Asunto(s)
Autoinmunidad , Coroiditis/complicaciones , Infecciones Bacterianas del Ojo/complicaciones , Panuveítis/etiología , Tuberculosis Ocular/complicaciones , Adulto , Antituberculosos/uso terapéutico , Coroiditis/tratamiento farmacológico , Coroiditis/microbiología , ADN Bacteriano/análisis , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Infecciones Bacterianas del Ojo/microbiología , Femenino , Angiografía con Fluoresceína/métodos , Fondo de Ojo , Glucocorticoides/uso terapéutico , Humanos , Mycobacterium tuberculosis/genética , Panuveítis/diagnóstico , Panuveítis/inmunología , Tomografía de Coherencia Óptica/métodos , Tuberculosis Ocular/diagnóstico , Tuberculosis Ocular/tratamiento farmacológicoAsunto(s)
Coroides/diagnóstico por imagen , Coroiditis/diagnóstico , Infecciones Bacterianas del Ojo/diagnóstico , Angiografía con Fluoresceína/métodos , Infecciones por Mycobacterium/diagnóstico , Mycobacterium/aislamiento & purificación , Tomografía de Coherencia Óptica/métodos , Adulto , Coroides/microbiología , Coroiditis/microbiología , Infecciones Bacterianas del Ojo/microbiología , Fondo de Ojo , Humanos , Masculino , Infecciones por Mycobacterium/microbiologíaRESUMEN
PURPOSE: To describe a case of tubercular serpiginous-like choroiditis that progressed, despite antitubercular medication, corticosteroids, and immunomodulatory treatment, which ultimately quieted after two intravitreal methotrexate injections. METHODS: Case report. RESULTS: A 35-year-old woman reported a shadow in the left eye for 2 weeks. She presented with tubercular serpiginous-like choroiditis in the right eye 2 years prior. At that time, she was started on antituberculosis therapy but was noncompliant and lost to follow-up. On re-presentation, there was a new active left-eye serpiginous lesion, with repeat positive QuantiFERON gold testing. Four antituberculosis drugs were started, followed by corticosteroids and azathioprine, with continued progression despite aggressive treatment. She was finally given 2 intravitreal methotrexate injections (400 µg/0.1 cc) 1 month apart, with final arrest of lesion extension. The uveitis remained quiet for over 24 months, and the patient was able to discontinue all systemic therapy. CONCLUSION: Intravitreal methotrexate injections halted progression of treatment-refractory tubercular serpiginous-like choroiditis.
Asunto(s)
Coroiditis/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Metotrexato/uso terapéutico , Tuberculosis Ocular/tratamiento farmacológico , Adulto , Antituberculosos/uso terapéutico , Coroiditis/diagnóstico , Coroiditis/microbiología , Quimioterapia Combinada , Femenino , Humanos , Inyecciones Intravítreas , Prueba de Tuberculina , Tuberculosis Ocular/diagnóstico , Tuberculosis Ocular/microbiología , Agudeza VisualRESUMEN
PURPOSE: To characterize the ophthalmic clinical and multimodal imaging findings of disseminated Mycobacterium chimaera infection after cardiothoracic surgery. DESIGN: Observational case series. PARTICIPANTS: Four patients (8 eyes) with disseminated M. chimaera infection. METHODS: Patients were evaluated with biomicroscopy, OCT and OCT angiography, fundus autofluorescence, and fluorescein and indocyanine green angiography. MAIN OUTCOME MEASURES: Clinical and multimodal imaging findings of patients with disseminated M. chimaera infection. RESULTS: All 4 patients were white men with a mean age of 65.5 years (range, 60-75 years) who had aortic valve or root infection, or both, with M. chimaera diagnosed by culture, gene sequencing, or both. All 4 patients demonstrated bilateral choroidal lesions on funduscopy and evidence of osteomyelitis by imaging, culture analysis, or both at the time of ocular diagnosis. Indocyanine green and OCT angiography revealed numerous additional subclinical choroidal lesions and were used to track disease response to therapy. Fluorescein angiography and fundus autofluorescence were useful in determining lesion age and activity. All patients were treated with 3- or 4-drug antimycobacterial therapy. Three underwent revision of cardiothoracic surgery with removal of infected graft. One patient went on to demonstrate progressive ocular disease that was noted before each of his surgical revisions. Two patients showed improvement in ocular and systemic disease, however one of them developed a choroidal neovascular membrane. The final patient was a single encounter whose clinical and imaging findings showed longstanding inactive disease. CONCLUSIONS: Ophthalmologists should be aware of the systemic and ocular findings of this rare life-threatening disease. Multimodal imaging is useful in corroborating a diagnosis of ocular M. chimaera and particularly in evaluating patient response to therapy, because choroidal activity seems to mimic systemic activity. Treating physicians should be aware of the co-occurrence of choroiditis and osteomyelitis. Choroidal neovascular membrane can also be a late complication of this disease.
