Persistent Intraocular Rubella Infection in a Patient with Fuchs' Uveitis and Congenital Rubella Syndrome

Abstract

bThere is growing evidence for the role of rubella virus in Fuchs' uveitis syndrome (FUS). This report is the first to show persistent intraocular rubella virus in a 28-year-old man with congenital rubella syndrome (CRS), who presented with blurred vision and was diagnosed with FUS. CASE REPORTA 28-year-old man of Afro-Caribbean descent was referred to a tertiary hospital in 2006 with progressively worsening vision in both eyes. There was no history of pain, conjunctival injection discharge, photophobia, photopsia, or floaters. He had been diagnosed at birth with congenital rubella syndrome (CRS), following a clinical diagnosis of maternal rubella in pregnancy and presentation with profound deafness and cataracts. He did not have any cardiac defects. His visual acuities on presentation in 2006 were 6/36 and 6/12 in the right and left eye, respectively. Examination revealed bilateral anterior uveitis with stellate keratic precipitates as well as bilateral posterior subcapsular lens opacities. Intraocular pressures were within normal limits in both eyes. Dilated fundus examination was normal.The clinical diagnosis of Fuchs' uveitis syndrome (FUS) was made based on the presence of a bilateral low-grade anterior uveitis with typical keratic precipitates and the absence of posterior synechiae or acute symptoms of pain, redness, and photophobia. Investigations for other causes of uveitis were carried out, including serum angiotensinogen-converting enzyme, syphilis serology, and antinuclear antibody titers, which were all negative. The full blood count, renal and liver function tests, and erythrocyte sedimentation rate (ESR) were normal, and the sickle cell screen was negative. The serum rubella IgM was negative, and the rubella IgG was positive.His reduced visual acuity was attributed to his bilateral lens opacities, which is a common feature of FUS. Right followed by left eye phacoemulsification cataract extraction and intraocular lens implantation were performed under general anesthesia to improve vision. One-hundred-microliter samples of aqueous humor (AH) were aspirated through a paracentesis prior to both cataract surgeries. The rest of the operations were performed in a standard manner and without complications. The postoperative treatment regimen consisted of hourly dexamethasone as 0.1% drops that were tapered over 6 weeks and with chloramphenicol as 0.5% drops 4 times a day (q.d.s.) for 1 week.A venous blood sample, urine sample, and throat swabs were collected for serological and microbiological investigations. The serum sample confirmed serological evidence of past rubella infection with an unusually high titer (Table 1). Samples of aqueous fluid were sent to the national rubella reference laboratory at Colindale, United Kingdom, for detection of rubella RNA and intraocular antibody production, by calculating the rubella-specific antibody index (AI Rub ) based upon the Goldmann-Witmer index (GW-I) (1). This compares the relative levels of specific antibody in aqueous and serum samples and compares them with...

Zika Virus RNA Replication and Persistence in Brain and Placental Tissue

“…This finding may indicate temporal persistence of Zika virus RNA in placental tissues. Persistence of other viruses in immune-privileged organs (e.g., eyes, placenta, fetal brain) has been reported ( 35 , 36 ) . Previous studies related to other arboviruses, including West Nile and chikungunya viruses, have also reported persistence of arbovirus RNA in various tissues by RT-PCR ( 37 – 39 ).…”

Rubella

“…Urine and TSs or OFs are about equivalent as sources of viral RNA, but the ease of obtaining TSs or OFs make these specimens the primary ones that are collected. 8, 54 Urine is often a source of infectious virus from CRS patients. Specimens for virus detection and for IgM/IgG detection can be transported by standard methods.…”

“…5–7 Detection of rubella virus RNA in the aqueous humor of a 28-year-old patient diagnosed with CRS and FUS verifies that infection can last for decades. 8 …”

Genomic characterization of a persistent rubella virus from a case of Fuch’ uveitis syndrome in a 73 year old man

“…An association between infectious agent(s) and FUS is not completely characterized, but in this case RuV was clearly found. The development of more sensitive nucleic acid detection tests for RuV, HSV, CMV, and toxoplasmosis will likely contribute to future diagnostic tests and may help with proper management of FUS [13,23]. …”

“…One previous report of FUS in a 28-year-old congenital rubella syndrome patient described 252 nt rubella sequences from both eyes which partially overlapped the standard genotyping window [13]. There were five nucleotide differences between the two FUS derived sequences which the authors attributed to independent rubella virus evolution in the right and left eyes.…”