Selected Eye Abstracts
Tomasz Chmielewski, Joanna Brydak-Godowska, Beata Fiecek, Urszula Rorot, Elżbieta Sędrowicz, Małgorzata Werenowska, Dorota Kopacz, Agata Hevelke, Magdalena Michniewicz, Dariusz Kęcik, Stanisława Tylewska-Wierzbanowska
(Laboratory of Rickettsiae, Chlamydiae and Spirochetes, National Institute of Public Heath – National Institute of Hygiene, Warsaw, Poland)
Med Sci Monit 2014; 20:927-931
DOI: 10.12659/MSM.890149
Published: 2014-06-05
Background: Clinical data have shown that tick-borne diseases caused by Borrelia burgdorferi sensu lato, Bartonella spp., Coxiella burnetii, andRickettsia spp. can affect the central nervous system, including the eye. The aim of this study was to establish a relationship between the incidence of cataract and evidence of bacterial infections transmitted by ticks.
Material and Methods: Fluid with lenticular masses from inside of the eye and blood from 109 patients were tested by PCR and sequencing. Sera from patients and the control group were subjected to serological tests to search specific antibodies to the bacteria.
Results: Microbiological analysis revealed the presence of Bartonella sp. DNA in intraoperative specimens from the eye in 1.8% of patients. Serological studies have shown that infections caused by B. burgdorferi sensu lato and Bartonella sp. were detected in 34.8% and 4.6% of patients with cataract surgery, respectively.
Conclusions: Presence of DNA of yet uncultured and undescribed species of Bartonella in eye liquid indicates past infection with this pathogen. Specific antibodies to B. burgdorferi sensu lato and Bartonella sp. are detected more frequently in patients with cataract compared to the control group. This could indicate a possible role of these organisms in the pathological processes within the eyeball, leading to changes in the lens. Further studies are needed to identify Bartonella species, as well as to recognize the infectious mechanisms involved in cataract development.
Keywords: Bartonella spp, Borrelia burgdorferi sensu lato, Coxiella burnetii, Rickettsia spp, Cataract
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Przegl Epidemiol. 2002;56 Suppl 1:85-90.
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[Ophthalmic manifestations in Lyme borreliosis]
[Article in Polish]
Zagórski Z, Biziorek B, Haszcz D.
Katedra i I Klinika Okulistyki Akademii Medycznej w Lublinie.
We reviewed ophthalmic manifestations in Lyme borreliosis, concentrating on clinical and laboratory diagnosis, differential diagnosis and treatment options. Ocular involvement may occur in every stage of the disease. Conjunctivitis and episcleritis are the most frequent manifestations of the early stage. Neuro-ophthalmic disorders and uveitis occur in the second stage whereas keratitis, chronic intraocular inflammation and orbital myositis have been reported in the third stage of borreliosis.
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Ophthalmology. 1989 Aug;96(8):1194-7.
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Bilateral keratitis in Lyme disease.
Kornmehl EW, Lesser RL, Jaros P, Rocco E, Steere AC.
Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven.
Lyme disease, caused by the spirochete Borrelia burgdorferi, has ophthalmic manifestations. The authors describe two cases of Lyme keratitis characterized by multiple focal, nebular opacities at varying levels of the stroma which may progress to edema, neovascularization, and scarring. Close observation, in addition to systemic antibiotic therapy, may be sufficient if the visual axis is not involved, and the patient is asymptomatic.
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Ophthalmologe. 1997 Aug;94(8):591-4.
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[Acute Borrelia infection. Unilateral papillitis as isolated clinical manifestation]
[Article in German]
Pradella SP, Krause A, Müller A.
Klinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität, Halle-Wittenberg.
BACKGROUND: Borrelia burgdorferi is the cause of erythema chronicum migrans and Lyme disease. Ticks like Ixodes ricinus are responsible for transmission. Frequently, the tick bite is not noticed by the patient. Eye manifestations, such as keratoconjunctivitis, scleritis, chronic uveitis, vitritis, chorioretinitis, optic nerve disease, orbital myositis and paresis of the eye muscles, often occur after a long period of time and vary greatly. PATIENTS AND METHODS: We present below the case reports of a man 38 years old and a woman of 31, each with manifestation of an ocular Borrelia infection (papillitis and panuveitis, respectively).
