1/61. Conservative management of documented neuroretinitis in cat scratch disease associated with bartonella henselae infection.BACKGROUND: bartonella henselae has been identified as the causative agent of the neuroretinitis associated with cat scratch disease (CSD). Immunofluorescent antibody tests with good sensitivity and specificity are available to aid in diagnosis. Despite diagnostic advances, optimal management remains controversial. We present a case of documented B. henselae macular neuroretinitis managed without antibiotics and discuss antibiotic use in this condition. methods: We examined a young woman with macular neuroretinitis and established a diagnosis of CSD. Management consisted of a review of the literature, followed by educating her about the condition and close observation. We documented the course of her disease. RESULTS: We diagnosed neuroretinitis associated with B. henselae infection based on immunofluorescent antibody titres and clinical presentation. Our patient's neuroretinitis resolved promptly without antibiotic therapy. CONCLUSIONS: Macular neuroretinitis in CSD can be satisfactorily diagnosed with the use of fluorescent antibodies in the appropriate clinical setting. Optimal treatment for the disease has not been established and observation combined with patient education remains an appropriate option. The self-limited nature of the disease implies that treatment studies not using controls must be interpreted with great caution. Adverse drug reactions and other iatrogenic complications can be reduced by limiting antibiotic use in settings where a meaningful treatment benefit has not been established.- - - - - - - - - - ranking = 1keywords = aid (Clic here for more details about this article) |
2/61. Progression of cytomegalovirus retinitis in acquired immunodeficiency syndrome: a case report.We report an AIDS patient with cytomegalovirus (CMV) retinitis that developed from an early minor lesion and progressed to extended involvement of the retina and severe deterioration of vision due to poor compliance with ganciclovir treatment. A 33-year-old man was known to have acquired immunodeficiency syndrome (AIDS) for eight months. The patient had no complaint of visual symptoms. A routine eye examination revealed his visual acuity to be 6/6 in both eyes. The dilated eye fundus examination using indirect ophthalmoscopy disclosed a localized white yellowish granular lesion in the peripheral retina of the right eye and a completely normal left eye. CMV retinitis with initial manifestation in the right eye was diagnosed. Due to incomplete treatment with ganciclovir, the retinal lesion rapidly enlarged and extended to the posterior pole, with eventual destruction of the nerve fiber layer and optic disc. The visual acuity of right eye dropped from 6/6 to 1/60 within six months. This case report indicates the importance of early, dilated eye fundus examination and recognition of early CMV retinitis in order to salvage visual function in AIDS patients. Completion of the anti-CMV treatment course in halting the progression of CMV retinitis is also emphasized.- - - - - - - - - - ranking = 306.94711320943keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
3/61. Cat-scratch neuroretinitis.BACKGROUND: cat-scratch disease is a subacute regional lymphadenitis, usually preceded by a history of a cat scratch or exposure to kittens. The disease is caused by bartonella henselae, and possibly bartonella quintana, pleomorphic gram-negative rods formerly known as Rochalimaea henselae and Rochalimaea quintana. Ocular involvement is rare and typically manifests as either Parinaud's oculoglandular syndrome or neuroretinitis. patients with neuroretinitis resulting from cat-scratch disease may be asymptomatic or experience mild-to-severe vision loss. The clinical features, angiographic appearance, differential diagnosis, and management of cat-scratch neuroretinitis are discussed. CASE REPORT: A 30-year-old white woman reported to the eye clinic with painless, decreased vision in the right eye. A diagnosis of cat scratch neuroretinitis was made on the basis of the history of cat scratch, clinical appearance, and angiographic findings. Treatment with oral ciprofloxacin restored vision to normal in 4 weeks. CONCLUSION: Painless vision loss associated with optic nerve swelling and macular star exudate should alert suspicion of systemic disease. Additional findings--including positive history of a cat scratch, lymphadenopathy, and flu-like symptoms--may indicate bartonella henselae or bartonella quintana infection. While treatment remains controversial, appropriate serology testing may aid in the diagnosis and management of the underlying infection.- - - - - - - - - - ranking = 1keywords = aid (Clic here for more details about this article) |
4/61. Demonstration of Bartonella grahamii dna in ocular fluids of a patient with neuroretinitis.We describe the clinical and laboratory features of a 55-year-old human immunodeficiency virus-negative female patient who presented with bilateral intraocular inflammatory disease (neuroretinitis type) and behavioral changes caused by a Bartonella grahamii infection. diagnosis was based on the PCR analysis of dna extracted from the intraocular fluids. dna analysis of the PCR product revealed a 100% identity with the 16S rRNA gene sequence of B. grahamii. The patient was successfully treated with doxycycline (200 mg/day) and rifampin (600 mg/day) for 4 weeks. This is the first report that demonstrates the presence of a Bartonella species in the intraocular fluids of a nonimmunocompromised patient and that indicates that B. grahamii is pathogenic for humans.- - - - - - - - - - ranking = 6.8515934395299keywords = immunodeficiency (Clic here for more details about this article) |
