Proptosis ocular a causa de la infección-enfermedad por VIH-sida / Ocular proptosis caused by HIV-AIDS infection-disease

RESUMEN Se presenta a un paciente que ingresó en el antiguo Hospital Provincial Clínico Quirúrgico Docente "José Ramón López Tabrane", de Matanzas. El motivo del ingreso fue una proptosis ocular derecha de instauración súbita en el curso de la infección-enfermedad por VIH-sida. Se le realizaron múltiples estudios para poder definir la causa, y, pese a imponer tratamiento oportuno, falleció a los 15 días del mismo. La epidemia de sida continúa creciendo mundialmente. El conocimiento de las manifestaciones oculares; tanto las alteraciones del segmento anterior como las del posterior, y las infecciones asociadas, permiten mayor posibilidad de preservar la función visual en estos pacientes (AU).

ABSTRACT We present the case of a patient who entered the former Provincial Teaching Clinical Surgical Hospital "José Ramón López Tabrane", of Matanzas. The cause of admission was a sudden right ocular proptosis in the course of an HIV-AIDS infection-disease. Many different studies were carried out to define the cause, and although he was timely treated, he died 15 days after the treatment. The AIDS epidemic is still growing around the world. The knowledge of ocular manifestations, the alterations of the anterior segment as much as the alterations of the posterior one, and the associated infections allow a higher possibility of preserving the visual function in these patients (AU).

Evaluation of used eye drop containers for microbial contamination in outpatient department of tertiary care teaching hospital

Background: Contaminated eyedrops are considered as serious risk factor for many iatrogenic ocular infections. Apart from the risk of infection, microbial contamination may alter the pH of the solution thereby reducing the efficacy of drugs. Presently many preservatives are added to these eye drops preparations to extend the duration of use. Hence authors aimed this study to find the contamination rates in such eye drop preparations.Methods: This was a prospective observational research conducted at Ophthalmology OPD, of tertiary care teaching hospital for the period of 2 months. Total fifty five used eyedrops were collected.Results: Authors found that 25.45% of the collected eye drops were contaminated with various organisms, viz. E. coli (10.90%), Staphylococcus aureus (9.09%), Pseudomonas aerugenosa (1.81%), Bacillus subtilis (1.81%) and Candida albicans (1.81%). Among various eyedrops, mydriatic (60%) eyedrops had the highest rate of contamination. We also found that, different preservatives in the eye drops were presents with different level of microbial contamination.Conclusions: The present study showed that there is a definite co-occurrence between eyedrop contamination and ocular infections irrespective of preservatives. This research raises a concern about questionable efficacy of preservatives.

Ocular infections caused by Candida species: Type of species, in vitro susceptibility and treatment outcome.

Purpose: To report clinical and microbiological profile of patients with ocular candidiasis. Materials and Methods: Patients with ocular candidiasis were retrospectively identified from microbiology records. Significant isolates of Candida species were identified by Vitek 2 compact system. Minimum inhibitory concentration (MIC) of antifungal agents such as amphotericin B, itraconazole, voriconazole, fluconazole and caspofungin was determined by E test and of natamycin by microbroth dilution assay. Data on treatment and outcome were collected from medical records. Results: A total of 42 isolates of Candida were isolated from patients with keratitis-29, endophthalmitis-12 and orbital cellulitis-1. The most common species isolated was Candida albicans (12-keratitis, 4-endophthalmitis, 1-orbital cellulitis). All except one isolate were susceptible to amphotericin B. MIC of caspofungin was in the susceptible range in 28 (96.5%) corneal isolates while 12 out of 29 (41.3%) corneal isolates were sensitive to fluconazole. Resistance to voriconazole was seen in four corneal isolates. All isolates were susceptible to natamycin and all except two isolates were resistant or susceptible dose-dependent to itraconazole. Outcome of healed ulcer was achieved in 12/18 (66.6%) patients treated medically, while surgical intervention was required in 11 patients. Among the isolates from endophthalmitis patients, 11/12 were susceptible to amphotericin B, 6/12 to voriconazole and all to natamycin. Ten out of 11 patients (one patient required evisceration) with endophthalmitis were given intravitreal amphotericin B injection with variable outcome. Conclusions: Ocular candidiasis needs early and specific treatment for optimal results. Candida species continue to be susceptible to most commonly available antifungals including amphotericin B, voriconazole and natamycin.

Antibiotic resistance in ocular bacterial pathogens.

