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Ocular Disease II > Uveitis: Infectious Etiologies Study Guide > Flashcards

Uveitis: Infectious Etiologies Study Guide Flashcards

1
Q

Leprosy

  1. Organism?
  2. Organism Type?
  3. Transmission?
  4. Systemic Disease?
  5. Ocular Disease?
  6. Diagnosis
  7. Treatment? (CDR)
A
  1. Mycobacterium Leprae
  2. Gram + Intracellular Bacteria
  3. Unknown
  4. Tuberculoid or Lepromatous Types; Skin Lesions
  5. Granulomatous Anterior Uveitis, Intermediate Uveitis, Retinal Vasculitis
  6. Lepromin Skin Test
  7. Clofazimine, Dapsone, Rifampin
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2
Q

Tuberculosis

  1. Organism?
  2. Organism Type?
  3. Transmission?
  4. Systemic Disease?
  5. Ocular Disease?
  6. Diagnosis? (3)
  7. Treatment? (many)
A
  1. Mycobacterium Tuberculosis
  2. Bacterium
  3. Breathing in Aerosolized Droplets
  4. Self-limited Pneumonia that leads to Lung Granulomas. Chills, Cough, Fatigue, Fever, Night Sweats, Loss of Appetite, Weight Loss
  5. Bilateral Granulomatous Anterior Uveitis, Choroidal Granulomas (Tubercles), Interstitial Keratitis, Phylecenular Keratoconjunctivitis
  6. PPD, Quantiferon-TB Gold, CXR
  7. Isoniazid & Rifampin for 9 months.
    * Encouraged to also use Ethambutol, Streptomycin, or Pyranzinamide for the FIRST 3 Months. Purpose: PREVENT RESISTANCE

*Most Peeps currently: 2 Month course of Isoniazid, Rifampin, Ethambutol, and Pyranzinamide, then 4 months of Isoniazid and Rifampin

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3
Q

Brucellosis

  1. Organism? (2)
  2. Organism Type?
  3. Transmission?
  4. Systemic Disease?
  5. Ocular Disease?
  6. Diagnosis?
  7. Treatment? (2)
A
  1. Brucella Abortis (Cattle), Brucella Suis (Pigs)
  2. Bacterium
  3. Coming in contact w/infected Animals, meat, or dairy products
  4. Arthalgia, Chills, Fever, Headache, Lymphadenopathy, and Splenomegaly
  5. Recurrent Anterior Uveitis, Localized Thickening of IRIS, Multiple IRREGULAR CHOROIDAL EXUDATES associated with LITTLE INFLAMMATION and Retinal Detachment
  6. Blood Test. Culture
  7. Doxycycline and Streptomycin
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4
Q

Whipple Disease

  1. Organism?
  2. Organism Type?
  3. Transmission?
  4. Systemic Disease?
  5. Ocular Disease?
  6. Diagnosis?
  7. Treatment?
A
  1. Tropheryma Whipplei
  2. Bacterium
  3. Fecal-Oral Route
  4. CHRONIC DIARRHEA, Weight Loss, and Gray-BROWN Skin Tone
  5. Anterior Uveitis, Vitritis, and COMPLETE OPHTHALMOPLEGIA (no eye movement)
  6. Tropheryma Whipplei DNA PCR!!
  7. IV Streptomycin & Penicillin G or Ceftriaxone.

After this, do TREMETHOPRIM-Sulfamethaxazole BID x 1-2 yrs

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5
Q

Chronic Granulomatous Disease

  1. Organism?
  2. Organism Type?
  3. Transmission?
  4. Systemic Disease?
  5. Ocular Disease?
  6. Diagnosis?
  7. Treatment?
A
  1. None
  2. None
  3. X-Linked Recessive OR Autosomal Recessive. This PREDISPOSES children to Pyogenic Infections
  4. Phagocytes DO NOT FUNCTION PROPERLY. Causes more ONGOING INFECTIONS
  5. Blepharoconjunctivitis w/Pannus Formation & Inflammatory Chorioretinal Lesions that can cause EXCESSIVE SCARRING
  6. Ocular Exam
  7. Depends on Corticosteroid or Antibiotic Efficacy (how well they work I’m assuming)
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6
Q

