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1.
BMC Neurol ; 23(1): 192, 2023 May 16.
Article in English | MEDLINE | ID: mdl-37194001

ABSTRACT

BACKGROUND: Pseudorabies virus (PRV) was thought to only infect animals. Recent studies have shown that it can also infect human. CASE PRESENTATION: We report a case of pseudorabies virus encephalitis and endophthalmitis, diagnosed 89 days after onset, confirmed with intraocular fluid metagenomic next generation sequencing (mNGS) after the result of two cerebrospinal fluid (CSF) mNGS tests were negative. Although treatment with intravenous acyclovir, foscarnet sodium, and methylprednisolone improved the symptoms of encephalitis, significant diagnostic delay resulted in permanent visual loss. CONCLUSIONS: This case suggests that pseudorabies virus (PRV) DNA in the intraocular fluid may have a higher positivity than that in the CSF. PRV may persist in the intraocular fluid for an extended period and may thus require extended antiviral therapy. Patients with severe encephalitis and PRV should be examined with the focus on pupil reactivity and light reflex. A fundus examination should be performed in patients with a central nervous system infection, specifically, those in a comatose state, to help reduce eye disability.


Subject(s)
Aqueous Humor , Blindness , Encephalitis, Viral , Endophthalmitis , Herpesvirus 1, Suid , Pseudorabies , Pseudorabies/complications , Pseudorabies/diagnosis , Pseudorabies/drug therapy , Encephalitis, Viral/complications , Encephalitis, Viral/diagnosis , Encephalitis, Viral/drug therapy , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Endophthalmitis/virology , Herpesvirus 1, Suid/genetics , Herpesvirus 1, Suid/isolation & purification , Metagenomics , High-Throughput Nucleotide Sequencing , Delayed Diagnosis , Humans , Male , Middle Aged , Aqueous Humor/virology , Acyclovir/therapeutic use , Foscarnet/therapeutic use , Methylprednisolone/therapeutic use , Antiviral Agents/therapeutic use , Blindness/virology , DNA, Viral/isolation & purification
3.
Curr Eye Res ; 46(12): 1934-1935, 2021 12.
Article in English | MEDLINE | ID: mdl-33661715

ABSTRACT

Ophthalmologic nvolvement in SARS-CoV-infected patients is variegated. One of the ophthalmologic pathologies is optic neuritis. Optic neuritis in SARS-CoV-infected patients may precede the classical pulmonary manifestations of COVID-19 and can be unilateral or bilateral. Optic neuritis has been repeatedly reported in COVID-19 patients and may occur with or without affection of other cranial nerves. Since cerebro-spinal fluid parameters can be abnormal in COVID-19 associated optic neuritis, these patients require a spinal tap. Before diagnosing SARS-CoV-2 associated optic neuritis various differentials need to be excluded. Since SARS-CoV-2 causes endothelial damage complicated by thrombus formation and thromboembolism, ophthalmologic vascular complication due to an infection with SARS-CoV-2 such as anterior ischemic optic neuropathy (AION), central retinal artery occlusion (CRAO), and retinal vein occlusion need to be excluded. CRAO may result from arterial hypertension, myocarditis, heart failure, Takotsubo syndrome, atrial fibrillation, or atrial flutter, frequent cardiac complications of COVID-19. Since CRAO can be accompanied by ischemic stroke, patients with SARS-CoV-2 associated optic neuritis need to undergo a cerebral MRI.


