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Rym M, Yasmine H, Marwa A, Imen H, Monia C. Varicella zoster virus-associated non-necrotizing retinitis: case report. J Ophthalmic Inflamm Infect 2023; 13:31. [PMID: 37410194 DOI: 10.1186/s12348-023-00353-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/18/2023] [Indexed: 07/07/2023] Open
Abstract
PURPOSE To describe clinical features and the course of a case of non-necrotizing herpetic retinitis secondary to Varicella zoster virus (VZV). MATERIEL AND METHODS A single case report documented with multimodal imaging. RESULTS A 52-year-old female patient with a past medical history of diabetes mellitus who presented with painful red right eye (OD). Ophthalmic examination showed perilimbal conjunctival nodule, granulomatous anterior uveitis, sectoral iris atrophy and increased intraocular pressure. Fundus examination in OD revealed posterior multifocal retinitis. Left eye examination was unremarkable. Polymerase chain reaction (PCR) of aqueous humor sample confirmed the presence of VZV DNA. Systemic antiviral therapy allowed the improvement of intraocular inflammation and disappearance of the retinal non necrotizing retinitis after one year of regular follow-up. CONCLUSION Non-necrotizing retinitis is an underdiagnosed form of VZV ocular infection.
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Affiliation(s)
- Maamouri Rym
- Department of Ophthalmology, Habib Thameur Hospital, 3, Rue Ali Ben Ayed, 1089, Montfleury, Tunis, Tunisia.
| | - Houman Yasmine
- Department of Ophthalmology, Habib Thameur Hospital, 3, Rue Ali Ben Ayed, 1089, Montfleury, Tunis, Tunisia
| | - Abdelaziz Marwa
- Department of Ophthalmology, Habib Thameur Hospital, 3, Rue Ali Ben Ayed, 1089, Montfleury, Tunis, Tunisia
| | - Helal Imen
- Department of Pathology, Habib Thameur Hospital, Boulevard du 9 Avril 1938, 1006, Tunis, Tunisia
| | - Cheour Monia
- Department of Ophthalmology, Habib Thameur Hospital, 3, Rue Ali Ben Ayed, 1089, Montfleury, Tunis, Tunisia
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Bispo PJM, Belanger N, Li A, Liu R, Susarla G, Chan W, Chodosh J, Gilmore MS, Sobrin L. An All-in-One Highly Multiplexed Diagnostic Assay for Rapid, Sensitive, and Comprehensive Detection of Intraocular Pathogens. Am J Ophthalmol 2023; 250:82-94. [PMID: 36709019 PMCID: PMC10760444 DOI: 10.1016/j.ajo.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/08/2023] [Accepted: 01/17/2023] [Indexed: 01/27/2023]
Abstract
PURPOSE Intraocular infections are sight-threatening conditions that can lead to vision loss. Rapid identification of the etiologies plays a key role in early initiation of effective therapy to save vision. However, current diagnostic modalities are time consuming and lack sensitivity and inclusiveness. We present here a newly developed comprehensive ocular panel designed to improve diagnostic yields and provide a tool for rapid and sensitive pathogen detection. DESIGN Experimental laboratory investigation. METHODS A panel containing 46 pathogens and 2 resistance/virulence markers that are commonly detected in intraocular infections was developed. Genomic targets were scrutinized for stretches predicted to be specific for a particular species while being conserved across different strains. A set of primers for sample enrichment, and two 50mer NanoString compatible probes were then designed for each target. Probe-target hybrids were detected and quantified using the NanoString nCounter SPRINT Profiler. Diagnostic feasibility was assessed in a pilot clinical study testing samples from infectious retinitis (n = 15) and endophthalmitis (n = 12) patients, for which the etiologies were confirmed by polymerase chain reaction (PCR) or culture. RESULTS Analytical studies demonstrated highly sensitive detection of a broad spectrum of pathogens, including bacteria, viruses, and parasites, with limits of detection being as low as 2.5 femtograms per reaction. We also found excellent target specificity, with minimal cross-reactivity detected. The custom-designed NanoString ocular panel correctly identified the causative agent from all clinical specimens positive for a variety of pathogens. CONCLUSION This highly multiplexed panel for pathogen detection offers a sensitive, comprehensive, and uniform assay run directly on ocular fluids that could significantly improve diagnostics of sight-threatening intraocular infections.
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Affiliation(s)
- Paulo J M Bispo
- From the Department of Ophthalmology (P.J.M.B., N.B., A.L., R.L., G.S., W.C., J.C., M.S.G., L.S.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Infectious Disease Institute (P.J.M.B., N.B., J.C., M.S.G., L.S.), Harvard Medical School, Boston, Massachusetts, USA.
| | - Nicole Belanger
- From the Department of Ophthalmology (P.J.M.B., N.B., A.L., R.L., G.S., W.C., J.C., M.S.G., L.S.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Infectious Disease Institute (P.J.M.B., N.B., J.C., M.S.G., L.S.), Harvard Medical School, Boston, Massachusetts, USA
| | - Ashley Li
- From the Department of Ophthalmology (P.J.M.B., N.B., A.L., R.L., G.S., W.C., J.C., M.S.G., L.S.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Renee Liu
- From the Department of Ophthalmology (P.J.M.B., N.B., A.L., R.L., G.S., W.C., J.C., M.S.G., L.S.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Gayatri Susarla
- From the Department of Ophthalmology (P.J.M.B., N.B., A.L., R.L., G.S., W.C., J.C., M.S.G., L.S.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Weilin Chan
- From the Department of Ophthalmology (P.J.M.B., N.B., A.L., R.L., G.S., W.C., J.C., M.S.G., L.S.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - James Chodosh
- From the Department of Ophthalmology (P.J.M.B., N.B., A.L., R.L., G.S., W.C., J.C., M.S.G., L.S.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Infectious Disease Institute (P.J.M.B., N.B., J.C., M.S.G., L.S.), Harvard Medical School, Boston, Massachusetts, USA
| | - Michael S Gilmore
- From the Department of Ophthalmology (P.J.M.B., N.B., A.L., R.L., G.S., W.C., J.C., M.S.G., L.S.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Infectious Disease Institute (P.J.M.B., N.B., J.C., M.S.G., L.S.), Harvard Medical School, Boston, Massachusetts, USA; Department of Microbiology and Immunobiology (M.S.G.), Harvard Medical School, Boston, Massachusetts, USA
| | - Lucia Sobrin
- From the Department of Ophthalmology (P.J.M.B., N.B., A.L., R.L., G.S., W.C., J.C., M.S.G., L.S.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Infectious Disease Institute (P.J.M.B., N.B., J.C., M.S.G., L.S.), Harvard Medical School, Boston, Massachusetts, USA
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The role of antibody indexes in clinical virology. Clin Microbiol Infect 2021; 27:1207-1211. [PMID: 33813108 DOI: 10.1016/j.cmi.2021.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Serological techniques are an essential part of the diagnostic tools used in clinical virology. Among these techniques, antibody indexes are not novel, but do require specific expertise. Their niche has expanded substantially in recent years due to increasing evidence of their performance to diagnose viral infections. OBJECTIVES This narrative review describes the background and clinical applications of antibody indexes. The first objective is to provide an overview of the theoretical background, insights for implementation, limitations and pitfalls. The second objective is to review the available evidence for the diagnostic performance, with a specific focus on viral encephalitis and uveitis. SOURCES A comprehensive literature search was performed in PubMed, including original studies and reviews, with no time limit on the studies included. The following search terms were used: antibody index, Goldmann-Witmer coefficient, Reibergram, viral encephalitis, viral uveitis, herpes simplex virus, varicella zoster virus, cytomegalovirus, Epstein-Barr virus, rubella virus, measles virus, enterovirus, influenza virus, flaviviruses. CONTENT Antibody indexes can support the diagnosis of a spectrum of viral infections in immune privileged sites such as the central nervous system and the eye, through the demonstration of virus-specific intrathecal or intraocular antibody production. This is especially useful in situations where PCR has a lower positivity rate: infections with rapid viral clearance due to natural immunity or treatment and chronic stages of viral infections. IMPLICATIONS Antibody indexes expand the clinical microbiologist's diagnostic toolbox. Careful interpretation of the results of these assays is crucial and further standardization of methods is required to improve interchangeability of results between laboratories.
