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Figure shows both in vivo (TST test) and in vitro (IGRAs) release of inflammatory cytokines by T-cells sensitized to mycobacterial antigens. In the skin test, antigens are injected intra dermally which bring specific lymphocytes to the site causing release of cytokines resulting in induration. In the blood test, mononuclear cells from peripheral blood produce IFN-γ from sensitized T-cells which is measured by ELISA. [6] Adapted from: Andersen P, Munk ME, Pollock JM, et al. Specific immune-based diagnosis of tuberculosis. Lancet 2000;356:1099-04
Source publication
Uveitis is a complex disorder including both infectious and non-infectious etiologies. Clinical diagnosis is a challenge because many diseases share common clinical signs. Laboratory support is crucial for confirming the clinical diagnosis. Laboratory diagnosis includes direct tests and indirect tests. For example smear, culture, and molecular diag...
Citations
... Therefore, VRL can be easily mis-diagnosed, mistreated, and commonly result in delayed diagnosis and delayed appropriate treatment [5]. While a uveitis evaluation requires blood tests and various imaging studies to assess for systemic infectious and inflammatory causes, [6] physicians need to know when to suspect VRL and seek appropriate evidence for the presence of malignant lymphoma. When a diagnosis is uncertain, a biopsy is necessary to obtain a more definitive, diagnostic specimen from the aqueous, vitreous, choroid or retina; however, all biopsies may be associated with potential surgical risks and complications [7]. ...
Background
Vitreoretinal lymphoma (VRL) is a rare intraocular malignancy that poses a diagnostic challenge due to the non-specific clinical presentation that resembles uveitis. The use of spectral domain optical coherence tomography (SD-OCT) has emerged as a valuable imaging tool to characterize VRL. Therefore, we sought to determine the specific OCT features in VRL compared to the uveitides.
Methods
Retrospective chart review of patients who were seen at Mayo Clinic from January 1, 2010 through December 31, 2022.
The medical records and SD-OCT images at time of initial presentation were reviewed in patients with biopsy-proven VRL, intermediate uveitis, or biopsy-confirmed sarcoid posterior uveitis. Patients with VRL or similar uveitides including intermediate uveitis or sarcoid posterior uveitis were included.
Results
There were 95 eyes of 56 patients in the VRL group and 86 eyes of 45 patients in the uveitis group, of whom 15 (33.3%) were diagnosed with intermediate uveitis and 30 (66.7%) with sarcoid chorioretinitis. The SD-OCT features more commonly seen at initial presentation in VRL patients (vs. uveitis) included preretinal deposits (31.6% vs. 9.3%, p = 0.002), intraretinal infiltrates (34% vs. 3.5%, p < 0.001), inner retinal hyperreflective spots (15.8% vs. 0%, p < 0.001), outer retinal atrophy (22.1% vs. 2.3%, p < 0.001), subretinal focal deposits (21.1% vs. 4.7%, p = 0.001), retinal pigmented epithelium (RPE) changes (49.5% vs. 3.5%, p < 0.001), and sub-RPE deposits (34.7% vs. 0%, p < 0.001). Features more frequently seen in uveitis included epiretinal membrane (ERM) (82.6% vs. 44.2%, p < 0.001), central macular thickening (95.3% vs. 51.6%, p < 0.001), cystoid macular edema (36% vs. 11.7%, p < 0.001), subretinal fluid (16.3% vs 6.4%, p = 0.04), and subfoveal fluid (16.3% vs. 3.2%, p = 0.003). Multivariate regression analysis controlling for age and sex showed absence of ERM (OR 0.14 [0.04,0.41], p < 0.001) and absence of central macular thickening (OR 0.03 [0,0.15], p = 0.02) were associated with VRL as opposed to uveitis.
Conclusion
OCT features most predictive of VRL (vs. uveitis) included absence of ERM and central macular thickening.
... However, raised IgG titres 3 to 4 times the normal level or increasing titres on repeat testing should be taken into consideration. 102 Demonstration of intraocular antibody synthesis is considered a valuable tool and is measured by paired aqueous and serum analysis of anti-Toxoplasma antibody titres, known as Goldmann-Witmer coefficient (GWC). A value higher than one usually indicates intraocular-specific antibody production, and a value greater than 4 suggests a recent infection. ...