Fungal Disease

  1. Most common Fungal disease associated w/Uveitis?
  2. Who is at risk for Fungal Disease? (5)
  3. Fungal Endophthalmitis usually presents as what?
  4. What species of fungal organisms MOST FREQUENTLY cause Fungal Endophthalmitis?
    a. Which of these Species is the MOST COMMON?
    b. Second most common?
  5. Pts w/Fungal Endophthalmitis may complain of what?
    a. However, the disease is sometimes what?
  6. Endogenous Endophthalmitis can occur from what other 5 things?
  7. Diagnosis? (2 things)
  8. Treatment? (3)
A
  1. Histoplasmosis (POHS)
  2. Post-operative Pts, Immunosuppressed or Immunocompetent Pts w/Systemic Mycotic Infection, IV Drug Users, and Pts w/Ocular Trauma
  3. Panuveitis
  4. Candidia
    a. ALBICANS
    b. ASPERGILLUS
  5. of FLOATERS!
    a. Asymptomatic and only seen on Ophthalmologic Screening
  6. Blastomyces Dermatitidis, Coccidioides Immitis, Cryptococcus Neoformans, Histoplasma Capsulatum, Sporotrichum Schenckii
  7. Aqueous and/or Vitreal Cultures
  8. Amphotericin B, Ketoconazole, or Fluconazole
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7
Q

Neuroretinits

  1. What is it?
    a. Associated with 1 of 2 things?
    b. % that are Idiopathic?
    c. Typically Uni or Bi Lateral?
  2. Organism?
    a. Most Common?
    b. Other? (13)
  3. Organism Type?
  4. Transmission?
  5. Systemic Disease?
  6. Ocular Disease?
  7. Diagnosis?
  8. Treatment? (2)
A
  1. Optic Neuropathy w/Optic Disc Edema
    a. Peripapillary or Macular Hard Exudates (Macular Star)
    b. 50%
    c. Unilateral typically
  2. a. Bartonella Henselae (Cat-Scratch Disease) MOST COMMON
    b. Idiopathic (Leber’s Stellate Neuroretinitis), Hep B, HSZ, HZV, Histoplasmosis, Lyme Disease, Leptospirosis, Mumps, Salmonella, Toxocariasis, Toxoplasmosis, Tuberculosis, Typhus
  3. Bacterium
  4. Cat Scratch
  5. Fever, Lymphadenopathy, Papule or Pustule at Inoculated Site
  6. Optic Disc Edema w/MACULAR STAR
  7. Bartonella IgG & IgM; Other Serology specific to Dx.
  8. Doxycycline or Erythromycin. IT DEPENDS on ETIOLOGY
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8
Q

Syphilis

  1. AKA? Why?
    a. Inoculation Period? Avg Time?
    b. Number of Stages the disease is divided into?
    c. What stage also has divisions and what are they?
    d. If left Untreated, what will happen?
    e. Pt may be co-infected with what other Virus?
    f. Who is TESTED for SYPHILIS? (VDRL)
    g. What is a CLASSIC SIGN of Congenital Syphilis along with Hutchinson Teeth (Notched, Thin, Upper Incisors w/Abnormal Spacing)?

h. Syphilis Pt may have a Pigmentary Retinopathy. What is this called?
i. When is Uveitis common in Syphilis? (What stage)?

A
  1. Great Imitator. Because is can infect all eye tissues and look like other diseases.
    a. 10-90 days; Avg: 3 Wks
    b. 3 stages: Primary, Secondary and Tertiary
    c. Tertiary: Benign, Cardiovascular, or Neurosyphilis
    d. It will DISSEMINATE
    e. HIV
    f. ALL EXPECTANT MOTHERS
    g. Interstitial Keratitis
    h. Salt and Pepper Fundus
    i. In Late Tertiary Syphilis
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9
Q

Syphilis (2)

  1. Organism?
  2. Organism Type?
  3. Transmission?
  4. Systemic Disease?
    a. Primary?
    b. Secondary?
    c. Latent?
    d. Tertiary?
  5. Ocular Disease?
  6. Diagnosis?
  7. Treatment?
A
  1. Treponema Pallidum
  2. Spirochete Bacterium
  3. Sexual Contact, Transplacental Spread
  4. a. Chancre (no pain. Erythematous papule shows up about 4 wks after infection. Goes away in 1-2 mnths).
    b. Generalized Rash, Rash on Palms & Soles, Condylomata Lata (papules at mucocutaneous junctions & moist areas of the skin), Fever, malaise, headache, nausea, anorexia, arthralgia, lemphadenopathy, ANTERIOR UVEITIS & MENINGITIS
    c. During 1st yr of infection: Recurrent Mucocutaneous Lesions. 30% progress to TERTIARY STAGE
    d. Benign Subgroup: GUMMA (Chronic Granulomatous Lesions that heals w/SCARRING & FIBROSIS): MOST COMMON in SKIN and MUCOUS MEMBRANES but can occur in any tissue.