5/61. Exudative retinal detachment and retinitis associated with acquired syphilitic uveitis.PURPOSE: To describe three cases of exudative retinal detachment and focal retinitis associated with acquired syphilitic uveitis. methods: Three patients who were referred for evaluation of uveitis were examined. Slit-lamp examination, ophthalmoscopy, B-scan ultrasonography, fundus photography, and fluorescein angiography were performed before and after therapy. RESULTS: Each patient had uveitis with exudative retinal detachment, periphlebitis, and focal retinitis. Laboratory testing (fluorescent treponemal antibody absorption) revealed positive serology for active syphilis in all cases. Human immunodeficiency virus antibody testing was negative in all patients. retinal detachment resolved in all cases after treatment with intravenous penicillin. Despite resolution of subretinal fluid, visual acuity remained poor in eyes in which the macula was detached. CONCLUSION: syphilis is a cause of exudative retinal detachment. Antibiotic therapy can lead to retinal reattachment. Early recognition and treatment may prevent severe vision loss.- - - - - - - - - - ranking = 6.8515934395299keywords = immunodeficiency (Clic here for more details about this article) |
6/61. Diffuse toxoplasmic retinochoroiditis as the initial manifestation of acquired immunodeficiency syndrome.Toxoplasmic retinochoroiditis is an important opportunistic retinal infection in human immunodeficiency virus (hiv)-infected patients. It may present as diffuse necrotizing retinochoroiditis instead of a focal lesion and may be the initial manifestation of hiv infection. A 50-year-old heterosexual man presented with blurred vision in his left eye of 3 months' duration. Fundus examination revealed diffuse necrotizing retinochoroiditis, mainly at the posterior pole, with marked vitritis in the left eye. Serologic studies and aqueous fluid antibody titers indicated recent toxoplasmic infection. Positive enzyme immunoassays (EIA) and Western blot tests proved hiv infection. The retinochoroiditis and vitritis improved after an antitoxoplasmic regimen with trimethoprim-sulfamethoxazole (TMP-SMX). Nonetheless, toxoplasmic encephalitis developed 6 months after the onset of ocular toxoplasmosis and responded well to TMP-SMX. This is the first case of toxoplasmic retinochoroiditis as the initial manifestation of AIDS reported in taiwan. We suggest that toxoplasma infection should be included in the differential diagnosis of diffuse necrotizing retinochoroiditis and vitritis. We also recommend that adults with newly diagnosed ocular toxoplasmosis be screened for hiv infection.- - - - - - - - - - ranking = 252.40928400707keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
7/61. Progressive outer retinal necrosis and acute retinal necrosis in fellow eyes of a patient with acquired immunodeficiency syndrome.PURPOSE: To describe an unusual concurrence of acute retinal necrosis and progressive outer retinal necrosis in fellow eyes of a patient with acquired immunodeficiency syndrome (AIDS). methods: Interventional case report. In a 37-year-old man with AIDS and herpes zoster keratitis in the right eye, progressive outer retinal necrosis developed in the right eye and acute retinal necrosis developed in the left eye. RESULTS: Disparate presentations of retinitis persisted in each eye, and retinal detachment and vision loss ensued in both eyes despite antiviral therapy. CONCLUSION: Distinct features of acute retinal necrosis and progressive outer retinal necrosis do not necessarily reflect systemic factors, and they may be variant manifestations of the same underlying infection.- - - - - - - - - - ranking = 306.94711320943keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
8/61. Identification of a unique bk virus variant in the CNS of a patient with AIDS.Human polyomavirus BK (BKV; GenBank or EMBL or DDBJ accession no. NC001538) is often reactivated in immunosuppressed patients. Reactivation has been associated primarily with excretion of the virus in the urine, and there have been few reports of renal and/or neurological disease caused by BKV in patients with acquired immunodeficiency syndrome (AIDS). polymerase chain reaction, Southern blotting, and sequencing were used to detect and identify the noncoding control region (NCCR) of BKV in different tissues in an AIDS patient with meningoencephalitis, retinitis, and nephritis. An undescribed reorganized NCCR variant of the virus, completely different from the variants detected in peripheral blood leukocytes (PBLs) and urine, was identified in the cerebrospinal fluid (CSF) and CNS tissues. These results suggest that rearrangements in the NCCR of the virus have resulted in a BKV variant, which is better adapted to the host cell machinery of the cells in CNS tissue. The rearranged variant (BKV CNS) might have been involved in the initiation and/or development of the pathological lesions observed in the CNS-related tissues of this patient.- - - - - - - - - - ranking = 61.389422641886keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
9/61. Sustained-release ganciclovir therapy for treatment of cytomegalovirus retinitis. Use of an intravitreal device.A surgically implantable device for sustained intravitreal release of ganciclovir has been developed. The device delivers ganciclovir intraocularly over approximately 4 to 5 months. Eight patients with acquired immunodeficiency syndrome (AIDS) and associated cytomegalovirus (CMV) retinitis were recruited as part of a phase 1 study. Thirteen eyes with active CMV retinitis underwent surgical implantation of the ganciclovir device. All eyes showed resolution of the CMV retinitis; none showed progression. visual acuity remained unchanged in three eyes, improved in six eyes, and decreased in four eyes. Surgical complications included mild vitreous hemorrhage, astigmatism, and suprachoroidal placement of the device. retinal detachment occurred in three eyes as the retinitis resolved. This new intraocular drug delivery system offers many advantages compared with intravenous therapy or repeated intravitreal ganciclovir injections for the management of CMV retinitis in patients with AIDS.- - - - - - - - - - ranking = 61.389422641886keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
10/61. Treatment of aggressive cytomegalovirus retinitis with ganciclovir in combination with foscarnet in a child infected with human immunodeficiency virus.ganciclovir and foscarnet are both effective for cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome, but the benefits of either agent given alone are limited. A child infected with human immunodeficiency virus who had cytomegalovirus retinitis that progressed despite treatment with either agent alone received the combination of ganciclovir and foscarnet. This treatment resulted in a sustained clinical response.- - - - - - - - - - ranking = 95.647389839536keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
| | Next -> |