La enfermedad producida por el virus chikungunya. ¿Qué esperar luego del estadio agudo? / Chikungunya virus (CHIKV): what can be expected after the acute phase?

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Characteristics of childhood uveitis leading to visual impairment and blindness in the Netherlands.

PURPOSE: To investigate the clinical characteristics of childhood uveitis leading to visual impairment or blindness. METHODS: In this descriptive study, we reviewed data from the medical records of 58 children with visual impairment or blindness due to childhood uveitis, which were seen at an institute for visually impaired patients (Bartiméus) between January 1981 and December 2012, in a retrospective, cross-sectional manner. RESULTS: Thirty-two of the 58 children (55%) were visually impaired and 26 (45%) were legally blind. Uveitis was posterior in 76% of all cases. Infectious uveitis represented 74% of all cases, of which 86% was congenital. Five patients (9%) had uveitis related to a systemic disease, and ten patients (17%) had idiopathic uveitis. There was a decrease in infectious causes over the last decades (p = 0.04) and an increase in idiopathic uveitis (p < 0.01), but the rate of children with posterior uveitis remained constant. There was an overall decrease in the number of children with uveitis referred to Bartiméus. The number of ocular complications at the time of intake was higher in children with acquired disease compared with congenital diseases (p < 0.01), as it was in children with non-infectious uveitis compared with infectious uveitis (p = 0.04). Most comorbidities that were noted were seen in children with infectious uveitis. CONCLUSION: Most patients suffering from visual impairment or blindness due to childhood uveitis had posterior and/or infectious uveitis, mostly congenital. There is a shift in causes which shows a decrease in infectious causes and an increase in idiopathic causes.

Factors of occurrence of ocular toxoplasmosis. A review.

Acquired and congenital toxoplasmosis are frequently complicated by ocular toxoplasmosis. The diagnosis relies on clinical aspects, response to specific treatment and results of biological assays. The incidence and the prevalence of this complication are difficult to establish precisely and depend on the prevalence of the parasite infection in the general population, and are affected by factors such as type of exposure to the parasite, genetic backgrounds of the parasite and the host, and type of immune response elicited by the parasite.

Granulomatous uveitis and congenital cataract: a rare association.

INTRODUCTION: The association of a granulomatous uveitis and congenital cataract and is rarely observed in newborn children. We describe the history of two patients presenting simultaneously with these two features in the absence of a TORCH infection. PATIENTS AND METHODS: The first patient, a boy born in 1997, presented to our hospital two days after birth with multiples Koeppe's and Busacca's nodules and bilateral cataract. The second patient, a boy born in 2006, was referred two weeks after birth. He presented with a severe unilateral granulomatous uveitis, multiples iris nodules, a high intraocular pressure of 45 mmHg and a congenital cataract. THERAPY AND OUTCOME: Lens extraction produced a rapid resolution of uveitis in these two patients. TORCH infection was ruled out in both children by history, extensive serologies performed simultaneously in mother and child or PCR of ocular fluids. CONCLUSIONS: A congenital cataract associated with a granulomatous uveitis is an extremely rare association. The removal of the lens resulted in complete resolution of the inflammation: a phacogenic mechanism could be at the origin of ocular inflammation in both cases.

[Clinical informative value of new methods of ultrasonic examination in the differential diagnosis of various forms of congenital diseases of the eyes in children]. / Klinicheskaia informativnost' novykh metodov ul'trazvukovogo issledovaniia v differentsial'noi diagnostike razlichnykh form vrozhdennoi patologii glaz u detei.

Clinical informative value of computer echography for the differential diagnosis of severe intrauterine uveitis (68 children, 96 eyes), retinopathy neonatorum (37 children, 74 eyes), Coats' retinitis (35 children, 35 eyes), and retinoblastoma (17 children, 26 eyes) was studied in a group of 157 children (231 eyes) with opaque refracting media. Ultrasonic diagnostic equipment with a high level of computer support essentially improved the resolving capacity of echography and detected accessory acoustic signs of some congenital ocular diseases.

Congenital nuclear cataracts and uveitis in HIV-transgenic mice.

