RESUMO
Optic neuropathy can be of infectious or non-infectious/idiopathic aetiology. Many infectious organisms can cause optic neuropathy that can be of varied presentation including papillitis, retrobulbar optic neuritis, neuroretinitis, and optic perineuritis. Detailed history, ocular, systemic/neurologic examination along with appropriate laboratory evaluation can help clinicians to identify the infectious agent causing optic neuropathy. In spite of recent advanced techniques in serological testing and molecular diagnostics like polymerase chain reaction (PCR), the identification of these pathogens is still a diagnostic challenge. It is ideal to have an infectious disease (ID) consultant in the management team, as most of these infections are multisystem involving diseases. Most infectious agents can be effectively treated with specific antibiotics, with or without corticosteroid therapy, but visual recovery is highly variable and depends entirely on early diagnosis of the causative agent. This review article will provide an overview of common pathogens involved in ION and will describe their management paradigms.
Assuntos
Doenças do Nervo Óptico , Humanos , Doenças do Nervo Óptico/diagnóstico , Doenças do Nervo Óptico/microbiologia , Doenças do Nervo Óptico/tratamento farmacológico , Antibacterianos/uso terapêutico , Neurite Óptica/diagnóstico , Neurite Óptica/microbiologia , Neurite Óptica/tratamento farmacológico , Infecções Oculares/diagnóstico , Infecções Oculares/microbiologia , Infecções Oculares/tratamento farmacológicoAssuntos
Empiema Tuberculoso/complicações , Mycobacterium tuberculosis/imunologia , Neurite Óptica/microbiologia , Dermatopatias Bacterianas/microbiologia , Adolescente , Empiema Tuberculoso/diagnóstico , Empiema Tuberculoso/tratamento farmacológico , Feminino , Humanos , Necrose/microbiologia , Neurite Óptica/diagnóstico por imagem , Pele/patologia , Transtornos da Visão/microbiologiaAssuntos
Doenças do Nervo Abducente/microbiologia , Eritema Migrans Crônico/microbiologia , Doença de Lyme/complicações , Neurite Óptica/microbiologia , Idoso , Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Doxiciclina/uso terapêutico , Humanos , Doença de Lyme/tratamento farmacológico , MasculinoRESUMO
Lyme disease is a rare condition caused by the bacterium Borrelia burgdorferi. Despite typical symptoms including fever, headache, fatigue, and a characteristic skin rash, sometimes we cannot find those due to the lack of physician consultation in those early stages. If this disease is left untreated, infection could spread to the nervous system causing neuroborreliosis, an atypical and complicated manifestation of this disease. We present the case of an atypical papillitis, probably caused by this bacterium. We suspected this because of the results on the indirect test bloods and the improvement of the symptoms after treatment. This entity should be considered as a possible diagnosis of atypical optical neuropathies, particularly if it occurs in an endemic area.
