Optic neuritis following SARS-CoV-2 infection.

The most common neurologic symptoms in COVID-19 are headache, anosmia, and dysgeusia. Optic neuritis is an unusual manifestation of SARS-CoV-2 infection. We report a case of a patient who initially consulted for vision loss in the absence of respiratory symptoms. She was diagnosed with optic neuritis following SARS-CoV-2 infection. Delay in diagnosis of neuro-ophthalmic manifestations of COVID-19 may lead to irreversible optic atrophy. A mechanism in which viral antigens would induce an immune response against self-proteins, or direct SARS Cov-2 infection of the central nervous system, may be involved in optic nerve injury.

Herpes viruses in optic neuritis: Similar to Bell's palsy.

OBJECTIVE: Optic Neuritis (ON) might unfold either as a single intracranial neuritis or as multiple sclerosis, a widespread demyelinating disorder. Different herpes viruses have been proposed as potential participants in the etiology of multiple sclerosis (MS). To analyze the potential presence of herpes viruses in blood and subarachnoid area at the time of ON and contrast the findings according to long-term evolution either as intracranial neuritis or as progression to multiple sclerosis. PATIENTS AND METHODS: In a prospective investigation we searched the presence of DNA from 5 herpes viruses (HSV-1, HSV-2, VZV, EBV and HHV6) in CSF and blood lymphocytes from 54 patients with ON, patients were followed 62 ±â€¯3 months; those who developed MS were separated from those with ephemeral ON. Long-term prognosis of ON was related to DNA findings. RESULTS: As compared with controls, DNA from HSV-1 was significantly more frequent in CSF and blood from cases with ON; VZV and HSV-2 were found only in CSF; EBV was found only in blood samples (p < 0.006). CONCLUSIONS: Our results point out the potential participation of HSV, VZV and EBV in ON; suggesting the intervention of various herpes viruses as triggering agents of autoimmunity. However, the number of positive cases was minor than negative cases. Also, our results suggest that the etiological mechanisms in ON could be similar to those of neuritis of the facial nerve (Bell's palsy).

Ophthalmologic aspects of chikungunya infection.

Chikungunya fever, a viral disease epidemic in some parts of the world is newly introduced in the Americas. This is of considerable international concern, with a growing incidence owing to developing urbanization, tourism, and trade. Ocular manifestations of chikungunya fever are not frequent, but of great relevance. Common manifestations include conjunctivitis, optic neuritis, iridocyclitis, episcleritis, retinitis and uveitis. Diagnostic and monitoring investigations would include optical coherence tomography, fundus fluorescein and indocyanine green angiography, visual field analysis, and electrophysiologic tests. There have been no prospective, randomized therapeutic trials, and it is unclear if the disease is self-limiting or if treatment is actually beneficial. Prognosis varies, ranging from full resolution to permanent vision loss despite intervention.

Optic neuritis complicating herpes zoster ophthalmicus in an immunocompetent patient / Zoster optic neuritis in immunocompentent

A 58-year-old woman presented with rash over the left side of the face and intense acute uveitis. Following careful review of the symptoms and dilated fundus examination unilateral optic neuritis was discovered. The rash was typical of varicella zoster dermatitis. Patients presenting with herpes zoster ophthalmicus should always undergo dilated fundus examination, as there is a potential risk of unexpected posterior segment inflammation. Early diagnosis and prompt treatment can avoid visual sequelae.

Paciente de 58 anos de idade apresentando erupção cutânea no lado esquerdo da face e intensa uveíte unilateral. Após cuidadosa revisão dos sintomas e exame de fundo do olho foi detectada neurite óptica. O rash era típico de dermatite por varicella zoster. Pacientes apresentando quadro de herpes zoster oftálmico devem ser submetidos ao exame de fundo do olho devido ao risco de inesperada inflamação do segmento posterior. Diagnóstico precoce e tratamento imediato podem evitar danos visuais.

Herpes zoster optic neuritis.

