Parinaud's Oculoglandular Syndrome Research Articles

Parinaud oculoglandular syndrome secondary to sporotrichosis

Parinaud oculoglandular syndrome secondary to sporotrichosis

P162 Parinaud's Oculoglandular Syndrome as an atypical manifestation of sporotrichosis in Brazil

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectivesInform the general practitioner about the possibilities of atypical manifestations secondary to sporotrichosis, such as ocular manifestations, unrelated to the classic finding of contiguous lymphocutaneous ulcers.MethodsThis is a single-center, cross-sectional, retrospective study with patients evaluated and seen from June 2018 to April 2022 at the Mycology Outpatient Clinic of Hospital Universitário Oswaldo Cruz, University of Pernambuco.All patients were evaluated by the same infectious disease physician throughout the course, from diagnosis to outpatient discharge.Scrapings and cultures were collected by the institution's specialized Mycology team. Biopsies were sent to the University Pathology Service (CIAP).ResultsDuring the 4-year period, 231 patients started their treatment for sporotrichosis following clinical, laboratory, and histopathological criteria. Of these, 9 (3,8%) had Parinaud's Oculoglandular Syndrome, unilateral granulomatous conjunctivitis associated with ipsilateral preauricular or submandibular lymphadenitis (Fig. 1). Of the 9 reported cases, 8 presented manifestations only in the conjunctiva (88%), and 1 case also presented palpebral involvement (12%).Since most patients had a late diagnosis due to the difficulty in carrying out the specific investigation of the agent by a non-specialized team, the diagnosis by scraping and culture was compromised by early treatment with antifungals, especially itraconazole. It is becoming common in the Northeast of Brazil that the association of sick cats with typical manifestations of sporotrichosis is the main epidemiological factor since our case series for infections caused by soil manipulation is low. Therefore, 55% (5/9) had a clinical-epidemiological diagnosis of sporotrichosis, with an excellent clinical response to itraconazole 200 mg/day, as well as the 4 patients with diagnoses confirmed by culture (Fig. 2). The antifungal was taken after lunch since a fatty diet interferes with improved medication absorption. All patients were instructed not to use medications with known interactions, especially proton pump inhibitors and alcohol use.ConclusionHuman sporotrichosis has become endemic in Latin America in the last two decades, bringing relevant morbidity to those infected. Zoonotic transmission by direct contact with infected sick cats has been gaining ground in Northeast Brazil, creating important epidemiology when typical sporotrichosis lesions appear following contact with these animals. Lymphocutaneous sporotrichosis is known to be the most common manifestation, but there is a need for care teams working in primary and secondary care to identify atypical manifestations and expand the investigation into the possibility of fungal infections. The epidemiology of the neighborhood associated with the presence and contact with sick cats with ulcerative lesions must be considered and taken into account.

Serous retinal detachment and Parinaud's oculoglandular syndrome: an uncommon association

Serous retinal detachment and Parinaud's oculoglandular syndrome: an uncommon association

Parinaud's oculo-glandular syndrome secondary to sporotrichosis

Parinaud's oculoglandular syndrome (PCOS) is a rare eye disease caused by different etiological agents, including bacteria, viruses and fungi. PCOS is a special form of granulomatous conjunctivitis and is often associated with cat scratch disease, herpes simplex infection, sporotrichosis, blastomycosis, and coccidioidomycosis. Sporotrichosis is a subcutaneous mycosis caused by the fungus Sporothrix schenckii with global distribution and, in general, patients are treated on an outpatient basis. Since 1998, there has been an increase in cases in the State of Rio de Janeiro, Brazil, especially due to zoonotic transmission involving cats. PCOS is characterized by granulomatous conjunctivitis accompanied by adjacent pre-auricular lymphadenopathy and systemic symptoms such as sweating, feeling sick, and fever. Complementary tests including culture confirm the diagnosis of sporotrichosis. Its classic clinical presentation should always be remembered by specialists so that the correct diagnosis and treatment with antifungal agents is carried out early, so that the condition can be resolved without sequelae for the patients.

Parinaud's oculo-glandular syndrome secondary to sporotrichosis

Parinaud's oculo-glandular syndrome secondary to sporotrichosis

The Clinical Profile of Cat-Scratch Disease's Neuro-Ophthalmological Effects.