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Abstract
The uveitides are a heterogeneous group of diseases characterized by inflammation inside the eye. The uveitides are classified as infectious or non-infectious. The non-infectious uveitides, which are presumed to be immune mediated, can be further divided into those that are associated with a known systemic disease and those that are eye limited,-ie, not associated with a systemic disease. The ophthalmologist identifies the specific uveitic entity by medical history, clinical examination, and ocular imaging, as well as supplemental laboratory testing, if indicated. Treatment of the infectious uveitides is tailored to the particular infectious organism and may include regional and/or systemic medication. First line treatment for non-infectious uveitides is corticosteroids that can be administered topically, as regional injections or surgical implants, or systemically. Systemic immunosuppressive therapy is used in patients with severe disease who cannot tolerate corticosteroids, require chronic corticosteroids at >7.5 mg/day prednisone, or in whom the disease is known to respond better to immunosuppression. Management of many of these diseases is optimized by coordination between the ophthalmologist and rheumatologist or internist.
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Affiliation(s)
- Bryn M Burkholder
- Wilmer Eye Institute, Department of Ophthalmology, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Douglas A Jabs
- Wilmer Eye Institute, Department of Ophthalmology, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center for Clinical Trials and Evidence Synthesis, the Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Treatment of Cytomegalovirus Anterior Uveitis at a North American Tertiary Center With Oral Valganciclovir. Cornea 2020; 39:584-589. [PMID: 32068609 DOI: 10.1097/ico.0000000000002251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE Cytomegalovirus is an increasingly recognized cause of anterior uveitis. We present clinical features of cytomegalovirus anterior uveitis (CMVAU) and outcomes of oral valganciclovir treatment at a tertiary referral center in North America. METHODS This is a retrospective case series review (2002-2014) of immunocompetent patients with CMVAU treated with valganciclovir 900 mg BID and subsequent maintenance dosing of ≤450 mg BID. Most patients were prescribed topical corticosteroids concurrently. Diagnostic evaluations and clinical features at baseline and follow-up were reviewed. Resolution time, maintenance of quiescence, and adverse events were assessed. RESULTS Eighteen eyes of 16 patients were included. The mean age of diagnosis was 41 years. At diagnosis, mean best-corrected visual acuity was 0.30 LogMAR and mean intraocular pressure (IOP) was 18.4 mm Hg; 14 eyes (78%) had an active anterior chamber (AC) cell, 8 (44%) had circinate keratic precipitates, and 6 (33%) had iris atrophy. The mean follow-up duration was 48 months. Fourteen eyes of 12 patients were available for the 12-month follow-up; patients demonstrated improvement in best-corrected visual acuity (difference: -0.21 LogMAR, 95% CI -0.33 to -0.09; P = 0.003), AC cell (OR = 0.10, 95% CI 0.02-0.41; P = 0.002), and IOP (difference: -4.21 mm Hg, 95% CI -7.98 to -0.44; P = 0.03) compared with baseline. One patient experienced a serious adverse event likely due to valganciclovir. Thirteen eyes experienced recurrence of inflammation: 7 (54%) on prophylactic dose of valganciclovir and 6 (46%) after stopping. CONCLUSIONS Valganciclovir appears effective and safe for treating CMVAU in this retrospective case series. Long-term antiviral prophylaxis does not abolish recurrences, although it may possibly reduce their frequency when compared with no prophylaxis.
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Takhar JS, Joye AS, Somkijrungroj T, Laovirojjanakul W, Lin CP, Lietman TM, Porco TC, Keenan JD, Gebreegziabher EA, Seitzman GD, Rose-Nussbaumer J, Doan TA, Acharya NR, Gonzales JA. A double masked randomised 4-week, placebo-controlled study in the USA, Thailand and Taiwan to compare the efficacy of oral valganciclovir and topical 2% ganciclovir in the treatment of cytomegalovirus anterior uveitis: study protocol. BMJ Open 2019; 9:e033175. [PMID: 31862739 PMCID: PMC6937053 DOI: 10.1136/bmjopen-2019-033175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/04/2019] [Accepted: 11/25/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Cytomegalovirus (CMV) anterior uveitis is a recognised cause of anterior uveitis in immunocompetent patients and is preventable cause of vision loss. Ocular sequelae include corneal endothelial damage which can cause corneal oedema and failure, as well as glaucoma. Recurrences of inflammation are common and therefore patients are often exposed to long-term therapy. Oral therapy is available in the form of valganciclovir, although with the caveat of systemic side effects such as bone marrow suppression and renal failure necessitating regular interval laboratory monitoring. Recent reports have demonstrated that topical 2% ganciclovir solution may offer promising treatment outcomes in patients with CMV anterior uveitis with superior safety, cost-effectiveness and convenience profiles. An investigation into the relative equipoise of these therapies is warranted for these reasons. METHODS AND ANALYSIS The Systemic and Topical Control of Cytomegalovirus Anterior uveitis: Treatment Outcomes (STACCATO) trial is designed as a multicentre, block randomised by site, double-masked, placebo-controlled trial comparing the efficacy of oral valganciclovir, 2% topical ganciclovir and placebo in treating PCR-proven CMV anterior uveitis. Participant clinical evaluation will occur at three study time points by a masked study ophthalmologist over a 28-day period to assess resolution of ocular inflammation (secondary outcome). A control group will provide additional information about the possible impact that the infected host's immune response may play in controlling local viral replication. The primary analysis is an analysis of covariance (three arms) correcting for baseline to compare quantitative CMV viral load in the anterior chamber (AC) aqueous fluid before and 7 days after treatment. ETHICS AND DISSEMINATION The University of California San Francisco Committee on Human Research and the Khon Kaen University Institutional Review Board have given ethical approval. The results of this trial will be presented at local and international meetings and submitted for peer-reviewed journals for publication. TRIAL REGISTRATION NUMBER NCT03576898.
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Affiliation(s)
- Jaskirat S Takhar
- Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- John Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Ashlin S Joye
- Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Touro University California College of Osteopathic Medicine, Vallejo, California, USA
| | - Thanapong Somkijrungroj
- Ophthalmology, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand
- Ophthalmology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Chang-Ping Lin
- Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Thomas M Lietman
- Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Travis C Porco
- Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Jeremy D Keenan
- Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | | | - Gerami D Seitzman
- Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Jennifer Rose-Nussbaumer
- Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Kaiser Permanente, Redwood City, California, USA
| | - Thuy A Doan
- Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Nisha R Acharya
- Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - John A Gonzales
- Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
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Miserocchi E, Iuliano L, Fogliato G, Modorati G, Couto C, Schlaen A, Hurtado E, Llorenç V, Adan A, Bandello F. Bilateral Acute Retinal Necrosis: Clinical Features and Outcomes in a Multicenter Study. Ocul Immunol Inflamm 2018; 27:1090-1098. [PMID: 30059636 DOI: 10.1080/09273948.2018.1501494] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: To describe clinical features and outcome in bilateral acute retinal necrosis (BARN). Methods: Observational retrospective longitudinal review of ocular findings. Results: Thirty eyes of 15 patients (age 44.1 ± 15.8). Delay of involvement between eyes was 57.2 ± 105.2 months (median 3, range 0.5-360). Herpes simplex virus (HSV)-1 was the most frequent (20 eyes, 66.6%), followed by HSV-2 (five eyes, 16.7%) and varicella zoster virus (VZV, four eyes, 13.3%). Visual acuity worsened in 7 (23%) eyes, improved in 4 (13%), and remained stable in 19 (63%). Major complications included retinal detachment (11 eyes, 36%), optic atrophy (11 eyes, 33%), proliferative vitreoretinopathy (four eyes, 13.3%), neovascular glaucoma (four eyes, 13.3%), phthisis bulbi (three eyes, 10%). Symptoms-to-referral average time was 2.7 ± 1.0 weeks (range 1-4). Conclusions: In our study BARN was associated with severe visual outcome and high rate of ocular complications. Although BARN is a rare disease, the course is aggressive, regardless prompt referral in tertiary-care uveitis centers.
