69 research outputs found
Ocular Involvement in HIV infection and AIDS
Ringens, P.J. [Promotor]Danner, S.A. [Promotor]Horn, G.J. van den [Copromotor
Early- and late-stage ocular complications of herpes zoster ophthalmicus in rural South Africa
OBJECTIVES : To describe the spectrum of ocular complications of herpes zoster ophthalmicus (HZO)
in rural South Africa.
METHODS : Patients presenting with visual complaints and active or healed HZO at the
ophthalmology outpatient department of three hospitals in rural South Africa were included in this
study. Demographic and clinical data were collected, and HIV status was determined for all
participants.
RESULTS : Forty-eight patients were included, and 81% were HIV infected. Poor vision was reported
by 94% of patients, painful eye by 79% and photophobia by 63%. A diverse spectrum of ocular
complications was observed with corneal inflammation and opacification in 77% followed by
anterior uveitis in 65%. The majority (65%) presented with late-stage ocular complications
associated with irreversible loss of vision whereas early-stage complications, such as punctate
epithelial keratitis and anterior uveitis, were less common. Blindness of the affected eye was observed
in 68% of patients with late-stage complications. There was a considerable delay between onset of
symptoms and first presentation to the ophthalmology outpatient department (median time 35 days;
range 1–2500 days), and longer delay was associated with late-stage ocular complications (P = 0.02).
CONCLUSIONS : HZO patients present with relatively late-stage ocular complications, and blindness
among these patients is common. The delayed presentation to the ophthalmology outpatient
department of hospitals in our rural setting is of concern, and efforts to improve ocular outcomes of
HZO are urgently needed.In part funded by the Rotterdamse Stichting Blindenbelangen
and the Rotterdam Global Health Initiative. Anova
Health Institute receives a grant from the US President’s
Emergency Plan for AIDS Relief (PEPFAR) programme
via the US Agency for International Development.http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-31562017-03-31hb2016Medical Microbiolog
Clinical and corneal microbial profile of infectious keratitis in a high HIV prevalence setting in rural South Africa
The purpose of this investigation was to determine the clinical and corneal microbial profile of infectious keratitis in a high human immunodeficiency virus (HIV) prevalence setting in rural South Africa. Data in this cross-sectional study were collected from patients presenting with symptoms of infectious keratitis (n = 46) at the ophthalmology outpatient department of three hospitals in rural South Africa. Corneal swabs were tested for herpes simplex virus type 1 (HSV-1) and 2 (HSV-2), varicella zoster virus (VZV) and adenovirus DNA by real-time polymerase chain reaction (PCR
A case of panuveitis with hypopyon due to presumed ocular leishmaniasis in a HIV patient.
BACKGROUND: Post-kala-azar dermal leishmaniasis is a well-known immunologic cutaneous reaction. There are few case reports of ocular leishmaniasis. It is a sight-threatening condition that needs to be rapidly recognized and treated to avoid permanent visual loss. Ocular leishmaniasis panuveitis can present with severe inflammation in patients with highly active anti-retroviral therapy (HAART)-induced immune reconstitution syndrome. FINDINGS: A case of a 40-year-old man, human immunodeficiency virus (HIV) positive on HAART, with a presumed diagnosis of ocular leishmaniasis, is presented. He had a past history of visceral leishmaniasis and was referred to the uveitis service with rapidly worsening panuveitis and counting fingers vision in both eyes. On empirical anti-leishmania therapy and systemic steroids, the visual acuity of the left eye improved to 6/9 but remained poor in the right eye. Based on the medical history, improvement with therapy and the exclusion of other common infections, a presumed diagnosis of ocular leishmaniasis-related panuveitis was made. CONCLUSIONS: A major immune reaction against lingering parasites may play a key role in the pathogenesis of this sight-threatening and rapidly progressive condition. Both the infection and the immune reaction should be treated
Clinical and corneal microbial profile of infectious keratitis in a high HIV prevalence setting in rural South Africa
The purpose of this investigation was to determine
the clinical and corneal microbial profile of infectious keratitis
in a high human immunodeficiency virus (HIV) prevalence
setting in rural South Africa. Data in this cross-sectional study
were collected from patients presenting with symptoms of
infectious keratitis (n = 46) at the ophthalmology outpatient
department of three hospitals in rural South Africa. Corneal
swabs were tested for herpes simplex virus type 1 (HSV-1)
and 2 (HSV-2), varicella zoster virus (VZV) and adenovirus
DNA by real-time polymerase chain reaction (PCR) and for
bacteria and fungi by culture. Based on clinical history, disease
characteristics and laboratory results, 29 (63 %) patients
were diagnosed as viral keratitis, including 14 (48 %) viral keratitis cases complicated by bacterial superinfection, and
17 (37 %) as bacterial keratitis. VZV and HSV-1 DNA was
detected in 11 (24 %) and 5 (11 %) corneal swabs, respectively.
Among clinically defined viral keratitis cases, a negative
viral swab was predominantly (93 %) observed in cases with
subepithelial inflammation and was significantly associated
with an increased duration of symptoms (p=0.003). The majority
of bacteria cultured were Gram-positive (24/35), including
Staphylococcus epidermidis and S. aureus. Viral aetiology
was significantly associated with a history of herpes zoster
ophthalmicus (p < 0.001) and a trend was observed between
viral aetiology and HIV infection (p = 0.06). Twenty-one
(47 %) keratitis cases were complicated by anterior uveitis,
of which 18 (86 %) were HIV-infected cases with viral keratitis.
The data implicate a high prevalence of herpetic keratitis,
in part complicated by bacterial superinfection and/or uveitis,
in HIV-infected individuals presenting with infectious keratitis
in rural South Africa.http://link.springer.com/journal/10096hb2016Medical Microbiolog
Low incidence of the immune reconstitution inflammatory syndrome among HIV-infected patients starting antiretroviral therapy in Gabon: a prospective cohort study
Leaky doors: private captivity as a prominent source of bird introductions in Australia
The international pet trade is a major source of emerging invasive vertebrate species. We used online resources as a novel source of information for accidental bird escapes, and we investigated the factors that influence the frequency and distribution of bird escapes at a continental scale. We collected information on over 5,000 pet birds reported to be missing on animal websites during the last 15 years in Australia. We investigated whether variables linked to pet ownership successfully predicted bird escapes, and we assessed the potential distribution of these escapes. Most of the reported birds were parrots (> 90%), thus, we analysed factors associated with the frequency of parrot escapes. We found that bird escapes in Australia are much more frequent than previously acknowledged. Bird escapes were reported more frequently within, or around, large Australian capital cities. Socio-economic factors, such as the average personal income level of the community, and the level of human modification to the environment were the best predictors of bird escapes. Cheaper parrot species, Australian natives, and parrot species regarded as peaceful or playful were the most frequently reported escapees. Accidental introductions have been overlooked as an important source of animal incursions. Information on bird escapes is available online in many higher income countries and, in Australia, this is particularly apparent for parrot species. We believe that online resources may provide useful tools for passive surveillance for non-native pet species. Online surveillance will be particularly relevant for species that are highly reported, such as parrots, and species that are either valuable or highly commensal.Miquel Vall-llosera, Phillip Casse
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