ABSTRACT
PURPOSE: To describe the most important cause of infectious posterior uveitis in pediatric patients. METHODS: Review of the literature. RESULTS: The most important causes of infectious uveitis in pediatric patients are: cat-scratch disease, toxocariasis, tuberculosis, viral diseases and toxoplasmosis. Ocular manifestations include retinitis, neuroretinitis, choroidal granulomas, peripheral granulomas and posterior pole granulomas. CONCLUSION: Infectious posterior uveitis is a challenging subject and should be considered in the differential diagnosis of any posterior uveitis in children. Infectious uveitis must be excluded before initiating immunosuppressive therapy.
Subject(s)
Eye Infections, Bacterial , Eye Infections , Retinitis , Uveitis, Posterior , Uveitis , Animals , Humans , Child , Uveitis, Posterior/diagnosis , Uveitis, Posterior/drug therapy , Uveitis/diagnosis , Uveitis/drug therapy , Retinitis/diagnosis , Retinitis/drug therapy , Eye Infections/diagnosis , Eye Infections/drug therapy , Eye Infections, Bacterial/diagnosis , Choroid , GranulomaABSTRACT
INTRODUCTION: Ampiginous Choroiditis is a rare posterior uveitis that combines clinical features of Acute Multifocal Posterior Placoid Pigment Epitheliopathy and Serpiginous Chorioretinitis. Its pathophysiology is poorly understood and further studies are necessary to understand which mechanisms start the immunologic reaction. CASE REPORT: The purpose of this article is to report a well-documented case of Ampiginous Choroiditis following in seven days a RT-PCR confirmed SARS-CoV-2 infection, suggesting that the infection might have contributed as a trigger. CONCLUSION: Timely diagnosis and correct treatment are paramount to improve the visual outcomes, and the patient had successful response to systemic steroids.
Subject(s)
COVID-19 , Chorioretinitis , Choroiditis , Uveitis, Posterior , White Dot Syndromes , Humans , COVID-19/complications , COVID-19/diagnosis , SARS-CoV-2 , Choroiditis/diagnosis , Choroiditis/drug therapy , Chorioretinitis/diagnosis , White Dot Syndromes/diagnosis , Fluorescein AngiographyABSTRACT
PURPOSE: The aim of this study was to describe the epidemiological profile of uveitis cases treated at University Hospital Clementino Fraga Filho and to identify the presentation pattern of intraocular inflammation on the basis of clinical, anatomical, etiological, and demographic criteria. METHODS: A retrospective study was conducted using data from the medical records of 408 patients with active disease who attended the ophthalmology service between March and October 2018. Age, sex, visual acuity at the time of diagnosis, anatomical and etiological diagnoses, the clinical aspect, and the main symptoms reported during anamnesis were described. RESULTS: Of the 408 patients in the study, 52% were male and 48% were female. The patients' mean age was 42 years, and most (84%) were between 19 and 64 years old. Anterior uveitis was observed in 37.75% of the patients; posterior uveitis, in 49.75%; panuveitis, in 4.66%; and intermediate uveitis, in 3.43%. Only 18 patients (4.41%) presented with scleritis. Of the 390 patients with anatomical classifications, 76% had known etiologies, with the most prevalent diagnoses being toxoplasmosis (35.4%), followed by juvenile idiopathic arthritis (6.4%), ankylosing spondylitis (5.9%), and syphilis (4.9%). Infectious uveitis corresponded to 49.7% of the patients, while 26.6% of the cases were of noninfectious origin. Anterior uveitis had the highest number of cases classified as idiopathic (49.4%). In the cases of posterior uveitis, the etiology was established 94% of the time. The most frequent symptoms were ocular pain (71.8%) and blurring vision (56.8%). CONCLUSIONS: The present study confirmed the historical importance of infectious uveitis in our population, especially ocular toxoplasmosis. Uveitis appears to have no predilection for sex but mainly affects young people of working age, thus generating social and economic consequences. Despite the evolution of diagnostic methods, idiopathic uveitis remains one of the major etiologies. Epidemiological studies point to different presentation patterns of uveitis in different populations, but these may reflect the distinct characteristics of each institution.
