Uveitis is predominantly of infectious origin in a high HIV and TB prevalence setting in rural South Africa

Schaftenaar, Erik; Meenken, C.; Baarsma, G. S.; Khosa, N Sellina; Luijendijk, Ad; McIntyre, James; Osterhaus, Albert D. M. E.; Verjans, Georges M. G. M.; Peters, Remco P. H.

doi:10.1136/bjophthalmol-2016-308645

Cited by 15 publications

(6 citation statements)

References 18 publications

(20 reference statements)

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“…HIV/AIDS was found to be significantly associated with anterior and posterior uveitis. A similar trend was seen in a high HIV prevalence setting in rural South Africa, where 83% of HIV-infected patients had infectious uveitis compared to 51% of HIV-uninfected patients [ 16 ]. Rheumatologic disease was associated with an increased risk of anterior uveitis, panuveitis, and scleritis.…”

Section: Discussionsupporting

confidence: 68%

Incidence, prevalence, and risk factors of infectious uveitis and scleritis in the United States: A claims-based analysis

et al. 2020

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Background Ocular inflammation causes significant visual morbidity in the United States, yet little is known about the epidemiology of infectious uveitis and scleritis. This study aims to evaluate the epidemiology of infectious uveitis/scleritis employing a large national medical claims database. Methods This was a retrospective, case-control study, employing Optum’s de-identified Clinformatics® Data Mart Database, containing data from 21.5 million privately insured individuals with enrollment for at least 15 months within 2007–2015. Inclusion in the uveitis/scleritis sample required an index uveitis/scleritis diagnosis based on International Classification of Diseases, Ninth Revision (ICD-9) codes. Exclusion criteria included index date within 3 months after intraocular surgery. Rates for uveitis/scleritis were determined by anatomic site. Multivariable logistic regression analyses were performed to determine odds ratios for the incidence and prevalence of uveitis/scleritis by anatomic category. Findings Infectious etiologies accounted for less than 20% of uveitis/scleritis, with mean rates of 18.9 (incidence) and 60.6 (prevalence) per 100,000 persons. The mean prevalences of infectious anterior, intermediate, posterior, panuveitis, and scleritis were 27.7, 0.17, 23.4, 4.4, and 4.6, per 100,000, respectively. Overall risk of prevalent infectious uveitis/scleritis increased with age (OR>3.3 for each decade over age 18, p<0.01), female sex (OR = 1.2, p<0.01), non-Hispanic white race (OR<1 for all other races, p<0.01), as well as the East South Central census division (OR = 1.2, p<0.01), comprising Alabama, Kentucky, Missouri, and Tennessee. Medical comorbidities, including HIV infection (OR = 6.4, p<0.01) and rheumatologic disease (OR = 1.9, p<0.01), were common in the infectious uveitis/scleritis cohort. Conclusions The incidence and prevalence of infectious uveitis/scleritis in the United States were higher than previously reported estimates but remained lower than in developing countries. Rates varied by age, sex, race, and medical comorbidities, and may reflect differential susceptibility to various infectious agents with disparate geographic distributions within the United States.

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Section: Discussionsupporting

confidence: 68%

Incidence, prevalence, and risk factors of infectious uveitis and scleritis in the United States: A claims-based analysis

et al. 2020

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“…A uveíte é uma patologia ameaçadora à função ocular e é responsável por 25% de todos os casos de cegueira em países em desenvolvimento. Pode ocorrer tanto por causas não infecciosas quanto infecciosas e suas etiologias variam conforme a localização geográfica e os fatores ambientais relacionados ao indivíduo (SCHAFTENAAR, 2016).…”

Section: Discussionunclassified

Perfil epidemiológico das uveítes infeciosas em um hospital terciário no norte do Brazil, Amazonia Oriental