Cat-scratch disease is an illness caused by Bartonella henselae that occurs as a result of contact with an infected kitten or dog, such as a bite or scratch. It is more prevalent in children and young adults, as well as immunocompromised individuals. There are limited publications examining the features of CSD in patients. As such, the purpose of this research was to assess the clinical neuro-ophthalmological consequences of CSD reported in the literature. Among the ophthalmologic disorders caused by cat-scratch disease in humans, Parinaud oculoglandular syndrome, uveitis, vitritis, retinitis, retinochoroiditis and optic neuritis are the most prevalent. The neurological disorders caused by cat-scratch disease in humans include encephalopathy, transverse myelitis, radiculitis, and cerebellar ataxia. The current review addresses the neuro-ophthalmological clinical manifestations of cat-scratch disease, as described in papers published over the last four decades (1980–2022). All the data gathered were obtained from PubMed, Medline and Google Scholar. The current descriptive review summarizes the most-often-encountered clinical symptomatology in instances of cat-scratch disease with neurological and ocular invasion. Thus, the purpose of this review is to increase knowledge of cat-scratch disease’s neuro-ophthalmological manifestations.

Parinaud's oculoglandular syndrome by sporotrichosis: Red flag

Parinaud's oculoglandular syndrome by sporotrichosis: Red flag

Bartonella hanselae retinitis patient evaluated with multimodal retinal exams

BackgroundCat scratch disease is a systemic infectious illness caused by the bacterium Bartonella henselae. The most common ophthalmological involvement due to infection by Bartonella is Parinaud oculoglandular syndrome, whereas the most common posterior segment findings are neuroretinitis and subsequent late macular star. Moreover, other findings, such as retinal or subretinal lesions, intermediate uveitis and angiomatous lesions, may be present.Case presentationA 37-year-old female patient with retinal findings and serological confirmation of Bartonella infection was evaluated via multimodal retinal exams. The patient received treatment with doxycycline 100 mg twice daily for 2 weeks. One month after treatment, complete improvement of her visual scotoma symptoms was confirmed. A swept-source optical coherence tomography exam also showed decreases in the size and intraretinal extension of the lesion. Improvement of light perception at the affected area was confirmed by microperimetry.ConclusionsBartonella henselae infection, particularly retinitis, can present a variable spectrum of clinical and ophthalmological findings. Multimodal retinal exams can clearly identify lesion characteristics, thus providing important information for diagnosis and the evaluation of lesion improvement after antibiotic treatment.

Virulence Factors of Bacteria Related to Ocular Infections in Non Immunocompromised Patients: Review Article

The ocular surface is constantly exposed to pathogenic bacteria. Many Gram positive and Gram negative bacteria have been implicated in ocular infections, in non immunocompromised patients, causing severe vision impairment. These microorganisms have in their quiver a variety of arrows to cause infection. The aim of this study is to list the virulence factors of the main ocular pathogens. Data were extracted from PubMed and Google Scholar. <i>S. aureus</i> and <i>Streptococci, Bacillus cereus</i> and <i>Corynebacterium (non-diphtheriae)</i> are the main culprits as far as Gram positive bacteria are concerned. <i>S. aureus</i> causes infections of the lacrimal apparatus, cornea and eyelids, conjunctivitis, keratitis, and endophthalmitis. <i>Streptococcus pneumoniae, Streptococcus pyogenes, Enterococcus</i> and <i>Streptococcus viridians</i> are isolated from post injection endophthalmitis cases. S. pneumoniae</i> is most involved in keratitis, conjunctivitis, and endophthalmitis. <i>Streptococcus pyogenes</i> is most involved in blepharitis and hospital acquired conjunctivitis in neonates in the intensive care unit. <i>Enterococcus faecalis</i> is implicated in postoperative endophthalmitis cases. <i>Corynebacterium (non-diphtheriae) species</i> are involved mainly in infections complicating cataract surgery, keratoplasty, and vitrectomy. <i>Bacillus species</i> provoke conjunctivitis, keratitis and post-traumatic endophthalmitis. <i>Bacillus cereus</i> can cause rapidly destructive endophthalmitis. Among Gram negative bacteria, <i>Neisseria gonorrhoeae, Pseudomonas aeruginosa, Chlamydia trachomatis</i>, and <i>Bartonella species</i> are major ocular pathogens, responsible for severe ocular damage. Gonococcal conjunctivitis (GC) is still a cause of blindness in some developing countries. When it occurs in neonates, it is called gonococcal ophthalmia neonatorum. <i>P. aeruginosa</i> is related to contact lens-associated keratitis. <i>Chlamydia trachomatis</i> is the culprit of trachoma and inclusion conjunctivitis. <i>Bartonella henselae</i> causes bartonellosis or cat scratch disease, or cat scratch fever. Eye infection includes optic neuropathy and neuroretinitis. When the eye is the primary site of inoculation, the patients are diagnosed with Parinaud oculo-glandular syndrome (infection of the conjunctiva, eyelid and adjacent skin with regional lymphadenopathy). Chronic <i>Bartonella</i> infection provokes blurred vision, photophobia and eye irritation. Comprehension of the mechanism of infection, caused by these pathogens, is crucial in diagnosis and treatment.