Subject(s)
Uveitis, Anterior , Uveitis, Posterior , Uveitis , Adolescent , Adult , Brazil/epidemiology , Female , Hospitals, University , Humans , Male , Retrospective Studies , Uveitis/epidemiology , Uveitis/etiology , Uveitis, Anterior/complications , Uveitis, Posterior/complications , Vision Disorders/etiologyABSTRACT
Ocular toxoplasmosis is the leading cause of posterior uveitis worldwide. We conducted an observational study of 262 consecutive individuals (n = 344 eyes) with ocular toxoplasmosis who were followed over a 34-month period. Most subjects were T. gondii IgG + /IgM- (n = 242; 92.4%; 317 eyes), and 140 eyes (40.7%) had active lesions. For eyes in which retinal lesions were active at recruitment and best-corrected visual acuity (BCVA) could be measured (n = 133), 21.0% (n = 28) remained blind (BCVA below 20/400) after inflammation resolved. In these eyes, atypical ocular toxoplasmosis (OR 4.99; 95% CI 1.14-22.85; p = 0.0330), macular lesion (OR 9.95; 95% CI 2.45-47.15; p = 0.0019) and any complication (OR 10.26; 95% CI 3.82-30.67; p < 0.0001) were associated with BCVA below 20/200. For eyes with only inactive lesions at recruitment and BCVA measured (n = 178), 28.1% (n = 50) were blind. In these eyes, having at least one lesion larger than one disc-diameter (OR 6.30; 95% CI 2.28-22.46; p = 0.0013) and macular lesion (OR 5.69; 95% CI 2.53-13.54; p < 0.0001) were associated with BCVA below 20/200. Older age (OR 1.02; 95% CI 1.00-1.05; p = 0.0493) and active disease at presentation (OR 4.74; 95% CI 1.95-12.91; p = 0.0011) were associated with recurrences. Additional clinical attention should be directed towards patients with risk factors for poor visual outcome.
Subject(s)
Blindness/pathology , Toxoplasma/pathogenicity , Toxoplasmosis/pathology , Uveitis, Posterior/pathology , Adolescent , Adult , Age Factors , Aged , Antibodies, Protozoan/blood , Antiprotozoal Agents/therapeutic use , Blindness/drug therapy , Blindness/immunology , Blindness/parasitology , Brazil , Female , Humans , Immunoglobulin G/blood , Immunoglobulin M/blood , Male , Middle Aged , Pyrimethamine/therapeutic use , Recurrence , Retina/drug effects , Retina/immunology , Retina/parasitology , Retina/pathology , Risk Factors , Sulfadiazine/therapeutic use , Toxoplasma/drug effects , Toxoplasma/growth & development , Toxoplasmosis/drug therapy , Toxoplasmosis/immunology , Toxoplasmosis/parasitology , Treatment Outcome , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Uveitis, Posterior/drug therapy , Uveitis, Posterior/immunology , Uveitis, Posterior/parasitology , Vision, Ocular/drug effects , Visual Acuity/drug effectsABSTRACT
ABSTRACT Syphilis is a sexually transmitted infection caused by the spirochete Treponema pallidum. Ocular involvement can occur at any time, and it may affect 10% of patients in the secondary stage, and from 2% to 5% in the tertiary stage. Uveitis is the most common presentation of ocular syphilis, affecting 0.4% to 8% of patients with systemic disease. Chorioretinitis is the most common posterior alteration. We present the case of a 53-year-old male patient, presenting with bilateral low visual acuity and nyctalopia for 3 years. His physical examination revealed decreased pupillary reflex, anterior vitreous cells, physiologic papillae, arteriolar attenuation, reduced foveal reflex, diffuse retinal pigment epithelium atrophy, peripapillary and perivascular punctate pigment accumulation and peripheral chorioretinitis. Full-field electroretinogram was extinct in both eyes. Treponemal syphilis test was positive. Previously diagnosed as retinitis pigmentosa, evolved to blindness, despite proper treatment. Our case shows syphilis as a significant cause of blindness. Atypical presentations of retinitis pigmentosa must warn ophthalmologists to etiologies of pseudoretinitis pigmentosa, such as syphilis.