Subject(s)
COVID-19/complications , Eye Infections, Viral/diagnosis , Optic Neuritis/diagnosis , Retinal Diseases/diagnosis , Retinal Vessels/pathology , Retinitis/diagnosis , SARS-CoV-2 , Aged , Blindness/diagnosis , Blindness/virology , Diagnosis, Differential , Eye Infections, Viral/virology , Female , Humans , Optic Neuritis/virology , Retinal Diseases/virology , Retinal Vessels/virology , Retinitis/virology
4.
Curr Eye Res ; 46(8): 1247-1250, 2021 08.
Article in English | MEDLINE | ID: mdl-33530768

ABSTRACT

OBJECTIVE: We documented an older female with Coronavirus(CoV) Disease 2019 (COVID-19) and concomitant acquired monocular blindness. We examined this phenomenon in order to understand COVID-19 better. METHODS: We observed an older female with COVID-19 and concomitant acquired monocular blindness. The following indicators were monitored during the course of the disease: ocular examinations, flash visual evoked potential examination, a blood test for COVID-19 IgM antibodies, as well as nasopharyngeal swab and tear sample tests for COVID-19 nucleic acid. RESULTS: The patient's visual acuity for the left eye was NLP and the intraocular pressure was 51 mmHg. Keratic precipitates similar to mutton-fat were spread over the corneal endothelium of the left eye. The funduscopic examination of the patient's left eye revealed severe retinal arterial ischemia, and the color of the retina was off-white. Compared to the right eye, the flash visual evoked potential examination revealed a moderate decrease in P2 wave amplitude for the left eye. A blood test was positive for COVID-19 IgM antibodies, and a nasopharyngeal swab test taken for COVID-19 nucleic acid was positive on May 4, 2020. A sample of the patient's tears was taken, and the nucleic acid test for COVID-19 was still positive two weeks later. CONCLUSIONS: Our study was the first to find that acute viral retinitis could occur in patients with COVID-19 and severe blindness could be associated with SARS-CoV-2 infection. Therefore, physicians should consider the possibility of coronavirus infection in patients with an abnormal fundus or suddenly vision loss.


Subject(s)
Blindness/diagnosis , COVID-19/diagnosis , Eye Infections, Viral/diagnosis , Retinitis/diagnosis , SARS-CoV-2/isolation & purification , Aged , Blindness/virology , COVID-19/virology , COVID-19 Nucleic Acid Testing , COVID-19 Serological Testing , Evoked Potentials, Visual/physiology , Eye Infections, Viral/virology , Female , Fluorescein Angiography , Humans , Immunoglobulin M/blood , Photic Stimulation , Retina/physiopathology , Retinitis/physiopathology , Retinitis/virology , SARS-CoV-2/genetics , SARS-CoV-2/immunology , Visual Acuity
6.
Ugeskr Laeger ; 182(29)2020 07 13.
Article in Danish | MEDLINE | ID: mdl-32734862

ABSTRACT

This is a case report of a 68-year-old female referred to the SARS-CoV-2 ward with one week of intermittent fever and three days of progressive loss of vision. Laboratory work-up revealed severe coagulopathy, thrombocytopenia and hyperleukocytosis. MRI showed multiple ischaemic cortical lesions. Acute treatment with all-trans retinoic acid and cytoreduction was started and coagulation parameters corrected. Patients referred to pandemic wards must undergo stringent examination and be referred for further evaluation irrespective of suspected severe acute respiratory syndrome coronavirus-2 infection.


Subject(s)
Blindness/virology , Coronavirus Infections/diagnosis , Fever/virology , Leukemia, Promyelocytic, Acute/complications , Pneumonia, Viral/diagnosis , Aged , Betacoronavirus , COVID-19 , Coronavirus Infections/complications , Cytoreduction Surgical Procedures , Female , Humans , Pandemics , Pneumonia, Viral/complications , SARS-CoV-2 , Tretinoin/therapeutic use
7.
J Neurovirol ; 26(3): 433-436, 2020 06.
Article in English | MEDLINE | ID: mdl-31858485

ABSTRACT

A 53-year-old immunocompromised woman developed acute left eye blindness and paraparesis suspected to be due to neuromyelitis optica (NMO). During treatment for NMO, right eye blindness and progressive multiple cranial neuropathies developed. Cerebrospinal fluid polymerase chain reaction (PCR) revealed Varicella zoster virus (VZV). This case emphasizes the importance of considering VZV in individuals, particularly the immunocompromised, presenting with a constellation of neurological signs and symptoms, even in the absence of rash.


