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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 4. Angiogram of both eyes shows papillary, peri-papillary, and choroidal fluorescence along the superior and inferior arcades. The macula area of the left eye also shows staining along the superior peri-foveal region.
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f2a-opth-5-1401: Case 4. Angiogram of both eyes shows papillary, peri-papillary, and choroidal fluorescence along the superior and inferior arcades. The macula area of the left eye also shows staining along the superior peri-foveal region.

Mentions: Our choice of antibiotic treatment followed the guidelines proposed by Raoult et al.25 One antibiotic course of treatment (doxycycline 100 mg/12 hours for 8–10 weeks) was sufficient in four patients (Cases 1, 2, 3, and 5). Two courses were required in three patients (Cases 6 and 7), and three antibiotic courses were required for remission in one patient (Case 4). Doxycycline was always our first choice and was enough to cure the infection in four patients. Two more patients, however (Cases 4 and 6) reported gastric complaints after 2–3 days on doxycycline and we switched them to the fixed combination, 80 mg trimethoprim–400 mg sulfamethoxazole/12 hours for 8–10 weeks, following advice of the referring internist. After failure of this antibiotic, they were given doxycycline again, this time with strict gastric protection; although still some gastric complaints were present, patients were able to complete the entire treatment. One of them (Case 6) was cured, and the other one (Case 4) required a third treatment (Figure 2A to 2D) with 750 mg/12 hours for 10 days of oral ciprofloxacin. Serology tests were negative in all patients when re-tested 3 and 6 months after the end of the antibiotic therapy.


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 4. Angiogram of both eyes shows papillary, peri-papillary, and choroidal fluorescence along the superior and inferior arcades. The macula area of the left eye also shows staining along the superior peri-foveal region.
© Copyright Policy
Related In: Results  -  Collection

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

f2a-opth-5-1401: Case 4. Angiogram of both eyes shows papillary, peri-papillary, and choroidal fluorescence along the superior and inferior arcades. The macula area of the left eye also shows staining along the superior peri-foveal region.
Mentions: Our choice of antibiotic treatment followed the guidelines proposed by Raoult et al.25 One antibiotic course of treatment (doxycycline 100 mg/12 hours for 8–10 weeks) was sufficient in four patients (Cases 1, 2, 3, and 5). Two courses were required in three patients (Cases 6 and 7), and three antibiotic courses were required for remission in one patient (Case 4). Doxycycline was always our first choice and was enough to cure the infection in four patients. Two more patients, however (Cases 4 and 6) reported gastric complaints after 2–3 days on doxycycline and we switched them to the fixed combination, 80 mg trimethoprim–400 mg sulfamethoxazole/12 hours for 8–10 weeks, following advice of the referring internist. After failure of this antibiotic, they were given doxycycline again, this time with strict gastric protection; although still some gastric complaints were present, patients were able to complete the entire treatment. One of them (Case 6) was cured, and the other one (Case 4) required a third treatment (Figure 2A to 2D) with 750 mg/12 hours for 10 days of oral ciprofloxacin. Serology tests were negative in all patients when re-tested 3 and 6 months after the end of the antibiotic therapy.

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