Uveitis Related Infection

8/13/2019 Uveitis Related Infection

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UVEAL INFECTIONS AND INFESTATIONS

• Herpes zoster ophthalmicus

•

Acute retinal necrosis• Cytomegalovirus (CMV)

1. Viruses

• Presumed ocular histoplasmosis syndrome

• Candidiasis

5. Fungi

• Toxoplasmosis

• Ocular toxocariasis

4. Protozoa and worms

• Syphilis

• Lyme disease

2. Spirochaetes

• Tuberculosis

• Leprosy

3. Mycobacteria



Herpes zoster ophthalmicus• Iritis in 40% of cases• Within 3 weeks of onset of rash

Particularly if external nasalbranch involved - Hutchinson sign

Small-medium KP

Iris atrophy - 20%



Acquired immune deficiency syndrome (AIDS

• Pneumocystis carini ipneumonia

Opportunistic infections

• Toxoplasmosis

• Atypical mycobacterium

•

Cytomegalovirus• Cryptococcus

• Kaposi sarcoma • Lymphoma

Neoplasms

Candidiasis



Anterior features

Multiple molluscumcontagiosum

Eyelid Kaposi sarcoma Conjunctival Kaposi sarcoma

Severe herpes zosterophthalmicus

Peripheral herpes simplexkeratitis

Microsporidial keratitis



HIV retinal microangiopathy

• In 66% of AIDS

• In 40% of AIDS-related comple

• In 1% of asymptomatic HIVinfection

• Occasionally haemorrhages

• Transient cotton-wool spots



Indolent CMV retinitis

•

Frequently starts in periphery• Granular opacification • No vasculitis

• Slow progression

• Mild vitritis



Fulminating CMV retinitis

• Dense, white, confluent opacification

• Associated haemorrhages

• Mild vitritis

• May be associated with venous

sheathing• Frequently along vascular arcades



Progression of CMV retinitis

‘Brushfire-like’ extension alongcourse of retinal blood vessels

Optic nerve head involvement

Extensive retinal atrophy Atrophy and retinal detachment



Treatment of CMV retinitis

• Fewer haemorrhages

Signs of regression

• Less opacification

• Diffuse atrophic and

pigmentary changes

• Systemic - initially i.v. then oral• Intravitreal - injections or

slow-release devices

Foscarne t i.v. Ganciclovir

Cidofovir i.v.

Oth f d l i i AIDS



Other fundus lesions in AIDS

Choroidal pneumocytosis Atypical toxoplasmosisProgressive outer retinalnecrosis

Cryptococcal choroiditis Large cell lymphomaCandidiasis



Syphilis

• Uncommon, bilateral in 50%

Initially may be associated with dilatedvessels (roseolae)

Becomes chronic unless treated

Iridocyclitis

• Infection with spirochaete Treponema pall idum

• Uveitis may occur during secondary and tertiary stages



Posterior syphilitic uveitis

• May be bilateral• Frequently juxtapapillary

or central

Unifocal chorioretinitis

• May be bilateral

• Residual choroidal atrophyand RPE changes

Multifocal chorioretinitis

• Optic atrophy, vascularnon-perfusion and RPEchanges

Inactive neuroretinitis

• Usually unilateral• Disc oedema, macular

star and cotton wool spots

Acute neuroretinitis



Tuberculosis

• Negative chest X-ray does notexclude TB

• Useful in diagnosisof extrathoracic TB

• Positive skin test• Lung cavitation

• Infection with human (M. tuberculosis ) or bovine (M. bovis )

• Uveitis is uncommon and occurs during post-primary stage

Tuberculosis uveitis



Tuberculosis uveitis

Busacca nodules

Choroiditis - unifocalor multifocal

Posterior uveitis

Chronic granulomatous iridocyclitis

Mutton fat KP Koeppe nodules

Retinal periphlebitisLarge solitarychoroidal granuloma

Toxoplasmosis



Toxoplasmosis• Intracellular protozoan Toxoplasma gondii

• Cat is definitive host• Other animals and humans are intermediate hosts

Life cycles

C it l t i i l t



Congenital systemic involvement

Infestation during late pregnancymay cause hydrocephalus

Chorioretinal scarring at maculawhich may be bilateral

Severity of involvement of fetus depends on duration of gestationat time of maternal infestation

R ti kh iditi t l



Retinokhoroiditis toxoplasma

- heals within 1 to 4 months - ‘headlight in fog’

Vitritis may be severeUnifocal retinitis adjacent to old scar

• Recurrence of healed congenital lesion

• Usually between ages 10-35 years.



Pemeriksaan Penunjang

• Sabin dye test : titer 1/256

• Tes komplemen

• ELISA : IgM (+)

Treatment of toxoplasma retinitis



Treatment of toxoplasma retinitis

1. Systemic steroids

2. Clindamycin

3. Sulphonamides

4. Pyrimethamide

5. Co-trimoxazole

6. Azithromycin

Drugs

Indications

• Lesions at posterior pole, near optic disc or major blood vessel

• Very severe vitritis

•

AIDS patients irrespective of location or severity

Candidiasis



Candidiasis

• Drug addicts or compromised host• Patients with long-term indwelling catheters

Unifocal choroiditis

Risk groups

Infection with yeast-like fungus - Candida albicans

Multifocal retinitis and vitreous‘cotton-ball’ colonies

Vitreoretinal tractionEndophthalmitis

Progression

Documents

Uveitis Related Infection