Subject(s)
Blindness/diagnosis , Cranial Nerve Diseases/diagnosis , Encephalitis, Varicella Zoster/diagnosis , Lupus Erythematosus, Systemic/diagnosis , Neuromyelitis Optica/diagnosis , Retinal Necrosis Syndrome, Acute/diagnosis , Antiviral Agents/therapeutic use , Blindness/drug therapy , Blindness/immunology , Blindness/virology , Cranial Nerve Diseases/drug therapy , Cranial Nerve Diseases/immunology , Cranial Nerve Diseases/virology , Encephalitis, Varicella Zoster/drug therapy , Encephalitis, Varicella Zoster/immunology , Encephalitis, Varicella Zoster/virology , Female , Herpesvirus 3, Human , Humans , Immunocompromised Host , Lupus Erythematosus, Systemic/drug therapy , Lupus Erythematosus, Systemic/immunology , Lupus Erythematosus, Systemic/virology , Middle Aged , Neuromyelitis Optica/drug therapy , Neuromyelitis Optica/immunology , Neuromyelitis Optica/virology , Retinal Necrosis Syndrome, Acute/drug therapy , Retinal Necrosis Syndrome, Acute/immunology , Retinal Necrosis Syndrome, Acute/virology , Virus Activation
8.
Indian J Ophthalmol ; 65(11): 1233-1235, 2017 Nov.
Article in English | MEDLINE | ID: mdl-29133663

ABSTRACT

A 15-year-old healthy boy developed acute, rapidly progressing visual loss in left eye following herpes zoster dermatitis, with a combined central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO), along with optic perineuritis. Laboratory tests were negative. Despite an empirical, intensive antiviral treatment with systemic corticosteroids, and vision could not be restored in the affected eye. Herpes zoster dermatitis, in an immunocompetent individual, may be associated with a combined CRAO and CRVO along with optic perineuritis, leading to profound visual loss.


Subject(s)
Blindness/diagnosis , Dermatitis/diagnosis , Eye Infections, Viral/diagnosis , Herpes Zoster/diagnosis , Optic Neuritis/diagnosis , Retinal Artery Occlusion/diagnosis , Retinal Vein Occlusion/diagnosis , Adolescent , Antiviral Agents/therapeutic use , Aqueous Humor/virology , Blindness/drug therapy , Blindness/virology , Dermatitis/drug therapy , Dermatitis/virology , Eye Infections, Viral/drug therapy , Eye Infections, Viral/virology , Herpes Zoster/drug therapy , Herpes Zoster/virology , Herpesvirus 3, Human/isolation & purification , Humans , Immunocompetence , Magnetic Resonance Imaging , Male , Optic Neuritis/drug therapy , Optic Neuritis/virology , Polymerase Chain Reaction , Retinal Artery Occlusion/drug therapy , Retinal Artery Occlusion/virology , Retinal Vein Occlusion/drug therapy , Retinal Vein Occlusion/virology
10.
Neuron ; 92(5): 949-958, 2016 Dec 07.
Article in English | MEDLINE | ID: mdl-27930910

ABSTRACT

Zika virus (ZIVK) represents a new threat to global health, with particular relevance to neuroscientists, due to associated newborn and adult neurological disease. Consequences of vertical infection include microcephaly with brain and eye anomalies, and consequences of adult infection include Guillain-Barré syndrome (GBS) and meningoencephalitis. Recent data suggest specific vulnerability of neural progenitors to infection, leading to cell death and brain calcification, reminiscent of other viral syndromes. Prevailing models suggest entry into neuronal stem cells through transmembrane receptors, hijacking cellular signaling to interfere with neurogenesis and cell survival. Mechanisms of adult neurological disease are unknown, but recent evidence suggests propensity for infection of adult neural stem cells. Efforts focused on mechanisms of pathogenesis, vulnerabilities, and treatments are urgently needed.