Asunto(s)
Coroiditis/diagnóstico , Infecciones Bacterianas del Ojo/diagnóstico , Imagen Multimodal , Mycobacterium/aislamiento & purificación , Tuberculosis Ocular/diagnóstico , Tuberculosis/diagnóstico , Cuerpo Vítreo/microbiología , Anciano , Coroiditis/microbiología , Infecciones Bacterianas del Ojo/microbiología , Angiografía con Fluoresceína/métodos , Estudios de Seguimiento , Fondo de Ojo , Humanos , Masculino , Persona de Mediana Edad , Oftalmoscopía/métodos , Estudios Retrospectivos , Factores de Tiempo , Tomografía de Coherencia Óptica/métodos , Tuberculosis/microbiología , Tuberculosis Ocular/microbiología , Cuerpo Vítreo/diagnóstico por imagenRESUMEN
BACKGROUND: Ocular involvement in AIDS patients is a common event mainly caused by inflammation or infection. Despite the high prevalence rate of cryptococcosis in these individuals, ocular features have been occasionally described. CASE REPORT: A 20-year-old Brazilian female with HIV infection recently diagnosed was admitted with a respiratory profile presumptively diagnosed as Pneumocystis jirovecii pneumonia; an ophthalmologic exam suggested choroiditis by this agent as well. She was complaining of headaches and blurred vision which led to cryptococcal meningitis diagnosis by a CSF positive India ink stain and Cryptococcus neoformans positive culture. Despite therapy based on amphotericin B plus fluconazole, her clinical state progressively worsened and the patient died one week later. At necropsy, disseminated cryptococcal infection was evidenced in several organs including eyes, which presented bilateral chorioretinitis. CONCLUSIONS: Cryptococcal ocular involvement in AIDS patients has been occasionally proved among the cases already reported. Thus, the post mortem exam is still pivotal to improve the quality of the clinical diagnosis, especially in limited-resource settings.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Coroiditis/microbiología , Criptococosis/complicaciones , Cryptococcus neoformans , Resultado Fatal , Femenino , Humanos , Adulto JovenRESUMEN
A 47-year-old female presented with optic disc oedema, peripapillary subretinal fluid and scattered areas of choroiditis. Her ultrasound B-scan showed sclerochoroidal thickening with widening of sub-Tenon space. Subsequent investigations revealed a positive Mantoux test and high-resolution computed tomography of the chest was suggestive of pulmonary involvement. She responded well to antitubercular treatment and systemic corticosteroid. A review of the literature was conducted to identify additional reports on similar cases and discussed. A high index of suspicion and appropriate laboratory work-up can aid in the diagnosis of tuberculous posterior scleritis.