Assuntos
Infecções Oculares Bacterianas/diagnóstico , Neuroborreliose de Lyme/diagnóstico , Disco Óptico/patologia , Neurite Óptica/diagnóstico , Antibacterianos/uso terapêutico , Borrelia burgdorferi/isolamento & purificação , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções Oculares Bacterianas/microbiologia , Cefaleia/diagnóstico , Humanos , Neuroborreliose de Lyme/tratamento farmacológico , Neuroborreliose de Lyme/microbiologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Neurite Óptica/tratamento farmacológico , Neurite Óptica/microbiologia , Células Ganglionares da Retina/patologia , Tomografia de Coerência Óptica , Testes de Campo Visual , Campos VisuaisAssuntos
Encefalopatias/diagnóstico por imagem , Oftalmopatias/diagnóstico por imagem , Sinusite Maxilar/diagnóstico por imagem , Mucormicose/diagnóstico , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Cegueira/etiologia , Cegueira/microbiologia , Cegueira/terapia , Encefalopatias/microbiologia , Encefalopatias/terapia , Desbridamento , Exoftalmia/etiologia , Exoftalmia/microbiologia , Exoftalmia/terapia , Oftalmopatias/microbiologia , Oftalmopatias/terapia , Evolução Fatal , Feminino , Humanos , Imageamento por Ressonância Magnética , Sinusite Maxilar/microbiologia , Sinusite Maxilar/terapia , Pessoa de Meia-Idade , Mucormicose/diagnóstico por imagem , Mucormicose/microbiologia , Mucormicose/terapia , Neurite Óptica/diagnóstico por imagem , Neurite Óptica/microbiologia , Neurite Óptica/terapiaRESUMO
A 49-year-old Caucasian woman presented with subacute headache and right eye pain associated with scotoma, blurred vision and photophobia. MRI was suggestive of optic neuritis of the right optic nerve and she was treated with steroids. Due to persistent symptoms, a lumbar puncture was performed and cerebrospinal fluid analysis was positive for venereal disease research laboratory and rapid plasma reagin titres. On further history, she recalled experiencing an illness associated with diffuse rash, likely secondary syphilis, 1-2 months prior. She tested negative for HIV. She was treated with intravenous penicillin for 2 weeks following which she experienced improvement in symptoms.
Assuntos
Dor Ocular/microbiologia , Cefaleia/microbiologia , Neurite Óptica/microbiologia , Escotoma/microbiologia , Sífilis/complicações , Doença Aguda , Líquido Cefalorraquidiano/microbiologia , Dor Ocular/líquido cefalorraquidiano , Dor Ocular/diagnóstico , Feminino , Cefaleia/líquido cefalorraquidiano , Cefaleia/diagnóstico , Humanos , Pessoa de Meia-Idade , Neurite Óptica/líquido cefalorraquidiano , Neurite Óptica/diagnóstico , Escotoma/líquido cefalorraquidiano , Escotoma/diagnóstico , Punção Espinal , Sífilis/líquido cefalorraquidianoRESUMO
INTRODUCTION: Optic neuritis is a condition associated with various systemic diseases, such as multiple sclerosis, and is also considered a rare complication of Lyme disease. CASE: A 46-year-old white woman presented with sudden onset of bilateral vision loss. After extensive workup, she was diagnosed with Lyme optic neuritis based on the clinical presentation and positive serology. She was treated with doxycycline for 2 weeks. DISCUSSION: Lyme disease is caused by infection with the spirochete Borrelia burgdorferi. The most commonly affected areas include the skin, joints, heart, and nervous system. Lyme optic neuritis is a challenging diagnosis and therefore often underreported. Doxycycline or ceftriaxone for 2 weeks are recommended for treatment. CONCLUSION: We report this case to increase awareness among clinicians to include Lyme disease in the differential diagnosis of optic neuritis for unexplained cases of vision loss, particularly in Lyme endemic areas.
Assuntos
Doença de Lyme/complicações , Neurite Óptica/microbiologia , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Doxiciclina/uso terapêutico , Feminino , Humanos , Doença de Lyme/diagnóstico , Doença de Lyme/tratamento farmacológico , Pessoa de Meia-Idade , Neurite Óptica/diagnóstico , Neurite Óptica/tratamento farmacológico , WisconsinRESUMO
BACKGROUND: Syphilis, 'the great imitator', can present with a variety of symptoms. CASE DESCRIPTION: A 54-year-old woman attended the hospital clinic for vision problems, preceded by mouth ulcers. Following extensive serological investigations, the diagnosis 'syphilitic optic neuritis' was made. CONCLUSION: It is important to be thoughtful of systemic causes, like syphilis, when patients present with local symptomatology.