RESUMO A sífilis é uma infecção sexualmente transmissível causada pela espiroqueta Treponema pallidum. A sífilis ocular pode ocorrer em qualquer estágio da doença, chegando a 10% na forma secundária e a 2% a 5% em sua forma terciária. A uveíte é a manifestação ocular mais comum, ocorrendo em 0,4% a 8% dos pacientes com a doença sistêmica. A coriorretinite é a manifestação mais comum do segmento posterior. Apresentamos o caso de um paciente do sexo masculino, 53 anos, com queixa de baixa acuidade visual e nictalopia há ٣ anos. Seu exame físico revelou lentificação dos reflexos pupilares, celularidade no vítreo anterior, papilas fisiológicas, atenuação arteriolar, redução do reflexo foveal, atrofia difusa do epitélio pigmentar da retina, acúmulo punctato de pigmento em regiões peripapilar e perivascular e coriorretinite periférica. Eletrorretinograma de campo total extinto em ambos os olhos. O teste treponêmico foi positivo. Foi previamente diagnosticado como portador de retinose pigmentar, evoluindo com cegueira, a despeito do tratamento correto instituído. Esse caso mostra a sífilis como importante causadora de cegueira. Casos atípicos de retinose pigmentar devem alertar o oftalmologista para causas de pseudorretinose pigmentar, como a sífilis.
Subject(s)
Humans , Male , Middle Aged , Retinal Diseases/etiology , Syphilis/complications , Retinitis Pigmentosa/etiology , Retinal Diseases/diagnosis , Ceftriaxone/therapeutic use , Syphilis Serodiagnosis/methods , Fluorescein Angiography , Syphilis/diagnosis , Syphilis/drug therapy , Visual Acuity , Uveitis, Posterior/diagnosis , Uveitis, Posterior/etiology , Retinitis Pigmentosa/diagnosis , Blindness/etiology , Tomography, Optical Coherence , Electroretinography , Fundus OculiABSTRACT
ABSTRACT Choroidal tuberculomas are present in patients with ocular tuberculosis. They usually occur in a patient with previous history of tuberculosis, and are rarely the initial presentation, with no prior systemic manifestations. We present a patient with unilateral choroidal tuberculoma as the initial presentation of presumed ocular tuberculosis, which enabled earlier initiation of treatment.
RESUMO Os tuberculomas de coroide apresentam-se em pacientes com tuberculose ocular. Geralmente, ocorrem em indivíduos com história prévia de tuberculose e raramente têm apresentação inicial sem manifestações sistêmicas anteriores. Relatamos o caso de um paciente com tuberculoma de coroide unilateral com apresentação inicial de tuberculose ocular presumida, permitindo o início mais precoce do tratamento.
Subject(s)
Humans , Female , Adult , Tuberculoma/diagnosis , Choroid Diseases/diagnosis , Tuberculoma/drug therapy , Fluorescein Angiography , Choroid Diseases/drug therapy , Uveitis, Posterior/diagnosis , Tuberculosis, Ocular , Choroid/diagnostic imaging , Fundus Oculi , Antitubercular Agents/therapeutic useABSTRACT
ABSTRACT Vogt Koyanagi Harada disease affects several parts of the body, such as eyes, meninges, ears, and skin. The progressive course of the disease can lead to blindness and deafness. The case is presented of a Hispanic woman (mixed-race) with visual alterations, headache, tinnitus, hearing loss, and posterior uveitis with serous detachments of the retina in both eyes, as well as lymphocytic meningitis. The aim of the present study is to review the literature, the diagnostic strategies, and the appropriate treatment, as well as to update the immunogenetic pathogenesis of the disease.
RESUMEN La enfermedad de Vogt Koyanagi Harada compromete múltiples órganos tales como ojos, meninges, oídos y piel. El curso progresivo de la enfermedad puede llevar a ceguera y cofosis. Se describe un caso de esta enfermedad en mujer hispana (mestiza) con alteraciones visuales, cefalalgia, tinnitus e hipoacusia a quien se le encuentra uveítis posterior con desprendimientos serosos de retina en ambos ojos y meningitis linfocitaria. El objetivo del presente estudio es, mediante una revisión de la literatura, actualizar la patogénesis inmunogenética, conocer las estrategias diagnósticas y el tratamiento apropiado.