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Affiliation(s)
- Elisabetta Miserocchi
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute, University Vita-Salute , Milan , Italy
| | - Lorenzo Iuliano
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute, University Vita-Salute , Milan , Italy
| | - Giovanni Fogliato
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute, University Vita-Salute , Milan , Italy
| | - Giulio Modorati
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute, University Vita-Salute , Milan , Italy
| | - Cristobal Couto
- Ophthalmology Service, Hospital de Clinicas "José de San Martín", Universidad de Buenos Aires , Buenos Aires , Argentina
| | - Ariel Schlaen
- Ophthalmology Service, Hospital de Clinicas "José de San Martín", Universidad de Buenos Aires , Buenos Aires , Argentina
| | - Erika Hurtado
- Ophthalmology Service, Hospital de Clinicas "José de San Martín", Universidad de Buenos Aires , Buenos Aires , Argentina
| | - Victor Llorenç
- Clínic Institute of Ophthalmology, Clínic Hospital, Universitat de Barcelona , Barcelona , Spain
| | - Alfredo Adan
- Clínic Institute of Ophthalmology, Clínic Hospital, Universitat de Barcelona , Barcelona , Spain
| | - Francesco Bandello
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute, University Vita-Salute , Milan , Italy
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Bispo PJM, Davoudi S, Sahm ML, Ren A, Miller J, Romano J, Sobrin L, Gilmore MS. Rapid Detection and Identification of Uveitis Pathogens by Qualitative Multiplex Real-Time PCR. Invest Ophthalmol Vis Sci 2018; 59:582-589. [PMID: 29372257 PMCID: PMC5788046 DOI: 10.1167/iovs.17-22597] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Infectious uveitis is a serious sight-threatening infection commonly caused by herpesviruses and Toxoplasma gondii. Etiologic diagnosis based on the clinical evaluation is often challenging. We developed and validated a multiplex real-time PCR assay coupled with high-resolution melting (HRM) for rapid detection and identification of herpes simplex viruses 1 and 2 (HSV-1 and HSV-2), varicella-zoster virus (VZV), cytomegalovirus (CMV), and T. gondii. Methods The assay was designed to target pathogen genome regions that yield products with distinct melting temperatures. Analytical specificity, sensitivity, and precision of HRM identification were determined. Clinical validation was performed by testing 108 intraocular fluids collected from eyes suffering with infectious uveitis (n = 30) and controls (n = 78). Results A nonoverlapping high-precision profile for each pathogen was generated following HRM (coefficient of variation 0%). The assay was highly sensitive, with a limit of detection of 20 genome copies for herpesviruses and 200 genome copies for T. gondii. The intra- and interassay variability of cycle threshold (Ct) measurement was ≤4% and ≤6%, respectively. Thirteen intraocular specimens collected from suspected cases of infectious uveitis were positive (mean Ct values varied from 19.4 to 27.7). Melting profiles of positive cases were consistent with HSV-2 (n = 5), VZV (n = 5), CMV (n = 2), and T. gondii (n = 1). Amplicon identities were confirmed by sequencing. Control intraocular samples from patients without a clinical diagnosis of infectious uveitis were all negative. Conclusions This assay allows rapid, sensitive, and reliable detection and identification of the most common known causes of infectious uveitis, making early pathogen information-based intervention possible.
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Affiliation(s)
- Paulo J M Bispo
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States.,Department of Microbiology and Immunology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States
| | - Samaneh Davoudi
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States
| | - Matthew L Sahm
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States
| | - Ai Ren
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States
| | - John Miller
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States
| | - John Romano
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States
| | - Lucia Sobrin
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States
| | - Michael S Gilmore
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States.,Department of Microbiology and Immunology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States
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Grumet P, Kodjikian L, de Parisot A, Errera MH, Sedira N, Heron E, Pérard L, Cornut PL, Schneider C, Rivière S, Ollé P, Pugnet G, Cathébras P, Manoli P, Bodaghi B, Saadoun D, Baillif S, Tieulie N, Andre M, Chiambaretta F, Bonin N, Bielefeld P, Bron A, Mouriaux F, Bienvenu B, Vicente S, Bin S, Labetoulle M, Broussolle C, Jamilloux Y, Decullier E, Sève P. Contribution of diagnostic tests for the etiological assessment of uveitis, data from the ULISSE study (Uveitis: Clinical and medicoeconomic evaluation of a standardized strategy of the etiological diagnosis). Autoimmun Rev 2018; 17:331-343. [DOI: 10.1016/j.autrev.2017.10.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 10/28/2017] [Indexed: 12/19/2022]
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10
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Wong RW, Jumper JM, McDonald HR, Johnson RN, Fu A, Lujan BJ, Cunningham ET. Emerging concepts in the management of acute retinal necrosis. Postgrad Med J 2018; 89:478-85. [PMID: 23861500 DOI: 10.1136/postgradmedj-2012-301983rep] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Acute retinal necrosis (ARN), also known as Kirisawa-type uveitis, is an uncommon condition caused by infection of the retina by one of the herpes family of viruses, most typically varicella zoster virus or herpes simplex virus and less commonly cytomegalovirus. Clinical diagnosis can be challenging and is often aided by PCR-based analysis of ocular fluids. Treatment typically involves extended use of one or more antiviral agents. Long term retinal detachment risk is high. We review the literature on ARN and present an approach to the diagnosis and management of this serious condition.
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Kharel Sitaula R, Janani MK, Madhavan HN, Biswas J. Outcome of polymerase chain reaction (PCR) analysis in 100 suspected cases of infectious uveitis. J Ophthalmic Inflamm Infect 2018; 8:2. [PMID: 29322275 PMCID: PMC5762614 DOI: 10.1186/s12348-017-0144-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Polymerase chain reaction (PCR) analysis is an important tool in the diagnosis of infectious uveitis. A retrospective, interventional study of PCR analysis of ocular fluid in suspected infectious uveitis cases between January 2014 to July 2016 was done. Nested, real-time and broad range PCR was performed for detection of the genome of Mycobacterium tuberculosis, herpes virus family, Chikungunya virus, Toxoplasma gondii, fungus, eubacterium and propionibacterium acne. RESULTS Total of 100 cases included, mean age was 39.2 ± 15.4 years. Uveitis was unilateral in 82% and granulomatous in 40%. Mean visual acuity at the initial visit and final visit was 0.73 logMar and 0.63 logMar respectively. PCR analysis confirmed the clinical diagnosis in 70.1% patients. The sensitivity, specificity, positive predictive value and negative predictive value of PCR analysis was 90.2%, 93.9%, 93.9% and 90.2% respectively. The quantitative value of real-time M. tb. Positive PCR ranged from 32c/ml to 2722 c/ml. CONCLUSIONS PCR assay is an accurate technique with high sensitivity and specificity to diagnose the DNA genome in infectious uveitis.
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Affiliation(s)
- Ranju Kharel Sitaula
- Department of Ophthalmology, Maharajgunj Medical Campus, B. P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal.
| | - M K Janani
- Sankara Nethralaya Referral Laboratory, Chennai, India
| | - H N Madhavan
- Vidyasagar Institute of Medical Biotechnology and Science, Sankara Nethralaya Referral Clinical Laboratory, Medical Research Foundation, L & T Microbiology Research Centre, 18 College Road, Chennai, 600006, India
| | - Jyotirmay Biswas
- Uveitis and Ocular Pathology Department, Medical and Vision Research Foundations, Sankara Nethralaya, College road, Chennai, Tamil Nadu, India
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Murugan SB. Commentary: Iatrogenic cytomegaloviral retinitis following intravitreal steroid implantation. Indian J Ophthalmol 2018; 66:1363-1364. [PMID: 30127174 PMCID: PMC6113805 DOI: 10.4103/ijo.ijo_446_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Smit DP, Meyer D, Esterhuizen TM, De Groot-Mijnes JDF. Polymerase Chain Reaction and Goldmann-Witmer Coefficient Testing in the Diagnosis of Infectious Uveitis in HIV-Positive and HIV-Negative Patients in South Africa. Ocul Immunol Inflamm 2017; 27:189-196. [PMID: 29283745 DOI: 10.1080/09273948.2017.1407802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE To use polymerase chain reaction (PCR) and Goldmann-Witmer coefficient (GWC) calculation to diagnose infectious uveitis. METHODS Prospective cross-sectional study. RESULTS Twenty-seven of 106 patients had positive PCR and/or GWC results on aqueous humor (AH) sampling and 15 of 27 (55.6%) were HIV-positive. Patients with non-anterior uveitis (NAU) were more likely to be HIV+ (p = 0.005). More than 1 possible pathogen was identified in 9 of 27 patients of whom 7 were HIV+. The final clinical diagnosis was discordant with AH findings in 9 of 27 cases. A positive EBV PCR result was associated with a discordant diagnosis (p = 0.001). All cases of herpetic anterior uveitis (42.9% HIV+) tested PCR-/GWC+ while all cases of herpetic NAU tested PCR+/GWC- (83.3% HIV+). All rubella virus cases were PCR+/GWC+. CONCLUSION PCR is useful to diagnose herpetic NAU in HIV+ patients while GWC is useful to diagnose herpetic anterior uveitis.