Trindade¹,

Leão²,

Besteiro³

et al. 2023

Ciências Da Saúde E Suas Descobertas Científicas

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Objetivo: Descrever o perfil epidemiológico dos pacientes diagnosticados com uveítes infecciosas em hospital de referência em oftalmologia no estado do Pará. Métodos: É um estudo observacional, de corte transversal, analítico. A coleta de dados foi realizada a partir da análise dos prontuários dos pacientes por meio do Aplicativo de Gestão para Hospitais Universitários (AGHU). As variáveis estudadas no projeto são: sexo, faixa etária, classificação anatômica da uveíte e diagnóstico etiológico. Critérios de inclusão: pacientes com diagnóstico de uveíte infecciosa, maiores de 18 anos, de ambos os sexos e que foram atendidos no ambulatório de uveíte do HUBFS durante o período da coleta. Foram excluídos os pacientes que não apresentassem prontuários com todos os dados para preenchimento do protocolo de pesquisa. Resultados: A amostra foi composta por 69 pacientes, com maioria do sexo feminino, idade média de 43.3 anos, sendo as mais frequentes a faixa entre 50 a 59 anos (21.7%), seguida das faixas entre 20 a 29 anos e acima ou igual a 60 anos (20.3% ambas). Na avaliação do diagnóstico etiológico foi identificada maior proporção de Toxoplasmose (43.5%), seguida de Tuberculose e a iridociclite herpética. Em relação ao tipo de uveíte, a mais frequente foi a posterior (68.1%). A presença de HIV aconteceu em 09 pacientes e, entre eles o diagnóstico etiológico mais frequente foi a necrose aguda de retina, seguida da microangiopatia e da toxoplasmose. Conclusão: Os pacientes diagnosticados com uveítes infecciosas são predominantemente do sexo feminino, com faixa etária entre 50-59 anos e 20 a 29 anos. A etiologia mais frequente encontrada foi a Toxoplasmose, seguida de Tuberculose, e houve predominância da uveíte posterior.

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“…The risk factors most frequently documented are male sex, homosexuality and intravenous drug abuse, but the infection rates are also increasing in females and heterosexual individuals (1)(2)(3)(4)(5)(6)(7)(8). In 3 studies from South Africa, syphilis was identified as the cause of uveitis in 7% to 16.2% of cases (9)(10)(11).Ocular syphilis is diagnosed when ocular inflammation occurs in conjunction with a serologically confirmed systemic syphilis infection, and other causes for inflammation have been excluded. The relationship between ocular syphilis and neurosyphilis has been much debated, but it is assumed that, due to the embryological origin of the retina from the central nervous system, ocular syphilis is a clinical feature of neurosyphilis.…”

Section: Introductionmentioning

confidence: 99%

CXCL13, CXCL10 and CXCL8 as Indicators of Ocular and Neurological Involvement in Patients With Ocular Syphilis: An Observational Descriptive Study

Merwe¹,

Snyders²,

Kidd³

et al. 2022

Front. Ophthalmol.

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AimTo investigate the role of the chemokines CXCL13, CXCL10 and CXCL8 in the diagnosis of ocular- and neurosyphilis by examining the serum, aqueous humour (AH) and cerebrospinal fluid (CSF) of patients with ocular syphilis.MethodsAn observational descriptive study was performed prospectively at Tygerberg Academic Hospital in Cape Town, South Africa from 1 February 2018 till 31 January 2021 which enrolled 23 participants. 14 Patients were male and 9 female, 15 patients were HIV positive, and all patients were newly diagnosed with ocular syphilis. Upon diagnosis of ocular syphilis, the HIV status of each patient was determined, and 3 samples (AH, serum and CSF) were collected to measure the levels of CXCL13, CXCL10 and CXCL8 in each. All patients were treated with 14 days of intravenous Penicillin G and topical corticosteroid drops for uveitis.ResultsThe mean concentrations of all 3 biomarkers were higher in the AH and CSF than in the serum. The mean concentrations of the 3 measured biomarkers were markedly different when comparing both AH and CSF levels to serum levels. The level of CXCL13 measured in the AH correlated well with the concentrations found in the CSF of patients with neurosyphilis. In patients with neurosyphilis, mean AH levels of CXCL13 and CXCL10 were markedly higher than in serum while mean CSF levels of CXCL10 were also markedly higher than in serum. Also, the AH/serum ratio of CXCL13 and CXCL10, as well as the CSF/serum ratio of CXCL10, was much higher in patients with neurosyphilis than without. In patients with HIV infection, mean AH CXCL13 levels were much higher than in patients without HIV infection.ConclusionThe levels of CXCL13, CXCL10 and CXCL8 in the AH of patients with neurosyphilis are similar to previously reported levels in the CSF of patients with neurosyphilis and can potentially be an adjunct in the diagnosis of ocular syphilis. Patients with ocular syphilis who tested negative for neurosyphilis with conventional CSF testing showed features of neurosyphilis when analysing the CSF chemokines.

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Uveitis is predominantly of infectious origin in a high HIV and TB prevalence setting in rural South Africa

Abstract: Microbial aetiology of uveitis is common in areas where HIV and TB are endemic. In these settings, a high index of suspicion for infectious origin of uveitis is warranted.

Cited by 15 publications

References 18 publications

Incidence, prevalence, and risk factors of infectious uveitis and scleritis in the United States: A claims-based analysis

Incidence, prevalence, and risk factors of infectious uveitis and scleritis in the United States: A claims-based analysis

Perfil epidemiológico das uveítes infeciosas em um hospital terciário no norte do Brazil, Amazonia Oriental

CXCL13, CXCL10 and CXCL8 as Indicators of Ocular and Neurological Involvement in Patients With Ocular Syphilis: An Observational Descriptive Study

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