Subject(s)
Humans , Female , Adult , Uveitis, Posterior , Uveomeningoencephalitic Syndrome , Vision Disorders , Homeopathic PathogenesyABSTRACT
RESUMEN La toxoplasmosis ocular es la causa de uveítis posterior más frecuente en muchos países. El diagnóstico correcto se basa principalmente en las características clínicas de la enfermedad; pero en las formas de uveítis posterior atípicas se necesita el apoyo del laboratorio para confirmar el diagnóstico y no indicar tratamientos inapropiados. Se resalta el valor de la reacción en cadena de la polimerasa en fluidos oculares en pacientes con títulos serológicos en suero positivos para toxoplasma y presentaciones atípicas de uveítis posterior. Se presenta un caso clínico de una paciente con toxoplasmosis sistémica, confirmada con títulos serológicos en suero positivos, quien concomitó con uveítis posterior bilateral sin características típicas de toxoplasmosis ocular, en la cual la reacción en cadena de la polimerasa de fluidos oculares fue esencial en el diagnóstico. La reacción en cadena de la polimerasa en fluidos oculares constituye una herramienta inequívoca en el diagnóstico correcto de las formas atípicas de uveítis posteriores(AU)
ABSTRACT Ocular toxoplasmosis is the most frequent cause of posterior uveitis in many countries. Correct diagnosis is mainly based on the clinical characteristics of the disease, but in atypical forms of posterior uveitis laboratory support is required to confirm the diagnosis and not indicate inappropriate treatments. Evidence is provided of the usefulness of polymerase chain reaction in ocular fluids from patients with serum serological titers positive for toxoplasma and atypical presentations of posterior uveitis. A clinical case is presented of a female patient with systemic toxoplasmosis confirmed by positive serum serological titers and concomitant bilateral posterior uveitis without typical features of ocular toxoplasmosis, in which polymerase chain reaction in ocular fluids was essential for the diagnosis. Polymerase chain reaction in ocular fluids is an unequivocal tool for the correct diagnosis of atypical forms of posterior uveitis(AU)
Subject(s)
Humans , Female , Child , Aqueous Humor/cytology , Uveitis, Posterior/diagnostic imaging , Toxoplasmosis, Ocular/etiology , Polymerase Chain Reaction/methodsABSTRACT
PURPOSE: Report of clinical/multimodal imaging outcomes of patients with syphilitic uveitis alternatively treated with intravenous(IV) ceftriaxone, due to unavailability of penicillin G. METHODS: Chart review of all cases of syphilitic uveitis presenting to Hospital São Geraldo/HC-UFMG and treated with intravenous ceftriaxone, between January and August 2014. Clinical, serological and ophthalmological data were collected. RESULTS: Twelve consecutive patients with syphilitic uveitis receiving IV ceftriaxone were identified. All 24 eyes had active intraocular inflammation on clinical examination. All patients received IV ceftriaxone (2-4 g daily) for 14-21 days, supplemented with oral corticosteroid as needed in 9 patients (75%), after documented clinical response. Improvement in intraocular inflammation was seen in all 24 eyes, with median best-corrected visual acuity (BCVA) increasing from 20/50 to 20/20, after a mean follow-up of 5.3 months. CONCLUSION: IV ceftriaxone may be an effective alternative for treatment of syphilitic uveitis, in the setting of unavailability of penicillin G.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Ceftriaxone/administration & dosage , Chorioretinitis/drug therapy , Eye Infections, Bacterial/drug therapy , Syphilis/drug therapy , Uveitis, Posterior/drug therapy , Administration, Oral , Adult , Aged , Chorioretinitis/diagnosis , Chorioretinitis/physiopathology , Complementary Therapies , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/physiopathology , Fluorescein Angiography , Glucocorticoids/administration & dosage , Humans , Infusions, Intravenous , Male , Middle Aged , Multimodal Imaging , Retrospective Studies , Syphilis/diagnosis , Syphilis/physiopathology , Syphilis Serodiagnosis , Tomography, Optical Coherence , Uveitis, Posterior/diagnosis , Uveitis, Posterior/physiopathology , Visual Acuity/physiologyABSTRACT
