TNF-alpha gene polymorphism (-308G/A) and toxoplasmic retinochoroiditis.

AIM: To investigate the possible association between TNF-alpha (-308G/A) polymorphism and toxoplasmic retinochoroiditis (TR) in humans. METHODS: A cross-sectional study was performed which included 100 Brazilian patients with diagnosis of TR and 100 matched control subjects with positive serology to toxoplasmosis and no sign of uveitis. Genomic DNA was obtained from oral swabs of all subjects and amplified using the polymerase chain reaction (PCR) with specific primers flanking the locus -308 of TNF-alpha. PCR products were submitted to restriction endonuclease digestion and analysed by polyacrylamide gel electrophoresis to distinguish alleles, allowing the determination of the genotypes. RESULTS: There was no significant difference in the genotype (chi(2) = 0.79, p = 0.67), allele (chi(2) = 0.095, p = 0.75) and allele carriage (chi(2) = 0.70, p = 0.40) frequencies in TR patients compared with control subjects. Frequencies of the genotype (chi(2) = 2.05, p = 0.35) and allele (chi(2) = 0.13, p = 0.71) did not differ significantly between TR patients with and without recurrent episodes. CONCLUSION: This is the first study to investigate the association between TNF-alpha polymorphism and the occurrence of TR in humans. TNF-alpha gene polymorphism (-308G/A) does not seem to be associated with the occurrence or recurrence of TR.

Detection of herpesvirus DNA by the polymerase chain reaction (PCR) in vitreous samples from patients with necrotising retinitis.

AIMS: Viral uveitis and retinitis, usually caused by herpesviruses, are common in immunosuppressed patients. The diagnosis of viral anterior uveitis and retinitis is usually clinical. The polymerase chain reaction (PCR) has been used for the diagnosis of some viral infections, especially those caused by herpesviruses. This paper reports the use of PCR in the diagnosis of viral retinitis in vitreous samples from Brazilian patients. METHODS: PCR was used for the diagnosis of necrotising retinitis in vitreous samples from patients from the Hospital São Geraldo, Universidade Federal de Minas Gerais, Brazil. The vitreous samples were collected by paracentesis and stored until analysis. Samples were analysed by PCR using specific primers designed to amplify herpes simplex virus 1 (HSV-1), varicella zoster virus (VZV), or human cytomegalovirus (HCMV). In a case of anterior uveitis, PCR was performed with a sample from the anterior chamber. RESULTS: Herpesvirus DNA was amplified in 11 of 17 samples. HCVM DNA was detected in nine samples but DNA from HSV-1 and VZV were detected only once each. CONCLUSION: These results strongly suggest that PCR could be used for a rapid complementary diagnosis of viral uveitis and retinitis. A prospective study to evaluate the PCR results, clinical evolution, and treatment is imperative to corroborate the real value of PCR in diagnosis and how it could help the clinicians' approach.

Dacryocystographic examination does not identify early seventh nerve failure in leprosy patients.

Dacryocystographic examination was performed in two groups of patients: patients having leprosy and those not having leprosy, in order to look for early failure of the facial nerve. The results of this study show that this kind of examination does not improve diagnosis of leprosy.

Conjunctival biopsy in patients with leprosy.

The authors examined the eyes of 120 leprosy patients comprising of 30 cases each of tuberculoid, indeterminate, borderline and lepromatous leprosy. The investigation included biopsy of the bulbar conjunctiva on the upper temporal quadrant of the right eye. The study patients included both who were untreated, those that were being treated and those who were in observation after the end of treatment. The aim of the study was to identify the presence of M. leprae in the conjunctiva. Four such cases were found: one borderline patient with no treatment and three lepromatous patients who were being treated with MDT.

Clinical ocular study in leprosy patients at a sanitary dermatological hospital in Brazil.