Asunto(s)
Infecciones Bacterianas del Ojo/diagnóstico , Escleritis/diagnóstico , Tuberculosis Ocular/diagnóstico , Antituberculosos/uso terapéutico , Coroiditis/diagnóstico , Coroiditis/tratamiento farmacológico , Coroiditis/microbiología , Colorantes/administración & dosificación , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Infecciones Bacterianas del Ojo/microbiología , Femenino , Angiografía con Fluoresceína , Glucocorticoides/uso terapéutico , Humanos , Verde de Indocianina/administración & dosificación , Persona de Mediana Edad , Papiledema/diagnóstico , Papiledema/tratamiento farmacológico , Papiledema/microbiología , Escleritis/tratamiento farmacológico , Escleritis/microbiología , Líquido Subretiniano , Tuberculosis Ocular/tratamiento farmacológico , Tuberculosis Ocular/microbiología , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/tratamiento farmacológico , Agudeza VisualRESUMEN
PURPOSE: To study optical coherence tomography angiography (OCTA) and multimodal imaging features of Type 1 inflammatory choroidal neovascularization (CNV) in tubercular serpiginous-like choroiditis and response to anti-vascular endothelial growth factor therapy. METHODS: In this study, multimodal imaging was performed using OCTA, enhanced-depth imaging optical coherence tomography, fluorescein angiography, and indocyanine green angiography. Correlation of OCTA with other imaging modalities in the detection of CNV was performed. The changes in CNV configuration after anti-vascular endothelial growth factor therapy were assessed. RESULTS: In this study, nine eyes (8 patients; 5 females; mean age: 32.5 ± 11.57 years) with diagnosis of tubercular serpiginous-like choroiditis were included. All the eyes had presence of low-lying pigment epithelial detachments on enhanced-depth imaging optical coherence tomography. Using OCTA, it was possible to detect Type 1 CNV in all eyes. Type 1 CNV networks comprised fine anastomotic network of vessels, some of which had a hairpin loop configuration. After anti-vascular endothelial growth factor therapy, there was a decrease in branching and anastomosis. The visual acuity significantly improved from 0.49 ± 0.26 (20/60 Snellen equivalent) at baseline to 0.26 ± 0.17 (20/36 Snellen equivalent) (P = 0.03) in all eyes. CONCLUSION: Type 1 CNV can occur among patients with tubercular serpiginous-like choroiditis, leading to significant visual loss even in the healed stages of the disease. Optical coherence tomography angiography can help in the detection of Type 1 CNV where conventional multimodal imaging, including fluorescein angiography and OCT, fails to make a definitive diagnosis and thereby guide the initiation of anti-vascular endothelial growth factor therapy.
Asunto(s)
Neovascularización Coroidal/diagnóstico , Coroiditis/diagnóstico , Tuberculosis Ocular/diagnóstico , Adolescente , Adulto , Inhibidores de la Angiogénesis/uso terapéutico , Coroides/irrigación sanguínea , Coroiditis/microbiología , Colorantes/administración & dosificación , Femenino , Angiografía con Fluoresceína , Humanos , Verde de Indocianina/administración & dosificación , Masculino , Persona de Mediana Edad , Imagen Multimodal , Tomografía de Coherencia Óptica , Tuberculosis Ocular/microbiología , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Agudeza Visual , Adulto JovenAsunto(s)
Aspergilosis/diagnóstico , Coroiditis/diagnóstico , Infecciones Fúngicas del Ojo/diagnóstico , Trasplante de Hígado/efectos adversos , Escotoma/etiología , Antifúngicos/uso terapéutico , Aspergilosis/tratamiento farmacológico , Aspergilosis/microbiología , Coroiditis/tratamiento farmacológico , Coroiditis/microbiología , Infecciones Fúngicas del Ojo/tratamiento farmacológico , Infecciones Fúngicas del Ojo/microbiología , Humanos , Masculino , Persona de Mediana Edad , Escotoma/diagnóstico , Cuerpo Vítreo/microbiología , Voriconazol/uso terapéuticoRESUMEN
A rare case of 70-year-old woman with adult T-cell leukemia/lymphoma who developed multifocal choroiditis from a dissemination of Cryptococcus neoformans is reported. Ophthalmologic examination revealed multiple yellowish choroidal lesions in the posterior pole of both eyes. Sequential optical coherence tomographic images disclosed the involvement of the choroid and the consecutive changes in its architecture during the course of treatment. The recognition of these ocular manifestations may be important for the rapid diagnosis of C. nerformans-disseminated diseases. Rapid diagnosis and prompt therapy with intravitreal injection as well as systemic fosfluconazole and liposomal amphotericin B led to clinical improvement of intraocular cryptococcosis.