Cardiovascular: Aortitis, Aortic Aneurysms, Aortic Valvular Insufficiency, Narrowing of Coronary Ostia

Neurosyphilis: Meningitis, Optic Atrophy, Cranial Nerve Palsies, Argyll-Robertson Pupils (little to no reaction to light w/intact accommodative response), Dysphagia, Dysarthria, muscle weakness, paraplegia, Charcot Arthropathy (swollen feet), Bladder incontinence, Tabes Doralis (neurosyphilis in posterior columns and posterior roots of spinal cord: Cause pain, ataxia, sensory changes, decreased tendon reflexes, ocular findings)

  1. All Tissues
  2. FTA-ABS or MHA-TP and VDRL or RPR.
    * FTA-ABS and RPR are PREFERRED!
    a. False positive can happen in Pts w/SLE, Biliary Cirrhosis, Connective Tissue Disease (esp RA)
  3. Penicillin. Depends. See Next Slide
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10
Q

Syphilis (3): Treatment

  1. Primary and Secondary Syphilis
  2. Latent and Tertiary Syphilis, including Neurosyphilis
  3. Congenital Syphilis in Infant
A
  1. Procaine Penicillin, 2.4 million units IM Daily and PROBENECID: 1 g, PO qd x14 days or Benzathine Penicillin G: 2.4 million units IM in a Single dose.
    * If allergies: Do Doxycycline 100 mg PO bid x 15 days or Tetracycline 500 mg PO qid x 15 days
  2. Aqueous Crystalline Penicillin G: 3-4 million units IV q 4 h x 10-14 days
    or
    Benzathine Penicillin G: 2.4 million units IM each week x 3.
  3. Procaine Penicillin, 50,000 units/kg/day IM x 10 days, or Aqueous Crystalline Penicillin G: 50,000 units/kg/day IV in 2 divided doses x 10 days
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11
Q

Syphilis (4): Treatment 2

  1. What do experts suggest should be done with any ocular inflammation?
    a. What test should be repeated and when?
  2. Pts w/CSF involvement should have what done? Intervals?
  3. Pts getting therapy, esp. IV therapy, should be monitored for what reaction?
    a. What is it?
    b. What might this reaction Exacerbate?
    c. Prophylaxis with what drug type may help?
A
  1. Treat it like Neurosyphilis
    a. VDLR or RPR every 3 months for a year, after Treatment.
  2. Lumbar Puncture. Every 6 months for 3 years
  3. Jarisch-Herxheimer RxN
    a. Hypersensitivity response to TREPONEMAL ANTIGENS
    b. Preexisting Ocular Inflammation (like Uveitis or Interstitial Keratitis)
    c. Corticosteroids
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12
Q

Lyme Disease

  1. Organism?
  2. Organism Type?
  3. Transmission?
  4. Systemic Disease?
    a. Stage 1?
    b. Stage 2?
    c. Stage 3?
  5. Ocular Disease?
    a. Most common in Stage 1?
    b. Most common in Stage 2 and 3?
  6. Diagnosis?
  7. Treatment?
  8. This disease can look like syphilis. What other tests should be run even if you suspect Lyme Disease?
A
  1. Borrelia Burgdorferi
  2. Spirochete Bacterium
  3. Ixodes Dammini Tick
  4. a. Erythema Chronicum Migrans (Target Symbol or Bull’s eye rash)
    b. Disseminated
    c. Arthritis, Ataxia, Chronic Encephalomyelitis, Chronic Fatigue, Dementia, and Spastic Paraparesis
  5. a. Conjunctivitis
    b. Conjunctivitis & Uveitis
  6. Lyme Titer ELISA then confirm w/Western Blot. Cross Reactivity can occur w/FTA-ABS
  7. Amoxicillin, IV Ceftriaxone, or Doxycycline (depends on stage)
  8. FTA-ABS, RPR, and Infectious mononucleosis should also be considered as a possible cause of False-positive results
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13
Q