Ocular Sporotrichosis: 26 Cases with Bulbar Involvement in a Hyperendemic Area of Zoonotic Transmission

ABSTRACT Purpose To describe 26 cases of bulbar conjunctival sporotrichosis. Methods Review of clinical records of patients with bulbar conjunctivitis due to culture-proven Sporothrix spp. infection, in Rio de Janeiro, from 2007 to 2017. Results Twenty-six patients were identified. Median age was 25 years. Adults were more affected (53.8%), followed by adolescents (26.9%). There was a predominance of women (73.1%). Twenty-four patients (96%) reported contact with cats with sporotrichosis. Twenty-one patients (80.8%) presented a primary ocular sporotrichosis. Five patients presented associated eyelid lesions, and 21 (80.8%) tarsal conjunctivitis. Parinaud oculoglandular syndrome was observed in 17 (81%) patients. Eight patients (36.4%) reported the use of steroid drops before diagnosis was made. All patients but one were treated with oral itraconazole. Twenty-three patients (88.5%) were completely cured and three (11.5%) were lost to follow-up. Eight patients (34.8%) developed ocular sequelae. Conclusion Bulbar conjunctivitis is an important clinical presentation of ocular sporotrichosis. It can lead to ocular sequelae. Sporotrichosis should be considered in the differential diagnosis of ophthalmic external diseases, especially in patients with cat contact history

2311. Atypical Cat Scratch Disease Presentations

BackgroundCat scratch disease (CSD) is caused by B henselae, a Gram-negative intracellular bacilli which is transmitted to humans via cat bite/scratch. Typical CSD presents as regional lymphadenopathy and fever. However, there are multiple atypical presentations of cat scratch disease that have been reported including prolonged fever, absence of lymphadenopathy and systemic complications such hepatosplenic disease, osteomyelitis, Parinaud oculoglandular syndrome, neuroretinitis, encephalitis, and bacillary angiomatosis among other rare presentations. The aim of this study was to review the frequency, presentation, and treatment outcomes of aytpical CSD presentations at Nationwide Children’s Hospital (Columbus OH).MethodsThis was a retrospective study performed at Nationwide Children’s Hospital, Columbus, OH. EMR of patients were reviewed between January 2010 and March 2017 using ICD9 or ICD 10 codes for CSD. Patients were identified on the basis of compatible clinical presentation and confirmatory serological test or PCR results for B. henselae. Clinical, radiological, and histopathological findings were collectedResultsA total of 204 patients were serologically diagnosed as having cat scratch disease between January 2010 and July 2017. Of the 204 cases, 166 (81%) had typical CSD and 38 (18.6%) had atypical CSD. Of the atypical manifestations, 20 (52%) patients had no lymphadenopathy, 12 (31%) had osteomyelitis, 12 (31%) patients had hepatic and/or splenic microabscesses, 4 (10.5%) had osteomyelitis and hepatic/splenic involvement, 3 (1.5%) had encephalitis, 2 (5.2%) had neuroretinitis, and there was one case each (2.6%) of Parinaud oculoglandular syndrome, uveitis, pulmonary cavitary lesion, myocarditis, and endocarditis. Fever of unknown origin was present in 28 (75.6%) of the atypical CSD cases. The median duration of antibiotic treatment was 25 days (IQR 31) and median duration of illness in patients with atypical CSD was 51 days (IQR 56). The majority of patients were treated with dual antibiotic therapy that included rifampin.ConclusionIn children with fever of unknown origin, serologic testing for CSD should be performed even in the absence of lymphadenopathy and a search for underlying systemic complications is recommended for prompt diagnosis and appropriate treatment.Disclosures All authors: No reported disclosures.