Asunto(s)
Coroiditis/diagnóstico , Criptococosis/diagnóstico , Cryptococcus neoformans/aislamiento & purificación , Infecciones Fúngicas del Ojo/complicaciones , Infecciones Fúngicas del Ojo/diagnóstico , Leucemia-Linfoma de Células T del Adulto/complicaciones , Anciano , Anfotericina B/administración & dosificación , Anfotericina B/uso terapéutico , Antifúngicos/administración & dosificación , Antifúngicos/uso terapéutico , Coroiditis/sangre , Coroiditis/tratamiento farmacológico , Coroiditis/microbiología , Criptococosis/complicaciones , Cryptococcus neoformans/efectos de los fármacos , Cryptococcus neoformans/genética , Ojo/patología , Infecciones Fúngicas del Ojo/sangre , Infecciones Fúngicas del Ojo/tratamiento farmacológico , Resultado Fatal , Femenino , Fluconazol/administración & dosificación , Fluconazol/análogos & derivados , Fluconazol/uso terapéutico , Humanos , Inyecciones Intravítreas , Leucemia-Linfoma de Células T del Adulto/sangre , Leucemia-Linfoma de Células T del Adulto/tratamiento farmacológico , Coroiditis Multifocal , Organofosfatos/administración & dosificación , Organofosfatos/uso terapéutico , Tomografía de Coherencia ÓpticaAsunto(s)
Criptococosis/diagnóstico , Cryptococcus gattii/aislamiento & purificación , Infecciones Fúngicas del Ojo/diagnóstico , Retinitis/diagnóstico , Administración Oral , Adulto , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Coroiditis/diagnóstico , Coroiditis/microbiología , Criptococosis/tratamiento farmacológico , Criptococosis/microbiología , Quimioterapia Combinada , Oftalmopatías/diagnóstico , Oftalmopatías/microbiología , Infecciones Fúngicas del Ojo/tratamiento farmacológico , Infecciones Fúngicas del Ojo/microbiología , Fluconazol/uso terapéutico , Flucitosina/uso terapéutico , Infecciones por VIH/diagnóstico , Humanos , Infusiones Intravenosas , Masculino , Meningitis Criptocócica/diagnóstico , Meningitis Criptocócica/tratamiento farmacológico , Meningitis Criptocócica/microbiología , Retinitis/tratamiento farmacológico , Retinitis/microbiología , Tomografía de Coherencia Óptica , Cuerpo Vítreo/microbiología , Cuerpo Vítreo/patologíaRESUMEN
We report a case of a 47-year-old male patient presenting with diminution of vision in the left eye. The left eye fundus showed yellowish lesions with indistinct geographical margin extending over the posterior pole just abutting the macula, suggestive of diffuse choroiditis. The patient gave a history of testicular swelling for the past 2 years. Aqueous tap for polymerase chain reaction analysis was positive for IS6110 mycobacterial tuberculosis (TB) genome, and a biopsy of testicular sac was suggestive of tubercular epididymitis. A diagnosis of TB-multifocal serpiginoid choroiditis was established and was managed with anti-tubercular therapy and systemic steroids.
Asunto(s)
Coroiditis/etiología , ADN Bacteriano/análisis , Mycobacterium tuberculosis/genética , Reacción en Cadena de la Polimerasa/métodos , Testículo/microbiología , Tuberculosis de los Genitales Masculinos/complicaciones , Tuberculosis Ocular/complicaciones , Humor Acuoso/microbiología , Biopsia , Coroiditis/diagnóstico , Coroiditis/microbiología , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Coroiditis Multifocal , Mycobacterium tuberculosis/aislamiento & purificación , Testículo/patología , Tuberculosis de los Genitales Masculinos/diagnóstico , Tuberculosis de los Genitales Masculinos/microbiología , Tuberculosis Ocular/diagnóstico , Tuberculosis Ocular/microbiologíaAsunto(s)
Antituberculosos/uso terapéutico , Coroiditis/diagnóstico , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis Ocular/diagnóstico , Cuerpo Vítreo/microbiología , Coroiditis/microbiología , Coroiditis/terapia , ADN Bacteriano/análisis , Diagnóstico Diferencial , Humanos , Masculino , Mycobacterium tuberculosis/genética , Reacción en Cadena de la Polimerasa , Tuberculosis Ocular/microbiología , Tuberculosis Ocular/terapia , Vitrectomía , Cuerpo Vítreo/diagnóstico por imagen , Cuerpo Vítreo/cirugía , Adulto JovenRESUMEN
Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a rare inflammatory chorioretinopathy, which mainly affects young light-skinned, myopic adults between 20 and 30 years of age. The exact aetiology of APMPPE is unknown. Some patients report a viral or flu-like illness preceding the onset of APMPPE symptoms. This condition is usually bilateral and self-limiting with a good overall prognosis. Visual loss is sudden, but usually temporary. Relapses are very rare. Foveal involvement may lead to a worse visual prognosis. There is no current consensus on treatment. A wait-and-see approach with monitoring at short intervals is often sufficient. Based on a case example from our clinic we will demonstrate symptoms, diagnostic work-up and treatment options.
