Báo cáo y học: "Ocular manifestations of Rickettsiosis: 2. Retinal involvement and treatment" docx

Int. J. Med. Sci. 2009, 6 http://www.medsci.org 128 I I n n t t e e r r n n a a t t i i o o n n a a l l J J o o u u r r n n a a l l o o f f M M e e d d i i c c a a l l S S c c i i e e n n c c e e s s 2009; 6(3):128 © Ivyspring International Publisher. All rights reserved Short Communication Ocular manifestations of Rickettsiosis: 2. Retinal involvement and treat- ment Leila El Matri Department of Ophthalmology - Heidi Raies Eye Institute,Tunis (Tunisia) Published: 2009.03.19 The presence of retinitis, retinal vasculitis, optic neuropathy, or any intraocular inflammatory condi- tion in a patient with fever or rash, living in or re- turning from from an endemic area, especially during spring or summer, strongly suggests a diagnosis of Rickettsiosis. Systemic fundus examination, complemented with fluorescein angiography and ICG angiography in selected cases, may help establish the diagnosis of rickettsiosis while serologic testing is pending. Pre- vention is the mainstay of the disease control i.e. personal prevention against tick bites in endemic ar- eas and improvement of sanitary conditions. In patients with rickettsiosis retinal vascular in- volvement may present different clinical pictures: branch retinal artery occlusion, cystoid macular oe- dema, serous retinal detachment, and hypofluores- cent choroidal spots. [1] Rickettsial retinitis presents as white retinal lesions that are typically juxtavascular in location and are associated with mild vitreitis. Dif- ferential diagnosis with Toxoplasmosis is often re- quired. Large foci tend to involve all retinal layers extending to the retinal pigment epithelium and more deeply until the choroid. Small foci may also involve the entire retinal thickness, but in some cases only superficial retinal layers are involved and lesions re- semble cotton-wool spots. White retinal lesions may number from 1 to more than 5, may be variable in size and located at the periphery or posteriorly. If the optic disk is involved, there may be disc oedema and staining. [2] Treatment Systemic antibiotic treatment with doxycycline (100 mg/day for 10-14 days) represents the basic treatment. Systemic steroids, in association with do- cycycline is mandatory in the case of severe retinitis extending to the macular region, vitriitis, retinal vas- cular occlusion or optic nerve involvement. Further- more, the ophthalmologist should also choose to add local therapy, depending on the main ocular symptom i.e. topical antibiotics for conjunctivits or keratitis, topical steroids and mydriatics if anterior uveitis is present. References 1. Moncef Khairallah, Ahmed Ladjimi, Mohamed Chakroun, Riad Messaoud, Salim Ben Yahia, Sonia Zaouali, Foued Ben Romdhane, Noureddine Bouzouaia. Posterior segment mani- festations of Rickettsia conorii infection. Ophthalmology 2004; 111:529-534 2. Moncef Khairallah, Sonia Zaouali, Salim Ben Yahia, Ahmed Ladjimi, Riadl Messaoud and Sonia Attia. Anterior Ischemic Optic Neuropathy Associated with Rickettsia Conorii Infection. J Neuro-Ophthalmol 2005; 25:3 . S S c c i i e e n n c c e e s s 20 09; 6(3): 128 © Ivyspring International Publisher. All rights reserved Short Communication Ocular manifestations of Rickettsiosis: 2. Retinal involvement and treat- ment Leila. periphery or posteriorly. If the optic disk is involved, there may be disc oedema and staining. [2] Treatment Systemic antibiotic treatment with doxycycline (100 mg/day for 10-14 days) represents. Department of Ophthalmology - Heidi Raies Eye Institute,Tunis (Tunisia) Published: 20 09.03.19 The presence of retinitis, retinal vasculitis, optic neuropathy, or any intraocular inflammatory condi- tion