Treatment of presumed trematode-induced granulomatous anterior uveitis among children in rural areas of Egypt

Abstract

Purpose The purpose of this study is to evaluate the efficacy of systemic antiparasitic medications alone or in combination with surgical aspiration in management of presumed trematode-induced anterior uveitis in children. Patients and methods Prospective case series. Children who presented with anterior chamber (AC) granuloma were included in the study. All patients received antiparasitic treatment and after 2 weeks; patients were divided based on their clinical improvement in terms of the baseline granuloma area into two groups: group A (<2.5 mm 2) who continued on antiparasitic medications only (n = 15) and group B (≥2.5 mm 2) who underwent surgical aspiration (n = 15). Basic demographics data, visual acuity (VA), corneal thickness, granuloma area and AC activity (cells and flare) were recorded and analysed. Systemic work-up including stool and urine analysis, full blood count, chest X-ray and schistosomiasis titre were performed. Results Thirty eyes of 30 patients were included in the study with a mean age of 13.4 ± 2.42 years. All patients were male. Patients were examined and followed at Mansoura Ophthalmic Center, Mansoura University. Both groups showed statistically significant improvement in VA, AC activity, corneal thickness and granuloma area (p-value < 0.001), which was achieved with medical treatment only in group A. However, in group B granuloma required aspiration and did not recur after that. Conclusion Presumed trematode-induced AC granuloma is common among children living in the rural areas of Egypt. Antiparasitic medication alone was found to be effective for small-sized granulomas. Surgical aspiration is an effective adjuvant procedure to treat large-sized ones.

Trematode granuloma in children

“…Similar cluster was reported from different geographical locations along the basin of river Nile by R.M. Amin et al from Egypt with granulomatous anterior uveitis after swimming in the river [8][9] . Here again the etiological agent was proven by molecular diagnostics to be trematode.…”

Novel Data About Unusual Location of Toxoplasma Gondii Within Active Microbial Community in the Anterior Chamber of the Eye of Egyptian Rural Children

“…The belief that prevailed in the earlier periods and the related research studies indicated a stage of one of the atworms as the cause of these ocular infections [3][4][5][6]. Many Egyptian specialists in collaboration with their scienti c teams accepted such assumption and recommended antiparasitic drugs alone, in combination with surgical aspiration, or other interventions in the management of such presumed trematode-induced anterior uveitis in children in different governorates Amin et al [3] in Alexandria, El Nokrashy et al [7] in Mansoura, Sadek et al [8] in Al-Fayoum. The same concept was followed in India [4,6].…”

Management of presumed trematode-induced granulomatous intermediate uveitis

“…Therefore, prompt treatment is crucial for a favorable outcome. Current treatment modalities used include the following: (1) corticosteroids either topical, regional, or systemic; [8] (2) antimicrobial medications with controversial results; [9] (3) laser photocoagulation; [20] (4) surgical treatment for cases not responding to conservative treatment [1,8,9].…”