Prevention
� Monitoring
� Surgical prophylaxis
� Neonatal risk:
-In utero exposure
-Peripartum exposure
presentation
More generalised
� Red eye
� Blurred vision
� Decreased vision
� Ocular pain
� Headache
� Systemic symptoms
Ocular syphilis
Rising notifications since 2000.
� HIV co-infection (up to 70%)
� MSM (80-90% of new notifications)
� Rural and remote communities (4 X higher)
Cause:
� Chronic multi system disease
� Secondary or latent stage
Aetiological agent: Treponema pallidum
Transm
f
Ocular involvement of syphilis is at what stage of pathogenesis?
a) Incubation period
b) Primary syphilis
c) Asymptomatic period
d) Secondary syphilis
e) Latent syphilis
f) Tertiary syphilis
a
Syphilis pathogenesis:
Multiplication at site of entry
a) Incubation period
b) Primary syphilis
c) Asymptomatic period
d) Secondary syphilis
e) Latent syphilis
f) Tertiary syphilis
b
Syphilis pathogenesis:
Spread to regional lymph nodes and blood stream
- primary chancre
- enlarged inguinal nodes
a) Incubation period
b) Primary syphilis
c) Asymptomatic period
d) Secondary syphilis
e) Latent syphilis
f) Tertiary syphilis
c
Syphilis pathogenesis:
No or very slow multiplication of organisms
a) Incubation period
b) Primary syphilis
c) Asymptomatic period
d) Secondary syphilis
e) Latent syphilis
f) Tertiary syphilis
d
Syphilis pathogenesis:
Multiplication in extra-genital sites
- maculopapular rash on skin/mucous membranes
- Malaise and mild fever
a) Incubation period
b) Primary syphilis
c) Asymptomatic period
d) Secondary syphilis
e) Latent syphilis
f) Tertiary syphil
e
Syphilis pathogenesis:
Organisms dormant in liver, spleen and CNS
a) Incubation period
b) Primary syphilis
c) Asymptomatic period
d) Secondary syphilis
e) Latent syphilis
f) Tertiary syphilis
f
Syphilis pathogenesis:
Renewed multiplication and invasion plus a cell-mediated hypersensitivity response.
- Gummas in skin, bone, liver
- Cardiovascular syphilis: aortic lesions, hf
- Neurosyphilis: general paresis of insane, tabes dorsalis
a) Incubation
Syphilis
Diagnosis of what?
� Patient history
� Swab/Corneal scraping
-Culture of ulcers
� Genotype
- RT-PCR on aqueous, vitreous humor
� Serology
- Syphilis (treponemal and non-treponemal)
- HIV
penicillin G
As for neurosyphilis (Ocular infections considered equivalent to CNS) what is the treatment?
IM/IV
How should penicillin G be administered for neurosyphilis Ocular infections?
ocular syphilis
As for neurosyphilis Ocular infections considered equivalent to CNS):
� Penicillin G
Prolonged outpatient follow-up
� serology at 6, 12, 24 months
�Lumbar puncture
� screening
Adjunct steroid treatment
� Topical
� Systemic
This is management for?
b
ocular syphilis treatment is
a) localised
b) systemic
Acute retinal necrosis
A destructive retinitis which occurs due to reactivated viral infection.
Caused by:
o Herpes simplex virus types 1 and 2
o Varicella zoster virus
o Cytomegalovirus
o Epstein-Barr virus
Haematogenous
What is the origin of acute retinal necrosis?
Reactivated viral infection
What is the cause of acute retinal necrosis?
c
Acute retinal necrosis
a) bacterial
b) fungal
c) viral
d) parasite
acute retinal necrosis
Diagnosis of what?
� Patient history
� Genotype
- PCR on aqueous humor
� Serology
- Goldmann-Witmer coefficient
- Intraocular antibody:serum antibody
� Microscopy: Ocular fluid
Toxoplasma gondii
a parasite which is most commonly transmitted from animals to humans by contact with contaminated faeces. Causes Toxoplasmosis.
Toxoplasmosis
What is the most common cause of infectious
retinochoroiditis (up 60%)?
Retinochoroiditis
A relatively common manifestation of Toxoplasma gondii infection. Occurs when cysts deposited in or near the retina become active, producing tachyzoites.
Toxoplasma gondii
what is the aetiological for toxoplasmosis?
c
What is the intermediate host for Toxoplasmosis?
a) Cats
b) Rodents
c) Humans
d) Pigs
c
Toxoplasma gondii (causes toxoplasmosis) is a
a) helminth
b) bacteria
c) protozoa
d) fungi
e) virus
toxoplasmosis
Diagnosis of what?
� Patient history
� Genotype
-PCR on ocular fluid
� Serology
- Seroconversion (Acute, Convalescent)
- IgM (current infection)
- Rising IgG
c
Which is present?
