Bilateral presumed macular retinitis secondary to Rickettsial infection in south India

Kamath, Yogish Subraya; Gonsalves, Sarita R J; Vivekanand, Undrakonda; Bhat, Shailaja S; Rajurkar, Ketaki

doi:10.1177/0049475516660466

Cited by 3 publications

(4 citation statements)

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“…[ 6 ] Kamath et al . [ 7 ] reported an isolated case from South India with similar history and ocular features and WFT positivity.…”

Section: Discussionmentioning

confidence: 99%

“…Only sporadic accounts of ocular manifestations of rickettsiosis have been reported from India. [ 5 6 7 ] We report ocular manifestations, treatment given, and visual outcome in a subset of patients with systemic rickettsial disease who attended the Uvea Clinic in our tertiary eye care center. To the best of our knowledge, this is the first incidence of a case series on ocular rickettsiosis ( R. conorii ) being reported as a cluster from India.…”

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confidence: 99%

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Ocular manifestations of Rickettsia conorii in South India

Balasundaram

Manjunath

Baliga

et al. 2018

Indian J Ophthalmol

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Purpose:Among the major groups of rickettsiosis, the commonly reported diseases in India are: (a) Typhus group induced—scrub typhus, murine flea-borne typhus; (b) Spotted fever group induced—Indian tick typhus; and (c) Q fever. Though many scrub typhus outbreaks have been reported from India, only one outbreak of spotted fever—serologically proven Indian tick typhus (Rickettsia conorii)—has been reported. We report for the first time ocular manifestations of serologically proven R. conorii infection in a cluster of patients.Methods:In this retrospective study, case records patients with serologically proven Indian tick typhus (Rickettsia conorii) were reviewed for clinical manifestations and treatment outcomes.Results:In the months of February to April 2016, a cluster of 12 patients (23 eyes) visited us with defective vision. Examination showed multifocal retinitis; mostly bilateral; patients had a history of fever approximately 4 weeks prior to onset of symptoms. After excluding other causes of multifocal retinitis, a diagnosis of rickettsial retinitis was made after Weil–Felix test (WFT) was significantly positive, and enzyme-linked immunosorbent assay was positive for R. conorii. Course of the disease, visual outcome, and investigations are discussed. Doxycycline along with oral corticosteroids was effective in treating the condition.Conclusion:Systematic fundus examination should be part of the routine evaluation of any patient who presents with fever and/or skin rash living in or returning from a specific endemic area. Clinical clues to diagnosing ocular rickettsiosis could be multifocal retinitis predominantly involving the posterior pole and macular involvement in the form of serous macular detachment or macular hard exudates. A positive WFT still serves as a useful and cheap diagnostic tool for laboratory diagnosis of rickettsial disease. Doxycycline along with oral corticosteroids was effective in treating the condition.

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“…[ 6 ] Kamath et al . [ 7 ] reported an isolated case from South India with similar history and ocular features and WFT positivity.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Ocular manifestations of Rickettsia conorii in South India

Balasundaram

Manjunath

Baliga

et al. 2018

Indian J Ophthalmol

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“…Visual recovery occurs over three to five months with a resolution of retinal lesions. Most studies and case reports reported good visual recovery in patients with PFR due to rickettsial disease [ 2 , 4 , 10 , 11 , 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Post-fever Retinitis With a Positive Weil-Felix Test: A Study From a Tertiary Center in South India

Wani,

Tenagi,

Bubanale

et al. 2024

Cureus

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Background Post-fever retinitis (PFR) is reported two to six weeks after fever and affects one or both eyes. Rickettsial fever is one of the most common causes of PFR. This study aimed to report the clinical features and treatment outcomes of PFR cases with a positive Weil-Felix test. Methodology In this study, we collected demographic data, fever details, eye symptoms, ocular examination findings, optical coherence tomography (OCT) and fundus fluorescein angiography findings, laboratory findings, and length of follow-up of consecutive PFR cases with a positive Weil-Felix test. All cases were treated with oral doxycycline and prednisolone. Final best-corrected visual acuity (BCVA) and ocular examination findings were recorded. Visual field examination and follow-up OCT results were noted if available. Results A total of nine patients (eight males) with a mean age of 39.1 years with fever before ocular symptoms and positive Weil-Felix test were included. Six patients had bilateral disease. The mean initial and final BCVA in the affected eyes was 1.16 and 0.35 logMAR units, respectively (p < 0001). All 15 eyes had typical white retinitis patches and retinal hemorrhages which resolved after treatment. OCT showed hyperreflectivity and inner retinal disorganization over retinitis patches. White subretinal lines were noted in three patients and retinal nerve fiber bundle defect with corresponding visual field defect was seen in one eye. Conclusions In this study, PFR due to rickettsia infections has been reported from our region for the first time. Hence, eye specialists in the region should be aware of this entity.

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“…Rickettsial retinitis is increasingly being reported from the Indian subcontinent. [ 1 2 ] Rickettsia has to be considered in the standard list of differential diagnosis for cases of postfever retinitis/epidemic retinitis. It is definitely controversial whether a case of epidemic retinitis is because of direct microbial invasion or an immune-mediated phenomenon.…”

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confidence: 99%