Subject(s)
Brain/physiopathology , Guillain-Barre Syndrome/physiopathology , Meningoencephalitis/physiopathology , Microcephaly/physiopathology , Neural Stem Cells/virology , Pregnancy Complications, Infectious/physiopathology , Zika Virus Infection/physiopathology , Zika Virus/pathogenicity , Blindness/physiopathology , Blindness/virology , Brain/immunology , Brain/virology , Cell Survival , Cognitive Dysfunction/physiopathology , Cognitive Dysfunction/virology , Female , Guillain-Barre Syndrome/immunology , Guillain-Barre Syndrome/virology , Humans , Infant, Newborn , Interferons/immunology , Meningoencephalitis/immunology , Meningoencephalitis/virology , Microcephaly/immunology , Microcephaly/virology , Neurogenesis/physiology , Pregnancy , Pregnancy Complications, Infectious/immunology , Pregnancy Complications, Infectious/virology , Retinal Neurons/virology , Zika Virus/physiology , Zika Virus Infection/immunology , Zika Virus Infection/virology
11.
BMC Infect Dis ; 16(1): 582, 2016 10 19.
Article in English | MEDLINE | ID: mdl-27756232

ABSTRACT

BACKGROUND: Acute vision loss in the post-partum period can occur due to many reasons. Eclampsia, posterior reversible encephalopathy syndrome (PRES), pituitary apoplexy, and central serous retinopathy are some of the important causes. Cryptococcal meningitis as a cause of acute vision loss in the post-partum period has not been mentioned in literature. CASE PRESENTATION: A 25-year-old female presented to us with acute bilateral complete vision loss in the post-partum period. Her serum was tested positive for HIV antibodies. Cerebrospinal fluid (CSF) examination revealed cryptococcal meningitis. She was started on amphotericin B, antiretroviral drugs, and steroids. Though symptoms of meningitis resolved after treatment no significant improvement in vision was observed at 3 months. CONCLUSIONS: Cryptococcal meningitis may be considered as one of the causes of acute vision loss in pregnant/post-partum females with human immunodeficiency virus (HIV) positivity.


Subject(s)
AIDS-Related Opportunistic Infections/etiology , Blindness/etiology , Meningitis, Cryptococcal/diagnosis , AIDS-Related Opportunistic Infections/drug therapy , Acute Disease , Adult , Amphotericin B/therapeutic use , Blindness/microbiology , Blindness/virology , Female , HIV Antibodies/blood , HIV Seropositivity/microbiology , Humans , Meningitis, Cryptococcal/complications , Meningitis, Cryptococcal/drug therapy , Postpartum Period , Pregnancy , Treatment Outcome
15.
Trop Med Int Health ; 21(3): 334-9, 2016 Mar.
Article in English | MEDLINE | ID: mdl-26663773

ABSTRACT

OBJECTIVES: To describe the spectrum of ocular complications of herpes zoster ophthalmicus (HZO) in rural South Africa. METHODS: Patients presenting with visual complaints and active or healed HZO at the ophthalmology outpatient department of three hospitals in rural South Africa were included in this study. Demographic and clinical data were collected, and HIV status was determined for all participants. RESULTS: Forty-eight patients were included, and 81% were HIV infected. Poor vision was reported by 94% of patients, painful eye by 79% and photophobia by 63%. A diverse spectrum of ocular complications was observed with corneal inflammation and opacification in 77% followed by anterior uveitis in 65%. The majority (65%) presented with late-stage ocular complications associated with irreversible loss of vision whereas early-stage complications, such as punctate epithelial keratitis and anterior uveitis, were less common. Blindness of the affected eye was observed in 68% of patients with late-stage complications. There was a considerable delay between onset of symptoms and first presentation to the ophthalmology outpatient department (median time 35 days; range 1-2500 days), and longer delay was associated with late-stage ocular complications (P = 0.02). CONCLUSIONS: HZO patients present with relatively late-stage ocular complications, and blindness among these patients is common. The delayed presentation to the ophthalmology outpatient department of hospitals in our rural setting is of concern, and efforts to improve ocular outcomes of HZO are urgently needed.