RESULTS: By antibody-screening with the ELISA technique and Western Blot analysis we were able to prove the serological infection. After specific antibiotic therapy, ocular inflammation improved rapidly, as did visual acuity. The papillitis only healed partially.
CONCLUSIONS: In case of therapy-resistant inflammation of the eye we have to exclude general infections because cortisone therapy alone may result in worsening the condition. VECP can be used effectively in the differential diagnosis of papilloedemas. Early diagnosis and therapy of an acute Borrelia infection restrict the extent of the lesions and prevent ocular and general late manifestations. Seronegative values in subjects strongly suspected of having Lyme disease do not necessarily exclude the diagnosis of Lyme disease.
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Med Mal Infect. 2007 Dec;37 Suppl 3:S175-88. Epub 2007 Dec 11.
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[What kind of clinical, epidemiological, and biological data is essential for the diagnosis of Lyme borreliosis? Dermatological and ophtalmological courses of Lyme borreliosis]
[Article in French]
Service de dermatologie, hôpital d'instruction des armées Legouest, 27, avenue de Plantières, BP10, 57998 Metz Armées, France. thierry.boye@yahoo.fr
Lyme borreliosis (BL) is a multisystem infectious tick-transmitted disease. The diversity of Borrelia burgdorferi is the reason for a wide spectrum of dermatological and ophthalmologic presentations between patients from Europe and from other countries. In Europe, the main manifestations are dermatological. During the early stage, the diagnosis is clinical: finding erythema migrans (EM) a few days after a tick bite is sufficient; several EM mean an early-disseminated disease.
Borrelial lymphocytoma (only in Europe) is a solitary nodule or plaque (earlobe, nipple, scrotum), which appears during the second stage. The diagnosis relies on clinical and histological findings (B-cell infiltration) and a positive serological test.
It is sometimes difficult to make the difference between BL and B-cell lymphoma and pseudo lymphoma; an empirical antibiotic trial period will be helpful for the diagnosis in this case.
During the late stage, the clinical evolution of acrodermatitis chronica atrophicans is progressive: inflammatory then atrophic lesions appear, often on the hands, limbs, or feet. The diagnosis is made on histological findings (T-cell infiltration) and a positive serological test.
The relationship between BL and morphea or lichen sclerosus was not demonstrated according to the latest reports. Ocular manifestations are rare events occurring during every stage of the disease. A wide spectrum of presentations is possible (uveitis and optic neuritis).
BL is responsible for ocular infection or inflammation. A neurological presentation is often associated with the ocular manifestation. Proving the diagnosis is often difficult because of these polymorphous manifestations.
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MMW Fortschr Med. 2006 Jun 22;148(25):39-41.
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[Stage-oriented treatment of Lyme borreliosis]
[Article in German]
Nationales Referenzzentrum für Borrelien, Max v. Pettenkofer Institut, LMU München. nrz-borrelien@mvp.uni-muenchen.de
Every manifestation of Lyme borreliosis needs to be treated with antibiotics. The type of antibiotic applied and duration of treatment will depend on the stage and severity of the disease. Erythema migrans, Borrelia lymphocytoma, Lyme arthritis and acrodermatitis chronica atrophicans are primarily treated orally.
If neurological symptoms, severe Lyme carditis or eye manifestations are present, intravenous treatment is initially recommended. For oral therapy, doxycycline, amoxicillin, cefuroxime and, if intolerance is shown, azithromycin, are available.
For intravenous treatment ceftriaxone, cefotaxime or penicillin G is employed. The overall prognosis for treated Lyme borreliosis is good. However, in particular when manifestations with substantial organic injury have persisted, incomplete healing must be expected.
With the exception of erythema migrans, every manifestation should be subjected to a careful diagnostic work-up prior to the start of treatment, because premature antibiotic administration is not only associated with an elevated risk for the patient, but can also mask important diagnostic signs.
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Surv Ophthalmol. 2006 May-Jun;51(3):274-9.
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The ticking time bomb.
Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
A man with orbital myositis and optic neuritis tested positive serologically for multiple tick-borne diseases. Erlichiosis, babesiosis, and Lyme disease may occur together and affect the eye or orbit.
