RESUMO
PURPOSE: Infectious uveitis entities are usually rapidly progressive blinding diseases that can be prevented by prompt administration of specific antimicrobial therapy. With the aim of improving early diagnosis in patients with infectious uveitis, intraocular fluid samples from patients with sight-threatening posterior uveitis were investigated to determine the causative agent. METHODS: Thirty-eight patients with acquired immunodeficiency syndrome (AIDS) and retinitis, eight immunosuppressed patients with retinitis, 16 immunocompetent patients with acute retinal necrosis, and 22 immunocompetent patients with toxoplasmic retinochoroiditis were analyzed by polymerase chain reaction for the presence of herpesviruses and Toxoplasma gondii DNA and for local antibody production against these microorganisms. RESULTS: In patients with AIDS and retinitis, polymerase chain reaction was positive for cytomegalovirus DNA in 21 (91%) of the 23 ocular fluid samples obtained during active cytomegalovirus retinitis, whereas local antibody production analysis was negative in all cases. In acute retinal necrosis, varicella-zoster virus or herpes simplex virus could be established as the inciting agent in 81% of the cases, using the combination of both techniques. Polymerase chain reaction was positive in all samples obtained within two weeks after the onset of disease. Toxoplasma gondii DNA was detected in 4 of 13 samples (31%) from immuno-competent patients with active toxoplasmic retinochoroiditis; in each case, local antibody production was also detected. In contrast, no local antibody production was observed in two of three samples from transplant recipients that were positive for T. gondii DNA. All the control samples tested were negative for the above-mentioned tests. CONCLUSIONS: In patients with AIDS, polymerase chain reaction analysis is preferable above local antibody production in detecting the inciting agent of retinitis. In other cases, the combination of both techniques can make a valuable contribution to the diagnosis.
Assuntos
Humor Aquoso/virologia , Infecções Oculares Virais/diagnóstico , Reação em Cadeia da Polimerase/métodos , Testes Sorológicos , Toxoplasmose Ocular/diagnóstico , Uveíte Posterior/diagnóstico , Corpo Vítreo/virologia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Animais , Anticorpos Antiprotozoários/análise , Anticorpos Antivirais/análise , Humor Aquoso/parasitologia , Sequência de Bases , Citomegalovirus/genética , Citomegalovirus/imunologia , Primers do DNA/química , DNA de Protozoário/análise , DNA Viral/análise , Infecções Oculares Virais/parasitologia , Infecções Oculares Virais/virologia , Herpesvirus Humano 1/genética , Herpesvirus Humano 1/imunologia , Herpesvirus Humano 2/genética , Herpesvirus Humano 2/imunologia , Herpesvirus Humano 3/genética , Herpesvirus Humano 3/imunologia , Humanos , Hospedeiro Imunocomprometido , Dados de Sequência Molecular , Retinite/parasitologia , Retinite/virologia , Toxoplasma/genética , Toxoplasma/imunologia , Toxoplasmose Ocular/parasitologia , Toxoplasmose Ocular/virologia , Uveíte Posterior/parasitologia , Uveíte Posterior/virologia , Corpo Vítreo/parasitologiaRESUMO
We evaluated the ocular symptomatology in 3 HLA-A29 positive patients with uveitis. In two patients we saw bilateral flecked fundus lesions known as birdshot retinochoroidopathy. One patient with an idiopathic vasculitis had no depigmented fundus flecks. The differences and similarities in these 3 patients are described.