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Affiliation(s)
- Derrick P Smit
- a Division of Ophthalmology, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - David Meyer
- a Division of Ophthalmology, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - Tonya M Esterhuizen
- b Biostatistics Unit, Centre for Evidence Based Health Care, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
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Chronopoulos A, Roquelaure D, Souteyrand G, Seebach JD, Schutz JS, Thumann G. Aqueous humor polymerase chain reaction in uveitis - utility and safety. BMC Ophthalmol 2016; 16:189. [PMID: 27793120 PMCID: PMC5084402 DOI: 10.1186/s12886-016-0369-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 10/20/2016] [Indexed: 11/23/2022] Open
Abstract
Background To study the value and safety of aqueous humor polymerase chain reaction (PCR) analysis for Herpes simplex, varicella zoster, cytomegalovirus, Epstein-Barr virus and Toxoplasma gondii in patients with uveitis. Methods Records of 45 consecutive patients with anterior and posterior uveitis who underwent AC paracentesis with PCR were reviewed. The main outcome measure was frequency of PCR positivity. Secondary outcomes were alteration of treatment, safety of paracentesis, and correlation of keratitic precipitates with PCR positivity, Results The overall PCR positivity was 48.9 % (22/45). Therapy was changed because of the PCR results in 14/45 patients (37.7 %). One patient experienced a paracentesis related complication (1/45, 2.2 %) without long-term sequelae. Conclusion Aqueous PCR altered the diagnosis and treatment in over a third of our patients and was relatively safe. Aqueous PCR should be considered for uveitis of atypical clinical appearance, recurrent severe uveitis of uncertain etiology, and therapy refractory cases.
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Affiliation(s)
- Argyrios Chronopoulos
- Department of Ophthalmology, University Hospitals and School of Medicine, Geneva, Switzerland.
| | - Daniel Roquelaure
- Department of Ophthalmology, University Hospitals and School of Medicine, Geneva, Switzerland
| | - Georges Souteyrand
- Department of Ophthalmology, University Hospitals and School of Medicine, Geneva, Switzerland
| | - Jörg Dieter Seebach
- Division of Immunology and Allergy, University Hospitals and School of Medicine, Geneva, Switzerland
| | - James Scott Schutz
- Department of Ophthalmology, University Hospitals and School of Medicine, Geneva, Switzerland
| | - Gabriele Thumann
- Department of Ophthalmology, University Hospitals and School of Medicine, Geneva, Switzerland
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Apaijai N, Pintana H, Chattipakorn SC, Chattipakorn N. Effects of vildagliptin versus sitagliptin, on cardiac function, heart rate variability and mitochondrial function in obese insulin-resistant rats. Br J Pharmacol 2015; 169:1048-57. [PMID: 23488656 DOI: 10.1111/bph.12176] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 02/26/2013] [Accepted: 03/09/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND PURPOSE Long-term high-fat diet (HFD) consumption has been shown to cause insulin resistance, which is characterized by hyperinsulinaemia with metabolic inflexibility. Insulin resistance is associated with cardiac sympathovagal imbalance, cardiac dysfunction and cardiac mitochondrial dysfunction. Dipeptidyl peptidase-4 (DPP-4) inhibitors, vildagliptin and sitagliptin, are oral anti-diabetic drugs often prescribed in patients with cardiovascular disease. Therefore, in this study, we sought to determine the effects of vildagliptin and sitagliptin in a murine model of insulin resistance. EXPERIMENTAL APPROACH Male Wistar rats weighing 180-200 g, were fed either a normal diet (20% energy from fat) or a HFD (59% energy from fat) for 12 weeks. These rats were then divided into three subgroups to receive vildagliptin (3 mg·kg(-1)·day(-1)), sitagliptin (30 mg·kg(-1)·day(-1)) or vehicle for another 21 days. Metabolic parameters, oxidative stress, heart rate variability (HRV), cardiac function and cardiac mitochondrial function were determined. KEY RESULTS Rats that received HFD developed insulin resistance characterized by increased body weight, plasma insulin, total cholesterol and oxidative stress levels along with a decreased high-density lipoprotein (HDL) level. Moreover, cardiac dysfunction, depressed HRV, cardiac mitochondrial dysfunction and cardiac mitochondrial morphology changes were observed in HFD rats. Both vildagliptin and sitagliptin decreased plasma insulin, total cholesterol and oxidative stress as well as increased HDL level. Furthermore, vildagliptin and sitagliptin attenuated cardiac dysfunction, prevented cardiac mitochondrial dysfunction and completely restored HRV. CONCLUSIONS AND IMPLICATIONS Both vildagliptin and sitagliptin share similar efficacy in cardioprotection in obese insulin-resistant rats.
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Affiliation(s)
- Nattayaporn Apaijai
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Yusuf IH, Izadi S, Fung THM, Sallam A, Patel CK. Multifocal Necrotizing Chorioretinitis Following Phacoemulsification Surgery. Ocul Immunol Inflamm 2014; 23:261-5. [PMID: 24785099 DOI: 10.3109/09273948.2014.891756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Toxoplasma chorioretinitis is a leading cause of infectious posterior uveitis worldwide. METHODS We report an atypical presentation of Toxoplasma chorioretinitis presenting after uneventful cataract surgery in an 81-year-old male, with known hypernephroma and rheumatoid arthritis, treated with prednisolone and methotrexate. RESULTS He was treated for acute retinal necrosis and cytomegalovirus retinitis before Toxoplasma chorioretinitis was confirmed by vitreous biopsy 11 months after presentation. He developed a secondary rhegmatogenous retinal detachment, treated successfully with pars plana vitrectomy, silicone oil and endolaser. Visual acuity at discharge was 6/12 following silicone oil removal. DISCUSSION Necrotising chorioretinitis in immunosuppressed or elderly patients may present with an atypical phenotype. Clinical diagnosis in this context remains challenging. We discuss the clinical reasoning behind investigation and management of this patient group in whom viral and Toxoplasma retinitis may be clinically indistinguishable. The significance of vitreous PCR results in clinical decision making in the context of infectious posterior uveitis is discussed.
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Affiliation(s)
- Imran H Yusuf
- Department of Ophthalmology, Oxford Eye Hospital, Headley Way, Headington , Oxford , OX3 9DU United Kingdom
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The value of routine polymerase chain reaction analysis of intraocular fluid specimens in the diagnosis of infectious posterior uveitis. ScientificWorldJournal 2013; 2013:545149. [PMID: 24250270 PMCID: PMC3819945 DOI: 10.1155/2013/545149] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 08/22/2013] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the value of routine polymerase chain reaction (PCR) analysis on intraocular fluid from patients presenting with a first episode of suspected active infectious posterior uveitis in a population with a high prevalence of human immunodeficiency virus infection. DESIGN Retrospective, interventional case series. Participants. 159 consecutive patients presenting at a tertiary care hospital over a five-year period. METHODS PCR analysis was performed for cytomegalovirus, varicella zoster virus, herpes simplex virus types 1 and 2, Toxoplasma gondii, and Mycobacterium tuberculosis. RESULTS PCR analysis confirmed the initial clinical diagnosis in 55 patients (35%) and altered the initial clinical diagnosis in 36 patients (23%). The clinical diagnosis prior to PCR testing was nonspecific (uncertain) in 51 patients (32%), with PCR providing a definitive final diagnosis in 20 of these patients (39%); necrotizing herpetic retinopathy and ocular toxoplasmosis were particularly difficult to diagnose correctly without the use of PCR analysis. CONCLUSION The clinical phenotype alone was unreliable in diagnosing the underlying infectious cause in a quarter of patients in this study. Since the outcome of incorrectly treated infective uveitis can be blinding, PCR analysis of ocular fluids is recommended early in the disease even in resource poor settings.
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Abstract
Although microbial culture remains the gold standard for diagnosis of many ocular infections, the technique is limited by low yield, inability to detect certain organisms, and potentially long delays to results. DNA-based molecular diagnostic techniques use detection of specific nucleic acid sequences as evidence for presence of suspected pathogens. The polymerase chain reaction (PCR) is a powerful molecular biology technique that allows for detection of fewer than 10 copies of pathogen genome. Recent technical advances in PCR have permitted quantitation of pathogen load using quantitative PCR (qPCR), and have permitted multiplexing of primer sets. Use of pan-bacterial and pan-fungal primers for ribosomal DNA sequences has allowed diagnosis of bacterial and fungal infections using molecular techniques. In this review, we highlight recent advances in the application of PCR to the diagnosis of anterior segment and posterior segment ocular infectious diseases.