Asunto(s)
Enfermedades de la Coroides , Coroiditis , Enfermedades de la Retina , Enfermedad Aguda , Adulto , Enfermedades de la Coroides/microbiología , Coroiditis/microbiología , Angiografía con Fluoresceína , Fóvea Central , Humanos , Epitelio Pigmentado Ocular , Enfermedades de la Retina/microbiología , Adulto JovenRESUMEN
An immunocompromised patient had positive blood cultures for Mycobacterium intracellulare and no identifiable organ seeding was started on treatment. One month later, the patient was clinically well with negative blood cultures but drug-induced myelotoxicity had developed. Ocular fundus examination at this time revealed bilateral choroidal granulomas which changed patient management.
Asunto(s)
Antibacterianos/uso terapéutico , Coroiditis/diagnóstico , Infecciones Bacterianas del Ojo/diagnóstico , Huésped Inmunocomprometido , Complejo Mycobacterium avium/aislamiento & purificación , Infección por Mycobacterium avium-intracellulare/diagnóstico , Antibacterianos/efectos adversos , Coroiditis/diagnóstico por imagen , Coroiditis/tratamiento farmacológico , Coroiditis/microbiología , Infecciones Bacterianas del Ojo/diagnóstico por imagen , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Infecciones Bacterianas del Ojo/microbiología , Femenino , Humanos , Persona de Mediana Edad , Infección por Mycobacterium avium-intracellulare/diagnóstico por imagen , Infección por Mycobacterium avium-intracellulare/tratamiento farmacológico , Infección por Mycobacterium avium-intracellulare/microbiología , Resultado del TratamientoRESUMEN
A 37-year-old immunocompetent male patient presented with the blurring of vision, both eyes for the past1 year. Fundus examination revealed bilateral multiple subretinal abscesses with areas of healed serpiginous-like choroiditis. Laboratory investigations showed positive tuberculin skin test, positive QuantiFERON TB-Gold Test, and high resolution computed tomography chest showed enlarged mediastinal lymph nodes. The aqueous sample revealed polymerase chain reaction (PCR) positive for Mycobacterium tuberculosis (MTB) (MPB64 genome). He was treated antitubercular therapy (ATT) along with oral steroids. Although he responded well initially, he had recurrent inflammation and paradoxical worsening. This was managed with a high dose of intravenous corticosteroids, immune suppressive and ATT. He also had a diagnostic vitreous biopsy which was also PCR positive for MTB (IS6110 gene). He subsequently continued ATT along with corticosteroids and immune suppressive and responded well. We present this case report for its unusual presentation.