Subject(s)
Herpes Zoster Ophthalmicus/complications , Adolescent , Adult , Aged , Blindness/etiology , Blindness/virology , Delayed Diagnosis/adverse effects , Eye Pain/etiology , Female , HIV Infections/complications , Herpesvirus 3, Human , Humans , Male , Middle Aged , Photophobia/etiology , Rural Population , South Africa , Young Adult
17.
J Indian Med Assoc ; 111(9): 623-4, 2013 Sep.
Article in English | MEDLINE | ID: mdl-24968531

ABSTRACT

In India, the dengue disease has attained an unprecedented proportion with a sharp increase in the size of human population at risk recently. Presentation of the disease varies from asymptomatic illness to haemorrhagic manifestations and shock. Previously ocular findings were considered rare in dengue fever; but due to increased number of cases various types of ocular complications are described in present day case series. Here, is presented a case of a girl with serologically proven dengue fever who developed a subhyaloid premacular haemorrhage in one eye with superficial retinal haemorrhages and cotton wool spots in both eyes.


Subject(s)
Dengue/complications , Eye Hemorrhage/virology , Blindness/virology , Child , Eye Hemorrhage/surgery , Female , Humans , Lasers, Solid-State/therapeutic use , Vision, Low/virology
18.
Ocul Immunol Inflamm ; 20(5): 384-6, 2012 Oct.
Article in English | MEDLINE | ID: mdl-22957726

ABSTRACT

PURPOSE: To report a case of progressive outer retinal necrosis (PORN) presenting as a cherry red spot. METHODS: Case report. RESULTS: A 53-year-old woman with recently diagnosed HIV and varicella-zoster virus (VZV) aseptic meningitis developed rapid sequential vision loss in both eyes over 2 months. Her exam showed a "cherry red spot" in both maculae with peripheral atrophy and pigmentary changes, consistent with PORN. Due to her late presentation and the rapid progression of her condition, she quickly developed end-stage vision loss in both eyes. CONCLUSIONS: PORN should be considered within the differential diagnosis of a "cherry red spot." Immune-deficient patients with a history of herpetic infection who present with visual loss warrant prompt ophthalmological evaluation.


Subject(s)
AIDS-Related Opportunistic Infections/virology , Acquired Immunodeficiency Syndrome/virology , Blindness/virology , Mucolipidoses/virology , Retinal Necrosis Syndrome, Acute/virology , Acquired Immunodeficiency Syndrome/drug therapy , Acyclovir/analogs & derivatives , Acyclovir/therapeutic use , Antiretroviral Therapy, Highly Active , Antiviral Agents/therapeutic use , Disease Progression , Eye Infections, Viral/drug therapy , Eye Infections, Viral/virology , Female , Herpes Zoster Ophthalmicus/drug therapy , Herpes Zoster Ophthalmicus/virology , Humans , Middle Aged , Valacyclovir , Valine/analogs & derivatives , Valine/therapeutic use
19.
Ocul Immunol Inflamm ; 20(5): 336-41, 2012 Oct.
Article in English | MEDLINE | ID: mdl-22775065

ABSTRACT

PURPOSE: To report the prevalence of ocular manifestations in patients with HIV/AIDS and their correlation with the clinical stage of disease as well as the CD4 cell count. METHODS: 100 HIV-positive patients, who presented to a tertiary care hospital, were included. The WHO clinical staging of HIV/AIDS, CD4 count, duration of disease, and presence and type of ocular manifestations were noted. RESULTS: Overall, 46 patients (46%) had ocular manifestations related to HIV/AIDS. The most common manifestations were HIV retinopathy (12%) and cytomegalovirus (CMV) retinitis (7%). The prevalence of ocular manifestations correlated significantly with the WHO clinical stages 3 and 4 of HIV/AIDS (p = .001) and with low CD4 count (p = .001). CONCLUSIONS: CD4 cell counts and WHO clinical stage of HIV disease are important predictors for the occurrence of ocular morbidity in HIV-positive individuals. Routine comprehensive ophthalmic screening and appropriate initiation of therapy in these patients can potentially decrease ocular morbidity.