HIV/AIDS

  1. When can it be detected after infection?
  2. What big thing emerges when AIDS hits?
  3. Most common opportunistic infection associated with HIV?
    a. Others? (8)
A
  1. 2-8 wks
  2. Kaposi Sarcoma
  3. CMV
    a. Candida, Coccidioides Immitis, Cryptococcus Neoformans, Mycobacterium Avium Complex, Mycobacterium Tuberculosis, Pneumocystis, Toxoplasma Gondii, and VZV
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14
Q

HIV/AIDS (2)

  1. Organism?
  2. Organism Type?
  3. Transmission?
  4. Systemic Disease?
  5. Ocular Disease?
  6. Diagnosis?
  7. Treatment?
A
  1. HIV
  2. Retrovirus
  3. Infects CD4+ Helpter T-Cells via Sexual contact (Homo and Bi-sexual at higher risk), IV Drug abuse, Perinatal, Needlestick Injury, Blood Transfusion
  4. Fever, GI issues, Headache, Myalgia, Rash
  5. All Tissues. CMV Retinitis MOST COMMON. Immune Recovery Uveitis (IRU) can occur in response to HAART therapy and Immune Recovery.
    * Profound Vitritis, Anterior Uveitis, Cataract, Macular Edema, Epiretinal Membrane (ERM), and Optic Disc Edema
  6. HIV ELISA, confirmed by WESTERN BLOT! Virus can be cultured from Blood, Semen, and Solid Tissues, but Rarely from Saliva and Tears.
  7. HAART: Highly Active Antiretroviral Therapy. Lack of Adherence can lead to resistance and Failure of therapy.
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15
Q

CMV

  1. Organism?
  2. Organism Type?
  3. Transmission?
  4. Systemic Disease?
  5. Ocular Disease?
  6. Diagnosis?
  7. Treatment? (4)
A
  1. Cytamegalovirus
  2. Herpes Class Virus
  3. Hematogenous spread via Sexual contact, Transplantation, Transfusion, Transplacental
  4. None??
  5. Small, white retinal Infiltrates that may resemble a large Cotton Wool Spot (CWS); There’s ALWAYS a LOW-GRADE VITIRITIS.
    * Can present w/fine KP.

Pts Develop an ABSOlUTE SCOTOMA: due to RETINAL NECROSIS. Can lead to Rhegmatogenous Retinal Detachment

  1. Clinical. Pay attention to EDGE of the Lesions or Look for Advancement of the Border
  2. Cidofovir, Foscarnet, Fomivirsen, or Ganciclovir
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16
Q

Herpes Zoster

  1. Cases have been reported with Varicella, but most cases occur with what infection?
    a. Usually occurs with what?
    b. Cutaneous Herpes Zoster has been associated with what other Viral Infection?
  2. Organism
  3. Organism Type
  4. Transmission
  5. Systemic Disease
  6. Ocular Disease
  7. Diagnosis
  8. Treatment? (3): FAV
A
  1. Herpes Zoster infection
    a. Herpes Zoster Ophthalmicus (ocular involvement seen in 2/3 involving ophthalmic division of Trigeminal Nerve)
    b. HIV infection
  2. Varicella Zoster
  3. Herpes Class virus
  4. Direct Cutaneous contact
  5. Rash
  6. HZO can lead to ARN or PORN
  7. Clinical; VZV IgG and IgM
  8. Famvir, Acyclovir, and Valcyclovir
17
Q

Pneumocystis Jiroveci

  1. Organism?
  2. Organism Type?
  3. Transmission?
  4. Systemic Disease?
  5. Ocular Disease?
  6. Diagnosis?
  7. Treatment?
A
  1. Pneumocystis Jiroveci
  2. Fungus
  3. Inhalation
  4. Pneumonia
  5. Choroiditis: Characterized by Multifocal Placoid White Plaques in Choroid w/little evidence of Intraocular Inflammation
  6. Biopsy/Histopathology
  7. Trimethoprim-Sulfamethoxazole
18
Q

