ABSTRACT
Bartonella henselae es el agente etiológico de la enfermedad por arañazo de gato. Típicamente, se presenta como una linfadenopatía regional autolimitada y, con menor frecuencia, con compromiso sistémico y manifestaciones extraganglionares: hígado, bazo, hueso y ojo, entre otros. Se presenta un caso de enfermedad por arañazo de gato atípica en un paciente pediátrico inmunocompetente, en la que se evidenció compromiso meníngeo y ocular, este último como neurorretinitis. Se destaca la importancia de la búsqueda activa de complicaciones oculares en pacientes con compromiso sistémico por Bartonella henselae, que implica un cambio en el tratamiento y pronóstico de la enfermedad
Bartonella henselae is the etiologic agent of cat scratch disease. It typically presents as a self-limited regional lymphadenopathy and less frequently with systemic involvement and extranodal manifestations: liver, spleen, bone, eye, among others. A case of atypical cat scratch disease is presented in an immunocompetent pediatric patient, in which meningeal and ocular involvement was evidenced, the latter manifested as neuroretinitis. The importance of the active search for ocular complications in patients with systemic involvement by Bartonella henselae is highlighted, implying a change in the treatment and prognosis of the disease
Subject(s)
Humans , Male , Adolescent , Retinitis/complications , Cat-Scratch Disease/complications , Cat-Scratch Disease/diagnosis , Bartonella henselaeABSTRACT
La endocarditis bacteriana con hemocultivo negativo constituye un dilema diagnóstico. Tanto Bartonella como Coxiella pueden causarla, con presentaciones clínicas similares que pueden simular una vasculitis sistémica no infecciosa. Sin embargo, difieren en el tipo y la duración del tratamiento, por lo que es fundamental identificar el agente etiológico. Presentamos un caso de endocarditis por Bartonella henselae asociada a glomerulonefritis y neurorretinitis, con hemocultivo negativo, anticuerpos anticitoplasma de neutrófilos y antiproteinasa 3 positivos, y serología positiva para Bartonella con reacción cruzada para Coxiella burnetti. El diagnóstico etiológico fue confirmado a posteriori mediante amplificación y secuenciación parcial del gen ribC a partir de tejido de la válvula cardíaca. El paciente recibió tratamiento antibiótico e inmunosupresor seguido de recambio valvular aórtico y presentó evolución favorable.
Blood-culture negative endocarditis is a diagnostic challenge. Both Bartonella and Coxiella can cause it with similar clinical presentations mimicking a systemic vasculitis. The identification of the etiologic agent is essential because they differ in treatment type and duration. We present a case of blood-culture negative endocarditis caused by Bartonella henselae, associated with glomerulonephritis and neuroretinitis, with negative blood culture, positive anti-neutrophil cytoplasmic and antiproteinase 3 antibodies. The serology was positive for Bartonella with cross-reactivity to Coxiella burnetti. The etiological diagnosis was achieved by polymerase chain reaction amplification and sequencing of a ribC gene fragment. The patient received antibiotic and immunosuppressive treatment followed by replacement of the aortic valve with favorable medium-term evolution.
Subject(s)
Humans , Male , Adult , Retinitis/microbiology , Bartonella henselae/isolation & purification , Endocarditis, Bacterial/microbiology , Glomerulonephritis/microbiology , Retinitis/complications , Endocarditis, Bacterial/complications , Glomerulonephritis/complicationsABSTRACT
El virus de inmunodeficiencia humana (VIH)/ síndrome de inmunodeficiencia adquirida (SIDA), afecta a millones de personas alre-dedor del mundo. En Latinoamérica y el Caribe, casi 1.9 millones de personas viven con VIH/SIDA. Se caracteriza por ser una enfermedad multisistémica en donde las enfermedades oftalmológicas se presentan en un 70% a 80% de los pacientes infecta-dos. En estos pacientes las infecciones oportunistas son la principal causa de enfer-medad ocular sin embargo, es también causa de anomalías visuales, como la ano-malía de Peter que solo se presenta 1 en un millón de personas y es la causa de más del 40% de las opacidades corneales congéni-tas. Se presenta caso de femenina de 21 años de edad, procedente de San Pedro Sula, con antecedente de virus de inmuno-deficiencia adquirida en estadio B2, por transmisión vertical, en tratamiento con anti-rretrovirales, sin antecedentes maternos infecciosos sumados al VIH. Con historia de visión borrosa, lejana y cercana en ambos ojos con mayor severidad en ojo derecho. Además, refiere cefalea, frontal, pulsátil, de predominio vespertino que se irradia hacia parietal y occipital. Al exámen físico se encuentra agudeza visual disminuida, presión intraocular en límite superior, leuco-mas corneales y gonioscopía alterada en ambos ojos. Actualmente ambos ojos esta-bles y agudeza visual mejora con gradua-ción lo que es indicativo de un pronóstico favorable...(AU)
Subject(s)
Humans , Female , Adult , Retinitis/complications , Opportunistic Infections/complications , HIV , Eye Abnormalities , Acquired Immunodeficiency SyndromeABSTRACT
ABSTRACT Recurrent idiopathic neuroretinitis is an inflammatory optic neuropathy characterized by optic nerve edema and macular star, associated with painless and recurrent episodes of visual loss, poor visual prognosis, and visual field defects related to nerve fiber layer injury. The disorder is sometimes mistaken for atypical optic neuritis. However, early diagnosis is important for visual recovery. Long-term immunosuppression has been shown to reduce the rate of recurrence and protect against severe and irreversible vision loss.