Herpes zoster (HZ) is an acute infection caused by reactivation of the latent varicella-zoster virus [1]. Herpes zoster ophthalmicus (HZO) occurs when inflammation spreads from the ganglion of Gasser to the ophthalmic branch of the trigeminal nerve. Optic neuritis, a very rare sequela of HZO [2-4], can occur simultaneously to the acute vesicular skin eruption or, more frequently, as a postherpetic complication. We report on a 74-year-old woman who presented with HZ optic neuritis 45 days after developing an incompletely treated bout of trigeminal HZ, characterized only by pruritus. It is important to value the non-specific manifestations of cutaneous HZ in the prodromal phase, so as to offer timely and appropriate treatment.

[Bilateral optic neuritis after dengue viral infection: case report]. / Neurite óptica bilateral após infecção viral por dengue: relato de casos.

Dengue fever is a well known viral infection transmitted through the bite of an infected Aedes aegypti and Aedes albopictus mosquito. Its geographic distribution covers over 100 countries. Clinical presentation is variable and depends upon the age and immunological status of the patient. It can be classified as asymptomatic illness, dengue fever, dengue hemorrhagic or dengue shock syndrome. Ocular manifestations of dengue have been described, however there are few reports on neurological involvement. We hereby report two cases of bilateral optic neuritis after dengue viral infection. Both of them rapidly recovered the visual acuity without treatment.

Neurite óptica bilateral após infecção viral por dengue: relato de casos / Bilateral optic neuritis after dengue viral infection: case report

Dengue é uma doença viral transmitida pelos mosquitos Aedes aegypti e Aedes albopictus. Apresenta distribuição geográfica bastante ampla, sendo epidêmica em alguns países. A apresentação clínica depende da idade e do estado imunológico do paciente, podendo se apresentar de forma assintomática como, dengue clássica, hemorrágica e até como choque. Têm sido descritas muitas manifestações oculares, entretanto, poucos relatos de manifestações neurológicas causada por dengue. Relatamos dois casos de neurite bilateral pós infecção por dengue. Ambos apresentavam baixa de acuidade visual bilateral, papilite e alterações no campo visual e evoluíram com desaparecimento dos sintomas e sinais espontaneamente sem uso de medicação.

Dengue fever is a well known viral infection transmitted through the bite of an infected Aedes aegypti and Aedes albopictus mosquito. Its geographic distribution covers over 100 countries. Clinical presentation is variable and depends upon the age and immunological status of the patient. It can be classified as asymptomatic illness, dengue fever, dengue hemorrhagic or dengue shock syndrome. Ocular manifestations of dengue have been described, however there are few reports on neurological involvement. We hereby report two cases of bilateral optic neuritis after dengue viral infection. Both of them rapidly recovered the visual acuity without treatment.

Isolation of Inoue-Melnick virus from cerebrospinal fluid of patients with epidemic neuropathy in Cuba.

BACKGROUND: A mysterious disease spread over Cuba from 1991 to 1993, the cause of which has not been fully established. Major symptoms were the same in patients with the Cuban disease as in patients with subacute myelo-optico-neuropathy (SMON), which had occurred in Japan nearly 30 years ago and from which Inoue-Melnick virus (IMV) type 1 was first isolated. We investigated the presence of IMV in cerebrospinal fluid samples of patients with this epidemic neuropathy in Cuba. METHODS: The established method for detecting IMV in MRC-5 fibroblasts was used throughout the study, which was conducted in two independent laboratories, one in Buffalo, NY, and the other in Kyoto, Japan. The cerebrospinal fluid samples of 20 patients and four controls were provided by Cuban researchers. RESULTS: All cerebrospinal fluid specimens from 20 Cuban patients tested were positive for IMV type 2 (100%), and four cerebrospinal fluid specimens from Cuban controls were negative for IMV (0%). These clear-cut results were identical in both laboratories. CONCLUSION: Our study indicates an important association of IMV type 2 with patients of this Cuban epidemic. The etiologic role of IMV type 2 in the epidemic neuropathy in Cuba, along with weak cytopathic effect viruses isolated by the Cuban group, remains to be elucidated.

