Pathogenic microorganisms in ocular fluid of infectious uveitis patients with acquired immunodeficiency syndrome_Chinese Journal of Ocular Fundus Diseases

Authors：

Yang Yaling ¹ , He Taiwen ¹ , Chen Lirong ¹ , Bai Lin ² , Zhang Renfang ³ , Liu Qian ¹ ,  Lu Hongzhou ³

1. Department of Ophthalmplogy, Shangahi Public Health Clinical Center, Shanghai 201508, China;
2. Department of Ophthalmplogy, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai 200080, China;
3. Department of Infection and Immunology, Shanghai Public Health Clinical Center, Shanghai 201508, China;

Corresponding author：

Lu Hongzhou, Email: luhongzhou@shphc.org,cn

Keywords：

Acquired immunodeficiency syndrome/complications; Uveitis/etiology; Noxae; Aqueous humor

DOI：

10.3760/cma.j.cn511434-20200518-00219

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Objective To study the distribution of pathogenic microorganisms in the ocular fluid of patients with acquired immunodeficiency syndrome (AIDS) and infectious uveitis.Methods It was a retrospective case analysis. From June 2018 to December 2019, 31 AIDS patients with infectious uveitis who were hospitalized or outpatient at Shanghai Public Health Clinical Center were included in the study. Among them, there were 30 males and 1 female; the average age was 38.51±11.17 years. There were 20 cases of panuveitis, 10 cases of posterior uveitis, and 1 case of infectious endophthalmitis. Serum CD4⁺T lymphocyte count (CD4⁺TC) were 0 - 239/μl during the same period. The second-generation gene sequencing technology was used to detect the collected intraocular fluid. Among 31 specimens, aqueous humor and vitreous humor were 27 and 4 respectively.Results Among 31 specimens, 18 samples (58.1%, 18/31) of cytomegalovirus (CMV) were detected; varicella-zoster virus (VZV) were detected in 5 samples (16.1%, 5/31); Epstein-Barr virus were detected in 9 samples (29.0%, 9/31); human beta herpes virus type 6 (HHV6) were detected in 3 samples (9.7%, 3/31), human papillary molluscum virus (HPV), human polyoma virus, type G hepatitis virus were separately detected in 1 sample (3.2%, 1/31), all coexisting with other microorganisms. Parvovirus were detedcted in 8 samples (25.8%, 8/31); treponema pallidum were detedcted in 5 samples (16.1%, 5/31); toxoplasma gondii and Harmon coccidia were detedcted in 1 sample (3.2%, 1/31); synitelium Polycarpum were detedcted in 1 sample (3.2%, 1/31); mycobacterium tuberculosis complex, fungi, and microbacteria coexist were detedcted in 1 sample (3.2%, 1/31). Among the 18 CMV specimens, the number of gene sequences was more than 1059 (50.0%), and 104-1055 (27.7%). Among the 5 specimens of VZV, the number of gene sequences was＞1044 (80.0%). In one specimen, the mycobacterium tuberculosis complex, fungi, and microbacteria coexist, and the number of gene sequences were all＜100. The number of gene sequences of HHV6, HPV, human polyoma virus, type G virus, and parvovirus in all specimens was small. Among 31 specimens, 15 (48.4%) of pathogenic microorganisms were detected at least 2 species.Conclusions CMV and VZV are the main pathogenic microorganisms of infective uveitis in patients with serum CD4⁺TC＜100/μl; treponema pallidum, toxoplasma gondii or other protozoa, mycobacterium tuberculosis, and fungi cause more infectious uveitis which are common in AIDS patients with serum CD4⁺TC＞100/μl. The coexistence of two or more microorganisms can be detected in the intraocular fluid of AIDS patients with infectious uveitis.

Citation： Yang Yaling, He Taiwen, Chen Lirong, Bai Lin, Zhang Renfang, Liu Qian, Lu Hongzhou. Pathogenic microorganisms in ocular fluid of infectious uveitis patients with acquired immunodeficiency syndrome. Chinese Journal of Ocular Fundus Diseases, 2020, 36(9): 675-679. doi: 10.3760/cma.j.cn511434-20200518-00219 Copy

