Manifestaciones oftalmológicas por virus de Epstein-Barr / Ophthalmological manifestations caused by Epstein-Barr virus

Se trata de un paciente masculino de 26 años que acude por disminución brusca de la visión del ojo derecho. Se ingresó como una uveítis posterior dada por exudación extensa en área macular del ojo derecho, acompañada de edema del disco óptico, vasculitis aledaña a la lesión y hemorragias dispersas en llama en el polo posterior. La etiología era controversial y, el tratamiento más apropiado era debatible, por lo que se le realizaron estudios como retinografías seriadas, angiografías fluoresceínicas y reacción en cadena de polimerasa a una muestra del humor acuoso, que confirmó la etiología viral; lo que resultó en una agudeza visual final de 0,1. Posterior a 6 meses del cuadro inicial, el paciente presentó queratitis intraestromal en forma numular -que recurre ante episodios de stress-, para desaparecer luego de terapia tópica con antiinflamatorios no esteroideos y esteroideos. La baja incidencia de casos reportados con uveítis posterior por virus de Epstein Barr resulta de un pobre conocimiento de la presentación de la enfermedad, por tanto un retraso en la instauración del tratamiento. En estos casos la prueba de oro es la reacción de cadena de polimerasa

This article presented a 26 years-old male patient who went to the ocular service with sudden reduction of vision in his right eye. He was admitted to the hospital and diagnosed as posterior uveitis based on extensive exudation in the macular area of the right eye, edema of the optic disk, vasculitis next to the lesion and disperse hemorrhages in the posterior pole. The etiology of this case was controversial and the most suitable treatment was under discussion, so it was decided to perform serial retinographies, fluorescein angiographies and polymerase chain reaction in a aqueous humor sample taken from the patient. The viral etiology was confirmed, resulting in final visual acuity of 0.1. After 6 months of the initial clinical picture, the patient suffered nummular-shaped intrastromal keratitis - it appears in stress episodes- and finally disappears after topical therapy with non-steroidal and steroidal anti-inflammatory drugs. The low incidence of cases reported with posterior uveitis caused by Epstein Barr virus is due to the poor knowledge about the onset of this disease, and leads to delay in applying treatment. The golden rule in this case is the polymerase chain reaction

Dry eye disease caused by viral infection: review / Olho seco causado por infecções virais: revisão

Dry eye disease and ocular surface disorders may be caused or worsened by viral agents. There are several known and suspected virus associated to ocular surface diseases. The possible pathogenic mechanisms for virus-related dry eye disease are presented herein. This review serves to reinforce the importance of ophthalmologists as one of the healthcare professional able to diagnose a potentially large number of infected patients with high prevalent viral agents.

A síndrome do olho seco e as doenças de superfície ocular podem ser causadas ou agravadas por agentes virais. Diversos vírus são causadores ou tem associação suspeitada com as doenças de superfície ocular. Esta revisão apresenta os possíveis mecanismos patogênicos envolvidos no olho seco causado por infecões virais e reinforça a importância do oftalmologista como um dos profissionais de saúde capazes de diagnosticar um grande número de pacientes infectados por agentes virais altamente prevalentes.

Development of EKC after Eximer Laser Photorefractive Surgery and Subsequent Recurrence of EKC-like Keratitis

This research focuses on four cases of patients having undergone eximer laser photorefractive surgery who were diagnosed with adenoviral keratoconjunctivitis during the postoperative period and who later developed epidemic keratoconjunctivitis (EKC)-like keratitis. Two of the patients had undergone laser-assisted subepithelial keratectomy (LASEK), one had undergone laser in situ keratomileusis and one had photorefractive keratectomy. After the surgery adenoviral keratoconjunctivitis and recurrent late-developing EKC-like keratitis were observed in the patients. Recurrent late-developing EKC-like keratitis occurred in one of the patients, who had received LASEK as many as three times. The others had only one or two episodes.The corneal infiltrates of keratitis mainly occurred in the central cornea. Successful resolution of recurrent late-developing EKC-like keratitis was achieved through the use of topical steroids without sequelae and the final best-corrected visual acuity was as good as the base line. These keratitis infiltrates have been presumed to represent an immune response to the suspected adenoviral antigens deposited in corneal stroma during the primary adenoviral infection. Previous reports argued that patients with a history of adenoviral ketatoconjunctivitis were succeptible to adenoviral keratoconjunctivitis becoming reactivated; however, in our research, our patients had their first adenoviral infections after the eximer laser photorefractive surgery and reactivation was confirmed. We recommend that attention be paid to adenoviral infection after laser refractive operations, because these patients seem to have more frequent recurrences.

Solitary giant molluscum contagiosum presenting as lid tumor in an immunocompetent child.