RESUMO Neurorretinite recorrente idiopática é uma neuropatia óptica inflamatória caracterizada por edema do nervo óptico e estrela macular associada a episódios recorrentes de perda visual indolor, baixo prognóstico visual e desfeitos de campo visual relacionados a injúria da camada de fibras nervosas. Essa condição pode ser confundida com neurite óptica atípica e seu correto diagnóstico é importante para o prognóstico visual, uma vez que a imunossupressão continua previne episódios recorrentes que podem levar a perda visual severa e irreversível.
Subject(s)
Humans , Male , Adult , Retinitis/diagnosis , Optic Neuritis/diagnosis , Recurrence , Retinitis/complications , Retinitis/pathology , Vision Disorders/etiology , Visual Acuity , Optic Neuritis/pathology , Tomography, Optical Coherence , Diagnosis, Differential , Exudates and Transudates , Visual Field Tests , Macula Lutea/metabolism , Macula Lutea/pathologyABSTRACT
A 14-year-old girl presenting with visual loss in both eyes was diagnosed to have healed toxoplasma retinochoroiditis in the right eye with active choroidal neovascularization (CNV) secondary to toxoplasmosis in the left. She underwent combination photodynamic therapy (PDT) and intravitreal bevacizumab as primary treatment. PDT was performed as per the ‘Treatment of Age-related Macular Degeneration by Photodynamic therapy’ study protocol and was followed by intravitreal bevacizumab after 2 days. CNV regressed at 8 weeks of follow-up and remained stable at 8 months of follow-up. The initial visual acuity improved from 20/120 to 20/30. Combination therapy with PDT and intravitreal bevacizumab appears to be effective in the treatment of CNV secondary to toxoplasma retinochoroiditis.
Subject(s)
Adolescent , Angiogenesis Inhibitors/administration & dosage , Antibodies, Monoclonal/administration & dosage , Antibodies, Monoclonal, Humanized , Choroidal Neovascularization/drug therapy , Choroidal Neovascularization/etiology , Choroiditis/complications , Choroiditis/parasitology , Drug Therapy, Combination , Female , Follow-Up Studies , Humans , Intravitreal Injections , Photochemotherapy , Retinitis/complications , Retinitis/parasitologyABSTRACT
Posterior uveitic entities are varied entities that are infective or non-infective in etiology. They can affect the adjacent structures such as the retina, vitreous, optic nerve head and retinal blood vessels. Thorough clinical evaluation gives a clue to the diagnosis while ancillary investigations and laboratory tests assist in confirming the diagnosis. Newer evolving techniques in the investigations and management have increased the diagnostic yield. In case of diagnostic dilemma, intraocular fluid evaluation for polymerase chain testing for the genome and antibody testing against the causative agent provide greater diagnostic ability.