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10.	Harper TW, Miller D, Schiffman JC, et al. Polymerase chain reaction analysis of aqueous and vitreous specimens in the diagnosis of posterior segment infectious uveitis[J]. Am J Ophthalmol, 2009, 147(1): 140-147. DOI: 10.1016/j.ajo.2008.07.043.
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1. Mi H, Ho SL, Lim WK, et al. Trends in patterns of posterior uveitis and panuveitis in a tertiary institution in Singapore[J]. Ocul Immuno Inflamm, 2015, 23(4): 329-338. DOI: 10.3109/09273948.2014.946148.
2. Cheung CSY, Jekielek A, Bakshi N, et al. Clinical features of infectious posterior segment uveitis[J]. Can J Ophthalmol, 2018, 53(4): 425-431. DOI: 10.1016/j.jcjo.2017.11.004.
3. Abaño JM, Galvante PR, Siopongco P, et al. Review of epidemiology of uveitis in Asia: pattern of uveitis in a tertiary hospital in the Philippines[J]. Ocul Immunol Inflamm, 2017, 25(Sup1): S75-80. DOI: 10.1080/09273948.2017.1335755.
4. Khochtali S, Gargouri S, Zina S, et al. Acute multifocal retinitis: a retrospective review of 35 cases[J]. J Ophthalmic Inflamm Infect, 2018, 8(1): 18. DOI: 10.1186/s12348-018-0160-9.
5. Yen YF, Feng TY, Yi-Fong Su V, et al. Human immunodeficiency virus infection increases the risk of incident uveitis among people living with HIV/AIDS[J]. J Acquir Immune Defic Syndr, 2018, 79(2): 149-157. DOI: 10.1097/QAI.0000000000001782.
6. Schaftenaar E, Meenken C, Baarsma GS, et al. Uveitis is predominantly of infectious origin in a high HIV and TB prevalence setting in rural South Africa[J]. Br J Ophthalmol, 2016, 100(10): 1312-1316. DOI: 10.1136/bjophthalmol-2016-308645.
7. Smit DP, Esterhuizen TM, Meyer D, et al. The etiology of intraocular inflammation in HIV positive and HIV negative adults at a tertiary hospital in Cape Town, South Africa[J]. Ocul Immunol Inflamm, 2019, 27(2): 203-210. DOI: 10.1080/09273948.2018.1476555.
8. Mwanza J, Kayembe D. Uveitis in HIV-infected patients[J]. Eur J Ophthalmol, 2001, 11(1): 53-56. DOI: 10.1177/112067210101100110.
9. Scheepers MA, Lecuona KA, Rogers G, et al. The value of routine polymerase chain reaction analysis of intraocular fluid specimens in the diagnosis of infectious posterior uveitis[J/OL]. Scientific World Journal, 2013, 2013: 545149[2013-10-22]. http://europepmc.org/abstract/MED/24250270. DOI: 10.1155/2013/545149.
10. Harper TW, Miller D, Schiffman JC, et al. Polymerase chain reaction analysis of aqueous and vitreous specimens in the diagnosis of posterior segment infectious uveitis[J]. Am J Ophthalmol, 2009, 147(1): 140-147. DOI: 10.1016/j.ajo.2008.07.043.
11. Pathanapitoon K, Kongyai N, Sirirungsi W, et al. The diagnostic value of intraocular fluid analysis by polymerase chain reaction in Thai patients with uveitis[J]. Trans R Soc Trop Med Hyg, 2011, 105(11): 650-654. DOI: 10.1016/j.trstmh.2011.08.003.
12. Kumar A, Singh MP, Bansal R, et al. Development and evalution of multiplex real-time PCR for diagnosis of HSV-1, VZV, CMV, and toxoplasma gondii in patients with infectious uveitis[J]. Diagn Microbiol Infect Dis, 2017, 89(3): 191-196. DOI: 10.1016/j.diagnmicrobio.2017.08.002.
13. Sandhu HS, Hajrasouliha A, Kaplan HJ, et al. Diagnostic utility of quantitative polymerase chain reaction versus culture in endophthalmitis and uveitis[J]. Ocul Immunol Inflamm, 2019, 27(4): 578-582. DOI: 10.1080/09273948.2018.1431291.
14. Rose-Nussbaumer J, Goldstein DA, Thorne JE, et al. Uveitis in human immunodefificiency virus-infected persons with CD4⁺ T-lymphocyte count over 200 cells/ml[J]. Clin Exp Ophthalmol, 2014, 42(2): 118-125. DOI: 10.1111/ceo.12141.

Chinese Journal of Ocular Fundus Diseases

Pathogenic microorganisms in ocular fluid of infectious uveitis patients with acquired immunodeficiency syndrome

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