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Acta Clin Belg. 2005 Sep-Oct;60(5):270-5.
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An eye on inflammatory eye disease.
Afdeling Oogheelkunde, Universitair Ziekenhuis, Gent. philippe.kestelyn@ugent.be
The purpose of this article is to outline the interaction between ophthalmologists and internists in the management of uveitis. Two issues will be addressed: 1) which strategies should the internist follow when asked to investigate a case of uveitis; and 2) in which systemic diseases should the internist order an ocular examination to rule out intraocular inflammation.
The modern approach to the diagnosis of uveitis is based on the naming-meshing system popularized by Smith and Nozik. After a short history (ocular complaints, general health) an ophthalmic examination is carried out to determine the anatomic structures involved. Based on the results a uveitis is classified as anterior uveitis, intermediate uveitis, posterior uveitis, or panuveitis.
Associated factors (eg, unilateral versus bilateral, acute versus chronic, granulomatous versus nongranulomatous, etc.) are also assessed. Based on this information the type of uveitis will be named (eg, acute, nongranulomatous, unilateral, anterior uveitis) and matched (meshing) to a potential list of etiologies (eg, viral iritis, HLA-B 27 associated iritis).
Targeted questioning and selected medical and laboratory investigations based on the shortlist will then identify a possible cause for a particular patient's uveitis. In other words the ophthalmologist should never ask the internist to run the full battery of tests in a patient with uveitis. He rather should indicate which type of uveitis is present and what are the most likely diagnoses to be excluded.
Many systemic diseases cause diffuse inflammation and are associated with uveitis. These include tuberculosis, spirochaetal diseases such as Lyme disease and syphilis, sarcoidosis, Behçet syndrome, juvenile idiopathic arthritis, and HIV infection amongst many others.
Routine ophthalmic examination in patients with systemic disease may be indicated for diverse reasons: to prevent profound damage due to asymptomatic uveitis in JIA; to detect diagnostic clues in patients with febris e causa ignota; or to rule out opportunistic infections in HIV positive patients. It is clear that the information gained from routine examination in systemic disease will be greatly dependent on the prevalence of ocular involvement in a particular disease.
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Ophthalmology. 2004 May;111(5):1023-8.
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Orbital myositis associated with Borrelia burgdorferi (Lyme disease) infection.
Carvounis PE, Mehta AP, Geist CE.
Department of Ophthalmology, The George Washington University, Washington, DC 20037, USA.
OBJECTIVE: To report on the clinical findings in a patient with isolated left inferior rectus myositis associated with serologically confirmed Borrelia burgdorferi infection.
DESIGN: Interventional case report. TESTING: Comprehensive clinical, laboratory, and imaging evaluation. RESULTS: Contrast-enhanced computed tomography showed a swollen inferior rectus muscle with infraorbital soft tissue swelling in a patient with diplopia and prior symptoms consistent with manifestations of Lyme disease.
Positive serum and cerebrospinal fluid antibodies to B. burgdorferi by enzyme-linked immunoassay were confirmed by Western blot, and the cerebrospinal fluid/serum antibody ratio was elevated. No alternative cause for orbital myositis was found, and treatment with antibiotics resulted in a complete recovery.
CONCLUSIONS: Orbital myositis should be added to the expanding list of ophthalmic manifestations of Lyme disease. Correct diagnosis and appropriate antibiotic therapy may reduce the likelihood of further neurologic or ophthalmologic sequelae.
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Mikrobiyol Bul. 2003 Oct;37(4):255-9.
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[Clinical characteristics of Lyme disease in 12 cases]
[Article in Turkish]
Anlar FY, Durlu Y, Aktan G, Açikgöz E, Bingöl N, Madencioğlu V, Anlar B.
Ondokuz Mayis Universitesi Tip Fakültesi, Pediatri Anabilim Dali, Samsun.
Lyme disease, an infection caused by Borrelia burgdorferi, has been reported in many countries from America and Europe, however, knowledge about its epidemiology in Turkey is incomplete. In this study, the clinical characteristics of 12 cases with Lyme disease who were diagnosed with the positivity of B. burgdorferi antibodies by western blot method in the laboratory of Ankara Bayindir Medical Center, have been reviewed.