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Majumder PD, Sudharshan S, Biswas J. Laboratory support in the diagnosis of uveitis. Indian J Ophthalmol 2013; 61:269-76. [PMID: 23803478 PMCID: PMC3744779 DOI: 10.4103/0301-4738.114095] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 02/26/2013] [Indexed: 12/11/2022] Open
Abstract
Intraocular inflammations are still a diagnostic challenge for ophthalmologists. It is often difficult to make a precise etiological diagnosis in certain situations. Recently, there have been several advances in the investigations of uveitis, which has helped the ophthalmologists a lot in the management of such clinical conditions. A tailored approach to laboratory diagnosis of uveitic cases should be directed by the history, patient's symptoms and signs, and clinical examination. This review summarizes various modalities of laboratory investigations and their role in the diagnosis of uveitis.
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Affiliation(s)
| | - S Sudharshan
- Department of Uvea, Sankara Nethralaya, Chennai, India
| | - Jyotirmay Biswas
- Department of Uvea, Sankara Nethralaya, Chennai, India
- Department of Uvea and Ocular Pathology, Sankara Nethralaya, Chennai, India
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Kasetsuwan N, Tangmonkongvoragul C. Concomitant herpes simplex virus and cytomegalovirus endotheliitis in immunocompetent patient. BMJ Case Rep 2013; 2013:bcr-2012-007942. [PMID: 23667217 DOI: 10.1136/bcr-2012-007942] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A case of an immunocompetent 51-year-old healthy man with chronic recurrent disciform corneal oedema and hypertensive anterior uveitis in the right eye for 2 years was unresponsive to topical corticosteroid and systemic acyclovir. Diagnostic anterior chamber tapping was performed and viral DNA PCR was positive for both cytomegalovirus and herpes simplex virus. The patient was treated with both oral valganciclovir for 3 months and long-term oral acyclovir. His condition improved significantly after the treatment; intraocular pressure and anterior chamber inflammation were controlled and the remaining keratic precipitates in the cornea started to clear up.
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Affiliation(s)
- Ngamjit Kasetsuwan
- Department of Ophthalmology, Chulalongkorn University, Bangkok, Thailand.
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Do DV, Nguyen QD. Vitreous, Retinal, and Choroidal Biopsy. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00124-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Shi Y, Lu H, He T, Yang Y, Liu L, Zhang R, Zheng Y, Shen Y, Zhang Y, Zhang Z. Prevalence and clinical management of cytomegalovirus retinitis in AIDS patients in Shanghai, China. BMC Infect Dis 2011; 11:326. [PMID: 22115120 PMCID: PMC3235083 DOI: 10.1186/1471-2334-11-326] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 11/24/2011] [Indexed: 11/10/2022] Open
Abstract
Background Cytomegalovirus retinitis is a common AIDS-associated illness, leading to blindness in up to 30% of patients. This study was to investigate the prevalence and clinical management of the cytomegalovirus retinitis associated with AIDS in a large municipality of China. Methods Clinical and laboratory data from 23 cytomegalovirus retinitis patients (35 eyes) out of 303 hospitalized AIDS individuals in a single medical center were analyzed retrospectively. Two of 23 patients were diagnosed cytomegalovirus retinitis just before hospitalization without anti-CMV therapy. Ganciclovir combined with the high active anti-retroviral therapy was installed for treatment of cytomegalovirus retinitis after diagnosis was confirmed. The data were analyzed by specialists and statistics was also applied. Results The prevalence of cytomegalovirus retinitis in hospitalized AIDS patients was 7.6% in this study. The level of CD4+ T lymphocytes was correlated well with the occurrence of cytomegalovirus retinitis, showing 16.8% (19/113) (95% confidence interval: 10.4,25.0), 5.4% (3/56) (95% confidence interval: 1.1,14.9), and 1.4% (1/69) (95% confidence interval: 0.0,7.8) occurrence in the patients with CD4+ T lymphocyte counts < 50, 50~99, and 100~199 cells/μl, respectively. The mean CD4+ T lymphocyte counts was 31.7 ± 38.6 cells/μl in 23 AIDS patients with cytomegalovirus retinitis. Median CD4+ T lymphocyte count is 20 cells/μl with inter-quartile range as (5, 36). Seven patients died (11 eyes) and 16 patients (24 eyes) survived. The proportion of blindness and low vision in eyes infected with cytomegalovirus retinitis respectively was 20.8% (5/24) and 29.2% (7/24) when they were diagnosed in survivors. The ganciclovir therapy was effective in 16 patients (24 eyes). Clinical recovery of cytomegalovirus retinitis was 41.7% (10/24) and clinical improvement 58.3% (14/24). After anti-CMV treatment, the proportion of blindness or low vision was 16.7% (4/24). Conclusions The AIDS patients with CD4+ T lymphocyte < 50 cells/μl had increased susceptibility to cytomegalovirus associated retinitis. Cytomegalovirus retinitis is a serious disease causing blindness. The cytomegalovirus retinitis in the AIDS patients was response well to ganciclovir therapy. We should check their eyes routinely such as dilated fundus examination with an indirect ophthalmoscope in the AIDS patients with CD4+ T lymphocyte counts < 50 cells/μl.
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Affiliation(s)
- Ying Shi
- Shanghai Public Health Clinical Center affiliated to Fudan University, Shanghai 201508, China
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Hooper C, Pavesio C. Investigations in the diagnosis of uveitis. EXPERT REVIEW OF OPHTHALMOLOGY 2011. [DOI: 10.1586/eop.11.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Development and evaluation of loop-mediated isothermal amplification assay for rapid and inexpensive detection of cytomegalovirus DNA in vitreous specimens from suspected cases of viral retinitis. J Clin Microbiol 2010; 48:2050-2. [PMID: 20351207 DOI: 10.1128/jcm.02248-09] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A loop-mediated isothermal amplification (LAMP) assay for the rapid detection of cytomegalovirus (CMV) was developed and evaluated. The LAMP assay specifically amplified only CMV DNA, and no cross-reactivity with the DNA of herpes simplex virus type 1, varicella-zoster virus, adenovirus, Aspergillus flavus, or Staphylococcus aureus was observed. The sequences of the LAMP assay-positive CMV products were perfectly (100%) matched with the CMV sequence deposited in the GenBank database. The sensitivity of the LAMP assay was found to be 10 copies/microl of CMV DNA. Vitreous samples from 40 patients with suspected retinitis were subjected to LAMP and real-time PCR for the detection of CMV. Of 40 patients with suspected viral retinitis, 10 tested positive for CMV by the real-time PCR and LAMP assays. A 100% concordance was observed between the results of the two methods. The LAMP assay is a rapid, highly specific, and sensitive method for the diagnosis of retinitis caused by CMV.
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Walker JD, Opremcak EM. Noninfectious Posterior Uveitis. Semin Ophthalmol 2009. [DOI: 10.3109/08820539609067463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Yeung SN, Butler A, Mackenzie PJ. Applications of the polymerase chain reaction in clinical ophthalmology. Can J Ophthalmol 2009; 44:23-30. [PMID: 19169309 DOI: 10.3129/i08-161] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Molecular biology has become a valuable component in many areas of medicine, including ophthalmology. Polymerase chain reaction (PCR) is the most widely used tool. It has proven to be a powerful technique in diagnosis and quantification of microorganisms and antibiotic resistance screening. For a growing number of ophthalmic conditions PCR testing can be conducted. It is therefore important that clinicians be knowledgeable about the indications, strengths, and limitations of the technique. The purpose of this review is to explore the current role of PCR in the diagnosis and management of eye disease.
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Affiliation(s)
- Sonia N Yeung
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC.
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Zamir E. Cytomegalovirus Retinitis (CMVR) in AIDS. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00124-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Harper TW, Miller D, Schiffman JC, Davis JL. Polymerase chain reaction analysis of aqueous and vitreous specimens in the diagnosis of posterior segment infectious uveitis. Am J Ophthalmol 2009; 147:140-147.e2. [PMID: 18834576 DOI: 10.1016/j.ajo.2008.07.043] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Revised: 07/23/2008] [Accepted: 07/25/2008] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess polymerase chain reaction (PCR) analysis of intraocular fluid as a test for infectious uveitis of the posterior segment in a representative patient population. DESIGN Retrospective, interventional case series. METHODS One hundred and thirty-three patients with possible infectious chorioretinitis underwent PCR testing of aqueous or vitreous in a university setting. Baseline characteristics predictive of test positivity were identified. Positive and negative predictive values were calculated. RESULTS Four hundred and thirty-three PCR tests of 105 aqueous and 38 vitreous specimens (mean, 3.3 tests per patient) identified 77 of the 95 patients with a final clinical diagnosis of infectious uveitis (81%). Herpes simplex virus, varicella zoster virus, and cytomegalovirus PCR analysis were performed in almost all cases, with fewer tests for toxoplasmosis or Epstein-Barr virus. Clinical features associated with positive PCR results were retinal vascular inflammation (P < .001), optic nerve involvement (P = .008), immunocompromised state (P = .039), and extensive retinitis (P = .002). Cases sampled within one week of presentation were more likely to have positive PCR results than those sampled later (P = .071). The predictive value of positive and negative tests was 98.7% and 67.9%, respectively, in this patient group. Alteration in treatment based on PCR and syphilis serologic results led to resolution in 25 of 26 patients after treatment was changed. CONCLUSIONS PCR testing is a useful adjunct in the diagnosis of infectious causes of posterior uveitis. Cases with vascular or optic nerve inflammation, extensive retinitis, or immunocompromise are more likely to have positive PCR results and may benefit from PCR testing of aqueous humor.
