
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Affiliation(s)
- Chao Ma
- Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Haoyu Li
- Department of Ophthalmology, the Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China,Hunan Clinical Research Centre of Ophthalmic Disease, Changsha, Hunan, People’s Republic of China
| | - Shuwen Lu
- Department of Ophthalmology, the First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, People’s Republic of China
| | - Xian Li
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, England,School of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester, England
| | - Shuai Wang
- Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Wenzhan Wang
- Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China,Correspondence: Wenzhan Wang, Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, Henan, 450052, People’s Republic of China, Tel +86 371-66278091, Email
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Xi H, Zhang L, Xu B, Liu H, Li S. Metagenomic Next-Generation Sequencing to Investigate Infectious Endophthalmitis of Brucella: A Case Report. Front Med (Lausanne) 2022; 9:847143. [PMID: 35425780 PMCID: PMC9001913 DOI: 10.3389/fmed.2022.847143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 02/16/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Brucellosis is a systemic disease that exists prevalently in clinical manifestations. The symptoms present in organs such as the eyes (in ocular brucellosis) can lead to misdiagnosis or even failure to diagnose. Metagenomic Next-Generation Sequencing (mNGS), a high-throughput sequencing approach, could be applied for the detection of microorganisms. Case Presentation A 57-year-old female with acute right-eye vision loss, treated with clindamycin and dexamethasone sodium phosphate for 1.5 months, was difficult to diagnose using regular methods. mNGS was utilized for the aqueous fluid from the patient, and Brucella melitensis was identified. The inflammation was treated with 3 months of antibiotherapy. However, even with specific medicine and surgery, the vision remained poor because severe ocular conditions last for a long time. Conclusion It suggests that brucella should still be a probable pathogen in endophthalmitis despite its low incidence in non-epidemic areas. Moreover, mNGS can achieve early diagnosis and timely treatment for difficult-to-diagnose ocular infections.
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Affiliation(s)
- Huiyu Xi
- Department of Ophthalmology, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou, China
| | - Lishuai Zhang
- Department of Ophthalmology, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou, China
| | - Bo Xu
- Department of Ophthalmology, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou, China
| | - Haiyang Liu
- Department of Ophthalmology, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou, China
| | - Suyan Li
- Department of Ophthalmology, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou, China
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A Multiple Evanescent White Dot Syndrome–like Reaction to Concurrent Retinal Insults. ACTA ACUST UNITED AC 2021; 5:1017-1026. [DOI: 10.1016/j.oret.2020.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 11/19/2022]
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Zarzecki M, Saeed E, Mariak Z, Konopińska J. Recurrent monocular exudative retinal detachment as the first manifestation of squamous cell lung cancer: A case report. Medicine (Baltimore) 2021; 100:e25189. [PMID: 33726010 PMCID: PMC7982169 DOI: 10.1097/md.0000000000025189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/25/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE In this report, we present an extremely rare case of recurrent monocular exudative retinal detachment without concomitant ocular metastases. This turned out to be the first symptom of squamous cell lung cancer. PATIENT CONCERNS A 63-year-old woman was referred to our ophthalmology clinic by her primary care physician with a complaint of deteriorating vision in her right eye that had started four months prior, without concomitant pain. DIAGNOSES We observed a detachment in the lower part of the retina during her ophthalmoscopy. We did not find any tears, holes, or degenerative changes in the periphery of the retina of the right eye during the surgery. In addition, plaques, tumor masses, and metastases were absent. Therefore, we diagnosed her with unilateral paraneoplastic exudative retinal detachment. Imaging tests performed before surgery revealed perihilar density with a visible air bronchogram in the middle field of the left lung. This turned out to be squamous cell carcinoma. INTERVENTIONS Patient underwent pars plana vitrectomy and routine laboratory and imaging tests before the procedure that utilized 20-gauge instrumentation. The subretinal fluid and was drained and a tamponade using Densiron (Fluoron Co, Neu-Ulm, Germany) was applied. After ophthalmic treatment, patient underwent complex oncological treatment based on chemotherapy and radiotherapy. OUTCOMES Despite the application of heavy silicone oil (Densiron) into the vitreous chamber, we observed a recurrence of retinal detachment in the right eye during the follow-up visit, 13 months after the first ophthalmic surgery. Following subsequent pars plana vitrectomy, the Densiron and subretinal membranes were removed. Despite oncological treatment, the patient died, twenty months after the appearance of the first ocular symptoms. LESSONS Exudative retinal detachment without tumor metastasis to the eyeball can be one of the first signs of lung cancer in rare cases. Multidisciplinary care and imaging methods with greater accuracy will provide comprehensive care to the patients. It will not only facilitate timely detection and treatment of lung tumors but also for a plethora of oncological diseases.