Here we report the occurrence of pale yellowish perivascular preretinal dots in 12 patients with ocular syphilis. A case series of these patients was examined between March and October 2012 at the Uveitis Sector of Universidade Federal de São Paulo. After diagnostic confirmation of syphilis, fundus photographs and optical coherence tomography (OCT) were performed to verify the localization of the dots, and patients were treated with IV crystalline penicillin for 14 days. The study comprised 11 men (91.6%), 19 eyes, median presentation age of 38.1 years, and panuveitis as the main clinical manifestation (seven patients, 58.3%), being bilateral in four. Ten patients were taking oral prednisone (83.3%). Serum panels performed by the Venereal Disease Research Laboratory (VDRL) showed positive results in eight patients (66.7%), whereas VDRL cerebrospinal fluid (CSF) tests were negative in seven of nine collected (77.8%). However, serum FTA-Abs was positive in 100% of patients, and eight patients (66.7%) had HIV infection. The best corrected visual acuity (BCVA) presented after treatment improved in 10 eyes (55.6%), did not change in seven eyes (38.9%), and worsened in one eye (5.6%). Although not yet acknowledged in the literature as a typical manifestation of ocular syphilis, these are very common findings in clinical practice. We believe that preretinal dots are due to perivasculitis secondary to treponema infection. It is important recognize them and remember that syphilis can present in several forms, including the one presented in this study.
Relatar a ocorrência de pontos amarelo-esbranquiçados perivasculares pré-retinianos em 12 pacientes com sífilis ocular. Série de casos de 12 pacientes examinados entre março e outubro de 2012 no setor de uveítes da UNIFESP. Após confirmação diagnóstica de sífilis ocular, retinografias e OCT (optical coherence tomography) foram realizados para verificar a localização dos pontos e os pacientes foram tratados com penicilina cristalina IV por 14 dias. Dados demográficos incluíram 11 homens (91,6%), 19 olhos, mediana de idade de 38,1 anos, e a manifestação clínica principal foi panuveíte (7 pacientes, 58,3%), sendo bilateral em 4. Dez fizeram uso de prednisona oral (83,3%). VDRL (Venereal Disease Research Laboratory) sanguíneo foi positivo em 8 pacientes (66.7%), VDRL no líquor foi negativo em 7 de 9 coletados (77,8%), FTA-Abs sanguíneo foi positivo em 100% e 8 pacientes (66,7%) eram HIV positivos, AV após tratamento melhorou em 10 olhos (55,6%), não se alterou em 7 (38,9%) e piorou em 1 olho (5,6%). Embora ainda não reconhecida na literatura como uma manifestação típica da sífilis ocular, este achado é muito comum na prática clínica. Acreditamos que esses pontos são devidos a perivasculite secundária à infecção pelo treponema. É importante os reconhecer e lembrar que a sífilis pode se apresentar de várias formas, incluindo essa apresentada aqui.
Subject(s)
Humans , Uveitis , Syphilis Serodiagnosis , Retina , Eye Infections, Bacterial , Panuveitis , Uveitis, Posterior/diagnosis , Tomography, Optical CoherenceABSTRACT
Este reporte describe las formas de presentación clínica de uveítis posterior en pacientes con diagnóstico de aplasia medular. Se describe un caso, el tratamiento implementado y los resultados obtenidos.
Subject(s)
Case Reports , Uveitis, Posterior , Bone Marrow Transplantation , Anemia, AplasticABSTRACT
PURPOSE OF REVIEW: To provide an overview of ocular toxoplasmosis, the leading cause of infectious posterior uveitis, focusing on recent trends of disease epidemiology, pathogenesis, diagnosis, therapy and prevention. RECENT FINDINGS: Novel aspects of epidemiology, including growing importance of water transmission are discussed. The historical controversy of congenital versus postnatally acquired toxoplasmosis is revisited. Recent insights into pathogenesis of ocular toxoplasmosis are also reviewed, tipping the delicate balance between parasite virulence and host immunity. Diagnosis of ocular toxoplasmosis is also discussed in the light of serological, molecular and imaging tools. Finally, a critical analysis of current and emerging therapies for ocular toxoplasmosis is made. Preventive aspects are also commented upon. SUMMARY: Waterborne toxoplasmosis is increasingly recognized in outbreaks and in endemic areas. The importance of postnatally acquired toxoplasmosis is now well established, but should not lead to underestimation of congenital disease. Genetic determination of parasite virulence/individual susceptibility might correlate with disease outcomes. Serological, molecular and imaging tools may improve the diagnosis and follow-up of individuals with ocular toxoplasmosis. Despite emergence of alternative therapeutic regimens, including intravitreal antibiotics, classical therapy with sulfadiazine/pyrimethamine is still standard for toxoplasmic retinochoroiditis. Adequate prophylaxis is expected to have an effect in ocular burden of toxoplasmosis.