Assuntos
Neurite Óptica/microbiologia , Sífilis/complicações , Sífilis/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Nervo Óptico , Transtornos da Visão/microbiologiaRESUMO
We report the case of a 12-year-old girl who developed Guillain-Barré syndrome (GBS) and optic neuritis (ON) following Mycoplasma pneumoniae infection. Her symptoms, including bilateral vision impairment and tingling in her hands and right foot, were resolved after methylprednisolone pulse therapy. Serum anti-galactocerebroside (Gal-C) IgM antibodies were detected in our patient. This is the first report of a child with GBS and ON associated with M. pneumoniae infection.
Assuntos
Síndrome de Guillain-Barré/complicações , Neurite Óptica/complicações , Autoanticorpos/sangue , Criança , Feminino , Galactosilceramidas/análise , Galactosilceramidas/sangue , Síndrome de Guillain-Barré/microbiologia , Humanos , Metilprednisolona/farmacologia , Mycoplasma pneumoniae/patogenicidade , Neurite Óptica/tratamento farmacológico , Neurite Óptica/microbiologiaRESUMO
The classical presentation of secondary syphilis comprises skin rashes, mucosal ulceration and lymphadenopathy. However, this disseminated stage can also present with symptoms and signs of ocular, neurological, pulmonary, renal, musculoskeletal and digestive tract disease. We report the case of a gay man who presented with icteric hepatitis. Although he underwent an exhaustive series of investigations (some of which were invasive), syphilis was not initially considered in the differential diagnosis. His jaundice resolved spontaneously, but he subsequently developed an acute optic neuritis. Early syphilis is relatively common in men who have sex with men (MSM). Prompt diagnosis and treatment in this case would have prevented ocular involvement. Syphilis testing should be considered in all MSM presenting with unexplained symptoms and signs.
Assuntos
Infecções Oculares Bacterianas/diagnóstico , Hepatite/diagnóstico , Icterícia/diagnóstico , Neurite Óptica/diagnóstico , Sífilis/diagnóstico , Doença Aguda , Adulto , Diagnóstico Diferencial , Infecções Oculares Bacterianas/microbiologia , Hepatite/microbiologia , Humanos , Icterícia/microbiologia , Masculino , Neurite Óptica/microbiologia , Minorias Sexuais e de Gênero , Sífilis/complicaçõesRESUMO
Syphilitic chorioretinitis should be included in differential diagnosis of any form of ocular inflammation. A significantly higher proportion of human immunodeficiency virus (HIV)-positive patients with ocular syphilis as compared to HIV-negative cases have been reported in published studies. However, the clinical signs and symptoms are more insidious in HIV-negative patients who are easily misdiagnosed. We report a series of cases of ocular syphilis and describe the clinical manifestations and treatment outcomes of syphilitic chorioretinitis in HIV-negative patients in China.This was a retrospective case series study. The clinical records of patients with syphilis chorioretinitis were reviewed. Demographic information and findings of fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), and spectral domain optical coherence tomography (SD-OCT) were analyzed. All patients received the standard treatment. Ophthalmology examination and laboratory evaluation were repeated every 3 months. All changes were recorded. The treatment was considered successful if the patients had no inflammation in both eyes and rapid plasma reagin titer was negative after therapy.The study examined 41 eyes of 28 HIV-negative patients. The main complaints were blurry vision, floaters, and visual field defect. Twenty-seven eyes presented with panuveitis, and all had posterior involvement, including uveitis, vasculitis, chorioretinitis, and optic neuritis. The most common manifestations were uveitis and retinal vasculitis. Disc hyperfluorescence and persistent dark spots were the most common findings on FFA and ICGA. The ill-defined inner segment/outer segment junction was the most frequent manifestation on SD-OCT. Patients were diagnosed with syphilitic uveitis based on positive serological tests. Best-corrected visual acuity (BCVA) was improved in 34 eyes after treatment. Eleven patients were misdiagnosed before serological tests were performed. The delay in treatment led to long-standing cystoid macular edema and optic neuropathy, which were associated with poor BCVA (Pâ=â.037).The common manifestations of syphilitic chorioretinitis were uveitis, retinal vasculitis, and optic neuritis. Further diagnosis should be prompted by FFA, ICGA, and SD-OCT when ocular manifestation is suspected. The standard treatment for neurosyphilis was effective. If patients are presumed to be in low-risk groups such as HIV-negative, delays in diagnosis, and therapy may be likely. It is necessary to reiterate the importance of including syphilis uveitis as a differential diagnosis for any form of ocular inflammations, especially posterior uveitis and optic neuropathy.