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Kinast RM, Solomon SD, Cubillan LD, Hovakimyan A, Acharya N, Cunningham ET. Prevalence and causes of clinically detectable uveitic serous retinal detachment. Eur J Ophthalmol 2021; 31:3093-3098. [PMID: 33530714 DOI: 10.1177/1120672121991391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe the prevalence and causes of clinically detectable uveitic serous retinal detachment (SRD). METHODS Retrospective chart review of a large clinic-based series. RESULTS Serous retinal detachment was present in 78 of the 2761 (2.8%) patients. Vogt-Koyanagi-Harada (VKH) disease was the most commonly identified cause (38/78, 48.7%). Less common associated etiologies included toxoplasmic retinochoroiditis (8/78, 10.3%), sarcoidosis (5/78, 6.4%), intraocular lymphoma (4/78, 5.1%), presumed tuberculosis (3/78, 3.8%), and posterior scleritis (2/78, 2.6%). Fifteen patients (19.2%) with uveitic SRD at presentation had no identifiable etiology and were labeled idiopathic or indeterminant. Thirty of the 38 patients with VKH disease (78.9%) had positive neurological and/or integumentary findings, and therefore constituted either complete or incomplete subtypes of the disease. The remaining eight (21.1%) had presumed/ocular VKH disease limited to the eye. CONCLUSION While VKH disease by far is the most common cause of clinically detectable uveitic SRD, a number of other non-infectious and infectious inflammatory disorders were also associated with this distinctive clinical finding.
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Affiliation(s)
- Robert M Kinast
- Legacy Devers Eye Institute, Legacy Health System, Portland, OR, USA
| | - Sharon D Solomon
- Retina Division of the Wilmer Eye Institute, Department of Ophthalmology, the John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Leo Dp Cubillan
- Institute of Ophthalmology, National Institutes of Health, University of the Phillipines, Manila, Philippines
| | | | - Nisha Acharya
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, CA, USA
| | - Emmett T Cunningham
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, CA, USA.,The Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA.,The Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
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AlMutairi N, AlRubaie K, Asharari K, Albalawi H. Unusual bilateral panuveitis uveitis with brucellosis. Saudi J Ophthalmol 2021; 35:143-145. [PMID: 35391805 PMCID: PMC8982952 DOI: 10.4103/1319-4534.337852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 04/12/2020] [Accepted: 07/06/2020] [Indexed: 11/04/2022] Open
Abstract
Brucellosis is a zoonotic disease that can be found worldwide. Although it has been eradicated and is under control in most developed countries, it still represents an important health problem in many parts of the world. In this case report, we present a rare unusual findings of a case with panuveitis uveitis secondary to brucellosis.
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Adusumilli H, Krupa L, Shetty N, Rao S. Bilateral serous choroidal detachment in brucellosis and its management and outcome: Literature review and case report. Indian J Ophthalmol 2020; 68:1204-1206. [PMID: 32461483 PMCID: PMC7508090 DOI: 10.4103/ijo.ijo_1418_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
To report an unusual case of a 71-year-old livestock farmer with systemic brucellosis and ocular involvement. Examination showed vitreous haze with bilateral serous choroidal detachment. He was treated with topical antibiotics and corticosteroids, Tab rifampicin 600 mg and doxycycline 100 mg for 6 weeks with visual recovery and complete resolution of serous choroidal detachment in 2 weeks. This is the first case of bilateral serous choroidal detachment in a case of systemic brucellosis. Immune-mediated complex and direct microbial invasion of uveal tissue leading to serous choroidal detachment is the proposed pathogenesis that responds well to topical corticosteroids.