This study is based upon the observation f 363 leprosy patients having different types of the disease. At the time of the examination, we did not have any previous knowledge about the type of leprosy the patients were having. Thus, the eye examination was done without the knowledge of clinical diagnosis. The ocular examination protocol covered the following: visual activity, facial muscle function, eyebrows, eyelashes, lacrimal system, pupil, eye motility, corneal sensitivity, Schirmir's test and study of the anterior segment of the ocular bulb with a slit-lamp. The study patients included 275 cases of lepromatous leprosy, 57 tuberculoid, 29 indeterminate and two dimorphous cases. The age of the patients ranged between 18 and 82 years, and 229 of them were males. Among those patients, 183 were whites, 23 were black and 157 were mulatto.

Study of ocular changes in leprosy patients.

In this study, 997 leprosy patients were examined, 528 of them with lepromatous leprosy (53%), 199 with borderline leprosy (20%), 167 with tuberculoid leprosy (16%) and 103 (10.3%) with indeterminate leprosy. Changes in the ocular bulb were noted in 314 patients (31.5%) specially in those with lepromatous leprosy. These alterations were greater with increasing age of the patient and length of disease. Severe ocular lesions were rare, probably due to previous systemic treatment. The "pearls" in the fundus of the eye resulting from leprosy were also studied.

Presence of M. leprae in the conjunctiva, vitreous body and retina of a patient having lepromatous leprosy.

Histopathological study of the ocular globe of a lepromatous leprosy patient revealed the presence of lepra bacilli in the conjunctiva, sclera, episclera, cornea, iris, ciliary body, vitreous body and retina.

Bilateral iridocyclitis caused by Mycobacterium leprae diagnosed through paracentesis.

The authors conducted an anterior chamber paracentesis in a patient with lepromatous leprosy showing bilateral iridocyclitis. The paracentesis was performed in the outpatients department. The aqueous humor was studied by Ziehl-Nielsen staining method and the result was the isolation of the M. leprae in the anterior chamber. This study shows that M. leprae can promote uveitis in leprosy patients. Therefore, it should be looked for in patients having this type of disease.

Identification of M.leprae in conjunctiva of leprosy patients using the superior tarsal conjunctiva scrape technique.

The technique of superior tarsal conjunctiva scrape was used for identifying M.leprae in the conjunctiva in 56 leprosy patients (all of them multibacillary, some untreated and others treated with multidrug therapy). The technique of tarsal conjunctiva scrape was shown to be more suitable than conjunctival biopsy for identifying lepra bacilli. This technique is also easier to perform and has shown a statistical relation between bacilloscopical index of skin (BIsk) and bacilloscopical index of tarsal conjunctiva (BIconj) values. Thus, if the bacilli can be identified at tarsal conjunctiva we can assume greater systemic bacillary load in the patients.

Ocular and concomitant cutaneous sporotrichosis.

We report here the case of a 12-year-old girl with concomitant cutaneous and ocular sporotrichosis. Sporothrix schenckii was isolated from skin lesions and aqueous humour. The difficulty in the diagnosis and treatment of this form of mycosis is discussed and the data are compared with those published in the few reports available in the literature.

HTLV-I associated uveitis, myelopathy, rheumatoid arthritis and Sjögren's syndrome.

A 62 year-old white female presented with a 10-year-history of slowly progressive spastic paraparesis, pain and dysesthesia in the lower limbs and sphincter disturbance. A few years after the onset of the neurologic symptoms she developped migratory arthritis with swelling of the knees and pain on palpation of knees and fingers, dry eyes, mouth and skin. Two months before admission she presented bilateral nongranulomatous anterior uveitis. Examination revealed spastic paraparesis with bilateral Babinski sign, a decreased sensation level below L3, decreased vibration sense in the lower extremities, and a postural tremor of the upper limbs. Laboratory work-up disclosed HTLV-I positive tests in the blood and cerebrospinal fluid (CSF), and a mild pleocytosis in the CSF with a normal protein content. Nerve conduction velocity studies were normal. The present case shows the association of uveitis, arthritis and Sjögren's syndrome in a patient with tropical spastic paraparesis/human T-cell lymphotropic virus type I (HTLV-I) associated myelopathy (TSP/HAM), and illustrates the wide spectrum of clinical manifestations which may accompany this infection with this virus.