Asunto(s)
Absceso/tratamiento farmacológico , Antituberculosos/efectos adversos , Coroiditis/tratamiento farmacológico , Infecciones Bacterianas del Ojo/diagnóstico , Huésped Inmunocomprometido , Retina/diagnóstico por imagen , Tuberculosis Ocular/tratamiento farmacológico , Absceso/etiología , Absceso/microbiología , Adulto , Antituberculosos/uso terapéutico , Coroiditis/diagnóstico , Coroiditis/microbiología , Progresión de la Enfermedad , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Humanos , Masculino , Mycobacterium tuberculosis/aislamiento & purificación , Oftalmoscopía , Retina/microbiología , Tuberculosis Ocular/diagnósticoRESUMEN
PURPOSE: In this article, the authors describe multifocal choroiditis related to disseminated sporotrichosis in patients with HIV/AIDS. METHODS: We conducted a retrospective observational study of three patients infected with HIV who presented with disseminated sporotrichosis characterized by cutaneous lesions, multifocal choroiditis, and other manifestations, including osteomyelitis and involvement of the bone marrow, larynx, pharynx, and nasal and oral mucosa. RESULTS: Five eyes of three patients with HIV/AIDS showed multifocal choroiditis related to disseminated sporotrichosis. The CD4 counts ranged from 25 to 53 mm. All patients were asymptomatic visually. The ocular disease was bilateral in two patients. The lesion size ranged from 1/3 to 2 disc diameters. None of the patients had vitritis. Of the 12 lesions, 9 were localized in the posterior pole (Zone 1) and 3 were localized in the mild periphery (Zone 2). CONCLUSION: Multifocal choroiditis due to disseminated sporotrichosis can occur in profoundly immunosuppressed patients with HIV/AIDS.
Asunto(s)
Coroiditis/microbiología , Infecciones Fúngicas del Ojo/microbiología , Infecciones por VIH/complicaciones , Esporotricosis/etiología , Adulto , Humanos , Masculino , Coroiditis Multifocal , Estudios Retrospectivos , Sporothrix/aislamiento & purificaciónAsunto(s)
Coroiditis/diagnóstico , Ojo/diagnóstico por imagen , Desprendimiento de Retina/diagnóstico , Tuberculosis Ocular/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Coroiditis/complicaciones , Coroiditis/microbiología , Ojo/microbiología , Ojo/patología , Femenino , Angiografía con Fluoresceína , VIH-1 , Humanos , Imagen Óptica , Desprendimiento de Retina/complicaciones , Desprendimiento de Retina/microbiología , Tomografía de Coherencia Óptica , Personas Transgénero , Tuberculosis Miliar/complicaciones , Tuberculosis Miliar/diagnóstico , Tuberculosis Ocular/complicaciones , Adulto JovenRESUMEN
PURPOSE: To describe solitary idiopathic choroiditis in the setting of extensive animal exposure. METHODS: A 56-year-old asymptomatic female equestrian with an extensive history of exposure to horses and dogs and a trapper of wild animals and rodents was discovered to have an amelanotic choroidal mass in the macular region and referred for suspicious atypical nevus. RESULTS: Funduscopy revealed a deep yellow mass with overlying retinal pigment epithelial thinning and without visible subretinal fluid or lipofuscin. Mild hyperautofluorescence represented unmasking of scleral autofluorescence. Ultrasonography showed a 1.8-mm-thick echodense lesion. Enhanced depth imaging-optical coherence tomography disclosed a dense, elevated scleral mass with "volcanic" configuration, demonstrating choroidal compression and trace overlying subretinal fluid. These features were consistent with solitary idiopathic choroiditis/scleritis. Systemic evaluation for standard cat-related bartonellosis, tuberculosis, sarcoidosis, and syphilis were negative. Horse-, dog-, and rodent-related bartonellosis testing was not available. Observation was advised, and the findings remained stable at 6 months. CONCLUSION: Solitary idiopathic choroiditis is best imaged on enhanced depth imaging-optical coherence tomography as a scleral lesion with "volcanic" configuration and often secondary to previous Bartonella infection. Serologic positivity for cat-related Bartonella decays over time, and testing for horse-, dog-, or rodent-related Bartonella is not commonly used.