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Yang CS, Hsieh MH, Su HI, Kuo YS. Multiple Evanescent White Dot Syndrome Following Acute Epstein-Barr Virus Infection. Ocul Immunol Inflamm 2017; 27:244-250. [DOI: 10.1080/09273948.2017.1371763] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Chang-Sue Yang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Ophthalmology, National Yang-Ming University, Taipei, Taiwan
- Department of Ophthalmology, Taipei Medical University, Taipei, Taiwan
| | - Ming-Hung Hsieh
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Huan-I Su
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yih-Shiuan Kuo
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
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Abstract
A 29-year-old male diagnosed with brucellosis a week earlier was referred to the ophthalmology clinic with visual complaints. On examination, visual acuity was 20/25, he had conjunctival injection on slit lamp examination. There was also bilateral optic disk swelling plus retinal hyperemia (optic disc hyperemia and vascular tortuosity) and intraretinal hemorrhage on funduscopy. The patient was admitted and treated with cotrimoxazole, rifampin, doxycycline and prednisolone for 2 months. Ocular manifestations subsided gradually within 6 months after treatment. Brucellosis can affect the eye and lead to serious ocular complications. Early diagnosis and prompt treatment should be considered in endemic areas.
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Affiliation(s)
- Nooshin Bazzazi
- Department of Ophthalmology, Hamedan University of Medical Sciences, Iran
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Mesquida M, Llorenç V, Cervera C, Adán A. Brucelosis ocular. Med Clin (Barc) 2013; 140:284. [DOI: 10.1016/j.medcli.2012.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 07/05/2012] [Accepted: 07/05/2012] [Indexed: 11/26/2022]
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Margo CE, Harman LE. The visual impairment and inscrutable disease of Samuel Johnson. Surv Ophthalmol 2011; 57:66-76. [PMID: 22019375 DOI: 10.1016/j.survophthal.2011.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 05/28/2011] [Accepted: 07/19/2011] [Indexed: 11/30/2022]
Abstract
Samuel Johnson, the acclaimed author of the Dictionary of the English Language, survived childhood scrofula with impaired sight and hearing. The cause of his scrofula has been attributed to bovine tuberculosis, but mycobacterial infection does not satisfactorily account for the peculiar features of Johnson's eye disorder or his hearing loss. The subject of numerous biographies, Johnson may have the most scrutinized medical history of all time. Medical detectives, hampered by the vagueness of 18(th)-century diagnosis, suspect that phlyctenular eye disease related to tuberculosis was the reason for his visual impairment. Pediatric brucellosis can also explain childhood scrofula associated with visual and auditory disabilities, but it may be difficult to reconcile any single diagnosis given the uncertainties surrounding Johnson's medical and ocular histories.
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Affiliation(s)
- Curtis E Margo
- Department of Pathology, University of South Florida College of Medicine, Tampa, Florida, USA.
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A review on ophthalmic manifestations of brucellosis and reporting a case of ophthalmic brucellosis. IRANIAN RED CRESCENT MEDICAL JOURNAL 2011; 13:352-3. [PMID: 22737494 PMCID: PMC3371975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 11/02/2010] [Accepted: 11/10/2010] [Indexed: 11/04/2022]
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Schaal S, Schiff WM, Kaplan HJ, Tezel TH. Simultaneous Appearance of Multiple Evanescent White Dot Syndrome and Multifocal Choroiditis Indicate a Common Causal Relationship. Ocul Immunol Inflamm 2009; 17:325-7. [DOI: 10.3109/09273940903043923] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sungur GK, Hazirolan D, Gurbuz Y, Unlu N, Duran S, Duman S. Ocular involvement in brucellosis. Can J Ophthalmol 2009; 44:598-601. [DOI: 10.3129/i09-019] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Rolando I, Olarte L, Vilchez G, Lluncor M, Otero L, Paris M, Carrillo C, Gotuzzo E. Ocular Manifestations Associated with Brucellosis: A 26‐Year Experience in Peru. Clin Infect Dis 2008; 46:1338-45. [DOI: 10.1086/529442] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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