Subject(s)
Toxoplasmosis, Ocular/diagnosis , Uveitis, Posterior/diagnosis , Humans , Pyrimethamine/therapeutic use , Sulfadiazine/therapeutic use , Toxoplasma/immunology , Toxoplasmosis, Ocular/drug therapy , Toxoplasmosis, Ocular/parasitology , Uveitis, Posterior/drug therapy , Uveitis, Posterior/parasitologyABSTRACT
The diagnosis of ocular toxoplasmosis is mainly clinical, based in the presence of focal necrotizing retinochoroiditis often associated with a preexistent chorioretinal scar, and variable involvement of the vitreous, retinal blood vessels, optic nerve, and anterior segment of the eye. Recognition of this clinical spectrum of toxoplasmic retinochoroiditis is crucial, but other infectious, noninfectious, and neoplastic entities should also be considered in the differential diagnosis. Investigations such as serological tests, polymerase chain reaction of ocular fluids, and assessment of intraocular antibody synthesis are helpful in uncertain cases. This article provides an overview of the differential diagnosis of ocular toxoplasmosis, focusing on the most important entities to be considered and emphasizing distinctive features of each one of them in the clinical setting. Ocular toxoplasmosis has multiple clinical manifestations, which partially overlap with those of other entities and these should be carefully considered when making the differential diagnosis, particularly in less typical cases.
Subject(s)
Toxoplasmosis, Ocular/diagnosis , Chorioretinitis/congenital , Chorioretinitis/diagnosis , Chorioretinitis/parasitology , Diagnosis, Differential , Endophthalmitis/diagnosis , Endophthalmitis/microbiology , Eye Infections, Bacterial/diagnosis , Eye Infections, Fungal/diagnosis , Eye Neoplasms/diagnosis , Herpes Simplex , Herpes Zoster , Humans , Lymphoma/diagnosis , Macula Lutea/pathology , Retinal Diseases/diagnosis , Retinal Diseases/virology , Retinal Necrosis Syndrome, Acute/diagnosis , Retinal Necrosis Syndrome, Acute/parasitology , Retinal Neoplasms/diagnosis , Retinitis/parasitology , Syphilis/diagnosis , Tuberculosis, Ocular , Uveitis, Posterior/diagnosis , Uveitis, Posterior/microbiology , Vitreous BodyABSTRACT
BACKGROUND: To evaluate the anatomical and functional outcomes of intravitreal bevacizumab (1.25 or 2.5 mg) in the treatment of inflammatory choroidal neovascularization at 24 months. METHODS: We reviewed the clinical records of 22 consecutive patients (23 eyes) with choroidal neovascularization secondary to chorioretinal inflammatory disease in this interventional retrospective multicenter case series. Sixteen eyes (63.6%) received a dose of 1.25 mg of intravitreal bevacizumab, and 7 eyes (36.4%) received a dose of 2.5 mg of intravitreal bevacizumab. RESULTS: At baseline, the mean best-corrected visual acuity was 0.68 logarithm of minimum angle of resolution (Early Treatment Diabetic Retinopathy Study chart = 20/100). After intravitreal bevacizumab, best-corrected visual acuity improved significantly to 0.41 logarithm of minimum angle of resolution (20/51), 0.42 logarithm of minimum angle of resolution (20/53), and 0.40 logarithm of minimum angle of resolution (20/50) at 6, 12, and 24 months, respectively (P < 0.05). Fourteen eyes (60.8%) received 1 injection. Central macular thickness by optical coherence tomography decreased from 375.3 µm (range: 240-634 µm) at baseline to 241.6 µm (range: 189-306 µm) at 24 months of follow-up (P < 0.0001). CONCLUSION: Intravitreal bevacizumab at doses of 1.25 mg and 2.5 mg seems to provide stability or improvement in best-corrected visual acuity, optical coherence tomography, and fluorescein angiogram in inflammatory choroidal neovascularization at 24 months. All patients were treated after the underlying uveitic condition was controlled.