Bacterial infections of the eye are common and ophthalmologists are spoilt for choice with a variety of antibiotics available in the market. Antibiotics can be administered in the eye by a number of routes; topical, subconjunctival, subtenon and intraocular. Apart from a gamut of eye drops available, ophthalmologists also have the option of preparing fortified eye drops from parenteral formulations, thereby, achieving high concentrations; often much above the minimum inhibitory concentration (MIC), of antibiotics in ocular tissues during therapy. Antibiotic resistance among ocular pathogens is increasing in parallel with the increase seen over the years in bacteria associated with systemic infections. Although it is believed that the rise in resistant ocular bacterial isolates is linked to the rise in resistant systemic pathogens, recent evidence has correlated the emergence of resistant bacteria in the eye to prior topical antibiotic therapy. One would like to believe that either of these contributes to the emergence of resistance to antibiotics among ocular pathogens. Until recently, ocular pathogens resistant to fluoroquinolones have been minimal but the pattern is currently alarming. The new 8-fluoroquinolone on the scene-besifloxacin, is developed exclusively for ophthalmic use and it is hoped that it will escape the selective pressure for resistance because of lack of systemic use. In addition to development of new antibacterial agents, the strategies to halt or control further development of resistant ocular pathogens should always include judicious use of antibiotics in the treatment of human, animal or plant diseases.

Fungal endophthalmitis caused by Paecilomyces variotii, in an immunocompetent patient, following intraocular lens implantation.

We report the case of a 70-year-old man who was admitted for anterior endophthalmitis following an intraocular lens implantation. He had developed a fluffy growth resembling a fungal mass on the iris of the right eye. The mass was removed and sent for fungal studies to our department. Direct microscopy revealed hyphae. Further studies helped identify the fungus to belong to genus Paecilomyces. This is a rare case of fungal endophthalmitis caused by Paecilomyces variotii in an immunocompetent person.

Prevalence of bacterial pathogens causing ocular infections in South India.

Background / Aims: The eye may be infected from external sources or through intra-ocular invasion of micro-organisms carried by the blood stream. This study was undertaken to isolate and identify the specific bacterial pathogens causing ocular infections and to determine their in-vitro antibacterial susceptibilities to commonly used antibacterial agents. Materials and Methods: A retrospective analysis of all patients with clinically diagnosed bacterial ocular infections such as blepharitis, conjunctivitis, internal and external hordeolum, suppurative scleritis, canaliculitis, keratitis, dacryocystitis, preseptal cellulitis, endophthalmitis and panophthalmitis presenting between January 2005 and December 2005 was performed. Extra-ocular and intra-ocular specimens were collected and were subjected to direct microscopy and culture. Results: A total of 756 patients with bacterial ocular infections were analyzed, of which 462(61%) eyes had adnexal bacterial infection, 217(28.7%) had corneal infection, 6 (0.8%) had scleral involvement and the remaining 71(9.39%) eyes had infection of the intra-ocular tissues. The predominant bacterial species isolated was S. aureus (195 of 776; 25%) followed by S. pneumoniae (169 of 776; 21.78%) and coagulase negative staphylococci (142 of 776; 18.3%). The largest number of gram-positive isolates were susceptible to cefazolin (545 of 624; 87.34%), chloramphenicol (522 of 624; 83.65%) and gatifloxacin (511 of 624; 81.89%) and gram-negative isolates were to amikacin (127 of 136; 93.38%), gatifloxacin (125 of 136; 91.91%) and ofloxacin (119 of 136; 87.5%), while aerobic actinomycetes were to amikacin (100%), gatifloxacin (14 of 16; 87.5%), chloramphenicol (14 of 16; 87.5%) and ofloxacin (13 of 16; 81.25%). Conclusions: S. aureus frequently causes infections of eyelids and conjunctiva, S. pneumoniae of lacrimal apparatus and cornea and coagulase negative staphylococci causes intra-ocular infections. Of all routinely used antibacterials tested, flouroquinolones, especially gatifloxacin and ofloxacin represented a good choice for treating bacterial ocular infections.

Neurite óptica bilateral após infecção viral por dengue: relato de casos / Bilateral optic neuritis after dengue viral infection: case report

Dengue é uma doença viral transmitida pelos mosquitos Aedes aegypti e Aedes albopictus. Apresenta distribuição geográfica bastante ampla, sendo epidêmica em alguns países. A apresentação clínica depende da idade e do estado imunológico do paciente, podendo se apresentar de forma assintomática como, dengue clássica, hemorrágica e até como choque. Têm sido descritas muitas manifestações oculares, entretanto, poucos relatos de manifestações neurológicas causada por dengue. Relatamos dois casos de neurite bilateral pós infecção por dengue. Ambos apresentavam baixa de acuidade visual bilateral, papilite e alterações no campo visual e evoluíram com desaparecimento dos sintomas e sinais espontaneamente sem uso de medicação.

Dengue fever is a well known viral infection transmitted through the bite of an infected Aedes aegypti and Aedes albopictus mosquito. Its geographic distribution covers over 100 countries. Clinical presentation is variable and depends upon the age and immunological status of the patient. It can be classified as asymptomatic illness, dengue fever, dengue hemorrhagic or dengue shock syndrome. Ocular manifestations of dengue have been described, however there are few reports on neurological involvement. We hereby report two cases of bilateral optic neuritis after dengue viral infection. Both of them rapidly recovered the visual acuity without treatment.