Parinaud's oculoglandular syndrome: A case report

Abstract Clinical case A 33-year old woman presents with unilateral granulomatous conjunctivitis, ipsilateral regional lymphadenopathy and fever. A Bartonella henselae infection is demonstrated by indirect immunofluorescence, and a diagnosis of a Parinaud's oculoglandular syndrome is established. Outcome after treatment with oral doxycycline is satisfactory. Discussion Parinaud's oculoglandular syndrome is the most frequent ocular manifestation of a B. henselae infection.

Síndrome oculoglandular de Parinaud: a propósito de un caso

Clinical caseA 33-year old woman presents with unilateral granulomatous conjunctivitis, ipsilateral regional lymphadenopathy and fever. A Bartonella henselae infection is demonstrated by indirect immunofluorescence, and a diagnosis of a Parinaud's oculoglandular syndrome is established. Outcome after treatment with oral doxycycline is satisfactory. DiscussionParinaud's oculoglandular syndrome is the most frequent ocular manifestation of a Bartonella henselae infection.

Parinaud Oculoglandular Syndrome 2015: Review of the Literature and Update on Diagnosis and Management

Parinaud oculoglandular syndrome (POGS) is an ocular granulomatous inflammatory condition characterized by unilateral follicular bulbar or palpebral conjunctivitis. Although POGS often presents as an atypical manifestation of cat scratch disease (CSD), other infectious and autoimmune etiologies have been described. Due to the rare nature of this ocular syndrome and scarcity of literature on this topic, POGS is often missed on the initial diagnostic workup. Here, we provide a brief description of disease process, and present a review of the literature on POGS in the past two decades to understand the trends in etiology of disease. Based on the results of this review, we also suggest an algorithm for diagnosis and management of POGS.

Parinaud’s oculoglandular syndrome and possibly causing cortical cataract

De acordo com a Organização Mundial de Saúde, a catarata é a principal causa de cegueira e deficiência visual em todo o mundo. No entanto, a etiologia das cataratas frequentemente permanece desconhecida. Este relato descreve o desenvolvimento de catarata cortical em um paciente após Síndrome oculoglandular de Parinaud causada pelo fungo Sporothrix schenckii. Síndrome oculoglandular de Parinaud como possível causa de catarata cortical

Index of Suspicion

The reader is encouraged to write possible diagnoses for each case before turning to the discussion. We invite readers to contribute case presentations and discussions. Please inquire first by contacting Dr. Deepak Kamat at DKamat@med.wayne.edu. A 2-year-old boy with a history of eczema and food allergies to nuts and soy presents to the emergency department with a 10-day history of generalized edema. The swelling began in the periorbital area but soon progressed to involve his entire body. There have been no fevers or any recent illnesses other than 1 day of cough and a few watery stools. He has had no new exposures to foods or other substances. His family history is remarkable for multiple allergies and eczema. Physical examination reveals a temperature of 98.8°F (37.1oC), heart rate of 98 beats per minute, respiratory rate of 36 breaths per minute, blood pressure of 103/65 mm Hg, and an oxygen saturation of 97% on room air. His weight is 12.6 kg (34th percentile). He is noted to have a moderate amount of periorbital edema, decreased breath sounds at the lung bases bilaterally, a protuberant abdomen, and 2+ pitting edema on his lower extremities. The rest of his physical examination findings are within normal limits. Laboratory evaluation reveals a white blood cell count of 23,800/μL (23.8 × 109/L), with 37% neutrophils, 49% lymphocytes, 4% bands, 7% monocytes, and 3% eosinophils; hemoglobin level of 13.3 g/dL (133 g/L); and platelet count of 427 × 103/μL (427 × 109/L). Serum electrolyte, blood urea nitrogen, and creatinine levels are normal. Sodium level is 132 mEq/L (132 mmol/L). Serum albumin level is 1.7 g/dL (17 g/L) (reference range, 3.4-5.4 g/dL [34-54 g/L]). Total protein level is 3.8 g/dL (38 g/L). Aspartate aminotransferase, alanine aminotransferase, and coagulation profiles …

Central scotoma without prodromal illness caused by Bartonella henselae neuroretinitis

This case report describes Bartonella henselae neuroretinitis in a 26-year-old woman who presented to the emergency department with unilateral central scotoma and no prodromal symptoms, a unique presentation of this disease. B henselae, a gram-negative bacteria, is the cause of cat scratch disease. Cat scratch disease (CSD) is a self-limiting illness, which typically presents with regional lymphadenopathy, fever, and small skin lesions in associationwith a cat scratch or bite. The mostcommon ocular manifestations of cat scratch disease are Parinaud oculoglandular syndrome and neuroretinitis. All prior reported cases of CSD neuroretinitis presented with prodromal symptoms, not vision loss alone.

