The White Re)na. Joseph Alsberge, MD January 20, 2018

Size: px
Start display at page:

Download "The White Re)na. Joseph Alsberge, MD January 20, 2018"

Transcription

1 The White Re)na Joseph Alsberge, MD January 20, 2018

2 58 y/o man with floaters and pain OD x 2 weeks PMH: oral and genital herpes Va OD 20/50 Anterior OD: KP and 3+ AC cell Posterior: Vitri)s, occlusive vasculi)s, and mul)- focal peripheral white necro)zing re)ni)s

3 Va OS 20/16 Anterior OS: Quiet Posterior: Quiet with no re)ni)s

4 Diagnosis?

5 The White Re)na Infec)ons Viral Herpes Simplex Herpes Varicella Zoster Cytomegalovirus Dengue Fever West Nile Virus Chikungunya Parasite Toxoplasmosis Bacterial Syphilis Bartonella TB Fungal Candida Aspergillus Immune Behcet s disease Iatrogenic Surgical trauma Air Infusion Trauma Commo)o re)nae Tumor Lymphoma Congenital Myelinated NFL White without pressure Ischemia

6 Varicella Zoster and Herpes Simplex Viruses Vaso- occlusive peripheral re)ni)s, vasculi)s, vitri)s (the acute re)nal necrosis syndrome) Classically occurs in healthy, immuno- competent, adults

7 Cytomegalovirus Re)ni)s with hemorrhage and satellite lesions Slowly progressive, occurs in severely immunocompromised pa)ents (AIDS, bone marrow transplant recipients)

8 Chikungunya Virus Mosquito- borne Alphavirus, causes an acute, poten)ally fatal, febrile illness, Most outbreaks occur in the tropics Chikungunya re)ni)s tends to occur in the posterior pole with minimal vitri)s

9 Dengue Virus Mosquito- borne Flavivirus, causes Dengue Fever : headache, myalgia, rash and other symptoms Has been associated with a wide range of ocular inflammatory disease, including re)ni)s Courtesy Prof. Khalid Tabbara

10 West Nile Virus Mosquito- borne Flavirvirus that can cause severe encephali)s Has been associated with posterior pole re)ni)s with hemorrhage Courtesy Prof. Rathinam Sivakumar

11 The world is heavily interconnected You never know when a pa)ent with a mosquito- borne re)ni)s may land in your office!

12 Toxoplasmosis gondii Focal, round, necro)zing re)ni)s in the posterior pole with associated vitri)s The so- called headlight in the fog appearance Raw meat consump)on (oysters, pork) and exposure to cat feces are risk factors for infec)on by this parasite

13 Toxoplasmosis gondii Another case of toxoplasmosis re)ni)s Acute focal re)ni)s in the posterior pole adjacent to an old pigmented scar This is highly sugges)ve of toxoplasmosis and indicates reac)vated disease

14 Syphilis Syphilis can cause essen)ally any form of ocular inflamma)on However, re)ni)s with overlying superficial precipitates highly sugges)ve Rates of this bacterial disease have been rising in recent 4 days years later no treatment

15 Bartonella henslae Gram- nega)ve bacillus that is endemic in cats Classically associated with neurore)ni)s (i.e., op)c disc edema and macular star), can also cause mul)focal re)ni)s

16 Candida albicans Fungus that can cause ocular infec)on via endogenous route For example, in hospitalized pa)ents with indwelling catheters Candida re)ni)s may be focal or mul)focal, and can break through into the vitreous to produce a vitreous abscess

17 Lymphoma Always consider lymphoma: The Great Masquerader Can mimic infec)ous necro)zing re)ni)s Failure to respond to an)microbial therapy is a clue, )ssue diagnosis is defini)ve

18 Back to our pa)ent 58 y/o man OD 20/50 Pain and vision loss OD x 2 weeks PMH: oral and genital herpes Anterior: KP and 3+ AC cell Vitri)s, occlusive vasculi)s, mul)- focal peripheral white re)ni)s

19 Diagnosis: Acute Necrosis Syndrome due to VZV or HSV

20 Clinical findings Diagnos)c tes)ng Treatment Complica)ons Acute Re)nal Necrosis

21 Anterior segment findings Granulomatous large KP Stellate KP

22 ARN can present with concomitant scleri)s and elevated IOP

23 Posterior segment findings Peripheral necro)zing re)ni)s With non- perfusion and segmental arteriolar occlusion

24 Bilateral acute re)nal necrosis (BARN) Occurs in 1/3 rd of cases Onset of fellow eye typically within months Herpes virus likely progresses through the op)c chiasm from one eye to the other

