AIDS-Related Ocular Opportunistic Infections
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This document discusses various opportunistic infections that can affect the eyes of patients with AIDS as their CD4+ T-lymphocyte count decreases. Kaposi sarcoma, TB uveitis, toxoplasmosis, and CMV retinitis are more likely to occur at CD4+ counts below 500, 250, and 50 cells/ml respectively. These and other infections like herpes zoster ophthalmicus and candida endophthalmitis are described in terms of their symptoms, diagnostic approach, and treatment.
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AIDS-Related Ocular Opportunistic Infections
- 1. AIDS CD4+ T lymphocytes <500/ml; Kaposi Sarcoma, TB CD4+ T lymphocytes <250/ml; toxoplasmosis CD4+ T lymphocytes <50/ml; CMV retinitis 1 Kaposi Sarcoma TB uveitis Toxoplasmosis CMV retinitis Herpes zoster ophthalmicus Candida endophthalmitis By: ismah haron
- 2. KAPOSI SARCOMA Painless vascularized tumor – herpesvirus type 8 Eyelid skin, eyelid margin & conjunctiva Slow growing & rarely invasive Rx: exision/ focal radiation theraphy Indication for rx: cosmetic/ disturb vision 25% in HIV patients 2
- 3. TB UVEITIS Anterior uveitis Photophobia, tearing, eye pain, decreased vision Accompanied by constitutional symptoms of TB Culture for M. tuberculosis Anti TB drugs 3
- 4. TOXOPLASMOSIS T. gondii remains within an inactive chorioretinal scar Reactivation in HIV – toxoplasmic chorioretinitis Serology detection via indirect hemagglutination assay 4
- 5. CMV RETINITIS Reactivation of CMV, 5 to 10% of AIDS patients in developing countries Floaters, photophobias, visual loss w/o eye pain or red eye Rapidly progressive (destroyed the whole retina within 6 months) Cx: RV/RA occlusion and retinal detachment Ix: + conjunctival swab, PCR to confirm Rx: drugs – ganciclovir, foscarnet (IVOral, SE?) 5
- 6. 6
- 7. HERPES ZOSTER OPHTHALMICUS Reactivation of VZV infection 5 to 15 % of HIV patients Can affect either eyelids, cornea, sclera, iris, retina Vesicular rashes burst crusting ulcers Rx: IV/ oral acyclovir, gentian violet 1% bd 7
- 8. 8
- 9. CANDIDA ENDOPHTHALMITIS Candida Albicans Symptoms: red eye, scotoma, floaters, eye pain, photophobia Fundoscopy: Fluffy white retinal lesion with white snowball-like vitreous opacities Anti fungal e.g. amphothericin B 9 THANK YOU
Editor's Notes
- The classical appearance of CMV retinitis is that of a haemorrhagic retinal necrosis - sometimes described as ketchup (tomato sauce) on cottage cheese at the posterior pole with extension of the lesions along the vascular arcade and sheathing of the vessels. The white edge at the border of the lesion represents the active infection which will progress at a rate of about one disc diameter per week if untreated.
- Local application of gentian violet 1% on the affected skin will prevent superinfection and promote drying of the ulcerations. Complications of herpes zoster ophthalmicus (progressive outer retinal necrosis, or PORN) may include macular retinitis, optic nerve disease, acute vitreous hemorrhage, and/or retinal detachment
- http://www.yeastinfectioncure101.com/candida-endophthalmitis-eye-yeast-infection.html