Paradoxical response in ocular bartonellosis

IntroductionCat scratch disease is an infectious disease caused by thebacteria Bartonella henselae [1] and is transmitted by catscratches or exposure to cat saliva. The spectrum of itsocular manifestations includes Parinaud's oculoglandularsyndrome, iritis, vitritis, neuroretinitis, panuveitis, retinitisappearing as small white intraretinal infiltrates, and choroi-dal white lesions [1, 2]. B. henselae is reported to be themost common cause of neuroretinitis; typically character-ized by optic disk edema in association with a partial orcomplete macular star. The majority of infected patientspresenting with neuroretinitis reported in the literature aretreated with antibiotics. In some cases steroids were added.However several reports showed that even patients who didnot receive treatment had an excellent visual outcome [1].We describe here a paradoxical response to treatment in ayoung female presenting with bilateral neuroretinitis andinflammatory optic disk lesions.Case reportA 19-year-old healthy female presented with an abruptdeterioration of left eye vision of 1-day duration. For10 days prior to presentation, she was suffering from drycough; 5 days later she had intermittent fever up to 41°Cwith shaking chills. There was a history of contact with acat, but she denied being scratched. On admission, physicaland neurologic examinations were unremarkable. Ophthal-mologic assessment disclosed visual acuity of 4/4 in theright eye and 4/60 in the left eye. She had normal anteriorsegments and intraocular pressures. A left afferent pupillarydefect was noted. Funduscopy of the right eye showed asmall white optic disk lesion in its temporal aspect with adeep retinal white lesion along the superonasal arcade(Fig. 1). The left optic disk had blurred margins with biggerwhite lesions in its nasal and temporal aspects with anassociated localized vitreous opacity on its surface (Fig. 1).There was marked macular edema and two deep retinalwhite lesions along the superotemporal arcade and infer-onasal to the optic disk. Optical coherence tomography(OCT) revealed intraretinal fluid in the right papillomacularbundle and left exudative macular detachment (Fig. 2).Visual field examination showed right nasal step andsuperonasal arcuate defect while there was enlargement ofthe left blind spot with nasal step (Fig. 3). Work-uprevealed mild anemia with hemoglobin of 11.7 g% andleukocytosis of 14,800 (lymphocytes, 31%). Kidney andliver functions were within normal limits except for aslightly elevated lactate dehydrogenase at 768 (normalrange, 300–620 u/l). She had elevated erythrocyte sedi-mentation rate (ESR) (90 mm/h) and C-reactive protein(5.3 mg%; normal range, less than 1). Chest X-ray did notreveal any pathological findings, and CT scan and MRI ofthe head and brain showed mild thickening of the opticnerves bilaterally and hyperintense foci in the flairsequences in the intraocular aspects of the optic nerves,respectively. Cerebrospinal fluid cytology was normal.Serological tests were negative for HIV, syphilis, Brucella,Coxiella burnetti, toxoplasma, and toxocara. Serologicaltests for B. henselae revealed positive IgM titer at 75 units

Parinaud Oculoglandular Syndrome as a Prominent Presenting Feature of Kikuchi-Fujimoto Disease � A Case Report and Review of the Literature

Kikuchi-Fujimoto disease (KFD) is an often underdiagnosed form of lymphadenitis that clinically mimics lymphoma. Ocular manifestations are rare in patients with KFD and are under-appreciated in the literature. We describe a man who presented with eye redness, blurred vision, and pain on upward gaze associated with fever, weight loss and cervical lymphadenopathy. This presentation was initially interpreted as Parinaud oculoglandular syndrome which is most often caused by infection leading to an infectious workup. Lymph node biopsy was eventually performed and showed KFD. Kikuchi-Fujimoto disease needs to be added to the list of known causes of Parinaud oculoglandular syndrome. [N A J Med Sci. 2011;4(2):96-99.]

Parinaud Oculoglandular Syndrome as a Prominent Presenting Feature of Kikuchi-Fujimoto Disease � A Case Report and Review of the Literature

Parinaud Oculoglandular Syndrome as a Prominent Presenting Feature of Kikuchi-Fujimoto Disease � A Case Report and Review of the Literature