25 PCR Tes)ng and Isolate Frequency Consider PCR tes)ng of ocular fluid (aqueous or vitreous) PCR highly sensi)ve and specific (95% and 97%, respec)vely) for herpesviridae VZV accounts for majority of cases of ARN However in children and young adults, it is more ooen HSV- 2

26 Treatment: systemic an)viral is mainstay Valacyclovir (Valtrex ) 1-2 gm PO TID Intravitreal an)viral agents (foscarnet or ganciclovir) op)onal Oral steroids op)onal Consider hospitaliza)on for IV an)viral therapy if non- compliance issues or evidence of systemic infec)on Resolving re)ni)s 4 weeks following ini)a)on of treatment

27 Treatment: systemic an)viral is mainstay Valacyclovir (Valtrex ) 1-2 gm PO TID Intravitreal an)viral agents (foscarnet or ganciclovir) op)onal Oral steroids op)onal Consider hospitaliza)on for IV an)viral therapy if non- compliance issues or evidence of systemic infec)on Re)ni)s resolved at 4 months follow up

28 However, not all cases respond to standard therapy Case report of ARN that progressed despite IV acyclovir and ganciclovir Switch to foscarnet lead to resolu)on of re)ni)s Gene)c analysis revealed mul)- drug resistant strain of HSV- 2 In cases that fail to respond to standard therapy, consider drug resistance

29 Another in cases that fail to respond to standard therapy Vitreore)nal lymphoma can masquerade as infec)ous re)ni)s to a striking degree

30 Rhegmatogenous re)nal detachment is a common complica)on of ARN As ac)ve infec)on resolves, breaks can develop in areas of necro)c re)na

31 Rhegmatogenous Re)nal Detachment in ARN RRD occurs in 50-75% of eyes with ARN (weeks to months aoer ini)al presenta)on)

32 Some have advocated early prophylac)c barrier laser Ra)onale: prevent progression to detachment should breaks occur

33 The White Re)na Infec)ons Viral Herpes Simplex Herpes Varicella Zoster Cytomegalovirus Dengue Fever West Nile Virus Chikungunya Parasite Toxoplasmosis Bacterial Syphilis Bartonella TB Fungal Candida Aspergillus Immune Behcet s disease Iatrogenic Surgical trauma Air Infusion Trauma Commo)o re)nae Tumor Lymphoma Congenital Myelinated NFL White without pressure Ischemia

34 Thank You

Acute Retinal Necrosis Secondary to Varicella Zoster Virus in an Immunosuppressed Post-Kidney Transplant Patient

Acute Retinal Necrosis Secondary to Varicella Zoster Virus in an Immunosuppressed Post-Kidney Transplant Patient CM&R Rapid Release. Published online ahead of print September 20, 2012 as Aperture Acute Retinal Necrosis Secondary to Varicella Zoster Virus in an Immunosuppressed Post-Kidney Transplant Patient Elizabeth

More information

Field research to iden/fy infec/ous agents in animals and the environment to a6empt to predict emergence

Field research to iden/fy infec/ous agents in animals and the environment to a6empt to predict emergence Field research to iden/fy infec/ous agents in animals and the environment to a6empt to predict emergence John S Mackenzie Plenary session 3: Policies and Strategies to Meet the Challenge of Emerging Disease

More information

Bilateral acute retinal necrosis in a patient with multiple sclerosis on natalizumab

Bilateral acute retinal necrosis in a patient with multiple sclerosis on natalizumab Bilateral acute retinal necrosis in a patient with multiple sclerosis on natalizumab Arjun B. Sood, Emory University Gokul Kumar, Emory University Joshua Robinson, Emory University Journal Title: Journal

More information

Differential diagnosis of posterior uveitis

Differential diagnosis of posterior uveitis Differential diagnosis of posterior uveitis Diagnostic approach 45-year old male. Floaters and decreased vision since 1 week Fever, lymphadenopathy, myalgias, night sweats, two months ago Oral ulcer sporadically

More information

Necrotizing retinitis of multifactorial etiology

Necrotizing retinitis of multifactorial etiology Romanian Journal of Ophthalmology, Volume 61, Issue 1, January-March 2017. pp:49-53 CASE REPORT Necrotizing retinitis of multifactorial etiology Pirvulescu Ruxandra Angela* **, Popa Cherecheanu Alina*

More information

Introduction to Microbes and Infectious Disease

Introduction to Microbes and Infectious Disease Name: Date: Introduction to Microbes and Infectious Disease Station 1) Pathogens Pathogens are capable of causing. Examples: Station 3) Discovery My name is Anton von Leeuwenhoek, and in I documented my

