Infectious uveitis in immunocompromised patients and the diagnostic value of polymerase chain reaction and Goldmann-Witmer coefficient in aqueous analysis.
OBJECTIVE
To establish the causes of uveitis in immunocompromised patients and to determine the contribution of polymerase chain reaction (PCR) and Goldmann-Witmer coefficient (GWC) analysis of aqueous humor in patients with an infectious etiology.


METHODS
Retrospective case series of 56 consecutive immunocompromised patients with uveitis.


METHODS
All patients underwent full ophthalmologic examination and laboratory blood analysis for uveitis. Aqueous humor analyses were performed using PCR and GWC for cytomegalovirus (CMV), herpes simplex virus (HSV), varicella zoster virus (VZV), and Toxoplasma gondii.


RESULTS
Of 56 immunocompromised patients, 43 (77%), all posterior and panuveitis, had intraocular infections. Twenty-one (49%) had CMV, three (7%) had VZV, 11 (26%) had T. gondii, six (14%) had Treponema pallidum, and one (2%) each had Aspergillus and Candida. In AIDS patients, CMV was the most common cause. A strong correlation between AIDS and ocular syphilis was also observed (P = .007). In nonAIDS immunocompromised patients, T. gondii was most frequently detected. Twenty-seven patients were examined by both PCR and GWC; five (18.5%) were positive by both assays, 15 (55.5%) were positive by PCR alone and seven (26%) by GWC alone. Viral infections were detected by PCR in 16 of 17 (94%) cases; T. gondii in four of 10 (40%) patients. Using GWC, a viral infection was diagnosed in three of 17 (18%) and T. gondii in nine of 10 (90%) cases.


CONCLUSIONS
In immunocompromised patients, PCR is superior in diagnosing viral infections. Analysis of intraocular antibody production played a decisive role in the diagnosis of ocular toxoplasmosis.
Westeneng
Arnaud C
AC
F. C. Donders Institute of Ophthalmology, Utrecht, The Netherlands.
Rothova
Aniki
A
de Boer
Joke H
JH
de Groot-Mijnes
Jolanda D F
JD
D000163:Acquired Immunodeficiency Syndrome / Q000276:immunology; D000818:Animals; D000913:Antibodies, Protozoan / Q000032:analysis; D000914:Antibodies, Viral / Q000032:analysis; D001082:Aqueous Humor / Q000382:microbiology / Q000469:parasitology / Q000821:virology; D003587:Cytomegalovirus / Q000235:genetics / Q000276:immunology; D016054:DNA, Protozoan / Q000032:analysis; D004279:DNA, Viral / Q000032:analysis; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods*; D015817:Eye Infections / Q000175:diagnosis* / Q000382:microbiology / Q000469:parasitology / Q000821:virology; D005260:Female; D014645:Herpesvirus 3, Human / Q000235:genetics / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D016133:Polymerase Chain Reaction / Q000379:methods*; D012189:Retrospective Studies; D018139:Simplexvirus / Q000235:genetics / Q000276:immunology; D014122:Toxoplasma / Q000235:genetics / Q000276:immunology; D014605:Uveitis / Q000175:diagnosis* / Q000382:microbiology / Q000469:parasitology / Q000821:virology
D000913:Antibodies, Protozoan; D000914:Antibodies, Viral; D016054:DNA, Protozoan; D004279:DNA, Viral