Mycobacterium Avium-Intracellulare

  1. Organism?
  2. Organism Type?
  3. Transmission?
  4. Systemic Disease?
  5. Ocular Disease?
  6. Diagnosis?
  7. Treatment?
    a. First line drugs?
A
  1. Mycobacterium Avium-Intracellulare
  2. Bacterium
  3. Aerosolized Water, Piped hot water systems, Bathrooms, house dust, soil, birds, farm animals, cigarette components
  4. Lung disease, osteomyelitis, tenosynovitis, synovitis, and disseminated disease involving lymph nodes, CNS, liver, Spleen, and Bone Marrow
  5. Choroidal Infiltrates usually 50-100 um scattered thru the fundus
  6. Acid-fast bacillus staining & sputum culture
  7. 2 or 3 antimicrobials for 12 months.
    a. Macrolides (Clarithromycin or Azithromycin), Ethambutol, and Rifamycins (Rifampin and Rifabutin)
19
Q

Herpes Simplex Virus

  1. Organism?
  2. Organism Type?
  3. Transmission?
  4. Systemic Disease?
  5. Ocular Disease?
  6. Diagnosis?
  7. Treatment?
A
  1. Herpes Simplex
  2. Herpes Class Virus
  3. Direct Cutaneous Contact
  4. Vesicular Rash
  5. Keratitis, Keratouveitis, Retinitis, Secondary Glaucoma
  6. Clinica; HSV-1 & 2 IgG & IgM
  7. Viroptic 9x/d & Cycloplegic agent to prevent Synechiae. Topical Corticosteroids used in pts w/associated Uveitis, but is DELAYED until Corneal Epithelial Disease Resolves
20
Q

West Nile Virus

  1. Organism?
  2. Organism Type?
  3. Transmission?
  4. Systemic Disease?
  5. Ocular Disease?
  6. Diagnosis?
  7. Treatment?
A
  1. West Nile Virus
  2. ssRNA Virus
  3. via Culex Mosquito bite that previously bit an infected bird.
  4. Flu-like illness: Arthralgia, Chills, Headache, Fever, Myalgia, Rash, Retro-orbital Pain
  5. Multi-focal choroiditis (MOST COMMON), Optic Neuritis
  6. ELISA WNV IgM
  7. Supportive Care; No proven Tx.
21
Q

Human T-Lymphotropic Virus Type 1

  1. Organism?
  2. Organism Type?
  3. Transmission?
  4. Systemic Disease?
  5. Ocular Disease?
  6. Diagnosis?
  7. Treatment?
A
  1. Human T-Lymphotropic Virus Type 1
  2. Virus
  3. Sexual Contact, Breastfeeding, Transfusion, Needlestick Injury, IV Drug Use
  4. Adult T-Cell Leukemia/Lymphoma & Tropical Spastic Paraparesis
  5. Retinal Vasculitis, Uveitis, Vitreal Opacities
  6. HTLV-1 Serology
  7. Depends on Type: Antiretrovirals/Chemotherapy
22
Q

Toxoplasmosis

  1. Most common cause of What Uveitis?
    a. What does it produce? What does this leave?
    b. Have to watch for what at the Edge of the Retinal Lesions?

c. When does getting this disease cause the MOST CONCERN? (how do you avoid getting it?)
d. The presence of what titers suggests a Recently Acquired Infection?
e. Pts presenting w/his or her first attack of Toxoplasmosis, should be screened for what else?

A
  1. Posterior Uveitis
    a. Necrotic Retinitis. A Large ATROPHIC Scar
    b. CNVM
    c. Pregnancy. DONT CHANGE LITTER BOXES!
    d. IgM Titers
    e. HIV
23
Q

Toxoplasmosis (2)

  1. Organism?
  2. Organism Type?
  3. Transmission?
  4. Systemic Disease?
  5. Ocular Disease?
  6. Diagnosis?
  7. Treatment? (6)
A
  1. Toxoplasma Gondii
  2. Protozoan
  3. Cats or Ingesting meat w/Toxoplasma Cysts
  4. Fever, Malaise, Sore Throat (pharyngitis); Rarely CNS Disease
  5. Posterior Uveitis (necrotic Retinitis); Vitritis overlying the Retinitis; Granulomatous or Non-Granulomatous Anterior Uveitis; CNVM
  6. Clinical; Toxoplasmosis IgG & IgM; Fluorescein Angiography
  7. Bactrim, Clindamycin, Folate, Prednisone, Pyrimethamine, and Sulfadiazine
24
Q