We report the case of a three-year-old male child who presented with a single painless subcutaneously located upper lid mass of 1.2 × 1.5 cm with a central depression. The mass could be easily separated from overlying skin on complete excision biopsy and showed a never described before whitish brain like appearance consisting of multiple lobes and gyri, which histopathologically proved to be molluscum contagiosum (MC). Tests to investigate underlying immunodeficiency did not show any evidence of immunocompromised state.

A case of bilateral presumed chikungunya neuroretinitis.

Chikungunya fever is a relatively rare from of vector-borne viral fever caused by chikungunya virus and spread by bites of the Aedes aegypti and Aedes albopictus mosquito. Epidemics of chikungunya fever have been reported in the past from different parts of the world. Although the virus had been passive for quite some time, recent reports of outbreaks of chikungunya fever in several parts of Southern India have confirmed the re-emergence of this virus. Symptoms of this infection include abrupt onset of fever, chills, and headache, rash, severe joint pain, conjunctival injection and photophobia. Ocular manifestations have been recently reported with this infection. We report a case of a 48-year-old female patient, who presented with defective vision two weeks after a serology proven chikungunya infection. There was bilateral neuroretinitis with peripapillary cotton wool spots. These findings should be kept in mind as an ocular manifestation of chikungunya virus infection.

Molecular diagnosis of acute retinal necrosis secondary to cytomegalovirus in vitreous aspirate.

We report a case of a 45-year old Filipino post-kidney transplant patient maintained on steroids, who presented with floaters in her left eye. Vitreous aspirate was analyzed using polymerase chain reaction (PCR) for human cytomegalovirus (HCMV) and herpes simplex virus (HSV). A distinct band (435 bp) was found that confirmed the presence of HCMV. Since a rapid and accurate diagnosis is crucial for prompt administration of antiviral therapy, PCR-based analysis of vitreous aspirate provides a valuable tool in the diagnosis of patients with retinitis caused by herpes viruses.

Bilateral retinitis following chikun- gunya fever.

A 35-year-old male with a history of chikungunya fever, presented with diminution of vision in the right eye of one-week duration. His best corrected visual acuity (BCVA) was counting fingers 2 meters and 20/20 (Snellens) in the right and left eyes respectively. A diagnosis of neuroretinitis was made in the right eye while left eye showed features of retinitis. ELISA (serum) and polymerase chain reaction (aqueous) were positive for herpes simplex virus. The lesions did not show any response to antiviral or steroid treatment and appeared to be self-limiting. At five months follow-up, lesions had resolved well with BCVA of 20/120 and 20/20 in the right and left eyes respectively.

Ocular features of hantavirus infection.

Hantavirus infections are an emerging infectious disease that is beginning to be recognized both worldwide and in India as a cause of hemorrhagic fever that may present as a pulmonary syndrome or as a renal syndrome. Reports of ocular involvement are rare and include transient myopia, low intraocular pressure, conjunctival hemorrhages and changes of intraocular dimensions. Eleven patients (10 males, one female, mean age 37.6 years) were admitted to the intensive care unit for pyrexia of unknown origin or hemorrhagic fever following exposure to flood waters. Five male patients (mean age 31.6 years) were identified as suffering from hantavirus infection. In one patient, dot and blot intraretinal hemorrhages were seen in the macula of one eye and streak hemorrhages of the disc in the other. In the remaining four, no fundus abnormalities were seen. Ophthalmologists should be aware of these features.

Laboratory results in ocular viral diseases: implications in clinical-laboratory correlation

PURPOSE: To document etiology and predictive value of clinical diagnosis in laboratory confirmed viral diseases. METHODS: Reports of culture-positive cases of samples collected from patients presenting from January 1987 - December 2001 were evaluated. RESULTS: One thousand nine hundred and sixty-four (1964) cultures were submitted during 1987-2001. Twenty-six percent were positive (514). Human herpesvirus 1 was the most frequent agent isolated from all positive culture (56 percent). Adenovirus was the most common virus isolated from conjunctiva (66 percent), human herpesvirus 1 from lid and cornea (76 percent, 88 percent) and cytomegalovirus from vitreous (27 percent). Some unusual pathogens were recovered from conjunctiva as cytomegalovirus and from cornea as adenovirus, enterovirus and cytomegalovirus. Recognition of common viral syndromes was human herpesvirus 1 (88 percent), epidemic keratoconjunctivitis (88 percent), acute hemorrhagic conjunctivitis (70 percent) and varicella zoster virus (100 percent). However, some misdiagnosed cases were observed. Thirteen percent of conjunctivitis thought to be caused by herpes were due to adenovirus, 3.2 percent to Enterovirus, 3.2 percent to varicella zoster virus and 3.2 percent to human cytomegalovirus. Also, 5 percent of cases with a clinical diagnosis of herpes keratitis were caused by adenovirus and 2.7 percent by enterovirus. Finally, 4.8 percent of cases thought to be adenovirus conjunctivitis were herpes conjunctivitis. CONCLUSIONS: Human herpesvirus 1 remains the most frequently isolated virus from ocular sites in general (56 percent). Nonherpetic corneal isolates were in decreasing order: adenovirus, enterovirus and cytomegalovirus. Clinical and laboratory correlation was less than 90 percent. The most misdiagnosed cases were herpes conjunctivitis and keratitis, some cases of adenovirus conjunctivitis some cases of acute hemorrhagic conjunctivitis. It is essential that a rapid and...