Subject(s)
Angiogenesis Inhibitors/administration & dosage , Antibodies, Monoclonal/administration & dosage , Choroidal Neovascularization/drug therapy , Uveitis, Posterior/complications , Adolescent , Adult , Aged , Antibodies, Monoclonal, Humanized , Bevacizumab , Choroidal Neovascularization/diagnosis , Choroidal Neovascularization/etiology , Female , Fluorescein Angiography , Humans , Intravitreal Injections , Male , Middle Aged , Retrospective Studies , Tomography, Optical Coherence , Treatment Outcome , Uveitis, Posterior/diagnosis , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Visual Acuity/physiology , Young AdultABSTRACT
PURPOSE: FTY720 (fingolimod) is an immunomodulatory drug capable of preventing T-cell migration to inflammatory sites by binding to and subsequently downregulating the expression of sphingosine-1 phosphate receptor 1 (S1P(1)) leading in turn to T-cell retention in lymphoid organs. Additional effects of FTY720 by increasing functional activity of regulatory T cells have recently been demonstrated, raising the conversion of conventional T cells into regulatory T cells and affecting the sequestration of regulatory T cells in normal mice. In this study, the action of FTY720 in the ocular autoimmune model in mice was investigated. METHODS: Mice were immunized with 161-180 peptide and pertussis toxin and were treated with 1 mg/kg/d FTY720 by gavage (7-21 days postimmunization [dpi]) or left untreated. Spleen cells, harvested 21 dpi, were cultured and assayed for cytokine production. Draining lymph node, spleen, and eye cells 21 dpi were assayed for quantification of T-cell populations. Disease severity was evaluated by histologic examination of the enucleated eyes at 21 and 49 dpi. In addition, anti-IRBP antibodies were analyzed by ELISA. RESULTS: FTY720 was effective in suppressing the experimental autoimmune uveitis score. Although there was a reduction in the number of eye-infiltrating cells, FTY did not prevent Treg accumulation at this site. FTY720 leads to a significant increase of CD4(+)IFN-gamma(+) and CD4(+)Foxp3(+) cell percentages in lymph nodes, suggesting that this site could be the source of Treg cells found in the eye. CONCLUSIONS: The data showed that treatment in vivo with FTY720 was able to suppress EAU in mice. These results are indicative of the possible therapeutic use of FTY720 in ocular autoimmune processes.
Subject(s)
Autoimmune Diseases/prevention & control , Disease Models, Animal , Immunosuppressive Agents/administration & dosage , Propylene Glycols/administration & dosage , Sphingosine/analogs & derivatives , Uveitis, Posterior/prevention & control , Animals , Autoimmune Diseases/immunology , Autoimmune Diseases/pathology , CD4 Lymphocyte Count , CD4-Positive T-Lymphocytes , Cell Movement/immunology , Cytokines/metabolism , Enzyme-Linked Immunosorbent Assay , Eye Proteins/immunology , Fingolimod Hydrochloride , Flow Cytometry , Immunoglobulin G/blood , Interleukin-2 Receptor alpha Subunit/immunology , Intubation, Gastrointestinal , Lymph Nodes/immunology , Mice , Peptide Fragments/immunology , Retinol-Binding Proteins/immunology , Sphingosine/administration & dosage , T-Lymphocytes, Regulatory/immunology , Uveitis, Posterior/immunology , Uveitis, Posterior/pathologyABSTRACT
La toxoplasmosis ocular es una enfermedad producida por el parásito toxoplasma gondii. Es la causa más frecuente de uveítis posterior, es una enfermedad de distribución universal, al menos 500 millones de personas están infectadas en todo el mundo, ocasionando disminución de la visión y ceguera en muchas de ellas. Por tal motivo, realizamos una revisión actualizada sobre, la situación actual a nivel mundial, la historia de la enfermedad, la prevención, formas clínicas y el control de la toxoplasmosis. Se tratan otros aspectos de interés como el modo de transmisión, los hospederos (definitivos e intermediarios) y las manifestaciones clínicas más notables