Presumed Ocular Histoplasmosis

  1. Organism?
  2. Organism Type?
  3. Transmission?
  4. Systemic Disease?
  5. Ocular Disease?
  6. Diagnosis?
  7. Treatment?
  8. CNVM is HIGHLY PROBABLY and Typically Treated with 1 of 2 things?
    a. Typically found in what area?
A
  1. Histoplasma Capsulatum
  2. Fungus
  3. Inhalation
  4. Fever, Pneumonitis
  5. NO VITRITIS; ‘Histo’ Spots (Choroiditis w/circular, depigmented, Atrophic Lesions), Maculopathy (CNVM), Peripapillary Atrophy
  6. Clinical; Histoplasmin Skin Test is rarely used due to the risk of reactivating a CNVM
  7. Intravitreal Avastin vs. Laser therapy for CNVM
  8. Anti-VEGF Therapy or Laser Therapy
    a. Ohio-Mississippi River Valley
25
Q

Toxocariasis

  1. Organism?
  2. Organism Type?
  3. Transmission?
  4. Systemic Disease?
  5. Ocular Disease?
  6. Diagnosis?
  7. Treatment? (4)
  8. What was often found to have TOXOCARIASIS
A
  1. Toxocara Canis
  2. Nematode (Worm)/Parasite
  3. Dogs, or less likely, Ingesting contaminated food or soil
  4. Asthma-like Attacks, Convulsions, Cough, Fever, Splenomegaly
  5. Granuloma, Hypopyon, Massive Vitritis, and Optic Neuropathy
  6. Toxocara ELISA
  7. Diethylcarbamazine, Prednisone, Thiabendazole, Vitreous Surgery
  8. Eyes Enucleated for Suspected Retinoblastoma
26
Q

Onchocerciasis

  1. Organism?
  2. Organism Type?
  3. Transmission?
  4. Systemic Disease?
  5. Ocular Disease?
  6. Diagnosis?
  7. Treatment? (1)
  8. AKA? Why?
    a. Common where?
A
  1. Onchocerca Volvulus
  2. Parasite/Nematode (Worm)
  3. Blackflies
  4. Skin nodules, Pruritus (Itching)
  5. Anterior Uveitis, Chorioretinitis, Keratitis, Optic Neuropathy
  6. Skin Bx, Surgical Specimen
  7. Ivermectin
  8. RIVER BLINDNESS; Cuz Blackflies live and breed by rivers.
    a. in Africa, Central & South America, and the Arabian Peninsula
27
Q

Ophthalmomyiasis

  1. Organism?
  2. Organism Type?
  3. Transmission?
  4. Systemic Disease?
  5. Ocular Disease?
  6. Diagnosis?
  7. Treatment?
A
  1. Oestrus Ovis
  2. Parasite/Maggot (Fly Larva)
  3. Adult Fly Bite
  4. Fly Eggs deposited on Hair (scalp, Eyebrows, Eyelashes)
  5. Subretinal “Maggot” Tracks, Free-floating Maggot in Vitreous, Retinal Detachment
  6. Surgical Specimen
  7. Surgical Removal (eg. Vitrectomy)
28
Q

Cysticercosis

  1. Organism?
  2. Organism Type?
  3. Transmission?
  4. Systemic Disease?
  5. Ocular Disease?
  6. Diagnosis?
  7. Treatment?
  8. Most Prominent where?
A
  1. Taenia Solium
  2. Parasite
  3. Ingestion of Eggs
  4. CNS Disease
  5. Anterior Uveitis
  6. Surgical Specimen (Vitrectomy)
  7. Surgical Removal; Albendazole
  8. In Central and South America
29
Q

Diffuse Unilateral Subacute Neuroretinitis (DUSN)

  1. Organism?
  2. Organism Type?
  3. Transmission?
  4. Systemic Disease?
  5. Ocular Disease?
  6. Diagnosis?
  7. Treatment?
A
  1. Toxocara Canis vs. Other
  2. Nematode (worm)
  3. Ingestion
  4. N/A
  5. Optic Disc Edema, Subretinal “Worm” Tracks, Vitritis
  6. ERG, IA, ICG
  7. Laser Destruction of the Worm
30
Q