... A value higher than one usually indicates intraocular-specific antibody production, and a value greater than 4 suggests a recent infection. 102 Demonstration of local pathogen-specific antibody synthesis in an immune-privileged organ such as the eye can be helpful and has been utilized for the diagnosis of various other uveitic entities, including viral infections. However, antibody detection demonstrates the indirect presence of an infectious agent and it may be influenced by various factors, such as the interplay between the infectious process and host immune response, time of sample collection, etc. ...
... 110 Healthy individuals and patients with lepromatous leprosy will not show any reaction, whereas a positive skin reaction will be seen in tuberculoid and borderline tuberculoid leprosy patients. 102 Thus, the lepromin test has very little diagnostic value and is rarely used. The literature on the use of skin tests in various other infectious entities remains sparse. ...
Laboratory investigations can play a significant role in the diagnosis and decision-making of infectious uveitis. Though direct demonstration of the infective organism remains the gold standard of diagnosis, it is not always possible with ocular tissues. Recent advancements in molecular techniques have made it possible to overcome these limitations and to identify the genomic DNA of pathogens associated with infectious uveitis. Techniques such as next-generation sequencing can analyze all DNA-based lifeforms, regardless of whether they are bacteria, fungi, viruses, or parasites and have been used in the laboratory diagnosis of intraocular inflammation. On the other hand, serological tests, though they dominate the diagnostic landscape of various infectious etiologies in uveitis in routine clinical practice, have varied specificities and sensitivities in different infectious uveitis. In this review, we focus on various methods of laboratory diagnosis of infectious uveitis and discuss the recent advances in molecular diagnosis and their role in various infectious clinical entities.
... [66][67][68] In the phenotypic method of diagnosis, the physical parameter are being taken into consideration, for instance, the incubation period of monkeypox virus is 4-21 days and normally it is followed by prodromal illness where symptoms like pharyngitis, malaise, back pain, intense asthenia, myalgia, headache, and fever. 69,70 In the exanthema phase rashes and pea-sized lesions are seen; these are found to be different from smallpox lesions. The immunological identification of viruses is carried out with ELISA technique which detects IgG and IgM antibodies, whereas viral antigens can be identified with immunohistochemistry. [65][66][67][68][69][70] ...
... 69,70 In the exanthema phase rashes and pea-sized lesions are seen; these are found to be different from smallpox lesions. The immunological identification of viruses is carried out with ELISA technique which detects IgG and IgM antibodies, whereas viral antigens can be identified with immunohistochemistry. [65][66][67][68][69][70] ...
The unprecedented outbreaks of monkeypox viruses in non-endemic regions have created grave concern for global health. The World Health Organization has declared a public health emergency of international concern and stated the seriousness of monkeypox viruses. The gravity of this zoonotic disease cannot be underestimated, owing to the fact that this viral infection can cause pathetic situations if ignored. Keeping these lacunas, the scientific communities have expressed their interest towards the study of monkeypox viruses. Hence the present review discusses the etiological features, historical events, and vaccination along with management strategies to combat and counter the sudden outbreak. The review also highlights the current Indian scenario of the monkeypox virus; with scanty reports available, the present contributes towards the growing scientific knowledge to prevent a future threats to mankind.
... [62] Dark field microscopy, direct fluorescent antibody stains, polymerase chain reaction (PCR), and immunohistochemistry are all direct methods that are recommended for use in both primary and secondary syphilis. [62][63][64] T. pallidum-specific DNA sequences are detected using PCR tests. PCR was used to successfully detect spirochetes in the vitreous fluid of OcS patients. ...
... Serological tests are classified as non-treponemal or treponemal. [2,63] ...
... [62] The rapid plasma reagin (RPR) and venereal disease research laboratory (VDRL) tests are the most commonly used non-treponemal tests. [63] They are used to detect syphilis activity and assess treatment response. [63,67] Antibody titers correlate with syphilis activity. ...
