Clinical anophthalmia associated with congenital cytomegalovirus infection

Monkeypox viral infection and disease: A challenge for the allergist-immunologist

Background: Human monkeypox is a zoonosis caused by the monkeypox virus, an orthopoxvirus and close relative of variola virus, the causative agent of smallpox. The disease was first reported in central Africa in 1970, where it continues to be endemic and has historically affected some of the poorest and most marginalized communities in the world. The condition has recently attracted global attention due to >14,000 cases, including five deaths, reported by the World Health Organization, and a total of 5189 confirmed monkeypox cases in the United States reported by the Centers for Disease Control and Prevention as of July 29, 2022. On July 23, 2022, the World Health Organization declared the current monkeypox outbreak a Public Health Emergency of International Concern. Objective: The purpose of the present report was to review the epidemiology of monkeypox viral infection; its clinical manifestations; and current recommendations for diagnosis, treatment, and use of vaccines for prevention of the disease, with a focus on those aspects that have particular relevance to the allergist/immunologist. Results: Monkeypox was discovered in the early 1970s and, for years, has been well described by researchers in west and central Africa, where the disease has been present for decades. Although this outbreak thus far has mostly affected men who have sex with men, it is possible that the disease could become endemic and could begin spreading in settings where there is close physical contact, which is how the virus is transmitted. Conclusion: Monkeypox is a different viral infection from the coronavirus. Unlike the coronavirus, which is an extremely contagious respiratory pathogen, monkeypox is primarily transmitted through body fluids and/or prolonged skin-to-skin contact. Although the control of monkeypox will require renewed efforts and resources, we have learned much from the past and have the tools to stop this virus from becoming yet another serious illness with which Americans have to contend. The allergist/immunologist can play a significant role.

In utero eye development documented by fetal MR imaging

BACKGROUND AND PURPOSE

To date, very limited attention has been given to ocular abnormalities or growth parameters detected by fetal MR imaging. Our objective was to retrospectively determine the relationship between different parameters of eye development and estimated gestational age in the human fetus by use of fetal MR imaging.

MATERIALS AND METHODS

A retrospective study was performed to measure the transverse diameter, interocular distance, and lens diameter of the globes of 127 fetuses who had a morphologically normal central nervous system. Multiple single-shot T2 fast spin-echo images were obtained with a 1.5T magnet by use of contiguous 3-mm intervals in at least 2 orthogonal planes. Loess curves were fitted to explore the relationship between gestational age and each of the 3 measurements of interest. Different models were compared statistically to determine the model of best fit.

RESULTS

For each variable of interest, the "best" model of eye growth was a quadratic function. Specifically, lens growth seems to plateau after 36 weeks of gestation, interocular distance plateaus after 36 weeks of gestation, and globe growth plateaus after 42 weeks of gestation.

CONCLUSIONS

The lens, orbit, and interocular distance growth of the fetus can be demonstrated on fetal MR imaging. All 3 measurements suggest a quadratic model of growth, which indicates slowing of growth toward the end of gestation.

Discordant semilobar holoprosencephaly in monozygotic twins with de novo inv dup(15) marker chromosome and de novo mutation on SHH gene

We present a 30-year-old woman with a twin pregnancy, 1 fetus displaying a small head circumference, semilobar holoprosencephaly, and cleft lip as detected by ultrasound at 23 weeks of gestation. Fetal magnetic resonance imaging confirmed the diagnosis of semilobar holoprosencephaly. The other twin, however, had an appropriate fetal growth, devoid of any major structural anomalies. Karyotyping by G-banding of amniocentesis specimens in both fetuses showed 47,XY,+mar. Fluorescence in situ hybridization showed in the marker chromosome positive dicentric signals for the chromosome 15 centromere-specific alpha satellite DNA probe (D15Z1) and negative signals for the SNRPN probe (15q11-13), thus establishing a cytogenetic diagnosis of 47,XX,+mar.ish idic(15)(q11-q13)(D15Z1++,SNRPN-) for both fetuses. The parental karyotypes were normal. The fetuses, therefore, had a de novo inv dup(15) marker chromosome without involvement of the Prader-Willi region. Short tandem repeat markers (total 15 markers) confirmed that the fetuses were monozygotic twins. Short tandem repeat markers at the 15q region (total 6 markers) excluded the possibility of uniparental disomy (15) mat or uniparental disomy (15) pat. Molecular study in both fetuses of TGIF, SHH, SIX3, and ZIC2 genes revealed a heterozygous 1085 C > T (Ser 362 Leu) on the SHH gene, but a homozygous 1085 C > C (Ser 362 Ser) for both parents on the SHH gene. The couple decided to terminate the pregnancy at 26 weeks of gestation. To our knowledge, this is the first report of semilobar holoprosencephaly with inv dup(15) marker chromosome and missense SHH gene mutation 1085 C > T (Ser 362 Leu).

