High Prevalence of Fastidious Bacteria in 1520 Cases of Uveitis of Unknown Etiology

Abstract

The etiologic evaluation of uveitis is frequently unsuccessful when noninvasive methods are used. We conducted a prospective study to evaluate systematic screening for pathogens of uveitis. All patients with uveitis referred to the participating tertiary ophthalmology departments from January 2001 to September 2007 underwent intraocular and serum specimen collection. The standardized protocol for laboratory investigations included universal polymerase chain reaction (PCR)-based detection of any bacteria and mycoses, specific PCR-based detection of fastidious (difficult-to-grow) bacteria and herpes viruses, and culture of vitreous fluid. Sera were tested for fastidious bacteria. Among the 1321 included patients (1520 specimens), infection was diagnosed in 147 (11.1%) patients: 78 (53%) were caused by fastidious bacteria that included spirochetes, Bartonella species, intracellular bacteria (Chlamydia species, Rickettsia species, Coxiella burnetii), and Tropheryma whipplei; 18 by herpes viruses; and 9 by fungi. Bartonella quintana, Coxiella burnetii, Paracoccus yeei, Aspergillus oryzae, and Cryptococcus albidus were found to be associated with uveitis for the first time, to our knowledge. We recommend applying a 1-step diagnostic procedure that incorporates intraocular, specific microbial PCR with serum analyses in tertiary centers to determine the etiology of uveitis.

Case Report of Cryptococcus Albidus Peritonitis in a Peritoneal Dialysis Patient and a Review of the Literature

“…To our knowledge, just 26 cases of infection with C. albidus have been reported in the world literature [ Table 1 (1,(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)]. The present case is unusual both because peritonitis with C. albidus has never before been reported, and because cryptococcal peritonitis is in general very rare, with only 4 cases having been reported in patients on PD (24).…”

Paracoccus Yeei species causing bacterical conjuctivitis with cellulitis

“…One study reported the presence of a high amount of fastidious organisms in patients with culture negative uveitis using PCR and 16s rRNA gene sequencing. Interestingly, Paracoccus yeei was identified in one patient and it was concluded that that the uveitis was attributed to this organism (1). In another Issue 3 Copyright © 2015, Knowledge Enterprises Incorporated.…”

Diagnostic dilemmas in retinitis and endophthalmitis

“…8 Although some forms of uveitis, such as birdshot or sympathetic ophthalmia, are undoubtedly autoimmune, others, such as pars planitis and sarcoidosis, which are now classified as non-infectious, may ultimately be shown to be either direct infection or host response to infection. 9 Multifocal choroiditis (MFC) and presumed ocular histoplasmosis syndrome (POHS) are distinguishable by subtle clinical appearance, 10 but most reliably by the presence of vitreitis, which by definition is absent in POHS. If vitreitis is absent in MFC it is unlikely there is active choroidal inflammation requiring treatment.…”

“…29,34 The presumption is that PCR will eventually replace culture and sensitivity testing (by amplifying loci known to determine resistance to antibiotics 35 ) and enable the detection of unsuspected, fastidious, or previously unknown pathogens. 9,36,37 Intraocular Whipple disease is diagnosable by PCR of aqueous humor or vitreous. Two positive results are considered a definitive diagnosis of uveitis related to Whipple disease.…”