title: Molecular diagnosis and ocular imaging of West Nile virus retinitis and neuroretinitis.
abstract: OBJECTIVE
  To describe the ocular features of West Nile virus (WNV) infection proven by serology and molecular diagnostic techniques.
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  Fifty-two patients who presented to the uveitis clinic with ocular inflammatory signs and history of fever preceding ocular symptoms between January 2010 and January 2012 were enrolled for laboratory diagnosis. Serum samples were collected from 30 healthy controls from the same geographic area.
  
  
  METHODS
  Patients were tested for all endemic infectious diseases that can cause ocular inflammation by serology or molecular diagnostics. When patients had positive antibodies for WNV, serum/plasma samples were tested by real-time reverse transcription (RT) polymerase chain reaction (PCR) and RT loop-mediated isothermal gene amplification assays. The PCR product was subjected to nucleotide sequencing. Fundus fluorescence angiography (FFA), optical coherence tomography (OCT), and indocyanine green angiography were performed. Visual prognosis was analyzed.
  
  
  METHODS
  Clinical signs (retinitis, neuroretinitis, and choroiditis) and ocular complications (decrease in vision).
  
  
  RESULTS
  A total of 37 of 52 patients (71%) showed positive results for at least 2 laboratory tests for WNV. Fundus examination revealed discrete, superficial, white retinitis; arteritis; phlebitis; and retinal hemorrhages with or without macular star. The FFA revealed areas of retinal inflammation with indistinct borders, vascular and optic disc leakage, vessel wall staining, or capillary nonperfusion. Indocyanine green angiography confirmed choroidal inflammation in 1 of the patients who was diabetic. The OCT scan of the macula revealed inner retinal layer edema in active inflammation and retinal atrophy in late stage. At the final visit, 43% of patients had visual acuity better than 6/12.
  
  
  CONCLUSIONS
  In addition to previously reported clinical signs, retinitis, neuroretinitis, and retinal vasculitis were seen in this population. Atrophy of the inner retinal layer was seen on OCT after resolution of inflammation. Visual prognosis was good in patients with focal retinitis and poor in patients with occlusive vasculitis.
  
  
  BACKGROUND
  The author(s) have no proprietary or commercial interest in any materials discussed in this article.
authors: Uveitis Service, Aravind Eye Hospital & PG Institute of Ophthalmology, Madurai, India. rathinam@aravind.org
authors: Rathinam R
authors: RR
authors: Sivakumar
authors: Lalitha
authors: L
authors: Prajna
authors: Lalan Kumar
authors: LK
authors: Arya
authors: Praveen
authors: P
authors: Muraly
authors: Jyoti
authors: J
authors: Shukla
authors: Divyasha
authors: D
authors: Saxena
authors: Manmohan
authors: M
authors: Parida
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood; D002648:Child; D004396:Coloring Agents; D004279:DNA, Viral / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D015828:Eye Infections, Viral / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D005260:Female; D005451:Fluorescein Angiography; D005784:Gene Amplification; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques; D011239:Prednisolone / Q000627:therapeutic use; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D012166:Retinal Hemorrhage / Q000175:diagnosis; D031300:Retinal Vasculitis / Q000175:diagnosis; D012173:Retinitis / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D041623:Tomography, Optical Coherence; D014759:Viral Envelope Proteins / Q000235:genetics; D014792:Visual Acuity / Q000502:physiology; D014901:West Nile Fever / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D014902:West Nile virus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D004396:Coloring Agents; D004279:DNA, Viral; D005938:Glucocorticoids; D014759:Viral Envelope Proteins; D011239:Prednisolone; D007208:Indocyanine Green