Avaliação oftalmológica em pacientes com AIDS e neurotoxoplasmose / Ophthalmological evaluation of patients with AIDS and neurotoxoplasmosis

INTRODUÇÃO: Descrever os achados fundoscópicos em pacientes com AIDS e neurotoxoplasmose em fase ativa. MÉTODOS: Foi desenvolvido estudo prospectivo tipo série de casos incluindo 70 pacientes, de ambos os sexos, com idade variando de 20 a 63 anos, internados nas enfermarias de três hospitais públicos da Cidade do Recife, Pernambuco, com diagnósticos de AIDS e neurotoxoplasmose firmados segundo os critérios do Centers for Disease Control and Prevention (1992), no período de janeiro a outubro de 2008. Os pacientes se caracterizavam por: primeiro episódio de neurotoxoplasmose (65; 92,9 por cento) ou recidiva (5; 7,1 por cento); desconhecimento de ter AIDS (23; 32,9 por cento), contagem média de linfócitos T CD4 de 139,8 ± 3,04 células/mm3 e carga viral média igual a 137.080 ± 39.380 cópias/mL. Todos foram submetidos a exame oftalmológico, consistindo de: inspeção ocular; aferição da acuidade visual; investigação da função muscular extrínseca ocular e fundoscopia, empregando oftalmoscópio indireto binocular (modelo OHN 3.5 (Eyetec®) e lente externa de 20 dioptrias (Volk®). RESULTADOS: Os achados consistiram em: exsudatos algodonosos retinianos (8,6 por cento), constricção arteriolar difusa leve (8,6 por cento); lesões de retinocoroidite cicatricial, características de toxoplasmose ocular (5,7 por cento), atrofia do epitélio pigmentar retiniano (2,9 por cento), descolamento da retina (2,9 por cento), aumento de escavação papilar (1,4 por cento), degeneração periférica retiniana (1,4 por cento), macroaneurisma (1,4 por cento), papiledema bilateral (1,4 por cento), tração vítreo-retiniana (1,4 por cento). CONCLUSÕES: Pacientes com AIDS e neurotoxoplasmose podem apresentar alterações fundoscópicas características da toxoplasmose ocular, na forma ativa ou cicatricial, relacionadas ao HIV ou, ainda, a outras doenças oportunistas ou sistêmicas, podendo ser de grande auxílio num tratamento integral do paciente por uma equipe multiprofissional.

INTRODUCTION: To describe fundoscopic findings among patients with AIDS and active-phase neurotoxoplasmosis. METHODS: A prospective study of case series type was developed, including 70 patients of both sexes and ages ranging from 20 to 63 years who were admitted to the wards of three public hospitals in the city of Recife, Pernambuco, Brazil, from January to October 2008, with diagnoses of AIDS and neurotoxoplasmosis determined according to the criteria of the Centers for Disease Control and Prevention (1992). The patients were characterized by a first episode of neurotoxoplasmosis (65; 92.9 percent) or recurrence (5; 7.1 percent), unawareness of having AIDS (23; 32.9 percent), mean T CD4+ count of 139.8 ± 3.04 lymphocytes/mm³ and mean viral load of 137,080 ± 39,380 copies/ml. All patients underwent ophthalmological examination consisting of ocular inspection, gauging of visual acuity, investigation of ocular extrinsic muscle function and fundoscopy using a binocular indirect ophthalmoscope (model OHM 3.5 Eyetec®) and external lens of 20 diopters (Volk®). RESULTS: The findings consisted of retinal cotton-wool spot exudates (8.6 percent), slight diffuse arteriolar constriction (8.6 percent), retinochoroiditis scars characteristic of ocular toxoplasmosis (5.7 percent), atrophy of retinal pigment epithelium (2.9 percent), retinal detachment (2.9 percent), increased papillary excavation (1.4 percent), retinal peripheral degeneration (1,4 percent), macroaneurysm (1.4 percent), bilateral papilledema (1.4 percent) and vitreous-retinal traction (1.4 percent). CONCLUSIONS: Patients with AIDS and neurotoxoplasmosis may present fundoscopic abnormalities characteristic of ocular toxoplasmosis, either in active or in scar form, related to HIV or even to other opportunist or systemic diseases, which can be of great aid for integral treatment of patients by a multiprofessional team.

Alteraciones oftalmológicas en el SIDA / Ophthalmological alterations in AIDS

Se realizó esta revisión con el propósito de familiarizarse con las alteraciones oftalmológicas en pacientes con síndrome de inmunodeficiencia humana. Se recopiló literatura internacional, se estudió la información y se organizaron según los objetivos planteados. Se describen resumidamente las manifestaciones oculares más frecuentes en el paciente positivo al virus de la inmunodeficiencia humana. La epidemia de SIDA continúa creciendo mundialmente y el conocimiento de las manifestaciones oftalmológicas permitirá mayor posibilidad de preservar la función visual en los pacientes.

A review was made to get familiar with the ophthalmological alterations in patients with human immunodeficiency syndrome. The information collected from international literature was studied and organized. The most frequent ocular manifestations in the AIDS patient were described. The AIDS epidemic is still growing in the world and the knowledge of the ophthalmological alterations will offer greater possibilities to preserve the visual function in these patients.