PURPOSE: Patients infected with HIV-1 develop ocular manifestations, some due to opportunistic infections and others attributed to the virus itself. Among the latter are retinal microvasculopathy and uveitis. We have analysed the ocular phenotype in HIV-transgenic mice. METHODS: We have studied T26 transgenic mice which bear a gag-pol deleted HIV-1 genome. Transgene RNA was detected by Northern analysis. Ocular pathology was assessed by conventional histology, immunostaining for gp120 envelope protein, and in situ apoptosis detection with end-labelling. RESULTS: Abnormalities of lens epithelial cell development were detected as early as embryonic day 14.5. Histological changes included the malformation of an embryonal lens nucleus and poor closure of the lens suture lines. This resulted in congenital nuclear cataracts, as occur in congenital viral infections in human patients. In the adult animals, lenses were notable for extensive vacuolation, liquefaction, and degeneration of the cortex. Mild iridocyclitis and vitritis were also noted in adult transgenic mice. Immunostaining demonstrated the expression of gp 120 envelope protein within the lens epithelial and fibre cells. End-labelling with terminal deoxyribonucleotidyl transferase showed increased numbers of apoptotic cells in the adult lens. CONCLUSIONS: These findings suggest that one or more HIV-1 proteins are associated with congenital nuclear cataract formation and uveitis in HIV-transgenic mice.

[Cytomegalovirus infection in children with endogenous uveitis]. / Tsitomegalovirusnaia infektsiia u detei s éndogennymi uveitami.

A total of 405 children aged 3 months to 15 years with uveitis of different origin and localization and 50 mothers of children with intrauterine uveitis were tested for cytomegaloviruses (CMV). Chronic CMV infection was detected in 79% children and 88% mothers. Active CMV infection was diagnosed in 7.1% children with various clinical forms of uveitis; it was somewhat more frequent in cases with grave posterior uveitis and panuveitis complicated by detachment of the retina and vitreous fibrosis. Anti-CMV IgG antibodies indicate an infection, but their detection is insufficient for identifying the etiology of uveitis. Active CMV infection can be a cause of uveitis or aggravate uveitis of another etiology and favor the development of postoperative complications. In many cases active CMV infection was detected in children during remission without clinical signs of uveitis activity. Individual analysis of clinical laboratory data is needed for each patient in order to evaluate the etiological and pathogenetic role of active CMV infection.

[Rubella pigmentary pseudoretinopathy]. / Pseudoretinopatia pigmentara rubeolica.

Two cases of rubeolic pigmentary retinopathy with multiples anomalies at congener eye are presented. Both two cases present at congener eye microphthalmos and congenital cataract with uveitis in the first case and convergent strabismus and retard psychomotor in the second case. The retinal lesions are disseminated in all retinal surface in one observation, and only in the temporal retinal area in the second one. These retinal lesions associated with other ocular anomalies are characteristic for rubeolic etiology.

Anticorpos IgA específicos no soro e humor aquoso de pacientes com uveíte de provável etiologia toxoplásmica / Specific IgA antibodies in serum and aqueous humor samples from patients with uveits of probable toxoplasmic etiology

Com o objetivo de se verificar as respostas imune sérica e intra-ocular relativa aos anticorpos IgA específicos na uveíte de provável etiologia toxoplasmática, assim como a associaçäo desse anticorpo com os anticorpos IgG e IgM específicos, foram comparadas amostras de soro e humor aquoso de 24 pacientes portadores de uveíte de provável etiologia toxoplasmática e de 12 pacientes com catarata, através da reaçäo imunoenzimática (ELISA). No soro de pacientes com uveíte de provável etiologia toxoplasmática, foram detectadas 3,2% de amostras positivas para o anticorpo IgG. No humor aquoso de pacientes com uveíte, foram detectados anticorpos IgA, IgG e IgM específicos em 60% e 0% das amostras respectivamente. Nos pacientes com catarata näo foram detectadas amostras de humor aquoso positivas para o anticorpo IgA específico, no grupo de pacientes com uveíte, e apenas 4,2% de positividade nas respectivas amostras de soro, sugerem que houve produçäo intra-ocular deste anticorpo, e reforça a hipótese desta uveíte ser uma infecçäo crônica, provavelmente congênita

Prevalence of congenital and acquired toxoplasmic uveitis as evidenced by two serologic methods.