OBJETIVOS: Documentar a etiologia e prever a importância do diagnóstico clínico em doenças virais oculares confirmadas em laboratório. MÉTODOS: Todos os relatórios de pacientes com cultura viral positiva durante o período de janeiro 1987 - dezembro 2001 foram analisados. RESULTADOS: Quinhentos e quatorze (514) casos foram encontrados. Em geral, herpesvírus 1 humano foi o agente mais freqüentemente isolado. Adenovírus foi o vírus mais comumente isolado da conjuntiva (66 por cento), herpesvírus 1 humano das pálpebras e córnea (76 por cento, 88 por cento respectivamente) e citomegalovírus do vítreo (27 por cento). Alguns agentes não usuais foram isolados da conjuntiva como citomegalovírus e da córnea como adenovírus, enterovírus e citomegalovírus. Reconhecimento das síndromes virais comuns foi: herpervírus 1 humano (88 por cento), ceratoconjuntivite epidêmica (88 por cento), conjuntivite aguda hemorrágica (70 por cento). Porém, alguns casos com diagnóstico incorreto foram observados. Treze por cento das conjuntivites com diagnóstico de herpes foram causadas por adenovírus, 3,2 por cento por enterovírus, 3,2 por cento por varicella zoster vírus e 3,2 por cento por citomegalovírus. Também, 5 por cento dos casos com diagnóstico clínico de ceratite herpética eram adenovírus e 2,7 por cento enterovírus. Além disso, 4,8 por cento dos casos em que se pensaram em conjuntivite por adenovírus, eram conjuntivite por herpes. Finalmente, 30 por cento dos casos em que se diagnosticaram conjuntive hemorrágica aguda, o agente etiológico era adenovírus. CONCLUSÃO: Em geral herpesvírus humano 1 continua a ser o vírus mais comum encontrado nas infecções oculares (56 por cento). Agentes não herpéticos isolados da córnea foram em ordem decrescente: adenovírus, enterovírus e citomegalovírus. A correlação entre o diagnóstico clínico e laboratorial foi menor do que 90 por cento. Um diagnóstico rápido e específico é essencial em casos de apresentações virais atípicas...

Detection of cytomegalovirus in vitreous, aqueous and conjunctiva by polymerase chain reaction (PCR).

OBJECTIVE: To evaluate the diagnostic value of polymerase chain reaction (PCR) performed on vitreous, aqueous and conjunctiva for the detection of cytomegalovirus in AIDS patients with a clinical diagnosis of cytomegalovirus retinitis. MATERIAL AND METHOD: PCR-based assay was used to detect cytomegalovirus DNA in vitreous, aqueous and conjunctival samples from 24 patients with the acquired immunodeficiency syndrome (AIDS) who had untreated clinically diagnosed cytomegalovirus retinitis and from 15 immunocompetent patients, including 11 with retinal detachment, 2 with macular hole and 2 with vitreous hemorrhage. RESULTS: Cytomegalovirus DNA was detected in 16, 9 and 3 of 24 vitreous, aqueous and conjunctival samples, respectively, from patients with AIDS, untreated clinically diagnosis of cytomegalovirus retinitis; and in one patient out of 15 vitreous, aqueous and conjunctival samples from immunocompetent patients with vitreoretinal diseases. CONCLUSION: The use of PCR in the detection of cytomegalovirus in vitreous, aqueous and conjunctival samples had an equal specificity of 93% and had sensitivity of 67, 37 and 12%, respectively.

A rapid polymerase chain reaction protocol to detect adenovirus in eye swabs

Purpose: Viruses of the Adenoviridae family are associated with many clinical syndromes, processing 50 serotypes. These agents and viruses of the Herpesviridae family are the two major agents responsible for viral conjunctivitis, and a rapid diagnosis is important due to the epidemic character of adenoviral infection. Methods: We developed a PCR without DNA extraction for adenovirus using primers thath amplify a 300 tp gragament of the hexon capsid protein gene from many serotypes. Results: Swab samples from cornea of seven patients with keratoconjunctivitis were analyzed, and one of them was PCR positive for adenovirus. The sequence of this fragment shows a 100 percent homology with the sequence of adenovirus type 8. Conclusion: Sequencing of 300 bp from the hexon gene allows to identity almost all Ad serotypes, including all serotypes related to epidemic keratokonjuntivitis (8, 19,37) and almost all serotypes involved with Ad-associated conjunctivitis.

