Long-Term Clinical and Multimodal Imaging Findings in Patients with Disseminated Mycobacterium Chimaera Infection

Abstract

Background: To analyze long-term ophthalmic clinical and multimodal imaging findings of disseminated Mycobacterium (M.) chimaera infection after cardiothoracic surgery among the Swiss Cohort. Methods: Systemic and multimodal ophthalmic imaging and clinical findings including rate of recurrence were reviewed and correlated to a previously proposed classification system of choroidal lesions and classification of ocular disease. Main Outcomes Measures: long-term clinical and multimodal ocular imaging findings of M. chimaera. Results: Twelve patients suffering from systemic infection from M. chimaera were included. Mean age at the first ophthalmic examination was 59 years (range from 48 to 66 years). Mean duration of the follow-up was 22.63 ± 17.8 months. All patients presented with bilateral chorioretinal lesions at baseline; 5 patients had additional signs, including optic disc swelling (2), choroidal neovascularization (1), retinal neovascularization (1) and cilioretinal vascular occlusion (1). Four recurrence events after discontinuation or adjustment of the antibiotic treatment were observed. Progressive choroiditis was seen in 5 patients under treatment, 4 of them deceased. Conclusions: Expertise from ophthalmologists is not only relevant but also critical for the assessment of the adverse drug effect of antimycobacterial treatment along with monitoring therapeutic response and identifying recurrences.

Mycobacterium chimaera chorioretinitis preceding central nervous system lesions: a case report and review of the literature

“…Zweifel et al found that choroidal lesions were hyperfluorescent on fluorescein angiography and hypofluorescent on ICG angiography, correlating with lesions seen on SD-OCT [ 7 ]. The hypofluorescence seen on ICG angiography reflects nonperfusion from active or previously active lesions [ 7 , 11 ]. The hyperfluorescence seen on fluorescein angiography correlated to choroidal thickening and retinal elevation on SD-OCT [ 7 , 25 ].…”

“…Overall, the prognosis of disseminated M. chimaera infection is poor with an estimated mortality rate of 50% [ 2 , 6 , 9 , 26 , 27 ]. Systemic complications of disseminated M. chimaera infection can include splenomegaly, cytopenia, osteomyelitis, pneumonitis, hepatitis, nephritis, skin infection, chorioretinitis, cerebral vasculitis, endocarditis, myocarditis, mediastinitis, encephalopathy, and bloodstream infection [ 2 , 10 , 11 , 19 , 21 ].…”

“…In all previous cases, no neuroimaging was completed when the ocular involvement was discovered and thus, concomitant CNS and ocular involvement cannot be excluded [ 7 , 9 , 10 ]. One case reported systemic disseminated infection which developed CNS and ocular involvement 2 months later [ 11 ]. With this case, the timing of CNS and ocular involvement cannot be discerned because they were discovered at the same time [ 11 ].…”

“…One case reported systemic disseminated infection which developed CNS and ocular involvement 2 months later [ 11 ]. With this case, the timing of CNS and ocular involvement cannot be discerned because they were discovered at the same time [ 11 ].…”

Effect of Valsalva Maneuver on Choriocapillary Retinal Microvasculature

“…OCTA is able to provide quantitative microvascular information such as vessel density (VD) and vessel length density (VLD) 7 , 8 , 9 , 10 . Additionally, OCTA allows a clear and detailed visualization of retinal and choroidal microvasculature, and it is useful either for diagnostic purposes or for guiding treatment, and monitoring different retinal diseases, such as Fabryʼs disease, systemic sclerosis, optic neuritis, and infectious diseases affecting the choroid or retina 11 , 12 , 13 , 14 , 15 , 16 . Others demonstrated that VD does not change during the Valsalva maneuver in healthy young probands 17 .…”