Infectious optic neuropathies: a clinical update

Abstract

Different forms of optic neuropathy causing visual impairment of varying severity have been reported in association with a wide variety of infectious agents. Proper clinical diagnosis of any of these infectious conditions is based on epidemiological data, history, systemic symptoms and signs, and the pattern of ocular findings. Diagnosis is confirmed by serologic testing and polymerase chain reaction in selected cases. Treatment of infectious optic neuropathies involves the use of specific anti-infectious drugs and corticosteroids to suppress the associated inflammatory reaction. The visual prognosis is generally good, but persistent severe vision loss with optic atrophy can occur. This review presents optic neuropathies caused by specific viral, bacterial, parasitic, and fungal diseases.

Central Nervous System Involvement in Common Variable Immunodeficiency: A Case of Acute Unilateral Optic Neuritis in a 26-Year-Old Italian Patient

“…However, given their increased susceptibility to infections, microbial agents must be thoroughly ruled out in CVID patients. Among infectious causes of optic neuropathy, the most commonly isolated agents are Bartonella henselae, Borrelia burgdorferi, Treponema pallidum, Mycobacterium tuberculosis, Herpesviruses, Arboviruses, Toxoplasma ( 14 , 30 – 32 ). In our patients, a wide range of possible infectious causes of ON have been investigated and excluded.…”

“…Other potential causes include Acquaporin 4 (AQP4)-IgG-positive neuromyelitis optica spectrum disorders (NMOSD) ( 12 ) and Myelin oligodendrocyte glycoprotein (MOG)-IgG-associated encephalomyelitis ( 13 ), in addition to systemic autoimmune disorders such as connective tissue diseases, vasculitides, or sarcoidosis ( 11 ). A variety of bacterial, viral, parasitic, and fungal infectious agents can also be responsible for ON ( 14 ).…”

Bilateral Optic Neuritis: A Rare Complication of Mumps

“…Banwell et al estimated the incidence of pediatric ON in Canada to be 0.2 cases per million, but there is no other study to compare the incidence of this condition with other countries [9]. It can occur following infection with various pathogens including viruses (including influenza, mumps, and measles), bacteria (including Bartonella henselae, tuberculosis, syphilis, and Borrelia burgdorferi), fungi (including cryptococci, candida, Histoplasma, aspergillus, and mucormycosis) and parasites (including Toxoplasma gondii, Toxocara canis, Onchocerca volvulus, malaria, and Echinococcus), and is considered atypical [3]. A review done by Perez-Cambrodi et al proposed that bilateral optic neuritis in children is associated with a good prognosis as compared to adults, and suggested the use of short-term corticosteroids for the management of pediatric patients with poor bilateral visual acuity [10].…”

“…Optic neuritis in the majority of cases is idiopathic, while it is commonly associated with conditions that include multiple sclerosis, neuromyelitis optica (NMO) and less commonly with autoimmune diseases, infectious diseases and following vaccination [1]. Although rare, children most frequently develop bilateral ON, as compared to unilateral ON in adults, and often follows viral infections such as mumps, measles, rubella, and influenza [2][3]. The prevalence of optic neuritis is twice as high in England as in the United States, while it is significantly less prevalent in Eastern countries [4].…”

Current Recommendations on Optic Neuritis

“…If atypical optic neuritis is suspected, more detailed investigations for sarcoidosis and tuberculosis (see details in the AWMF guideline [5]) and a lumbar puncture should be ordered. Apart from mycobacteria, there are other pathogens that can rarely affect the optic nerves [20]. Suspected infective optic neuropathy should always be investigated if the patient is immunosuppressed, has fever, a skin rash or neurological symptoms or was recently in the tropics [20,21].…”