[The nutritional-viral etiology of epidemic neuropathy. The Group for the Study of Epidemic Neuropathy]. / Etiología nutro-viral de la neuropatía epidémica. Grupo para el estudio de la neuropatía epidémica.

Viral sequences of the cerebrospinal fluid were amplified by using oligonucleotides that are homologous to region 5' of the Enteroviruses. The results showed a great variability in the amplified sequences, suggesting the presence of enteroviral quasispecies with altered biological properties in the stressed individuals that may play an important role in the neurological damage.

Viral isolation from cases of epidemic neuropathy in Cuba.

OBJECTIVE: To investigate the possibility of a viral agent in the central nervous system of patients with epidemic neuropathy. DESIGN: Virus isolation attempts, in cell cultures and suckling mice, from cerebrospinal fluid (CSF) of neuropathy patients and controls undergoing lumbar puncture for unrelated reasons. Serologic studies in patients, contacts, and controls. SETTING: An epidemic of optic and peripheral neuropathy affected more than 50,000 people in Cuba in 1991 through 1993. Illness was associated with dietary limitations and increased physical demands accompanying the shortages of food and fuel experienced in Cuba since 1989. Most patients responded to parenteral vitamin therapy, and the epidemic began to subside when oral vitamin supplementation was begun for the entire Cuban population. RESULTS: Coxsackievirus A9 (five isolates) and a similar, less cytopathic virus (100 isolates) were recovered from 105 (84%) of 125 CSF specimens from neuropathy patients. The strains with light cytopathic effect were antigenically related to Coxsackieviruses A9 and B4 by cross-neutralization and immunoblotting assays. Virus persisted in CSF of some patients for 1 to 12 months. Cerebrospinal fluid from patients and both types of virus from cell culture produced illness, including complete posterior flaccid paralysis, in newborn mice, and virus was reisolated from the mice. Mouse tissues and sural nerve biopsy specimens from patients were stained by immunoperoxidase and colloidal gold techniques using hyperimmune rabbit antisera against the virus with light cytopathic effect. CONCLUSIONS: Coxsackievirus A9 or an antigenically related agent with a light cytopathic effect was present in CSF of 84% of 125 patients with epidemic neuropathy. The role of these agents, probably in combination with nutritional factors, in the pathophysiology of the disease requires further investigation.

[Cuban epidemic neuropathy. I. Viral isolation]. / Neuropatía epidémica cubana. Parte I. Aislamiento viral.

From the end of 1991 to June, 1993, an epidemic neuropathy affecting 50,963 persons occurred in Cuba. Two clinical forms of the disease were observed: the optic form (with or without peripheral manifestations, 52% of the cases) and the peripheral form (48%). The epidemiological studies revealed nutritional disorders, mainly a vitamin B complex deficiency due to economic difficulties faced by the country in the "special period". Smoking habit and alcohol consumption were identified as risk factors, particularly for the most severe forms of the disease. In the virological studies of the cerebrospinal fluid (CSF) a Coxsackie 9 virus was isolated in Vero cells in 4% of the cases, as well as another agent with mild cytopathogenic effect in 80% of the samples. Sixty seven percent of the CSF samples inoculated to lactating mice caused the disease or the death of the animals. The viral persistence was confirmed in the cerebrospinal fluid during al least 21 days in a group of patients, and for a year in another group.

[Cuban epidemic neuropathy. II. The antigenic characteristics of the viral isolates]. / Neuropatía epidémica cubana. Parte II. Algunas características antigénicas de los aislamientos virales.