Malaria

  1. Most common in what 4 areas?
  2. Treatment for the disease can have SEVERE RETINAL TOXICITY, leading to what?
  3. Pts using these drugs need to be monitored with what 2 things?
A
  1. Africa, Haiti, Indian Subcontinent, Papua New Guinea
  2. Bull’s Eye Maculopathy
  3. Humphrey Visual Field 10-2 and High Definition OCT (HD-OCT)
31
Q

Malaria

  1. Organism?
  2. Organism Type?
  3. Transmission?
  4. Systemic Disease?
  5. Ocular Disease?
  6. Diagnosis?
  7. Treatment?
A
  1. Plasmodium Falciparum or Plasmodium Vivax
  2. Protozoan
  3. Mosquito Bite
  4. Chills, Fever, Flulike Illness
  5. Cotton Wool Spots, Optic Neuritis, Panuveitis, Roth Spots, Retinal and Subconjunctival Hemorrhages
  6. Blood Smear
  7. Chloroquine, Hydroxychloroquine (Plaquenil)
32
Q

Bacterial Enodphthalmitis

  1. Most cases occur after what?
  2. What organism can cause Chronic Postoperative Uveitis?
    a. Especially when?
  3. It presents as what?
  4. Intravitreal injections may also rarely lead to what?
A
  1. Intraocular Surgery and are a Surgical Emergency
  2. Propionibacterium Granulosum
    a. After Cataract Extraction with IOL Placement
  3. Chronic, Low-Grade Anterior Segment Inflammation that starts from 2 months to 2 years after Cataract Surgery.
  4. to Endophthalmitis as Contamination from the Ocular Surface Enters the Eye upon Needle Insertion
33
Q

Bacterial Endophthalmitis

  1. Organism?
  2. Organism Type?
  3. Transmission?
  4. Systemic Disease?
  5. Ocular Disease?
  6. Diagnosis?
  7. Treatment?
A
  1. Propionibacterium Granulosum, Achromobacter, Pseudomonas Oryzihabitans, Mycobacterium, Staphylococcus Epidermidis, or Staphylococcus Aureus
  2. Bacterium
  3. Direct Contact
  4. N/A
  5. Anterior and/or Posterior Uveitis, Blur, Chemosis, Hypopyon, Hyperemia, and Pain
  6. Culture, PCR
  7. Amikacin, Ceftazidime, Intravitreal Vancomycin, Systemic Cephalosporins, and Vitrectomy
34
Q

Fungal Endophthalmitis

  1. How Common is it?
  2. How long after Eye surgery before it becomes symptomatic?
  3. Diagnosis of this should be suspected in whom?
A
  1. RARE
  2. May be months after eye surgery
  3. In ALL Patients w/Postoperative Inflammation that occurs weeks to months after Surgery
35
Q

Fungal Endophthalmitis

  1. Organism?
  2. Organism Type?
  3. Transmission?
  4. Systemic Disease?
  5. Ocular Disease?
  6. Diagnosis?
  7. Treatment?
A
  1. Candida or Aspergillus
  2. Fungus
  3. Direct Contact
  4. N/A
  5. Anterior Uveitis, Fluff Balls leading to “String of Pearls” and Vitritis
  6. Vx, Culture
  7. Vx, IOL Removal, Intravitreal and IV Amphotericin B, Oral Fluconazole and Oral Flucytosine
36
Q

Endogenous Endophthalmitis

  1. Majority of these are caused by what?
  2. Some of the predisposing factors to this condition are what?
  3. The Basic Principle is a Pre-existing what?
A
  1. Fungal
  2. AIDS, AI disease, Diabetes, IV Drug use, Hematologic Disorders, Immunosuppressive Therapy, and Malignancy
  3. Bacterial or Fungal Infection in the body is spread via the blood to the eye.
37
Q

Endogenous Endophthalmitis

  1. Organism?
  2. Organism Type?
  3. Transmission?
  4. Systemic Disease?
  5. Ocular Disease?
  6. Diagnosis?
  7. Treatment?
A
  1. Variable
  2. Bacteria, Fungus
  3. Hematogenous Spread
  4. Flulike Illness, and Persistent non-healing skin lesions
  5. Cellulitis, Corneal Scarring, Hypopyon, Panuveitis, Proptosis, Retinal Thickening (Retinitis), Retinal Periphlebitis, Roth Spots
  6. Vx, Culture
  7. IV Antibiotics/Antifungals

Ocular Disease II (15 decks)

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