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Tajunisah I, Reddy SC, Tan LH. Acute retinal necrosis by cytomegalovirus in an immunocompetent adult: case report and review of the literature. Int Ophthalmol 2007; 29:85-90. [DOI: 10.1007/s10792-007-9171-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2007] [Accepted: 10/23/2007] [Indexed: 11/27/2022]
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Affiliation(s)
- Lucia Sobrin
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Boston, MA 02114, USA
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Rozanova EB, Teplinskaia LE, Kaliberdina AF, Barisani-Asenbauer T. Cytomegalovirus antibodies in tear fluid of patients with retinitis. Arch Virol 2006; 151:2407-17. [PMID: 16830070 DOI: 10.1007/s00705-006-0813-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2006] [Accepted: 06/01/2006] [Indexed: 10/24/2022]
Abstract
The diagnosis of cytomegalovirus retinitis (CMV-R) is difficult and usually based on clinical criteria or invasive diagnostic procedures. The purpose of this study was to investigate a possible association between CMV-R and specific anti-CMV antibodies in tears. Paired tear and serum samples were obtained from 96 individuals, which included 20 children with congenital CMV infection and chorioretinitis, 56 adults with retinitis with clinical signs suggestive of viral infection, and 20 healthy control subjects, and were tested for CMV antibodies using ELISA. The prevalence of anti-CMV antibodies in tears was found to be 80% (16/20) in children, 35% (20/56) in adults, and 5% (1/20) in control subjects. Furthermore, high antibody levels were detected in 35% (7/20) of children and 10.7% (6/56) of adults with retinitis, and were not found in control subjects. There was a strong association between high tear levels of anti-CMV antibodies and active ocular infection. No correlations were found between tear and serum antibodies. ELISA sensitivity was 80% and specificity 95%. Further studies are needed to compare the tear and intraocular levels of CMV-specific antibodies in patients with retinitis to find out if CMV antibody testing in tear fluid could substitute for more invasive diagnostic procedures.
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Affiliation(s)
- E B Rozanova
- Department of Immunology and Virology, Helmholtz Research Institute of Eye Diseases, Sadovaya-Chernogriazskaya, Moscow, Russia.
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Acharya N, Lietman T, Cevallos V, Whitcher JP, Saidel M, Stone D, Duncan J, Margolis TP. Correlation between clinical suspicion and polymerase chain reaction verification of infectious vitritis. Am J Ophthalmol 2006; 141:584-5. [PMID: 16490520 DOI: 10.1016/j.ajo.2005.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2005] [Revised: 10/05/2005] [Accepted: 10/06/2005] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare polymerase chain reaction (PCR) results to presumptive clinical diagnosis in patients with vitritis. DESIGN Retrospective review of PCR laboratory records from vitreous samples. METHODS Fifty consecutive laboratory records of vitreous samples sent for PCR testing were reviewed. Three reviewers with uveitis training ranked the clinical suspicion of a specific diagnosis using a classification system (scale of 1 to 4) and were masked to the PCR results. RESULTS The degree of clinical suspicion of a particular diagnosis was significantly associated with a positive PCR result (P = .048). Higher clinical suspicion was significantly more associated with a positive PCR result compared with cases with lower clinical suspicion (P = .01). CONCLUSIONS If the clinical suspicion of a specific diagnosis is low, the PCR for any infectious etiology is unlikely to be positive.
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Affiliation(s)
- Nisha Acharya
- Proctor Foundation, Department of Ophthalmology, University of California-San Francisco, 95 Kirkham Street, San Francisco, CA 94143, USA.
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Do DV, Loewenstein A, Green WR, Haller JA. Vitreous, Retinal, and Choroidal Biopsy. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50047-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kosobucki BR, Freeman WR. Retinal Disease in HIV-infected Patients. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50098-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tran THC, Stanescu D, Caspers-Velu L, Rozenberg F, Liesnard C, Gaudric A, Lehoang P, Bodaghi B. Clinical characteristics of acute HSV-2 retinal necrosis. Am J Ophthalmol 2004; 137:872-9. [PMID: 15126152 DOI: 10.1016/j.ajo.2003.12.036] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2003] [Indexed: 11/15/2022]
Abstract
PURPOSE To report the clinical features and evaluate the visual outcome of eleven cases of herpes simplex virus-2 (HSV-2) related acute retinal necrosis syndrome (ARN). DESIGN Retrospective interventional case series. METHODS Twelve eyes of eleven patients from two European centers, diagnosed with HSV-2 related acute retinal necrosis syndrome were retrospectively reviewed. Herpes simplex virus-2 DNA was detected by polymerase chain reaction in intraocular fluids (aqueous and/or vitreous). Findings at initial examination, clinical evolution with antiviral therapy, complications and final visual acuity were evaluated. RESULTS Herpes simplex virus-2 DNA was detected in all cases. No sample was positive for more than one virus. The mean age of disease in the first eye was 36 years (ranged from 10 to 57 years). Five patients were women and six were men. All patients were immunocompetent. Previous medical history included neonatal herpes (n = 1), previous ARN (n = 3), trauma (n = 1) and systemic corticosteroid administration before occurrence of ARN (n = 3). Preexisting pigmented chorioretinal scars were found in three cases. Patients were treated with high dose intravenous acyclovir or foscarnet +/- intravitreal ganciclovir +/- interferon. The mean follow-up was 14.5 months (from 5 to 22 months). At the end of the follow-up period, five eyes (41.7%) showed improvement of visual acuity of two or more lines. Final visual acuity was 20/60 or better in four eyes (33.3%), 20/400 or better in four eyes (33.3%) and less than 20/400 in four eyes. CONCLUSION History of neonatal herpes, triggering events such as neurosurgery, periocular trauma, high-dose corticosteroids, and chorioretinal scars suggest that HSV-2 retinitis reflects reactivation of HSV-2 infection.
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MESH Headings
- Acyclovir/therapeutic use
- Adult
- Antiviral Agents/therapeutic use
- Aqueous Humor/virology
- Child
- DNA, Viral/analysis
- Drug Therapy, Combination
- Eye Infections, Viral/diagnosis
- Eye Infections, Viral/drug therapy
- Eye Infections, Viral/virology
- Female
- Foscarnet/therapeutic use
- Ganciclovir/therapeutic use
- Herpes Simplex/diagnosis
- Herpes Simplex/drug therapy
- Herpes Simplex/virology
- Herpesvirus 2, Human/genetics
- Herpesvirus 2, Human/isolation & purification
- Humans
- Interferons/therapeutic use
- Male
- Middle Aged
- Polymerase Chain Reaction
- Retinal Necrosis Syndrome, Acute/diagnosis
- Retinal Necrosis Syndrome, Acute/drug therapy
- Retinal Necrosis Syndrome, Acute/virology
- Retrospective Studies
- Virus Activation
- Visual Acuity
- Vitreous Body/virology
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Affiliation(s)
- Thi Ha Chau Tran
- Department of Ophthalmology, Pitié-Salpetrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
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39
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Tran THC, Bodaghi B, Rozenberg F, Cassoux N, Fardeau C, LeHoang P. Prise en charge diagnostique et thérapeutique des rétinites nécrosantes herpétiques. J Fr Ophtalmol 2004; 27:223-36. [PMID: 15039624 DOI: 10.1016/s0181-5512(04)96124-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To study the viral cause and present the management of necrotizing herpetic retinopathies. METHODS Charts of patients presenting with acute retinal necrosis (ARN) or progressive outer retinal necrosis (PORN) diagnosed between March 1997 and June 2001 were retrospectively reviewed. Intraocular specimens were obtained in 33 cases to determine the viral cause using polymerase chain reaction-based assays and/or detection of intraocular antibody production. RESULTS The mean age was 43.4 Years. Herpesvirus genome was identified in 29 patients (80.5%). In the ARN group (32 patients, 38 eyes), herpes simplex virus (HSV) DNA was found in 11 patients (34.4%), varicella-zoster virus (VZV) in nine patients (28.1%), and cytomegalovirus (CMV) in four patients (12.5%). One patient (3.1%) presented an Epstein-Barr virus (EBV) infection. ARN was bilateral at initial examination in six patients and secondary bilateralization was observed in four patients. In the PORN group (four patients, eight eyes), the retinitis was bilateral and VZV DNA was detected in all cases. Two patients were treated with intravenous acyclovir, six with foscarnet alone, ten with intravenous foscarnet + acyclovir, 18 with intravenous foscarnet and intravitreous ganciclovir injections. Complications of necrotizing herpetic retinitis were cataract (26%), optic nerve atrophy (23.9%), and retinal detachment (17.4%). Final visual acuity was less or equal to 20/200 in 47.8% of cases. CONCLUSIONS It is important to determine the specific viral etiology since progression and prognosis may be different in herpetic necrotizing retinitis caused by HSV, VZV, or CMV. Visual prognosis is improved by intensive antiviral therapy, but remains poor if complications occur.