Physicians' recognition of early symptoms such as erythema migrans and later findings pertaining to the nervous system, joints, eye, and skin, and general awareness of the role of tick bites may increase the rate of diagnosis and allow earlier treatment of Lyme disease.
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Lancet. 2003 Nov 15;362(9396):1639-47.
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Comment in:
Lancet. 2004 Jan 17;363(9404):249.
Lancet. 2004 Mar 13;363(9412):901.
Lyme borreliosis.
Department of Hygiene and Medical Microbiology of the University Vienna, 1095 Wien, 15, Kinderspitalgasse, Austria. gerold.stanek@univie.ac.at
Lyme borreliosis is the most common tick-transmitted disease in the northern hemisphere and is caused by spirochaetes of the Borrelia burgdorferi species complex.
A complete presentation of the disease is an extremely unusual observation in which a skin lesion results from a tick bite and is followed by heart and nervous system involvement, and later on by arthritis. Late involvement of eye, nervous system, joints, and skin can also occur.
The only sign that enables a reliable clinical diagnosis of Lyme borreliosis is erythema migrans.
Other features of some diagnostic value are earlobe lymphocytoma, meningoradiculoneuritis (Garin-Bujadoux-Bannwarth syndrome), and acrodermatitis chronica atrophicans. The many other symptoms and signs have little diagnostic value.
Microbial or serological confirmation of borrelial infection is needed for all manifestations of the disease except for typical early skin lesions. However, even erythema migrans might not be pathognomonic for Lyme borreliosis, especially in the southern part of the USA where there is no microbiological evidence for infection with the agent.
Treatment with antibiotics is beneficial for all stages of Lyme borreliosis, but is most successful early in the course of the illness. Prevention relies mainly on avoiding exposure to tick bites but there is some interest in chemoprophylaxis and also in vaccine development following initial disappointments.
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Ophthalmology. 2002 Jan;109(1):143-5.
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Posterior scleritis associated with Borrelia burgdorferi (Lyme disease) infection.
Department of Ophthalmology, University Erlangen-Nürnberg, Schwabachanlage 6, D-91054 Erlangen, Germany.
OBJECTIVE: To report on the clinical findings in a patient with posterior scleritis associated with infection with Borrelia burgdorferi. DESIGN: Interventional case report.
PARTICIPANT: A 39-year-old male ranger who experienced posterior scleritis after several tick bites with erythema migrans.
TESTING: Extensive ophthalmic and systemic workup, including serologic testing and imaging techniques. RESULTS: Sonography and contrast-enhanced computed tomography showed a large scleral mass (16 x 12 x 13 mm) in a patient with painful proptosis in the left eye with episcleral vascular dilation, reduction in bulbar motility, and chorioretinal folds in the upper temporal quadrant.
Treatment with high-dose corticosteroids resulted in rapid regression of clinical symptoms and of the scleral mass. Intensive workup revealed immunoglobulin M antibodies (enzyme-linked immunoassay, Western immunoblot) and a positive lymphocyte transformation assay against B. burgdorferi. No other cause for posterior scleritis could be identified.
CONCLUSIONS: Posterior scleritis should be added to the list of ocular manifestations associated with Lyme disease. Because corticosteroids alone resulted in rapid improvement of clinical symptoms, the scleritis might be mediated by autoimmunologic mechanisms.
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Pediatrics. 2001 Aug;108(2):477-81.
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Optic neuropathy in children with Lyme disease.
Rothermel H, Hedges TR 3rd, Steere AC.
Division of Rheumatology/Immunology, Tufts University School of Medicine, New England Medical Center, Boston, MA 02111, USA.
Involvement of the optic nerve, either because of inflammation or increased intracranial pressure, is a rare manifestation of Lyme disease. Of the 4 children reported here with optic nerve abnormalities, 2 had decreased vision months after disease onset attributable to optic neuritis, and 1 had headache and diplopia early in the infection because of increased intracranial pressure associated with Lyme meningitis.
In these 3 children, optic nerve involvement responded well to intravenous ceftriaxone therapy. The fourth child had headache and visual loss attributable to increased intracranial pressure and perhaps also to optic neuritis.