Asunto(s)
Enfermedades de los Trabajadores Agrícolas/diagnóstico , Infecciones por Bartonella/complicaciones , Coroiditis/patología , Animales , Coroiditis/diagnóstico por imagen , Coroiditis/microbiología , Perros , Femenino , Caballos , Humanos , Persona de Mediana Edad , Imagen MultimodalRESUMEN
AIMS: The aim of this study was to detect Mycobacterium tuberculosis (MTB) DNA with polymerase chain reaction (PCR) in aqueous or vitreous samples of patients suffering from choroiditis presumed to be infectious origin. SETTINGS AND DESIGN: Hospital-based, retrospective case-control study. SUBJECTS AND METHODS: In all, forty eyes of forty patients with choroiditis divided into two groups - Group A (serpiginous-like choroiditis, ampiginous choroiditis, multifocal choroiditis) and Group B (choroidal abscess, miliary tuberculosis (TB), choroidal tubercle) were analyzed retrospectively. In 27 controls (patients without uveitis undergoing phacoemulsification), anterior chamber aspirate was done and sample subjected to real-time PCR. Patients underwent nested PCR for MTB using IS6110 and MPB64 primers from aqueous (n = 39) or vitreous (n = 1). All patients underwent detailed ophthalmological examination by slit-lamp biomicroscopy, fundus examination by indirect ophthalmoscopy, and fundus photograph and fundus fluorescein angiography if required. STATISTICAL ANALYSIS: Positive results of PCR for MTB within the group and between two groups were statistically analyzed using Chi-square test. RESULTS: There were 25 males and 15 females. Mean age at presentation was 34.66 years (range, 14-62). PCR positivity rates were 41.3% (n = 12/29) and 81.82% (n = 9/11) in Groups A and B, respectively. No controls had PCR-positive result. Comparison of PCR positivity rates showed statistically significant difference between Groups A and B (P = 0.028). Systemic TB was detected in 57.14% (n = 12/21) of all PCR-positive cases (Group A - 33.3%, n = 4/12; Group B - 88.9%, n = 8/9). Systemic antitubercular treatment (ATT) for 9 months and oral steroids were successful in resolution of choroiditis in all PCR-positive patients (n = 21) without disease recurrence. CONCLUSIONS: Eyes with choroiditis of suspected/presumed tubercular origin should be subjected to PCR for diagnosis of TB and subjected to ATT for prevention of recurrences.
Asunto(s)
Humor Acuoso/microbiología , Coroiditis/diagnóstico , ADN Bacteriano/análisis , Mycobacterium tuberculosis/genética , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Derivación y Consulta , Tuberculosis Ocular/diagnóstico , Adolescente , Adulto , Coroiditis/microbiología , Femenino , Angiografía con Fluoresceína , Fondo de Ojo , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Reproducibilidad de los Resultados , Estudios Retrospectivos , Tuberculosis Ocular/microbiología , Adulto JovenRESUMEN
PURPOSE: To compare 3 different molecular techniques to detect the Mycobacterium tuberculosis genome in vitreous fluid of eyes with multifocal serpiginoid choroiditis (MSC). DESIGN: Prospective, interventional case series. PARTICIPANTS: Eleven patients (11 eyes) with active MSC in at least 1 eye underwent diagnostic pars plana vitrectomy (PPV) between October 2012 and December 2013. METHODS: Vitreous fluid samples were subjected to multitargeted polymerase chain reaction (PCR) for a M. tuberculosis assay, the Gene Xpert MTB/RIF assay (Cepheid, Sunnyvale, CA), and a line probe assay (GenoType MTBDRplus; Hain Lifescience, GmbH, Nehren, Germany). The samples with positive results were subjected to rpoB gene sequencing to demonstrate rifampicin resistance. The clinical details, digital fundus imaging, and treatment details and outcomes also were noted. MAIN OUTCOME MEASURES: Detection of the M. tuberculosis genome and rifampicin resistance in the vitreous samples. RESULTS: Of the 11 eyes subjected to PPV, the multitargeted PCR results for tuberculosis were positive for 10 eyes, the MTBDRplus assay results were positive in 6 eyes, and the Gene Xpert MTB/RIF assay results were positive in 4 eyes. Rifampicin resistance was detected in 3 eyes by rpoB gene sequencing, in 3 eyes by the MTBDRplus assay, and in 1 eye by the Gene Xpert MTB/RIF assay. CONCLUSIONS: We detected the M. tuberculosis genome in the vitreous fluid of eyes with MSC using 3 different molecular techniques. Rifampicin resistance was detected for the first time in eyes with MSC.