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Affiliation(s)
- T H C Tran
- Service d'Ophtalmologie, Hôpital Pitié Salpêtière, 47-83, boulevard de l'Hôpital, 75013 Paris
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40
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Chichili GR, Athmanathan S, Farhatullah S, Gangopadhyay N, Jalali S, Pasricha G, Sharma S. Multiplex polymerase chain reaction for the detection of herpes simplex virus, varicella-zoster virus and cytomegalovirus in ocular specimens. Curr Eye Res 2004; 27:85-90. [PMID: 14632159 DOI: 10.1076/ceyr.27.2.85.15947] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE A majority of ocular viral diseases are caused by herpes group of viruses. Such infections, especially atypical herpetic keratitis, iridocyclitis and intra-ocular inflammations, can often present with overlapping clinical manifestations misleading the diagnosis. Molecular techniques are most useful in such instances for an accurate and rapid diagnosis since conventional methods are time consuming and less sensitive. A multiplex PCR was developed and used for the detection of herpes simplex virus (HSV), varicella zoster virus (VZV), and cytomegalovirus (CMV) in ocular samples. METHODS One hundred and forty six ocular samples (corneal scrapings - 52, aqueous fluid - 36, vitreous fluid - 31, tissues - 26, skin vesicle scraping - 1) were included in the study. The sensitivity of the assay was determined using serial dilutions of standard strains of HSV, VZV, and CMV vis-à-vis plaque forming assay. RESULTS The sensitivity of the assay was 4, 4 and 12 PFU/ml or 20, 20 and 60 genome copy numbers of HSV, VZV and CMV respectively. Using DNA from various sources (fungal, bacterial, human leukocytes, tissues) along with standard positive controls, the assay was found to be highly specific. HSV DNA was detected in majority of the clinical samples (33.6%), most frequent being corneal samples. Comparatively, VZV and CMV infections were detected in small number of samples (VZV-3, CMV-2). CONCLUSIONS We found the assay very useful in our set-up whenever a differential diagnosis of herpetic infections was suggested by the ophthalmologist. The multiplex PCR we have described here can be of greater value in clinics with larger number of patients suspected of having HSV, VZV or CMV infections.
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Affiliation(s)
- Gurunadh Reddy Chichili
- Jhaveri Microbiology Center, Hyderabad Eye Research Foundation, L.V. Prasad Eye Institute, L.V Prasad Marg, Banjara Hills, Hyderabad, India
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41
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Bodaghi B, Rozenberg F, Cassoux N, Fardeau C, LeHoang P. Nonnecrotizing herpetic retinopathies masquerading as severe posterior uveitis. Ophthalmology 2003; 110:1737-43. [PMID: 13129871 DOI: 10.1016/s0161-6420(03)00580-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Aqueous humor analysis can be performed in severe atypical forms of posterior uveitis unresponsive to conventional treatment to exclude a viral infection. DESIGN Noncomparative interventional case series. PARTICIPANTS Thirty-seven immunocompetent patients seen with corticosteroid-resistant forms of posterior uveitis underwent extensive evaluation, including anterior chamber paracentesis, to rule out a nonnecrotizing viral retinopathy. INTERVENTION Aqueous fluid samples were prospectively obtained. Polymerase chain reaction (PCR) and serologic evaluation of intraocular antibody production against herpesviruses were performed by molecular techniques and enzyme-linked immunosorbent assay. MAIN OUTCOME MEASURES Polymerase chain reaction and local antibody production for herpes simplex virus types 1 and 2, varicella-zoster virus, cytomegalovirus, and Epstein-Barr virus were determined on aqueous fluid samples. RESULTS Viral infection was confirmed in 5 cases (13.5%). Clinical presentation included birdshot-like retinochoroidopathy, occlusive bilateral vasculitis, and cystoid macular edema. An antiviral regimen was initiated in all cases. Inflammation was stabilized, and steroid dosage could be significantly reduced. CONCLUSIONS Identification of a viral agent during severe posterior uveitis can dramatically change therapeutic management.
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MESH Headings
- Acyclovir/analogs & derivatives
- Acyclovir/therapeutic use
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Viral/analysis
- Antiviral Agents/therapeutic use
- Aqueous Humor/virology
- Diagnosis, Differential
- Drug Therapy, Combination
- Enzyme-Linked Immunosorbent Assay
- Eye Infections, Viral/diagnosis
- Eye Infections, Viral/drug therapy
- Eye Infections, Viral/virology
- Female
- Fluorescein Angiography
- Glucocorticoids/therapeutic use
- Herpesviridae/genetics
- Herpesviridae/immunology
- Herpesviridae/isolation & purification
- Herpesviridae Infections/diagnosis
- Herpesviridae Infections/drug therapy
- Herpesviridae Infections/virology
- Humans
- Male
- Middle Aged
- Polymerase Chain Reaction
- Prednisone/therapeutic use
- Retinal Diseases/diagnosis
- Retinal Diseases/drug therapy
- Retinal Diseases/virology
- Uveitis, Posterior/diagnosis
- Uveitis, Posterior/drug therapy
- Uveitis, Posterior/virology
- Valacyclovir
- Valine/analogs & derivatives
- Valine/therapeutic use
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Affiliation(s)
- Bahram Bodaghi
- Department of Ophthalmology, Pitié-Salpêtrière Hospital, Paris, France
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42
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Abstract
The polymerase chain reaction (PCR) is a powerful molecular biologic technique that permits detection and identification of infinitesimal quantities of DNA. It is well suited to the diagnosis of infectious posterior segment ocular inflammatory disease. In this review, the basic biochemistry of PCR, indications for its use, strengths and limitations to the technique, and examples of clinical application of PCR to posterior segment disease will be discussed. Emerging uses of PCR in linking pathogen to disease will also be outlined. After completion of this article, the reader will be able to describe the basic biochemistry and practical application of PCR in the diagnosis of posterior segment inflammatory disease, list the indications, advantages, and disadvantages of the technique, and outline the application of PCR diagnostics to individual differential diagnoses.
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Affiliation(s)
- Russell N Van Gelder
- Department of Ophthalmology and Visual Sciences, Department of Molecular Biology and Pharmacology, Washington University Medical School, Campus Box 8096, 660 South Euclid Avenue, St. Louis, MO 63110, USA.
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44
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Yamamoto N, Wakabayashi T, Murakami K, Hommura S. Detection of CMV in plasma and aqueous humor specimens from AIDS patients with CMV retinitis using the amplicor CMV test. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2003; 34:351-4. [PMID: 12069018 DOI: 10.1080/00365540110077489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
A DNA hybridization test (the Amplicor CMV test) for CMV DNA was used to detect CMV DNA in paired plasma and aqueous humor specimens from 37 AIDS patients with ophthalmoscopically diagnosed CMV retinitis. CMV was detected in 25/37 (67.6%) plasma specimens and in 32/37 (86.5%) aqueous humor specimens. Thus, the Amplicor CMV test using aqueous humor specimens seems to be a useful diagnostic test for CMV retinitis and one that is more sensitive than determination of CMV DNA in plasma specimens.