Despite treatment with ceftriaxone and steroids, he had persistent increased intracranial pressure leading to permanent bilateral blindness.
Clinicians should be aware that neuro-ophthalmologic involvement of Lyme disease may have significant consequences. If increased intracranial pressure persists despite antibiotic therapy, measures must be taken quickly to reduce the pressure.
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Ophthalmology. 2000 Mar;107(3):581-7.
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The expanding clinical spectrum of ocular lyme borreliosis.
Mikkilä HO, Seppälä IJ, Viljanen MK, Peltomaa MP, Karma A.
Department of Ophthalmology, Helsinki University Central Hospital, Finland.
OBJECTIVE: To delineate the clinical manifestations of ocular Lyme borreliosis, while concentrating on new symptoms and findings and the phase of appearance of ophthalmologic disorders. DESIGN: Observational case series.
PARTICIPANTS: Ten patients with Lyme borreliosis-associated ophthalmologic findings previously reported from the Helsinki University Central Hospital in addition to 10 new cases that have since been diagnosed.
INTERVENTION/TESTING: The patients underwent medical and ophthalmologic evaluation. The diagnosis of Lyme borreliosis was based on medical history, clinical ocular and systemic findings, determinations of antibodies to Borrelia burgdorferi by enzyme-linked immunosorbent assay and immunoblot analysis, the detection of DNA of B. burgdorferi by polymerase chain reaction, and exclusion of other infectious and inflammatory causes.
MAIN OUTCOME MEASURES: Ocular complaints, presenting ophthalmologic findings, and the stage of Lyme borreliosis were recorded.
RESULTS: Four patients presented with a neuro-ophthalmologic disorder, five had external ocular inflammation, 10 patients had uveitis, and one had branch retinal vein occlusion.
One patient developed episcleritis and one patient developed abducens palsy within 2 months of the infection incident. In the remaining 14 patients in whom the time of infection was traced, the ocular manifestations appeared in the late stage of Lyme borreliosis.
Two patients with a neuro-ophthalmologic disorder and one with external ocular inflammation experienced severe photophobia, whereas the main reported symptom of the patients with uveitis was decreased visual acuity.
Four patients with external ocular disease and one with a neuro-ophthalmologic disorder experienced severe periodic ocular or facial pain. Retinal vasculitis developed in seven patients with uveitis.
CONCLUSIONS: Lyme borreliosis can cause a variety of ocular manifestations, which develop mainly in the late stage of the disease. Photophobia and severe periodic ocular pain can be characteristic symptoms of Lyme borreliosis. In the differential diagnosis of retinal vasculitis, Lyme borreliosis should be taken into account, especially in endemic areas.
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Br J Ophthalmol. 1999 Oct;83(10):1149-52.
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Ocular manifestations in children and adolescents with Lyme arthritis.
Huppertz HI, Münchmeier D, Lieb W.
Children's Hospital, University of Würzburg, Würzburg, Germany.
BACKGROUND: Lyme arthritis is the most frequent late manifestation of Lyme borreliosis and has been associated with ocular inflammation.
METHODS: A group of 153 children and adolescents with arthritis, 84 of whom had Lyme arthritis and 69 other causes of arthritis, were followed prospectively for 22-73 (median 44) months in the course of a national study.
RESULTS: Three of 84 patients with Lyme arthritis had ocular inflammation (4%), including keratitis, anterior uveitis, and uveitis intermedia. All three had symptoms of decreased visual acuity. Whereas anterior uveitis disappeared without sequelae, a corneal scar and a permanent loss of visual acuity in the patients with keratitis and intermediate uveitis remained. Systematic examination of all patients revealed no further ocular involvement.
Of 69 patients with other causes of arthritis who were followed in parallel as a control group, four of 15 patients with early onset pauciarticular juvenile rheumatoid arthritis had chronic anterior uveitis and two of 12 patients with juvenile spondyloarthropathy had acute anterior uveitis.
CONCLUSIONS: Ocular involvement with keratitis, anterior uveitis, and intermediate uveitis may occur in children and adolescents with Lyme arthritis. Visual loss appears to be symptomatic, making regular ocular screening of such patients unnecessary.
PMID: 10502576 [PubMed - indexed for MEDLINE]