Pervasive ocular anomalies in posterior microphthalmos

BACKGROUND

Posterior microphthalmos is a relatively rare condition that has been reported to coexist with several other ophthalmic conditions. However, to the best of the authors' knowledge, there are no previous reports that have found posterior microphthalmos and refractive, binocular, retinal, and neurologic considerations, along with a possible hereditary component. The following report documents the coexistence of posterior microphthalmos with severe hyperopia, esotropia, macular folds, and optic nerve hypoplasia in a pair of siblings.

CASE REPORT

A 9-year-old Hispanic girl presented for a comprehensive eye examination. Best-corrected visual acuity (VA) was reduced in both eyes with poorer VA in the right eye. Binocular testing found a small angle constant right esotropia (ET). On dilated fundus examination, a peculiar, elevated, dolphin-shaped folding of the macula was identified, the right eye greater than the left eye, that extended toward an anomalous optic nerve head in both eyes (OU), presumed to be a disc hypoplasia. The patient's brother, who also exhibited severe hyperopia and ET, presented with a similar acuity reduction, a nearly identical folded macular appearance, the right eye more so than the left eye, and a probable optic nerve hypoplasia. Pachymetry, ultrasonography, and ocular coherence tomography imaging of both siblings found thickened corneas in the presence of posterior microphthalmos OU and macular folds affecting only the retina, leaving the choroid and sclera unaffected.

CONCLUSIONS

Posterior microphthalmos may exist in the presence of ocular anomalies along with refractive, binocular, retinal, neurologic, and genetic considerations. In this case, optical coherence tomography provided information on the internal morphology of the macular folds, which helped direct the differential diagnosis. The similar presentation among siblings supports a hereditary component that warrants further investigation.

Ocular colobomata

Ocular colobomata present diagnostic and therapeutic challenges in patients of all ages, but especially in young children. The "typical" coloboma, caused by defective closure of the fetal fissure, is located in the inferonasal quadrant, and it may affect any part of the globe traversed by the fissure from the iris to the optic nerve. Ocular colobomata are often associated with microphthalmia, and they may be idiopathic or associated with various syndromes. Types and severity of complications vary depending on the location and size of the colobomata. This article reviews the pathogeneses, categorization, genetic bases, differential diagnoses and management of ocular coloboma.

Cellular gene expression altered by human cytomegalovirus: global monitoring with oligonucleotide arrays

Mechanistic insights to viral replication and pathogenesis generally have come from the analysis of viral gene products, either by studying their biochemical activities and interactions individually or by creating mutant viruses and analyzing their phenotype. Now it is possible to identify and catalog the host cell genes whose mRNA levels change in response to a pathogen. We have used DNA array technology to monitor the level of approximately 6,600 human mRNAs in uninfected as compared with human cytomegalovirus-infected cells. The level of 258 mRNAs changed by a factor of 4 or more before the onset of viral DNA replication. Several of these mRNAs encode gene products that might play key roles in virus-induced pathogenesis, identifying them as intriguing targets for further study.

Cyclopia and congenital cytomegalovirus infection

We describe the first documented association of congenital cytomegalovirus (CMV) infection and cyclopia. A previous report has suggested that any infant with congenital ocular defects should be investigated for CMV infection [Frenkel et al, 1980]. Our case underlines this suggestion and questions a teratogenic role for CMV in cyclopiaholoprosencephaly. More documented cases may help clarify the relationship of transplacental CMV infection to the holoprosencephaly developmental field defect, including cyclopia.

Prosthetic treatment of severe microphthalmos in infancy

Four infants with blind, severely microphthalmic eyes have been treated with cosmetic scleral shells. Through periodic refitting, this method has permitted the development of symmetrical ocular appearance without the need for surgery. We recommend that this treatment be initiated in early infancy in appropriate patients.

Anophthalmos and first branchial arch defects

The association of unilateral mandibulofacial dysostosis and anophthalmos at the same side is reported. The proband presented at the age of six months with: right anophthalmos and hypoplasia of the orbit at the same side, hypoplasia of the right mandible and maxilla, right external ear deformity, cyanotic heart disease, hemivertebrae, cataract and corneal opacity in the left eye. This case shows the maximal effect of the abnormal development of the first branchial arch (the mandible, maxilla, and ears) on the globe and the orbit. The other end of the spectrum in which the minimal effect on the globe was present (unilateral absence of choriocapillaris and retinal pigment epithelium inferiorly) was reported by Cotlier & Alghadyan in 1981. This supports the concept that abnormal development of the mandible may influence the development of the orbit and the globe. The extent of the influence of the abnormal developing first branchial arch on the eye is discussed.

Ocular findings in pediatric systemic disease

The many diseases and disorders that frequently have ophthalmologic implications in the pediatric age group are discussed.