Opportunistic Infections of the Eye in Immunocompromised Patients

Abstract

All opportunistic infections of the eye have their origin in the suppression of the immune system of the host. The immunosuppression can be acquired through the human immune deficiency virus or as a result of immunosuppressive therapy in solid-organ transplant recipients with a maintenance therapy of cyclosporin and prednisone or during chemotherapy in patients with myelo-proliferative disorders. Generally, in less than 2% could severe opportunistic infections of the eye, like cytomegalovirus (CMV) or herpes virus infection, be found in transplant and cancer patients with chemotherapy. About 35–70% of patients with AIDS exhibit ocular manifestations of disease, so the most notable opportunistic infection with an incidence of 35% would be CMV retinitis. Less frequent are progressive outer retinal necrosis syndrome, Kaposi’s sarcoma and optic neuropathies. This paper reviews recent advances in the diagnosis and special local therapies of the worst opportunistic infections in immunocompromised hosts.

CMV retinitis after allogeneic bone marrow transplantation: a report of five cases

“…Cytomegalovirus (CMV) retinitis (CMVR) is very rare in transplanted patients. In solid organ transplant patients less than 2% develop CMVR (1, 2) even though the pediatric population is at higher risk, especially after primary CMV infection post transplant, where an incidence as high as 14% has been reported (3). After hematopoietic stem cell transplantation (SCT), the only larger study published on development of CMVR showed an incidence of 1.4% in patients who were alive after day 100 post transplant and who had developed a chronic clinical extensive graft‐versus‐host disease (GVHD) (4).…”

Rapid regression of cystoid macular edema associated with cytomegalovirus retinitis in adult acute myeloid leukemia by intravitreal methotrexate combined with oral valganciclovir: A case report with comparison of binocular outcome

“…In a study by Crippa et al, 8 CMV retinitis was found to be a late complication of HSCT and was mainly seen in patients with antecedent CMV reactivation or disease. The median time of diagnosis of CMV retinitis was 251 days (range, 106–356 days).…”

“…CMV retinitis was the AIDS-defining diagnosis in about 5% of patients with HIV infections 7. Among SOT patients, <2% develop CMV retinitis; however, the pediatric population is at a higher risk 8. After HSCT, the only large study published on CMV retinitis development showed an incidence of 1.4% in patients who were alive 100 days post-transplant 9…”

Progressive outer retinal necrosis in immunocompromised kidney allograft recipient

“… reported the prevalence of ocular opportunistic infection, such as retinitis, in 0.69% kidney transplant recipients. Guembel and Ohrloff described severe CMV and HSV infections of the eye in < 2% of transplant and cancer patients with chemotherapy, analyzed together. Eid et al.…”