Subject(s)
AIDS-Related Opportunistic Infections/virology , Acquired Immunodeficiency Syndrome/virology , Blindness/virology , Cytomegalovirus Retinitis/virology , Eye Infections/virology , AIDS-Related Opportunistic Infections/drug therapy , AIDS-Related Opportunistic Infections/epidemiology , AIDS-Related Opportunistic Infections/immunology , Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/immunology , Adolescent , Adult , Aged, 80 and over , Antiretroviral Therapy, Highly Active , Blindness/drug therapy , Blindness/epidemiology , Blindness/immunology , CD4 Lymphocyte Count , Child , Child, Preschool , Cross-Sectional Studies , Cytomegalovirus Retinitis/drug therapy , Cytomegalovirus Retinitis/epidemiology , Cytomegalovirus Retinitis/immunology , Eye Infections/drug therapy , Eye Infections/epidemiology , Eye Infections/immunology , Female , Humans , Incidence , India , Male , Middle Aged , Prevalence , Severity of Illness Index , Tertiary Care Centers/statistics & numerical data , Young Adult
20.
J Immunol ; 188(9): 4631-43, 2012 May 01.
Article in English | MEDLINE | ID: mdl-22467659

ABSTRACT

Stromal keratitis is a chronic immunopathological lesion of the eye caused by HSV-1 infection that can result in blindness. Because the inflammatory lesions are primarily orchestrated by Th1 cells, and to a lesser extent by Th17 cells, inhibiting their activity represents a useful form of therapy. In this study we evaluated the therapeutic potential of galectin-1 (gal-1), an endogenous lectin that in some autoimmune diseases was shown to suppress the functions of Th1 and Th17 cells. Treatment was begun at different times after ocular infection with HSV and the outcome was assessed clinically as well as for effects on various immune parameters. Treatment with recombinant gal-1 significantly diminished stromal keratitis lesion severity and the extent of corneal neovascularization. Treated mice had reduced numbers of IFN-γ- and IL-17-producing CD4(+) T cells, as well as neutrophil infiltration in the cornea. Furthermore, disease severity was greater in gal-1 knockout mice compared with their wild-type counterparts. The many effects of gal-1 treatment include reduction in the production of proinflammatory cytokines and chemokines, increased production of IL-10, and inhibitory effects on molecules involved in neovascularization. To our knowledge, our findings are the first to show that gal-1 treatment represents a useful approach to control lesion severity in a virally induced immunopathological disease.


Subject(s)
Corneal Neovascularization/immunology , Galectin 1/immunology , Herpesvirus 1, Human/immunology , Keratitis, Herpetic/immunology , Animals , Blindness/genetics , Blindness/immunology , Blindness/metabolism , Blindness/pathology , Blindness/virology , Corneal Neovascularization/genetics , Corneal Neovascularization/metabolism , Corneal Neovascularization/pathology , Corneal Neovascularization/virology , Galectin 1/genetics , Galectin 1/metabolism , Herpesvirus 1, Human/genetics , Herpesvirus 1, Human/metabolism , Interleukin-10/genetics , Interleukin-10/immunology , Interleukin-10/metabolism , Keratitis, Herpetic/genetics , Keratitis, Herpetic/metabolism , Keratitis, Herpetic/pathology , Mice , Mice, Knockout , Th1 Cells/immunology , Th1 Cells/metabolism , Th1 Cells/pathology , Th17 Cells/immunology , Th17 Cells/metabolism , Th17 Cells/pathology
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