More information

Herpetic Eye Disease Jason Duncan, OD, FAAO Diplomate, American Board of Optometry Associate Professor, Southern College of Optometry

Herpetic Eye Disease Jason Duncan, OD, FAAO Diplomate, American Board of Optometry Associate Professor, Southern College of Optometry Herpetic Eye Disease Jason Duncan, OD, FAAO Diplomate, American Board of Optometry Associate Professor, Southern College of Optometry I have what?! How to break the news Meet the Herpes Quick virology

More information

Retinal Manifestations of Systemic Disease Part 1

Retinal Manifestations of Systemic Disease Part 1 The Retina and Systemic diseases Retinal Manifestations of Systemic Disease Part 1 Sundeep Dev, MD VRSF Retinal Update 2019 VitreoRetinal Surgery, PA 1 Retinitis/Vasculitis Vitreous cells Serous detachments

More information

Mosquito-Borne Uveitis

Mosquito-Borne Uveitis UCSF December Course- 2016 San Francisco, CA Mosquito-Borne Uveitis Emmett T. Cunningham, Jr, MD, PhD, MPH Department of Ophthalmology, California Pacific Medical Center Department of Ophthalmology, Stanford

More information

VIRAL INFECTIONS OF THE CNS. Anne A. Gershon, Columbia University

VIRAL INFECTIONS OF THE CNS. Anne A. Gershon, Columbia University VIRAL INFECTIONS OF THE CNS Anne A. Gershon, Columbia University A Patient with Aseptic Meningitis 15 yo female, previously in good health Complained of severe headache, stiff neck, fever No rash LP: 323

More information

Moncef Khairallah, MD

Moncef Khairallah, MD Moncef Khairallah, MD Department of Ophthalmology, Fattouma Bourguiba University Hospital Faculty of Medicine, University of Monastir Monastir, Tunisia INTRODUCTION IU: anatomic form of uveitis involving

More information

Ganciclovir-resistant CMV retinitis in a patient with wild-type plasma CMV. North Carolina School of Medicine, Chapel Hill, NC

Ganciclovir-resistant CMV retinitis in a patient with wild-type plasma CMV. North Carolina School of Medicine, Chapel Hill, NC JCM Accepts, published online ahead of print on 15 February 2012 J. Clin. Microbiol. doi:10.1128/jcm.00029-12 Copyright 2012, American Society for Microbiology. All Rights Reserved. 1 Ganciclovir-resistant

More information

Retina Grand Rounds. Stephen Huddleston MD Charles Retina Institute University of Tennessee Hamilton Eye Institute

Retina Grand Rounds. Stephen Huddleston MD Charles Retina Institute University of Tennessee Hamilton Eye Institute Retina Grand Rounds Stephen Huddleston MD Charles Retina Institute University of Tennessee Hamilton Eye Institute Fundus Autoflourescence 2013 2016 Plaquenil Toxicity Excellent treatment for a variety

More information

10 EYE EMERGENCIES. Who goes, who you better not send! Brant Slomovic, MD, FRCPC University Health Network

10 EYE EMERGENCIES. Who goes, who you better not send! Brant Slomovic, MD, FRCPC University Health Network 10 EYE EMERGENCIES Who goes, who you better not send! Brant Slomovic, MD, FRCPC University Health Network DISCLOSURES I have none PVD CASE 1 WHAT IS A PVD? a process of aging (45-55) liquefaction of vitreous

More information

CNS Infec*ons. Leonard Sowah, MBChB, MPH, FACP

CNS Infec*ons. Leonard Sowah, MBChB, MPH, FACP CNS Infec*ons Leonard Sowah, MBChB, MPH, FACP Overview Epidemiology and risk factors of CNS infec*ons Diagnosis and clinical evalua*on, treatment and sequelae of common CNS infec*ons, meningi*s, encephali*s

More information

Ocular Toxoplasmosis Uveitis course Antalya Miles Stanford Medical Eye Unit St Thomas Hospital London

Ocular Toxoplasmosis Uveitis course Antalya Miles Stanford Medical Eye Unit St Thomas Hospital London Ocular Toxoplasmosis Uveitis course Antalya 2013 Miles Stanford Medical Eye Unit St Thomas Hospital London Toxoplasma gondii Obligate, intracellular, apicomplexan protozoan Infects > 1/3 world population

More information

PRECISION PROGRAM. Injection Technique Quick-Reference Guide. Companion booklet for the Video Guide to Injection Technique