Anti Toxoplasma antibodies were sought in 34 patients with uveitis and 20 healthy individuals by IHAT and IFAT. The total sero-positivity rate was 26.5%. The prevalence was significantly higher among patients with posterior (42.9%) than with anterior uveitis (7.1%) and control (10%) indicating significant role of Toxoplasma as an aetiologic agent of posterior uveitis. 14.4% of patients with seropositive uveitis were considered to be due to primarily acquired Toxoplasma infection as evidenced by their significant higher IFAT mean titre (576.7 +/- 322.1) than IHAT (48 +/- 18.5). The reported toxoplasmic anterior uveitis case is most probably secondary to posterior involvement.

[State of the vitreous body in children with congenital uveitis]. / Sostoianie steklovidnogo tela u detei s vrozhdennymi uveitami.

Comprehensive examinations of 150 children (229 eyes) with congenital uveitis have revealed vitreous changes in 75.9 percent. The structure of different opacities is presented and relationship between vitreous opacities patterns and subatrophy severity and intraocular pressure parameters detected. Recommendations are given on how to interpret the data of ultrasonic scanning and define the indications for opticoreconstructive surgery.

[Variants of pupillary blocks in children with congenital and early acquired uveitis]. / Varianty zrachkovykh blokov u detei s vrozhdennymi i ranopriobretennymi uveitami.

Analysis of postuveal complications in 351 children of early age has shown that pupillary block of different type and degree develops in 43% of cases (226 of 526 eyes with uveitis) and more frequently after intrauterine uveitis. In 23.5% of cases, pupillary block is associated with glaucoma, in 44.2%--with normotonia, and in 32.3%--with hypotonia. A clinical and pathogenetic polymorphism of postuveal blocks is shown, three main types of combined pupillary blocks singled out, the connexion with the state of the vitreous body observed. On the basis of dynamic follow-up within 10 years and analysis of results after treatment of 85 eyes, a differential microsurgical approach to treatment is proposed. The usage of adequate surgical intervention allows to achieve a hypotensive and organ-preserving effect, to improve hydro- and hemodynamic indices and the functional state of the eye.

[Morphologic changes of the nucleolar system of lymphocytes as the indicator of sensitivity to tuberculin and Toxoplasma antigen]. / Morfologicheskie izmeneniia nukleoliarnogo apparata limfotsitov kak ppkazate'l chuvstvite'lnosti k tuberkulinu i toksoplazmen- nomu antigenu.

A study was made of the nucleolar apparatus of peripheral blood lymphocytes of the newborns, infants and their mothers before and after incubation in vitro with tuberculin or toxoplasmic antigen. It was established that in the presence of sensitization to one or another antigen, there was an increase in the relative count of lymphocytes having a zone of clarification near nucleoli. In children vaccinated with BCG, such an effect was noted in 81.3% of the cases, whereas in children with verified toxoplasmosis, in all the cases. It is recommended that the method designed might be used as alternative for the complement fixation test in the diagnosis of toxoplasmosis.

Uveítes posteriores na infância / Posterior uveitis in childhood

As uveítes posteriores mais comuns na infância säo as formas endógenas e tem uma importância clínica grande porque raramente se acompanham de sinais anteriores e näo säo detectadas pois as crianças näo se queixam de borramento de visäo. A toxoplasmose é a forma mais frequente. Outras formas congênitas e adquiridas säo descritas com ênfase na precocidade do diagnóstico e do tratamento

Hereditary and congenital factors in inflammations of the uveal tract.

The discovery of associations between HLA antigens and particular diseases has provided an explanation for some racial differences in the incidence of uveitis. Acute anterior uveitis is strongly associated with HLA B27 and this hereditary influence has been substantiated by evidence of familial cases. HLA B5 occurs more frequently in Japanese patients with Behçet's disease and HLA BW22J and HLA DWa are associated with the Vogt-Koyanagi-Harada disease. HLA B7 and HLA DRW2 occur more frequently in patients with presumed ocular histoplasmosis. Some possible explanations for these associations are discussed. Syphilis, cytomegalic inclusion disease, and toxoplasmosis can all produce a congenital form of uveitis.

Physiopathology of Fuchs's heterochromic cyclitis.

The aetiopathogenesis of Fuchs's disease is still unknown. Recent findings indicate that the role of the sympathetic nervous system can be excluded and that the theory of heredodegeneration is a more probable explanation. A congenital predisposition to the disease which may possibly be related to some malformation of the iris vessels should be considered. This may explain why the disease is not always unilateral. The recent immunological anomalies found in the aqueous humour should be confirmed. Comparative studies of clinical, vascular, and immunological data could be of great interest in the future.