Syphilis is a sexually transmitted systemic disease caused by the spirochete Treponema pallidum. If left untreated, syphilis progresses in four stages: Primary, secondary, latent, and tertiary. Since the turn of the 20th century, the global prevalence of syphilis has sharply increased. Syphilis and human immunodeficiency virus (HIV) coinfection are common because they share similar transmission routes. Ocular syphilis (OcS) is a rare syphilis complication, but its prevalence has recently increased as a result of the rise in syphilis cases. OcS may occur at any stage of syphilis. However, it may not always be accompanied by systemic findings. In such cases, ocular involvement may be the disease’s first and only manifestation. OcS can affect any structure of the eye, yet the most common manifestations are posterior uveitis and panuveitis. Due to the variety of clinical manifestations, the disease is known as “the great imitator.” As a result, syphilis serology is advised for any patient with unknown intraocular inflammation. Although clinical signs can be indicative of OcS, it is diagnosed using laboratory tests. Multimodal ocular imaging is required for differential diagnosis, treatment, and follow-up. It is highly recommended that patients with suspected or confirmed syphilis be tested for HIV infection. OcS is treated just like neurosyphilis with systemic penicillin. If OcS is treated promptly and effectively, a good visual prognosis is possible; otherwise, it may lead to permanent blindness.
... Viral infections occur in close synchrony with environmental factors; the vector responsible for transmission of virus, is directly influenced by conducive environmental conditions for its own breeding and dissemination [8,9]. Serological assays tend to remain positive, in a population, long after the epidemic or illness has subsided [5,10]. Serologies may not provide a definitive evidence of an ongoing ocular infection in this subset of retinitis and guiding treatment based on the same is unlikely to yield better results and could sometimes delay institution of antiinflammatory therapy. ...
Purpose
To report a series of five cases with retinitis following episodes of febrile illness, its evaluation, management and outcome.
Method
Retrospective, consecutive case series of five patients presenting with acute retinitis, following a febrile illness.
Results
The retinal lesions had a sudden onset with rapid evolution, preceded by a febrile episode within one month of presentation, in all cases. Extensive serology and PCR testing were non-contributory toward identifying the etiology and guiding therapy. Systemic corticosteroid therapy was effective in hastening the resolution of lesions.
Conclusion
Post-fever retinitis appears to be a distinct clinical form of acute hemorrhagic non-necrotizing retinitis without a uniformly identifiable cause, and some evidence pointing toward a para-infectious etiology secondary to flu-like illnesses. With an unusual morphological presentation and annual seasonal patterns in the endemic areas, it is important to differentiate this entity, from other forms of infectious retinitis, before initiating corticosteroid therapy.
... [62] Dark field microscopy, direct fluorescent antibody stains, polymerase chain reaction (PCR), and immunohistochemistry are all direct methods that are recommended for use in both primary and secondary syphilis. [62][63][64] T. pallidum-specific DNA sequences are detected using PCR tests. PCR was used to successfully detect spirochetes in the vitreous fluid of OcS patients. ...
... Serological tests are classified as non-treponemal or treponemal. [2,63] ...
... [62] The rapid plasma reagin (RPR) and venereal disease research laboratory (VDRL) tests are the most commonly used non-treponemal tests. [63] They are used to detect syphilis activity and assess treatment response. [63,67] Antibody titers correlate with syphilis activity. ...
... However, the subspecialty of uveitis has progressed in leaps and bounds over the past decades. It currently involves the use of sophisticated immunological biomarkers, [5] molecular diagnostics, advanced imaging techniques, and manipulation of interleukins and cytokines using biological agents to get the best results for our patients. [6] Of special note are the recent advances in imaging every layer of the uveal tract including enhanced depth imaging using optical coherence tomography (EDI-OCT), swept-source OCT technology to image deeper into the choroid, fundus autofluorescence, indocyanine green angiography with confocal scanning laser imaging to get sharper images, and wide-field and ultra-wide-field imaging techniques. ...
... The issue begins with a beautiful account of the history and evolution of the USI, pays tribute to the pioneers of uveitis practice in India, and then moves on to many different forms of uveitis and scleritis. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Since the eye is an immune-privileged site and the cause of uveitis is often multifactorial, it becomes difficult to identify the underlying etiology. In these circumstances, a careful workup, based on history, clinical findings, and your own acumen and experiences, is the best way to establish the cause. ...
... In this issue of the IJO, Rathinam et al., have provided a comprehensive overview of the range of different immunological tests currently available in our armamentarium. [1] However, to use these tests meaningfully, it is important to remember certain fundamental principles about the application of these tests. These are listed below. ...
Commentary- Understanding immunological tests for uveitis -Ten Essentials