Assuntos
Coriorretinite/microbiologia , Infecções Oculares Bacterianas/complicações , Sífilis/complicações , Uveíte/microbiologia , Adulto , Idoso , Antibacterianos/uso terapêutico , China , Coriorretinite/tratamento farmacológico , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções Oculares Bacterianas/microbiologia , Feminino , Angiofluoresceinografia , Humanos , Masculino , Pessoa de Meia-Idade , Neurite Óptica/tratamento farmacológico , Neurite Óptica/microbiologia , Vasculite Retiniana/tratamento farmacológico , Vasculite Retiniana/microbiologia , Estudos Retrospectivos , Sífilis/tratamento farmacológico , Sífilis/microbiologia , Tomografia de Coerência Óptica , Resultado do Tratamento , Uveíte/tratamento farmacológico , Acuidade VisualRESUMO
Tuberculosis (TB) remains a worldwide burden, with a large majority of new active TB cases occurring in underdeveloped and developing countries. Tuberculous meningitis (TBM) is one of the common infections of central nervous system. Other manifestations include intracranial tuberculoma, tubercular brain abscess, spinal tuberculoma, and granulomatous arachnoiditis. Visual impairment in TBM may be due to optic neuritis, optochiasmatic arachnoiditis (OCA), tuberculoma in the chiasmatic region or in the optic pathways, chorioretinitis, secondary to hydrocephalus and increased intracranial pressure, and finally due to ethambutol toxicity. We report a case of young girl with concurrent spinal cord intramedullary tuberculoma and multiple intracranial tuberculomas with TBM and bilateral visual impairment due to tuberculous optic neuritis.
Assuntos
Neurite Óptica/microbiologia , Doenças da Medula Espinal/complicações , Tuberculoma Intracraniano/complicações , Tuberculose Meníngea/complicações , Cegueira/microbiologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Doenças da Medula Espinal/diagnóstico por imagem , Tuberculoma Intracraniano/diagnóstico por imagem , Tuberculose Meníngea/diagnóstico por imagem , Adulto JovemRESUMO
The incidence of co-infection with Treponema pallidum and human immunodeficiency virus (HIV) is increasing in developing and developed countries. The neurological complications of both infections occasionally occur simultaneously during a clinical course. We herein report the case of an HIV carrier with syphilitic meningomyelitis and subclinical optic neuropathy. The patient presumably had latent syphilis and slowly developed longitudinally extensive transverse myelitis (LETM). A cerebrospinal fluid examination confirmed the diagnosis of active neurosyphilis based on an elevated T. pallidum hemagglutination assay index. A change in the patient's immune status, possibly due to HIV, might have converted the syphilis from latent to active, leading to LETM of the spinal cord.