Subject(s)
Anti-Inflammatory Agents/therapeutic use , Choroiditis/complications , Choroiditis/diagnosis , Diagnosis, Differential , Fluorescein Angiography/methods , Fundus Oculi , Humans , Infections/complications , Prognosis , Retinitis/complications , Retinitis/diagnosis , Tomography, Optical Coherence/methods , Uveitis, Posterior/diagnosis , Uveitis, Posterior/drug therapy , Uveitis, Posterior/etiologyABSTRACT
Cat scratch disease (CSD) is a self limited condition characterized by fever, lymph node enlargement and less often eye involvement. Central nervous system involvement by Bartonella henselae infection is possibly an important cause of morbidity; its role as an agent of aseptic meningitis is unknown. We report a case of a 40 years-old man with CSD accompanied by aseptic meningitis and neuroretinitis. Serum indirect immmunofluorescence (IFI) assays for B. henselae were positive and the cerebrospinal fluid (CSF) analysis showed mononuclear pleocytosis and increased level of protein. Serological tests for other etiologies were negative. The patient responded well to antibiotic therapy with oral doxycicline plus rifampin and in the 12th day of hospitalization evolved to total regression of the headache and partial regression of the visual loss. Clinicians should consider CSD as a differential diagnosis when assessing previously healthy patients with aseptic meningitis associated with regional lymphadenopathy and epidemiological history of feline contact.
Subject(s)
Adult , Humans , Male , Cat-Scratch Disease/complications , Meningitis, Aseptic/complications , Retinitis/complications , Bartonella henselae , Fluorescent Antibody Technique, IndirectABSTRACT
PURPOSE: To describe an unusual case of rapidly progressive outer retinal necrosis (PORN) with vitreous hemorrhage in a 41-year-old woman with acquired immunodeficiency syndrome (AIDS), who had retinitis developed from what was probably varicellar-zoster virus combined with cytomegalovirus (CMV) and herpes simplex type 1,2, as proven by the polymerase chain reaction restriction fragment length polymorphism method (PCR-RFLP). METHODS: This study is a case report detailing clinical follow-up and an aqueous humor test by PCR-RFLP. RESULTS: The deep, white retinal lesions coalesced and progressively expanded in a circumferential manner, with sparing of the perivascular retina. However, retinal and vitreous hemorrhages, unusual findings for PORN, could be noted around the optic nerve. Varicellar-zoster virus (VZV), cytomegalovirus (CMV), and herpes simplex types 1,2 (HSV-1,2) were detected in the aqueous humor by PCR. CONCLUSIONS: PORN has been described as a variant of necrotizing herpetic retinopathy, occurring particularly in patients with AIDS. Although the etiologic agent has been reported to be VZV, concurrent or combined etiologic agents can include HSV-1, HSV-2, and CMV in AIDS patients. Therefore, combined antiviral therapy with acyclovir and ganciclovir could be more reasonable as an initial therapy.
Subject(s)
Humans , Female , Adult , Vitreous Hemorrhage/complications , Retinitis/complications , Necrosis , Herpes Zoster , Disease Progression , Acquired Immunodeficiency Syndrome/complicationsABSTRACT
Os autores apresentam um caso de pacientre com neuro-retinite, retinite superficial e estrela macular, onde estabelecem o diagnóstico presumido de cat scratch disease. Comentam sobree outras formas de manifestaçäo retiniana da doença e sobre o tratamento.
Subject(s)
Adult , Female , Humans , Bartonella henselae/etiology , Cat-Scratch Disease/etiology , Macula Lutea/pathology , Optic Neuritis , Retinitis/complicationsABSTRACT
Os autores avaliam a coróide de dois casos comprovados de neurorretinite difusa unilateral sub-aguda (DUSN) através da video-angiografia digital com indocianina verde (ICGV). Dos dois casos avaliados, em um, o nematódio foi morto com laser e no outro demonstram fotograficamente a retinite que corresponde a morte do nematódio com o tiabendazol oral. Através da ICGV demonstram que a coróide näo é envolvida na patologia
Subject(s)
Humans , Male , Female , Child , Adolescent , Choroid , Choroid Diseases/etiology , Retinitis/complications , Angiography, Digital Subtraction , Indocyanine Green , Retinitis , Video RecordingABSTRACT
Existe uma correlaçäo epidemiológica importante entre AIDS e sífilis. A infecçäo pelo vírus da imunodeficiência humana (HIV) acelera o curso natural da sífilis, fazendo com que estágios mais avançados da doença sejam atingidos mais precocemente. Os autores relatam 2 novos casos da associaçäo sífilis ocular/AIDS e fazem uma revisäo dos 22 casos anteriormente publicados. Discutem a possibilidade de alteraçäo das respostas imunológicas e enfatizam a alta incidência de neurossífilis, sugerindo que sempre se faça a análise do líquor quando se constatar essa associaçäo