Analysis of aqueous humor in ocular toxoplasmosis: detection of low avidity IgG specific to Toxoplasma gondii.

Using a modified enzyme-linked immunosorbent assay that included dissociation of antigen antibody complexes with 6M urea solution, we analyzed the avidity of Toxoplasma-specific IgG in aqueous humor and serum samples from 24 patients with toxoplasmic chorioretinitis. As a control, we studied aqueous humor and serum samples from 14 cataract patients without history of uveitis and serum samples from 10 patients with recent primary systemic toxoplasmic infection without ocular lesions. IgG avidity was markedly lower in aqueous humor samples from patients with toxoplasmic chorioretinitis than in serum samples, despite those samples presenting higher levels of Toxoplasma-specific IgG than in serum samples. The detection of the low-avidity Toxoplasma-specific antibodies can offer a valuable aid to make a specific etiologic diagnosis and perhaps contribute to understand the pathogenic mechanisms of ocular toxoplasmosis.

Toxoplasmosis and mental retardation--report of a case-control study.

A case-control study evaluating the association between mental retardation and toxoplasmosis was conducted among 845 school children in Belo Horizonte, MG, Brazil. Cases (450) were mentally retarded children attending a public school for special education. Controls (395) were children from the regular public school system. Clinical and anthropometric examinations and interviews were carried out to determine risk factors for toxoplasmosis and mental retardation. Diagnosis of Toxoplasma gondii infection was based upon an indirect immunofluorescent test (IFA); 55% of cases and 29% of controls were positive. The Relative Odds of mental retardation in children with positive serology was 3.0 (95% CI 2.2-4.0). Maternal exposure to cats and contact with soil were associated with an increased risk of mental retardation. Retinochoroiditis was fourfold more prevalent among cases than controls and was only diagnosed in T. gondii IFA positive participants. Congenital toxoplasmosis, in its subclinical form, appears to be an important component in the etiology of mental retardation, especially in high risk (lower socio-economic) groups. The population attributable risk was estimated as 6.0-9.0%, suggesting the amount of mental retardation associated with this infection.

[Median mandibular cysts. A case report]. / Cisti mediane della mandibola. Caso monografico.

A case of median mandibular cyst is reported. The main aspects of the origin, diagnosis and therapy of median mandibular cysts are described, together with endodontic problems and differential diagnosis.

Isolation Leishmania sp from aqueous humor of a patient with cutaneous disseminated leishmaniasis and bilateral iridocyclitis (preliminary report)

Os autores descrevem um caso raro de leishmaniose con lesoes cutaneas disseminadas, manifestacoes sistemicas e comprometimento ocular, sendo este caracterizado por iridociclite bilateral nao granulomatosa. A gravidade do quadro oftalmologico e a ausencia de resposta ao tratamento, a despeito da melhora das manifestacoes cutaneas e sistemicas, levaram a realizacao de puncao propedeutica da camada anterior ocular. A partir do humor aquoso isolou-se Leishmania sp. Os autores desconhecem na literatura qualquer outro caso onde tal achado tenha sido demonstrado

Isolation of Leishmania sp. from aqueous humor of a patient with cutaneous disseminated leishmaniasis and bilateral iridocyclitis (preliminary report).

The authors report an uncommon case of leishmaniasis with disseminated cutaneous lesions, systemic manifestations and ocular involvement, the latter being characterized by bilateral nongranulomatous iridocyclitis. The severity of the ophthalmologic lesions and its unresponsiveness to therapy (in spite of satisfactory regression of both systemic and cutaneous manifestations) lead to a needle aspiration of the anterior eye chamber content. From this material Leishmania sp was isolated. To our knowledge this is the first time that Leishmania has been shown into the ocular globe.