Abstract
Objective. To assess the value of routine polymerase chain reaction (PCR) analysis on intraocular fluid from patients presenting with a first episode of suspected active infectious posterior uveitis in a population with a high prevalence of human immunodeficiency virus infection. Design. Retrospective, interventional case series. Participants. 159 consecutive patients presenting at a tertiary care hospital over a five-year period. Methods. PCR analysis was performed for cytomegalovirus, varicella zoster virus, herpes simplex virus types 1 and 2, Toxoplasma gondii, and Mycobacterium tuberculosis. Results. PCR analysis confirmed the initial clinical diagnosis in 55 patients (35%) and altered the initial clinical diagnosis in 36 patients (23%). The clinical diagnosis prior to PCR testing was nonspecific (uncertain) in 51 patients (32%), with PCR providing a definitive final diagnosis in 20 of these patients (39%); necrotizing herpetic retinopathy and ocular toxoplasmosis were particularly difficult to diagnose correctly without the use of PCR analysis. Conclusion. The clinical phenotype alone was unreliable in diagnosing the underlying infectious cause in a quarter of patients in this study. Since the outcome of incorrectly treated infective uveitis can be blinding, PCR analysis of ocular fluids is recommended early in the disease even in resource poor settings.
Highlights
In developed countries, uveitis affects approximately 200 per 100,000 in the population, and uveitis and its complications account for up to 35% of severe visual impairment [1]
The most common infectious aetiologies are Toxoplasma gondii (TG), herpes simplex virus (HSV), and varicella-zoster virus (VZV), whereas CMV is a common pathogen in countries with a high prevalence of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) [3,4,5]
The aetiological diagnosis of infectious uveitis is initially made on the basis of the associated clinical features, but there is often significant overlap between the phenotypic expressions of these different pathogens, thereby limiting the ability to accurately identify the causative organism by clinical examination [7]
Summary
Uveitis affects approximately 200 per 100,000 in the population, and uveitis and its complications account for up to 35% of severe visual impairment [1]. Blindness and visual impairment caused by infectious uveitis can be prevented by early identification of the responsible pathogen and the subsequent prompt administration of appropriate antimicrobial therapy [1]. This is critical in immunocompromised patients [3, 6]. The aetiological diagnosis of infectious uveitis is initially made on the basis of the associated clinical features, but there is often significant overlap between the phenotypic expressions of these different pathogens, thereby limiting the ability to accurately identify the causative organism by clinical examination [7]. Establishing a diagnosis based on clinical findings is difficult in cases
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