PRECISION PROGRAM. Injection Technique Quick-Reference Guide. Companion booklet for the Video Guide to Injection Technique Injection Technique Quick-Reference Guide PRECISION PROGRAM Companion booklet for the Video Guide to Injection Technique Available at www.ozurdexprecisionprogram.com Provides step-by-step directions with

More information

Herpesviruses. Tools of diagnosis : what to use and when. Corinne Liesnard Laboratory of Virology Erasme Hospital - ULB

Herpesviruses. Tools of diagnosis : what to use and when. Corinne Liesnard Laboratory of Virology Erasme Hospital - ULB Herpesviruses Tools of diagnosis : what to use and when Corinne Liesnard Laboratory of Virology Erasme Hospital - ULB Evolution of the techniques in the virology lab Techniques : "Classic" methods Ag detection

More information

Potential etiologies of infection in these patients are diverse, including common and uncommon opportunistic infections.

Potential etiologies of infection in these patients are diverse, including common and uncommon opportunistic infections. In the name of God Principles of post Tx infections 1: Potential etiologies of infection in these patients are diverse, including common and uncommon opportunistic infections. Infection processes can progress

More information

Acyclovir dose for chicken pox

Acyclovir dose for chicken pox Buscar... Acyclovir dose for chicken pox Acyclovir (Zovirax) treats infections caused by the herpes viruses including genital herpes, cold sores, shingles and chicken pox. Includes Acyclovir side effects.

More information

REFRESHER: ANTERIOR UVEITIS

REFRESHER: ANTERIOR UVEITIS REFRESHER: ANTERIOR UVEITIS 2. SAoO Kongress 28.2.2018 Messe Luzern Dr. med. Christian Böni Augenklinik Universitätsspital Zürich Christian Böni Seite 1 Anterior Uveitis: Clinical Issues Diagnostics: yes

More information

Dilemmas in the Management of Meningitis & Encephalitis HEADACHE AND FEVER. What is the best initial approach for fever, headache, meningisums?

Dilemmas in the Management of Meningitis & Encephalitis HEADACHE AND FEVER. What is the best initial approach for fever, headache, meningisums? Dilemmas in the Management of Meningitis & Encephalitis Paul D. Holtom, MD Professor of Medicine and Orthopaedics USC Keck School of Medicine HEADACHE AND FEVER What is the best initial approach for fever,

More information

o White dot syndromes pattern recognition o Activity and damage o Quality of life o Key points o Idiopathic o Sarcoidosis o Multiple sclerosis

o White dot syndromes pattern recognition o Activity and damage o Quality of life o Key points o Idiopathic o Sarcoidosis o Multiple sclerosis Introduction Clinical Assessment of Posterior Uveitis Philip I. Murray Centre for Translational Inflammation Research University of Birmingham Birmingham and Midland Eye Centre o Classification of uveitis

More information

Public Health Image Library. CDC/ Cynthia Goldsmith. Image #

Public Health Image Library. CDC/ Cynthia Goldsmith. Image # Zika Virus Fredrick M. Abrahamian, D.O., FACEP, FIDSA Clinical Professor of Medicine UCLA School of Medicine Director of Education Department of Emergency Medicine Olive View-UCLA Medical Center Sylmar,

More information

Various presentations of herpes simplex retinochoroiditis A case series

Various presentations of herpes simplex retinochoroiditis A case series Various presentations of herpes simplex retinochoroidits 47 Various presentations of herpes simplex retinochoroiditis A case series M. T. K. Perera 1, T. S. Keragala 1, M. Gamage 2 The Journal of the College

More information

Non-reproductive tissues and cells

Non-reproductive tissues and cells Colour key Tested pathogen VIRAL Minimum requirements as set out in Directive 2004/23/EC More stringent testing - legy binding on national level More stringent testing - recommended on national level Not

More information

Disseminated shingles acyclovir

Disseminated shingles acyclovir Disseminated shingles acyclovir The Borg System is 100 % Disseminated shingles acyclovir Two developed disseminated herpes zoster, one developed cytomegalovirus. Reduced response to acyclovir,. Disseminated

More information

Human Herpes Viruses (HHV) Mazin Barry, MD, FRCPC, FACP, DTM&H Assistant Professor and Consultant Infectious Diseases KSU

Human Herpes Viruses (HHV) Mazin Barry, MD, FRCPC, FACP, DTM&H Assistant Professor and Consultant Infectious Diseases KSU Human Herpes Viruses (HHV) Mazin Barry, MD, FRCPC, FACP, DTM&H Assistant Professor and Consultant Infectious Diseases KSU HERPES VIRUS INFECTIONS objectives: ØTo know the clinically important HHVs. ØTo

More information

Rare Presentation of Ocular Toxoplasmosis

Rare Presentation of Ocular Toxoplasmosis Case Report Rare Presentation of Ocular Toxoplasmosis Rakhshandeh Alipanahi MD From Department of Ophthalmology, Nikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, Iran. Correspondence:

More information

Molecular Diagnos/cs has emerged as one of the largest and fastest growing segments in the $54 billion in-vitro diagnos/c (IVD) industry.