Síndrome Torch / Torch syndrome

Con el propósito de mostrar la importancia del examen oftalmológico en niños con afecciones sistémicas y manifestaciones oculares se describe el caso de un lactante de 41 días, con antecedentes de meningoencefalistis, neumopatía , microcefalia y opacidad corneal, en cuyos examen oftalmológico con biomicroscopio se comprobó una extensa úlcera de la córnea, de la cual se identificó-mediante cultivo, reacción de polimerasa en cadena y anticuerpos monoclonales-un virus herpes simples tipo 2. El examen oftalmológico completo en niños con alteraciones o malformaciones oculares, asociadas a manifestaciones sistemáticas, posiblemente causadas por infección congénita o perinatal puede ser de gran utilidad para orientar el diagnóstico y tratamiento. El examen oftalmológico puede facilitar la orientación del diagnóstico y el establecimiento oportuno del tratamiento correspondiente al agente etiológico en recién nacidos o lactantes menores con alteraciones oculares asociadas a manifestaciones sistémicas, posiblemente causadas por infecciones congénitas o perinatales, es posible que el diagnóstico pueda tener gran importancia en el pronóstico y la prevención de secuelas en el propio niño y en el control del riesgo de transmisión de la infección a otros recién nacidos. Para ilustrar la contribución del examen oftalmológico en estos pacientes se describe a continuación el caso de un lactante menor con síndrome TORCH, en el cual la sospecha clínica del agente etiológico fue posible mediante el examen oftalmológico.

The diagnostic significance of enzyme linked immuno-sorbent assay for herpes simplex, varicella zoster and cytomegalovirus retinitis.

PURPOSE: To evaluate the diagnostic usefulness of enzyme linked immuno-sorbent assay (ELISA) in single serum samples to associate herpes simplex virus (HSV), varicella zoster virus (VZV) or cytomegalovirus (CMV) with viral retinitis as against polymerase chain reaction (PCR) on intraocular specimens. It was also designed to study the seroprevalence in normal healthy individuals, and the genomic prevalence of HSV, VZV and CMV in patients without an active viral inflammatory process. METHODS: PCR for the detection of HSV, VZV and CMV genomes was done on 33 and 90 intraocular fluids from viral retinal patients and non-viral controls respectively. ELISA was done on 30 and 100 serum samples from viral retinitis patients and normal healthy controls respectively. RESULTS: PCR did not detect HSV, VZV and CMV genomes except one, in which VZV-DNA was detected. ELISA showed prevalence rates of 28%, 83% and 90% for antibodies against HSV, VZV and CMV respectively in the normal population. In the 30 viral retinitis patients, PCR detected HSV-DNA in 2 (6.7%), VZV-DNA in 7 (23.3%) and CMV-DNA in 6 (20.0%) patients, while ELISA detected antibodies against HSV, VZV and CMV in 13 (43.3%), 24 (80.0%) and 23 (76.7%) patients respectively. ELISA was of value in indirect diagnosis only in 6 (20.0%) as compared to 15 (50.0%) of 30 patients by PCR, this difference was statistically significant (McNemar test, P value = 0.005). CONCLUSION: Serology by ELISA is no longer a useful diagnostic tool to associate HSV, VZV and CMV viruses with viral retinitis.

Frosted retinal branch angiitis in an immunocompetent adult due to herpes simplex virus.

A case of acute severe loss of vision due to perivasculitis typical of frosted retinal branch angiitis due to Herpes simplex virus in an otherwise healthy young Omani lady is presented.

Herpes simplex virus DNA in the lens one year after an episode of retinitis.

The present report describes a case where HSV was detected by polymerase chain reaction (PCR) in the lens cortical material removed during cataract surgery one year after resolution of retinal inflammation in a patient with ARN.

Clinical features and virologic studies in viral retinitis.

Viral retinitis is an important infectious disease of the retina which can occur in both healthy and immunocompromized or immunodeficient individuals. The clinical picture and the role of laboratory studies in diagnosis of viral retinitis are still not well-defined. We correlated the clinical picture and virologic study in the serum and vitreous specimens by Enzyme-linked Immunosorbent Assay (ELISA), rapid immunofluorescence technique and culture in five clinically suspected patients of viral retinitis. None of the patients had any evidence of systemic viral infections. In four patients, the virus was detected by immunofluorescence, ELISA or culture from the vitreous sample. Paired serum samples showed elevation of antiviral IgG titre in two cases and high antiviral IgM titre in all cases. Our study evaluated the role of virological investigations of vitreous aspirate and rising antibody titre in the paired serum samples in the diagnosis of active viral retinitis.