|Year : 1979 | Volume
| Issue : 4 | Page : 18-20
Amoebic uveitis (Clinical study)
G Mukherjee, M Mohan, RK Batta
Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
Rajendra Prasad Centre for Ophthalmic Sciences, Ansari Nagar, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mukherjee G, Mohan M, Batta R K. Amoebic uveitis (Clinical study). Indian J Ophthalmol 1979;27:18-20
| Introduction|| |
Workers from all over the world have reported stray cases of uveitis associated with intestinal amoebiasis,,. A close relationship has been shown by a few but no one could definitely prove this relationship. It has only been confirmed by the process of exclusion and by noting clinical response to antiamoebic therapy. So far no one has tried to study the clinical nature and course of uveitis, serological pattern and response to antiamoebic therapy in details in selected cases of uveitis with positive stool for E. histolytica.
To know the pathogenesis, pathology and clinical course of the disease Mohan, Mukherjee and Batta conducted an experimental study. Parasites were injected intracamerally, intravitreously and suprachoroidally. A characteristic exudative haemorrhagic iridocyclitis was produced by intracameral injection and a typical focal choreoretinitis with haemorrhages in and around the lesion by suprachoroidal innoculation. These haemorrhages were considered as a pathognomonic finding in case of amoebic uveitis.
| Material and methods|| |
1063 cases of endogenous uveitis from uvea clinic of Dr. Rajendra Prasad Centre for Ophthalmic Sciences were studied. 42 cases suspected to be of amoebic uveitis were thoroughly investigated. The following investigations were carried out.
(i) Three consecutive samples of stool, by corcen. tration technique were examined for E. histolytica (ii) Indirect H.A. test for amoebiasis. (iii) Other routine and special investigations to rule out other causes of endogenous uveitis.
A course of antiamoebic therapy by metronidazole (flagy)) tablets 400 mg twice daily for 10 days was given. Stool examination repeated after therapy. Clinical course of the disease and therapeutic response was recorded.
| Observations|| |
Out of 1063 cases of endogenous uveitis examined in the uvea clinic 42 cases (3.95%) had positive stool for E. histolytica, 11 patients had history of chronic amoebic dysentry and one case had history of hepatitis. Most of the cases were bilateral. Anterior uveitis was seen in 14 cases (33.33%) where as posterior uveitis in 25 cases (59.52%), and pan uveitis in 3 cases (7.14%) [Table - 1]. Indirect H.A. (I.H.A.) test for amoebiasis was strongly positive in 11 cases and weakly positive in 16 cases.
Anterior uveitis: Out of the 14 cases of anterior uveitis 12 cases (85.71%) were active, 3 cases had haemorrhagic hypopyon [Figure - 1]; 5 cases (35.72%) had nongranulomatous lesion and 9 cases (64.28%) had granulomatous uveitis [Table - 2]. It was observed that these cases of nongranulomatous uveitis pass initially to intermediate type and finally to granulomatous lesion, with passage of time.
Posterior uveitis: 25 cases of posterior uveitis were seen, most of them were focal choreoretinitis (17 cases, 68%) and few were disseminated (7 cases, 28%) and only one (4%) I had diffuse chorioretinitis [Table - 3]. 19 cases (76%) were active out of which 8 cases had haemorrhagic chorioretinal lesion [Figure - 2].
Pan Uveitis: Only 3 cases had generalised uveal lesion, two cases had active lesion and both were non haemorrhagic.
Therapeutic response: Patients with active uveitis were treated with metronidazole. 21 cases (63.63%), showed good response and cured completely.
5 cases (15.15%) had initial response but recurred after the cessation of therapy. There was no response in 7 cases (21.21 %) [Table - 4]. They were treated with systemic corticosteroids and antibiotics were added to metronidazole therapy, the cases responded well.
| Discussion|| |
The reported prevalence of systemic amoebiasis varies from place to place even from same areas. C K. Rao et al (1977) reported prevalence rate ranging between 4.9 to 19.7 per cent from different areas of Delhi. Kasliwal et al (1968) reported 31-35% from Rajasthan, Chuttani (1961) reported as high as 41.3% from Chandigarh.
Sarda et al reported 8 cases of uveitis (anterior 6 and posterior 2) in a survey of 80 cases of intestinal amoeblasis. Present study of 42 cases of amoebic uveitis revealed that 54.77% are bilateral. Posterior segment, particularly the posterior pole involvement is common. Uveitis associated with other systemic diseases shows a similar pattern.
In early stages anterior uveitis had acute non granulomatous lesion with haemorrhagic exudate (3 out of 5 cases). Subacute and chronic cases showed intermediate type and later typical granulomatous type of lesion. These findings are in conformity with our earlier experimental work uveitis.
E. histolytica predominantly affects the posterior segment. Typically it produces a focal lesion of chorioretinitis in the posterior pole. Generalised uveal involvement is relatively uncommon (i. e. disseminated: 7 cases, diffuse one case and panuveitis: 3 cases), haemorrhagic exudates in the anterior chamber (60%) Haemorrhages in and around the chorioretinal lesions (42.1%) is a characteristic finding of amoebic uveitis. These clinical findings are supported by our earlier experimental works and reported by Barely et al. Barely et al also reported cystic lesion in the macular area but in our series we haven't seen such lesion. Possibly such lesions are seen only in United States, because of different strain of infective parasite. Other important cause of haemorrhagic uveitis is histoplasmosis, a very rare condition in our country. So we feel that amoebic uveitis should be considered the most important cause of haemorrhagic uveitis in India.
A good therapeutic response was seen in acute uveitis cases (63.33%) with metronidazole. There was recurrence of uveitis in 15.15% cases after cessation of therapy. Metronidazole is safe and specific for intestinal as well as extra intestinal amoebiasis. In cases of uveitis with positive stool for E. Histolytica, and/ or positive indirect H.A. test for amoebiasis, a course of metronidazole therapy should be given.
| Summary|| |
42 cases of suspected amoebic uveitis were thoroughly studied. Amoebic uveitis is mostly bilateral (54.77%); posterior segment involvement is common (59.52%) and has a tendency for a focal chorioretinal lesion. Haemorrhagic uveitis is pathognomonic of amoebic uveitis. A good therapeutic response was observed with metronidazole therapy.
| References|| |
Braley and Hamilton, H.E., 1957, Arh. Ophthal., 58, 1.
King, R.E., Praeger, D.L. and Hallette, J.W., 1964, Arch. Ophthal., 72, 16.
Paul, S.D., 1962, Proc. A.I.O.S., 9, 86.
Sarda, R.P., Mehrotra, A.S., Bhargava, B.N. and Sharma, R.G., 1963, East. Arch. Ophthal,1,183.
Mohan, M., Mukherjee, G., Batta, R.K., 1973, East. Arch. Ophthal., 1, 310.
[Figure - 1], [Figure - 2]
[Table - 1], [Table - 2], [Table - 3], [Table - 4]