Assuntos
Coinfecção/complicações , Infecções por HIV/complicações , Mielite Transversa/microbiologia , Neurite Óptica/microbiologia , Tabes Dorsal/complicações , Testes de Hemaglutinação , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mielite Transversa/diagnóstico por imagem , Neurite Óptica/diagnóstico por imagem , Treponema pallidumRESUMO
Mycoplasma pneumonia is a major pathogen of primary atypical pneumonia and has been known to cause various kinds of extrapulmonary manifestations involving almost all organs of the human body. Optic neuritis associated with M. pneumoniae infection has rarely been described and mostly, it combined other neurological complications including meningitis, meningoencephalitis, myelitis, and peripheral neuropathy. We report two patients who presented with isolated optic neuritis due to M. pneumoniae infection, and reviewed the literatures on five additional patients. All patients are child or young adults, and optic neuritis was unilateral (n = 3) or bilateral (n = 4). Remarkably, four patients did not have preceding history of respiratory M. pneumonia infection, and ocular pain or headache was accompanied in only three. Although initial visual acuities were severely reduced in most cases, visual outcome was excellent after systemic steroid and/or antibiotics treatment. M. pneumonia infection should be considered in the differential diagnosis of isolated optic neuritis, especially when occurring in a child or young adults, even though there was no preceding pneumonia, accompanying ocular pain, or headache. Various mechanisms including direct local inflammation, vascular occlusion, or indirect immune modulation due to M. pneumonia infection can lead to isolated neurological manifestations without pneumonia.
Assuntos
Cefaleia/microbiologia , Meningoencefalite/microbiologia , Mycoplasma pneumoniae , Neurite Óptica/microbiologia , Pneumonia por Mycoplasma/microbiologia , Criança , Feminino , Cefaleia/etiologia , Humanos , Masculino , Meningoencefalite/complicações , Meningoencefalite/diagnóstico , Neurite Óptica/complicações , Neurite Óptica/diagnóstico , Pneumonia por Mycoplasma/complicações , Pneumonia por Mycoplasma/diagnóstico , Acuidade Visual/fisiologia , Adulto JovemRESUMO
We report a case of confirmed Mycoplasma pneumoniae infection in the setting of unilateral anterior uveitis and perineuritis without coexisting systemic manifestations. We hypothesize a causal association between acute M. pneumoniae infection and this patient's ocular presentation. Delay in identification of M. pneumoniae infection in this case prompted treatment with systemic and topical steroids for presumed autoimmune etiology. The rapid resolution of symptoms without concurrent antibiotic treatment suggests a possible postinfectious autoimmune component that may be responsive to steroid treatment.
Assuntos
Infecções Oculares Bacterianas/microbiologia , Mycoplasma pneumoniae/isolamento & purificação , Neurite Óptica/microbiologia , Pneumonia por Mycoplasma/microbiologia , Uveíte Anterior/microbiologia , Doença Aguda , Adolescente , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/tratamento farmacológico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Imageamento por Ressonância Magnética , Neurite Óptica/diagnóstico , Neurite Óptica/tratamento farmacológico , Papiledema/diagnóstico , Papiledema/tratamento farmacológico , Papiledema/microbiologia , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/tratamento farmacológico , Prednisolona/uso terapêutico , Uveíte Anterior/diagnóstico , Uveíte Anterior/tratamento farmacológicoRESUMO
We describe an unusual case of hemorrhagic exudative optic neuropathy as an initial presentation of neurosyphilis in an immunocompetent patient. The clinicians have to be alert to consider a diagnosis of syphilitic optic neuropathy in cases with hemorrhagic exudative optic neuropathy.
Assuntos
Antibacterianos/uso terapêutico , Neurossífilis/diagnóstico , Disco Óptico/patologia , Nervo Óptico/patologia , Neurite Óptica/diagnóstico , Penicilina G/uso terapêutico , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurossífilis/microbiologia , Neurossífilis/patologia , Neurite Óptica/microbiologia , Neurite Óptica/patologia , Resultado do TratamentoRESUMO
We report a case of ocular tuberculosis (TB) which initially presented with disc edema and was mistaken for optic neuritis. With no definite pathology being identified, the patient was treated on the lines of optic neuritis with intravenous (IV) steroid with beneficial effect. Ocular TB was suspected when he presented later with a subretinal abscess. Based on positive Mantoux, QuantiFERON TB gold results and radiographic findings, a diagnosis of subretinal abscess of presumed tubercular etiology was made. The patient was successfully treated with anti-tubercular therapy. To the best of our knowledge, this is the first case report of ocular TB presenting as disc edema followed by subretinal abscess.