Bartonelosis ocular: Reporte de tres casos / Ocular bartonellosis: Report of three clinical cases

The characteristic clinical presentation of cat scratch disease is subacute regional lymphadenopathy; nevertheless, 5-25 percent of Bartonella henselcie infections may present an atypical or systemic form, with potential eye involvement. We describe three clinical cases of ocular bartonellosis in two adolescents and one young adult, who had close contact with cats; all of them presented persistent fever ranging from 15 to 21 days, and two of them developed a sudden unilateral loss of visual acuity associated with optic neuritis. The other patient presented retinal choroiditis and unilateral retinal microgranulomas, with normal visual acuity. Patients received macrolides as sole antimicrobial or in association with rifampin, and one patient was additionally treated with systemic corticoids. The outcome was favorable in two patients; one patient developed a permanent visual deficit. Ocular bartonellosis must be suspected in patients with close contact to cats or with cat scratches whom develop persistent fever and sudden loss of visual acuity.

La enfermedad por arañazo de gato se manifiesta típicamente como una linfadenopatía regional sub-aguda; sin embargo, 5 a 25 por ciento de los pacientes infectados por Bartonella henselae desarrollan formas atípicas o sistémicas de la enfermedad, pudiendo evolucionar con compromiso ocular. Consideramos de interés describir las características clínicas, tratamiento y evolución de tres pacientes con bartonelosis ocular, dos adolescentes y un adulto joven, que tenían antecedentes de contacto y/o rasguño por gatos. Todos cursaron con síndrome febril prolongado, con 15 a 21 días de duración, asociado a pérdida súbita de la agudeza visual unilateral en dos casos, cuya fondoscopia reveló neuritis óptica. El otro paciente presentó retino-coroiditis y microgranulomas retiñíanos, con agudeza visual conservada. Todos recibieron tratamiento antimicrobiano con macrólidos solos o asociados a rifam-picina y uno recibió además corticosteroides sisté-micos. La evolución fue satisfactoria en dos, quedando un paciente con déficit visual permanente. Recomendamos sospechar bartonelosis ocular en pacientes con antecedentes de contacto y/o rasguños por gatos, que cursan con un síndrome febril prolongado y/o disminución súbita de la agudeza visual.

Incidence of Helicobacter pylori in central serous chorioretinopathy: a case control study

Helicobacter pylori infection is one of the most common infections worldwide. Central serous chorioretinopathy [CSCR] is a serous macular detachment that usually affects young people. The aetiopathogenesis of the disease is still not completely understood. Recently, an interesting association has been observed between this disease and the H. pylori infection. This study was conducted to investigate a possible association between H. pylori infection and CSCR. A prospective study was performed and we evaluated a total of 54 CSCR patients [48 males and 6 females, median age 35.7 years], and a control group of 59 patients [25 women, 34 males; mean age 42.6 +/- 11 years] who referred to gastroenterology department of Imam Hospital, Ahvaz Jundishapur University of Medical Sciences, were studied. Central serous chorioretinopathy was diagnosed on the basis of findings in ophthalmic examinations and confirmed by fluorescein angiogram. All patients underwent a [13]C-urea breath test [UBT] and serum IgG anti-bodies to H. pylori by enzyme-linked immunosorbent assay technique to detect H. pylori infection. Patients were defined as H. pylori infected if both tests were positive. The mean duration of symptoms before diagnosis was 10.5 +/- 4.5 days. Overall no statistically significant difference was found between left and right eyes, bilaterally was in 5 patients [9.2%]. The incidence of H. pylori infection was 68.5% in CSCR patients and 65% in control subjects [p=0.64]. These results indicate that the prevalence of H. pylori infection is not higher in patients with CSCR than in controls. Further large studies will be required to determine the role of H. pylori infection in patients with CSCR

Further investigations on the association of Mycobacterium tuberculosis with Eales' disease.

PURPOSE: To apply polymerase chain reaction (PCR) on vitreous fluid (VF) from Eales' disease to further confirm its association with Mycobacterium tuberculosis. METHODS: Sixty nine VF samples from 69 patients (24 Eales' disease and 45 Non-Eales' as controls) were processed by conventional methods for detection of mycobacteria. Polymerase chain reaction (PCR) specific for IS 6110 and nested PCR (nPCR) using primers coding for MPB 64 gene were applied on all 69 VF. PCR based dot-blot hybridisation was applied on the IS 6110 amplified products of n PCR-positive VFs. RESULTS: Conventional methods (direct smear and culture) did not detect mycobacteria in any of the 69 VF samples. Five (20.8%) of 24 VF from Eales' and 2 (4.2%) of 45 VF from control patients tested positive for M. tuberculosis DNA by nPCR. This difference was statistically significant (P < 0.05). All 69 VF were negative by PCR for IS 6110. Two VF of Eales' patients positive by nPCR were also positive by DNA probe dot-blot hybridisation for IS 6110. CONCLUSION: Detection of M. tuberculosis DNA by PCR in a significant number of VF of Eales' disease patients reemphasizes the association of this bacterium with Eales' disease.