The ocular toxoplasmosis is an illness caused by Toxoplasma gondii parasite. It is the most frequent cause in posterior uveitis, and it spreads worldwide since at least 500 million people are infected in the entire world, causing decrease of vision and blindness in many of them. This is the reason why we made a literature review, the current situation worldwide, the history, the prevention, the clinical forms and the control of toxoplasmosis. Other interesting aspects were the channel of transmission, the hosts (intermediary and final) and the most remarkable clinical manifestations
Subject(s)
Humans , Male , Female , Toxoplasmosis, Ocular/complications , Toxoplasmosis, Ocular/epidemiology , Toxoplasmosis, Ocular/prevention & control , Uveitis, Posterior/etiology , Uveitis, Posterior/prevention & controlABSTRACT
Toxoplasma gondii causes posterior uveitis and the specific diagnosis is based on clinical criteria. The presence of anti-T. gondii secretory IgA (sIgA) antibodies in patients' tears has been reported and an association was found between ocular toxoplasmosis and the anti-T. gondii sIgA isotype in Brazilian patients. The purpose of this study was to provide an objective validation of the published ELISA test for determining the presence of anti-T. gondii sIgA in the tears of individuals with ocular toxoplasmosis. Tears from 156 patients with active posterior uveitis were analysed; 82 of them presented characteristics of ocular toxoplasmosis (standard lesion) and 74 patients presented uveitis due to other aetiologies. Cases of active posterior uveitis were considered standard when a new inflammatory focus satellite to old retinochoroidal scars was observed. The determination of anti-T. gondii sIgA was made using an ELISA test with crude tachyzoite antigenic extracts. Tears were collected without previous stimulation. Detection of sIgA showed 65.9% sensitivity (95% CI = 54.5-74.4), 71.6% specificity (95% CI = 59.8-81.2), a positive predictive value of 72% (95% CI = 60.3-81.5) and a negative predictive value of 65.4% (95% CI = 54.0-75.4). sIgA reactivity was higher in the tears of patients with active posterior uveitis due to T. gondii (p < 0.05). The test is useful for differentiating active posterior uveitis due to toxoplasmosis from uveitis caused by other diseases.
Subject(s)
Enzyme-Linked Immunosorbent Assay , Immunoglobulin A, Secretory/analysis , Tears/immunology , Toxoplasma/immunology , Toxoplasmosis, Ocular/diagnosis , Uveitis, Posterior/parasitology , Adolescent , Adult , Antibodies, Protozoan/analysis , Child , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Sensitivity and Specificity , Tears/parasitology , Young AdultABSTRACT
Toxoplasma gondii causes posterior uveitis and the specific diagnosis is based on clinical criteria. The presence of anti-T. gondii secretory IgA (sIgA) antibodies in patients' tears has been reported and an association was found between ocular toxoplasmosis and the anti-T. gondii sIgA isotype in Brazilian patients. The purpose of this study was to provide an objective validation of the published ELISA test for determining the presence of anti-T. gondii sIgA in the tears of individuals with ocular toxoplasmosis. Tears from 156 patients with active posterior uveitis were analysed; 82 of them presented characteristics of ocular toxoplasmosis (standard lesion) and 74 patients presented uveitis due to other aetiologies. Cases of active posterior uveitis were considered standard when a new inflammatory focus satellite to old retinochoroidal scars was observed. The determination of anti-T. gondii sIgA was made using an ELISA test with crude tachyzoite antigenic extracts. Tears were collected without previous stimulation. Detection of sIgA showed 65.9 percent sensitivity (95 percent CI = 54.5-74.4), 71.6 percent specificity (95 percent CI = 59.8-81.2), a positive predictive value of 72 percent (95 percent CI = 60.3-81.5) and a negative predictive value of 65.4 percent (95 percent CI = 54.0-75.4). sIgA reactivity was higher in the tears of patients with active posterior uveitis due to T. gondii (p < 0.05). The test is useful for differentiating active posterior uveitis due to toxoplasmosis from uveitis caused by other diseases.