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Intraocular inflammation as the main manifestation of Rickettsia conorii infection.

Agahan AL, Torres J, Fuentes-Páez G, Martínez-Osorio H, Orduña A, Calonge M - Clin Ophthalmol (2011)

Bottom Line: The main symptoms were visual loss, floaters, eye redness, photophobia, and ocular pain.Predominant ophthalmic signs included vasculitis, choroiditis, vitritis, and macular edema.Intraocular inflammation can occur as the main manifestation of Rickettsia conorii or Rickettsia spp. infection.

View Article: PubMed Central - PubMed

Affiliation: Ocular Immunology and Uveitis Unit, Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, Valladolid, Spain.

ABSTRACT

Objective: To report the clinical features and management of seven cases of intraocular inflammation caused by Rickettsia infection and review published literature.

Methods: Rickettsia conorii or Rickettsia spp. infection was diagnosed based on the following criteria: (1) positive serology according to the European Guidelines, (2) titer normalization after specific treatment, and (3) complete resolution of ophthalmic disease and accompanying symptoms after antibiotic therapy.

Results: Seven patients were referred for uveitis of unknown etiology. All came from regions where Mediterranean spotted fever is prevalent. One patient met the European guidelines criteria for Rickettsia spp. infection, while the other six cases met the criteria for R. conorii infection. The main symptoms were visual loss, floaters, eye redness, photophobia, and ocular pain. Predominant ophthalmic signs included vasculitis, choroiditis, vitritis, and macular edema. All patients required antibiotic treatment that resulted in the remission of the infection. Doxycycline was the first choice and the only antibiotic used to treat four patients. One patient needed ciprofloxacin as a second antibiotic after not responding to doxycycline. Two patients had doxycycline as a second antibiotic after not responding primarily to sulfonamides (which had been given after 2-3 days of doxycycline gastric intolerance); one of these patients needed ciprofloxacin as a third antibiotic.

Conclusion: Intraocular inflammation can occur as the main manifestation of Rickettsia conorii or Rickettsia spp. infection. It should be considered as a differential diagnosis for uveitis especially for patients living in countries where this infection is endemic in the world. Antibiotic treatment remains effective in the management of Rickettsia infection.

No MeSH data available.


Related in: MedlinePlus

Case 5. After treatment with sulfonamides and doxycycline, fundus photo shows that disc vessels are still dilated, but with distinct disc borders. There is marked decrease in vessel tortuosity and dilation. There is also an evident decrease in retinal edema and hemorrhages as compared to Figure 1A.
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f1b-opth-5-1401: Case 5. After treatment with sulfonamides and doxycycline, fundus photo shows that disc vessels are still dilated, but with distinct disc borders. There is marked decrease in vessel tortuosity and dilation. There is also an evident decrease in retinal edema and hemorrhages as compared to Figure 1A.

Mentions: The main symptoms included loss of vision in seven eyes and floaters in four eyes. Less frequently, the patients presented with redness, photophobia, and pain. Ophthalmic examinations revealed vitritis in nine eyes, macular edema in five eyes, and vasculitis, the predominant feature as expected, in six eyes. The vasculitis was venous and focal in nature with sheathing and mild leakage in all cases, except in Case 5, where phlebitis was more diffuse. Other ophthalmic signs included central retinal vein thrombosis in Case 5 (Figure 1A and 1B), due to venous inflammation, focal choroiditis, multifocal choroiditis, focal keratopathy, anterior chamber cells, posterior synechiae, retinal hemorrhages, and papillitis. Four cases were unilateral and three were bilateral. All patients had frequent contact with dogs and two patients were aware of insect bites, including one by tick and one by flea. One of the two patients recalled a cutaneous lesion compatible with erythema migrans after a tick bite. Three patients described transient extraocular manifestations of arthralgias and fever that had already disappeared before their first visit with us.


Intraocular inflammation as the main manifestation of Rickettsia conorii infection.

Agahan AL, Torres J, Fuentes-Páez G, Martínez-Osorio H, Orduña A, Calonge M - Clin Ophthalmol (2011)

Case 5. After treatment with sulfonamides and doxycycline, fundus photo shows that disc vessels are still dilated, but with distinct disc borders. There is marked decrease in vessel tortuosity and dilation. There is also an evident decrease in retinal edema and hemorrhages as compared to Figure 1A.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3198414&req=5

f1b-opth-5-1401: Case 5. After treatment with sulfonamides and doxycycline, fundus photo shows that disc vessels are still dilated, but with distinct disc borders. There is marked decrease in vessel tortuosity and dilation. There is also an evident decrease in retinal edema and hemorrhages as compared to Figure 1A.
Mentions: The main symptoms included loss of vision in seven eyes and floaters in four eyes. Less frequently, the patients presented with redness, photophobia, and pain. Ophthalmic examinations revealed vitritis in nine eyes, macular edema in five eyes, and vasculitis, the predominant feature as expected, in six eyes. The vasculitis was venous and focal in nature with sheathing and mild leakage in all cases, except in Case 5, where phlebitis was more diffuse. Other ophthalmic signs included central retinal vein thrombosis in Case 5 (Figure 1A and 1B), due to venous inflammation, focal choroiditis, multifocal choroiditis, focal keratopathy, anterior chamber cells, posterior synechiae, retinal hemorrhages, and papillitis. Four cases were unilateral and three were bilateral. All patients had frequent contact with dogs and two patients were aware of insect bites, including one by tick and one by flea. One of the two patients recalled a cutaneous lesion compatible with erythema migrans after a tick bite. Three patients described transient extraocular manifestations of arthralgias and fever that had already disappeared before their first visit with us.

Bottom Line: The main symptoms were visual loss, floaters, eye redness, photophobia, and ocular pain.Predominant ophthalmic signs included vasculitis, choroiditis, vitritis, and macular edema.Intraocular inflammation can occur as the main manifestation of Rickettsia conorii or Rickettsia spp. infection.

View Article: PubMed Central - PubMed

Affiliation: Ocular Immunology and Uveitis Unit, Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, Valladolid, Spain.

ABSTRACT

Objective: To report the clinical features and management of seven cases of intraocular inflammation caused by Rickettsia infection and review published literature.

Methods: Rickettsia conorii or Rickettsia spp. infection was diagnosed based on the following criteria: (1) positive serology according to the European Guidelines, (2) titer normalization after specific treatment, and (3) complete resolution of ophthalmic disease and accompanying symptoms after antibiotic therapy.

Results: Seven patients were referred for uveitis of unknown etiology. All came from regions where Mediterranean spotted fever is prevalent. One patient met the European guidelines criteria for Rickettsia spp. infection, while the other six cases met the criteria for R. conorii infection. The main symptoms were visual loss, floaters, eye redness, photophobia, and ocular pain. Predominant ophthalmic signs included vasculitis, choroiditis, vitritis, and macular edema. All patients required antibiotic treatment that resulted in the remission of the infection. Doxycycline was the first choice and the only antibiotic used to treat four patients. One patient needed ciprofloxacin as a second antibiotic after not responding to doxycycline. Two patients had doxycycline as a second antibiotic after not responding primarily to sulfonamides (which had been given after 2-3 days of doxycycline gastric intolerance); one of these patients needed ciprofloxacin as a third antibiotic.

Conclusion: Intraocular inflammation can occur as the main manifestation of Rickettsia conorii or Rickettsia spp. infection. It should be considered as a differential diagnosis for uveitis especially for patients living in countries where this infection is endemic in the world. Antibiotic treatment remains effective in the management of Rickettsia infection.

No MeSH data available.


Related in: MedlinePlus