With the aim of characterizing antigenically isolations producing mild cytopathogenic effect obtained from the cerebrospinal fluid of patients presenting with epidemic neuropathy, neutralization tests and western blot analysis were performed using hyperimmune sera of patients and hyperimmune sera of rabbits. It was confirmed that isolations with mild cutopathogenic effect studied have the same antigenic characteristics and that they are related to Coxsackie A9 and B4 viruses. Structural proteins were not detected in the strains with mild cytopathogenic effects, only antigens having a high molecular weight which were considered as precursor proteins for viral replication were confirmed.

[The physicochemical characterization of the agents isolated during the outbreak of epidemic neuropathy in Cuba. I]. / Caracterización físico-química de los agentes aislados durante el brote de neuropatía epidémica en Cuba. Parte I.

This paper reports on the physical and chemical characteristics of agents isolated from serum samples of patients presenting with epidemic neuropathy. The behaviour of isolated enteroviruses was as described for such viruses. Mild cytopathogenic effects-producing agents behaved in a variable form regarding sensitivity to chloroform; on the other hand they were neither sensitive to phosphonoacetic acid (PAA) nor to guanidine hydrochloride (GHC1) and grew in cells previously treated with bromodeoxyuridine (BDUR). These results suggest the presence of agents resembling enteroviruses and enveloped viruses. Further studies for the characterization of such agents need to be performed.

[The physicochemical characterization of the strains isolated during the outbreak of epidemic neuropathy in Cuba. II]. / Caracterización físico-química de los agentes aislados durante el brote de neuropatía epidémica en Cuba. Parte II.

The presence of 2 agents such as a Cox A9 strain and another mild cytopathogenic effect-producing strain, both isolated from patients presenting with epidemic neuropathy is reported in this paper. A mild cutopathogenic effect which was propagated in successive dilutions was developed in the dilution 10(-4) by means of the neutralization test of a Coxsackie A9 virus with its homologous hyperimmune serum. A gradient in saccharose was performed in a mild cytopathogenic effect-producing strain and a typical cytopathogenic effect of an Enterovirus developed from one of the fractions passed in tissular cultures in the presence phosphonoacetic acid (PAA). The possible pathogenic role of these viruses are discussed.

[The use of ELISA and ultramicro ELISA in identifying a Coxsackie A9 strain isolated during the epidemic of neuropathy in Cuba]. / Utilización del ELISA y el ultramicroELISA en la identificación de una cepa de Coxsackie A9 aislada durante la epidemia de neuropatía en Cuba.

During 1993 an outbreak of epidemic neuropathy characterized by 2 major clinical forms: the optic neuropathy and peripheral neuropathy, occurred in our country. Although the cause of the disease was considered to be multifactorial (mainly due to neurotoxic agents and to nutritional deficiency) an Enterovirus was isolated from the cerebrospinal fluid of a patient (strain 47/93, IPK) which was subsequently classified as a Coxsackie A9 virus (Cox A9) by the neutralization test, and using pools of Lim Benyesh Melnick (LBM) serum. Results obtained during the application of ELISA and ultramicro ELISA techniques for the identification of this agent from the supernatant of a culture of infected cells are reported, as well as the detection of antibodies to the strain found within populations with high and low incidence rates of the disease.

[The factors affecting the growth of the agent, producing a mild cytopathic effect, isolated in patients with epidemic neuropathy]. / Factores que influyen en el crecimiento del agente productor del efecto citopático ligero aislado en pacientes con neuropatía epidémica.

Certain factors influencing upon the growth of the agent producer of mild cytopathogenic effect and isolated from the cerebrospinal fluid of patients presenting with epidemic neuropathy are described in this paper. It was demonstrated that a concentration of NaHCO3 was essential for the occurrence of the cytopathogenic effect. Determined concentrations of MnCl2 allowed for the visualization of the cytopathogenic effect and increased viral yields.

[Standardization of the plaque method for viruses isolated in patients with epidemic neuropathy]. / Normalización del método de placas para los virus aislados en pacientes con neuropatía epidémica.

This paper reports on the necessary conditions for plaque development in mild cutopathogenic effect-producing agents which were isolated from samples of the cerebrospinal fluid of patients presenting with epidemic neuropathy.