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45
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Tran THC, Rozenberg F, Cassoux N, Rao NA, LeHoang P, Bodaghi B. Polymerase chain reaction analysis of aqueous humour samples in necrotising retinitis. Br J Ophthalmol 2003; 87:79-83. [PMID: 12488268 PMCID: PMC1771476 DOI: 10.1136/bjo.87.1.79] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2002] [Indexed: 11/04/2022]
Abstract
AIM To evaluate the diagnostic value of polymerase chain reaction (PCR) performed on aqueous humour for the detection of viral DNA in patients with necrotising herpetic retinitis. METHODS The clinical features and laboratory results of 22 patients (29 eyes) presenting with necrotising herpetic retinitis between March 1999 and June 2001 were reviewed retrospectively. Aqueous humour was obtained after anterior chamber paracentesis and PCR was performed in all cases. RESULTS Viral DNA was detected in the aqueous humour of 19 patients (86.4%). Epstein-Barr virus (EBV) seroconversion was evidenced in one additional patient. In the acute retinal necrosis (ARN) group (n = 19), varicella zoster virus (VZV) DNA was identified in six patients, herpes simplex virus 1 (HSV-1) DNA in two patients, herpes simplex virus 2 (HSV-2) DNA in four patients, and cytomegalovirus (CMV) genome in four patients. In the progressive outer retinal necrosis (PORN) group (n = 3), VZV DNA was detected in all patients. No sample was positive for more than one virus. CONCLUSIONS PCR analysis of aqueous humour in patients with clinical features of necrotising viral retinitis can provide specific aetiological orientation and the method appears to be safe and highly sensitive.
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Affiliation(s)
- T H C Tran
- Department of Ophthalmology, Pitié-Salpêtriére Hospital, Paris, France
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46
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Kuo IC, Imai Y, Shum C, Martin DF, Kuppermann BD, Margolis TP. Genotypic analysis of cytomegalovirus retinitis poorly responsive to intravenous ganciclovir but responsive to the ganciclovir implant. Am J Ophthalmol 2003; 135:20-5. [PMID: 12504692 DOI: 10.1016/s0002-9394(02)01758-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To determine whether cytomegalovirus (CMV) retinitis that responded poorly to intravenous ganciclovir therapy but responded to the ganciclovir implant was caused by virus with resistance mutations in the viral UL97 and UL54 genes. DESIGN Retrospective chart review and laboratory-based experimental study. METHODS Regions of the CMV UL97 and UL54 were amplified from the vitreous and analyzed for resistant mutations by a combination of DNA sequencing and restriction digestion. Vitreous from patients with AIDS and retinal infections other than CMV retinitis served as negative controls. RESULTS We amplified all target regions of UL97 DNA and most target regions of UL54 DNA from eight eyes with CMV retinitis. In one eye we found a ganciclovir resistance mutation at base 1781 of the UL97 gene, predicting an alanine to valine mutation at codon 594. In a second eye we found a ganciclovir resistance mutation at base 2960 of the UL54 gene, predicting an alanine to glycine mutation at codon 987. In two additional eyes, both from patients with bilateral retinitis, we found UL54 mutations that are likely to confer resistance to ganciclovir but have not been previously described. In both of these patients the UL54 genotype differed between the two diseased eyes. CONCLUSIONS Failure to control CMV retinitis with intravenous ganciclovir does not necessarily imply infection with a virus having a known mutation that confers drug resistance. The ganciclovir implant can be an effective therapy for CMV retinitis caused by virus with certain UL97 and UL54 resistance mutations. Cytomegalovirus UL54 genotypes can differ between eyes in patients with bilateral retinitis.
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Affiliation(s)
- Irene C Kuo
- Francis I. Proctor Foundation and the Department of Ophthalmology, University of California San Francisco, 94143-0944, USA
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47
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Abstract
The polymerase chain reaction (PCR) is a powerful molecular biologic technique for the analysis of very small amounts of DNA. This technique has found increasing use in the past 10 years for the detection of pathogenic organisms associated with many forms of ocular inflammatory and infectious disease. PCR has shown utility in the diagnosis of viral uveitis, infectious endophthalmitis, and parasitic eye disease. The strengths and weaknesses of this diagnostic technique are discussed. Additionally, uses of PCR in linking known pathogens to disease, and to discovering novel pathogens, are addressed.
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Affiliation(s)
- R N Van Gelder
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
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48
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Piper H, Ciulla TA, Danis RP, Pratt LM. Changing therapeutic paradigms in CMV retinitis in AIDS. Expert Opin Pharmacother 2000; 1:1343-52. [PMID: 11249469 DOI: 10.1517/14656566.1.7.1343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cytomegalovirus (CMV) retinitis is a common ocular complication of immunosuppression. The management of CMV retinitis has been continuously evolving over the last decade. The mainstay of therapy remains ganciclovir and foscarnet. However, increasing resistance and ongoing toxicities to these agents remain a challenge. Additional frequently utilised agents include cidofovir and fomivirsen. The advent of highly active antiretroviral therapy (HAART) has allowed the restoration of immunocompetency to many patients previously challenged by CMV infection. In some circumstances, HAART has even eliminated the need for ongoing antiviral therapy. This paper reviews the current treatment modalities, including their toxicities and dosing recommendations.
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Affiliation(s)
- H Piper
- Retina Service, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Newsom RS, Ong GL, Jackson TL, Coldrick I, Ripley LG, Fisher M, Casswell AG. Screening for CMV retinitis using chromatic discrimination thresholds and achromatic contrast sensitivity. Br J Ophthalmol 2000; 84:877-80. [PMID: 10906095 PMCID: PMC1723611 DOI: 10.1136/bjo.84.8.877] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Many patients with cytomegalovirus retinitis (CMVR) are unaware of visual disturbance so screening is advocated for patients with HIV and low CD4 counts. Many tests of retinal function have been recommended but few are effective at detecting CMVR. We assess the potential of chromatic discrimination thresholds and achromatic contrast sensitivity as screening tests for patients with CMVR. METHOD 11 HIV+ patients with CMVR, 16 age matched HIV+ patients, and 29 age matched controls were recruited. Visual acuity, chromatic discrimination thresholds, and achromatic contrast sensitivity were measured. Fundal examination was performed by slit lamp biomicroscopy for HIV+ patients. Those with CMVR were photographed and the CMVR graded from the photographs. RESULTS Loss of chromatic discrimination was found in patients with CMVR (tritan p<0.0005, red/green p<0.05). The same group had deterioration in achromatic contrast sensitivity at 2.2, 3.4, and 10 cpd (p<0.05). There was correlation between the zone of CMVR with chromatic gratings (tritan r=0.83, p<0.005). No statistically significant difference was found between the HIV+ patients and the controls for all tests (p>0.1). CONCLUSIONS HIV+ patients with CMVR have a loss of chromatic discrimination and achromatic contrast sensitivity and this may be used to screen HIV+ patients for CMVR.
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50
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Ganatra JB, Chandler D, Santos C, Kuppermann B, Margolis TP. Viral causes of the acute retinal necrosis syndrome. Am J Ophthalmol 2000; 129:166-72. [PMID: 10682968 DOI: 10.1016/s0002-9394(99)00316-5] [Citation(s) in RCA: 201] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The primary goal of this study was to determine the viral cause of the acute retinal necrosis syndrome in 28 patients (30 eyes). A secondary goal was to investigate possible associations between viral cause and patient age, and viral cause and central nervous system disease. METHODS A retrospective case series in which we reviewed the laboratory results and clinical histories of 28 patients (30 eyes) diagnosed with acute retinal necrosis syndrome, from whom vitreous or aqueous specimens were received, for diagnostic evaluation using previously described polymerase chain reaction-based assays. RESULTS Varicella-zoster virus, herpes simplex virus, and cytomegalovirus (CMV) DNA were detected in aqueous and/or vitreous specimens from 27 of 28 patients (29 of 30 eyes with a clinical history of acute retinal necrosis syndrome). No sample was positive for DNA from more than one virus. Varicella-zoster virus DNA was detected in 13 patients (15 eyes). Median age was 57 years. Herpes simplex virus type 1 DNA was detected in seven patients (seven eyes). Median age was 47 years. Six of these patients had a history of herpes simplex virus encephalitis. Herpes simplex virus type 2 DNA was detected in six patients (six eyes). Median age was 20 years. Three of these patients had a likely history of meningitis. Cytomegalovirus DNA was detected in one patient who was immunosuppressed iatrogenically. No viral DNA was detected in one patient from whom a sample was taken after 6 weeks of acyclovir therapy. CONCLUSIONS The data suggest that varicella-zoster virus or herpes simplex virus type 1 cause acute retinal necrosis syndrome in patients older than 25 years, whereas herpes simplex virus type 2 causes acute retinal necrosis in patients younger than 25 years. A history of central nervous system infection in a patient with acute retinal necrosis syndrome suggests that herpes simplex virus is likely to be the viral cause.
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Affiliation(s)
- J B Ganatra
- Francis I. Proctor Foundation, and the Department of Ophthalmology, University of California at San Francisco, 94143-0944, USA
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