Coinfections and differential diagnosis in immunocompetent patients with uveitis of infectious origin

Abstract

BackgroundMaking a definite diagnosis of infectious uveitis is a challenging task because many other infectious, and non-infectious uveitis, may have similar non-specific symptoms and overlapping clinical appearances. Co-infections in immunocompetent patients are not frequently proved with traditional serologic-diagnostic tools.MethodsDescriptive transversal study, in a Uveitis Service of an Ophthalmology Reference Center, in Bogotá, Colombia, from July 2014 to February 2016. Aqueous humor (AH) and/or vitreous fluid, blood and serum samples were collected from consecutive patients suspected of having infectious uveitis. The diagnosis of ocular toxoplasmosis (OT) was confirmed by the Goldmann–Witmer coefficient (GWC) and by polymerase chain reaction (PCR). Differential diagnosis by PCR in AH was done for viral origin such as Cytomegalovirus (CMV), Herpes simplex virus type 1 (HSV1), Herpes simplex virus type 2 (HSV2), Varicella zoster virus (VZV), Epstein-Barr virus (EBV) and Mycobacterium tuberculosis.ResultsIn 66 Colombian patients with uveitis of presumed infectious origin: 22 (33.3%) were confirmed as OT, 16 (24.2%) as undetermined OT, five (7.5%) as co-infections and 23 (34.8%) as other uveitis. Toxoplasma coinfection with M. tuberculosis was identified in one case by PCR and in four cases with HSV by GWC. The initial clinical diagnosis changed, after laboratory examination, in 21 cases (31.8%).ConclusionsClinical diagnosis can be changed by laboratory examination in a significant proportion of cases of uveitis. Diagnosis of OT should combine the use of PCR and GWC to reach the maximum of confirmation of cases. The use of multiple laboratory methods is necessary to identify co-infections and viral infections that can mimic OT in immunocompetent patients.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3613-8) contains supplementary material, which is available to authorized users.

<p>Macular edema associated with non-infectious uveitis: pathophysiology, etiology, prevalence, impact and management challenges</p>

“…Some authors suggest that clinical examination might be sufficient to make a diagnosis of an underlying disease (lupus, Adamantiades–Behçet’s disease, cytomegalovirus (CMV)-related retinitis, VKH); nevertheless, one should always keep in mind that an accurate diagnosis is of outmost importance as a mistreatment might be harmful 100…”

Intraocular Infiltration

“…1 In addition, co-infections of the eye in immunocompetent patients are not frequently confirmed using serologic diagnostic methods. 2 Multiplex polymerase chain reaction (PCR) and broad-range PCR of a sample of aqueous humor, therefore, ruled out viral (human simplex virus-1 and 2, varicella zoster virus, Epstein-Barr virus, CMV, and human herpesvirus 6-8), toxoplasma, tuberculosis, syphilis, and bacterial and fungal infections, ruling out opportunistic infection and allowing the diagnosis of intraocular leukemic cell infiltration. 3 Elevated lesions on the retina improved after two vitreous injections of 400 μg/ 0.1 mL of methotrexate and subsided with five sessions of 2-Gy radiotherapy.…”

A white circular-spot pattern of iridian atrophy associated with Varicella-zoster virus and Toxoplasma gondii coinfection: a case report

“…In a study of 66 Colombian patients with uveitis of presumed infectious origin, PCR analysis of aqueous humor and vitreous humor samples suggested that 33.3% were ocular toxoplasmosis and 7.5% were caused by a coinfection. Of this last group, 4.5% corresponded to VZV and Tg co-infections [2].…”

“…Toxoplasma gondii (Tg) is the most frequent agent involved in 39.8% of these cases [1], however,~7.5% of ocular toxoplasmosis cases can coexist with other infectious agents, e.g. Mycobacterium tuberculosis, cytomegalovirus (CMV), and varicella-zoster virus (VZV) [2].…”