No previous exposure to pathogen
a) IgM
b) IgG
c) Neither
d) both
b
Which is present?
Immune. Previous exposure, immunisation.
a) IgM
b) IgG
c) Neither
d) both
d
Which is present?
Current active infection
a) IgM
b) IgG
c) Neither
d) both
b
Four-fold increase between acute and convalescent during current active infection.
a) IgM
b) IgG
d
Management of toxoplasmosis
a) antibacterial
b) antiviral
c) antifungal
d) antiprotozoal
e) antihelminthic
Ocular toxocariasis
� Global distribution
� More commonly diagnosed in children
Cause: Haematogenous
Aetiological agent: Toxocara canis/Toxocara cati
Transmission: Common vehicle
a
Ocular toxocariasis is more commonly diagnosed in
a) children
b) adults
Toxocara canis/Toxocara cati
What is the aetiological agent for ocular toxocariasis?
Haematogenous
The origin of Ocular toxocariasis is?
a
Toxocara canis/Toxocara cati that causes ocular toxocariasis is a
a) helminth
b) bacteria
c) protozoa
d) fungi
e) virus
b
Transmission of ocular toxocariasis (Toxocara Canis/cati) is
a) Contact
b) Common vehicle
c) Vector
ocular toxocariasis
Diagnosis of what?
� Patient history
� Genotype
- PCR on ocular fluid
� Serology
- IgG in ocular fluid
a
Ocular toxocariasis is caused by a
a) helminth
b) bacteria
c) protozoa
d) fungi
e) virus
c
Ocular toxocariasis, humans are the
a) primary host
b) intermediate host
c) accidental host
ocular toxocariasis
Management of what?
� Antihelminthic therapy usually contraindicated
- Increased host inflammatory response to nematode death
� Corticosteroid therapy
HTLV-1 uveitis
High incidence in remote Australian communities, Japan and South America.
Cause:
� Vertical transmission
� Immune reaction
Aetiological agent:
� Human T-cell lymphotropic virus type 1 (HTLV-1)
Transmission: Contact-sexual
HTLV-1
What is the aetiological agent of HTLV-1 uveitis?
sexual contact
HTLV-1 uveitis is spread via?
HTLV-1 uveitis
Management of what?
� Corticosteroid therapy
- Topical
- Systemic
Poor prognosis due to poor compliance of treatment and difficulty accessing medical care.
Ocular tuberculosis
Most commonly choroidal tubercles and tuberculomas.
Cause
� Haematogenous
� Immune reaction
Aetiological agent
� Mycobacterium tuberculosis (Acid-fast bacillus)
Transmission: Contact
Mycobacterium tuberculosis
What is the aetiological agent of Ocular tuberculosis?
ocular tuberculosis
Diagnosis of what?
� Patient history
� Swab/surgical specimen
- Culture and sensitivity (very slow, sampling difficult)
� Tuberculin skin test
� Genotype
- PCR on aqueous, vitreous, epiretinal membranes - Low specificity
� Serology
- M. tuberculosis IgG
�
ocular tuberculosis
Management of what?
� Specialised treatment
- *HIV/AIDS
� Supervised by medical team
� Combination antimicrobial cocktail
� Adjuvant corticosteroid therapy
Pneumocystis choroiditis
� AIDS-defining illness
� Fungi (reclassified)
Cause:
� Latent reactivation
� Opportunistic
� Inhaled treatment for pneumonia
Aetiological agent:
� Pneumocystis jiroveci
Transmission: Contact
Pneumocystis jiroveci
what is the aetiological agent for pneumocystis choroiditis?
d
Ocular pneumocystis choroiditis (pneumocystis jiroveci) is caused by
a) helminth
b) bacteria
c) protozoa
d) fungi
e) virus
Pneumocystis choroiditis
Diagnosis of what?
� Patient history e.g. candidiasis, HIV
� Genotype
-PCR on ocular fluid
Pneumocystis choroiditis
Management of what?
ongoing systemic prophylactic treatment
d
Endophthalmitis is caused by what groups of aetiological agents?
i. bacteria
ii. fungi
iii. virus
iv. parasite
a) i only
b) ii only
c) iii only
d) i & ii
e) i & iii
f) i, ii, iii
g) i, ii, iii, iv
cataract surgery
90% of Endophthalmitis occurs exogenously after what?
Candida albicans/Aspergillus
What are the fungal aetiological agents for endophthalmitis?
endophthalmitis
Diagnosis of what?
-Patient history
-Culture, vitreous sample
- PCR
endophthalmitis
Management of what?
� Infectious agents protected from host immune defences
-Surgical management
� Diverse group of aetiological agents
-Targeted intravitreal antimicrobial injection