Molecular Diagnos/cs has emerged as one of the largest and fastest growing segments in the $54 billion in-vitro diagnos/c (IVD) industry. Molecular Diagnos/cs has emerged as one of the largest and fastest growing segments in the $54 billion in-vitro diagnos/c (IVD) industry. 10 The 5 largest segments of the IVD market are Central Lab Immunoassays,

More information

Disclosure. Learner Objectives. Congenital Infections. Question. Main Categories 4/26/2016

Disclosure. Learner Objectives. Congenital Infections. Question. Main Categories 4/26/2016 Communicating Communicability: Imaging of CNS Infections Aaron P. Kamer, MD Assistant Professor of Clinical Radiology Neuroradiology Section April 26, 2016 Disclosure Within the past 12 months: I have

More information

Antiviral Drugs. Munir Gharaibeh MD, PhD, MHPE School of Medicine, The University of Jordan November 2018

Antiviral Drugs. Munir Gharaibeh MD, PhD, MHPE School of Medicine, The University of Jordan November 2018 Antiviral Drugs Munir Gharaibeh MD, PhD, MHPE School of Medicine, The University of Jordan November 2018 Viruses Viruses are the smallest infective agents, consisting of nucleic acid (DNA or RNA) enclosed

More information

HSV DNA replication. Herpesvirus Latency. Latency and Chemotherapy. Human Herpesviruses - subtypes. Acyclovir (acycloguanosine) {Zovirax}

HSV DNA replication. Herpesvirus Latency. Latency and Chemotherapy. Human Herpesviruses - subtypes. Acyclovir (acycloguanosine) {Zovirax} Human Herpesviruses - subtypes Herpes Simplex I (HSVI) - herpes labialis (cold sores) herpes keratitis (eye infections) HSVII - herpes genitalis (genital herpes) Varicella Zoster virus (VZV) Chicken pox

More information

Equine Recurrent Uvei2s/ ERU. Equine Recurrent Uvei2s. Uvei2s. Uvea. Blood- ocular barrier. Uvea

Equine Recurrent Uvei2s/ ERU. Equine Recurrent Uvei2s. Uvei2s. Uvea. Blood- ocular barrier. Uvea Equine Recurrent Uvei2s/ ERU Equine Recurrent Uvei2s Moon blindness Iridocycli2s Periodic ophthalmia Tijn J.P. Spoormakers dipl. ECVS, cert ISELP Most common cause of blindness Uvei2s Inflamma2on of uvea

More information

Head prof. MUDr. E. Vlková, CSc.

Head prof. MUDr. E. Vlková, CSc. MUDr. Karkanová Michala, Oční klinika LF MU a FN Brno Head prof. MUDr. E. Vlková, CSc. 3 parts: iris (iris) ciliary body (corpus ciliare) choroid (choroidea) Function: regulating the entry of light into

More information

CNS Infections in the Pediatric Age Group

CNS Infections in the Pediatric Age Group CNS Infections in the Pediatric Age Group Introduction CNS infections are frequently life-threatening In the Philippines, bacterial meningitis is one of the top leading causes of mortality in children

More information

Non-reproductive tissues and cells

Non-reproductive tissues and cells Colour key Minimum requirements as set out in Directive 2004/23/EC More stringent - legy binding on national level More stringent - recommended on national level Not legy binding and not recommended on

More information

Development and validation of new diagnostic criteria for acute retinal necrosis

Development and validation of new diagnostic criteria for acute retinal necrosis Jpn J Ophthalmol DOI 10.1007/s10384-014-0362-0 CLINICAL INVESTIGATION Development and validation of new diagnostic criteria for acute retinal necrosis Hiroshi Takase Annabelle A. Okada Hiroshi Goto Nobuhisa

More information

Immunodeficiencies HIV/AIDS

Immunodeficiencies HIV/AIDS Immunodeficiencies HIV/AIDS Immunodeficiencies Due to impaired function of one or more components of the immune or inflammatory responses. Problem may be with: B cells T cells phagocytes or complement

More information

Herpesviruses. Infec3ous Diseases in Clinical Prac3ce February 2016

Herpesviruses. Infec3ous Diseases in Clinical Prac3ce February 2016 Herpesviruses Infec3ous Diseases in Clinical Prac3ce February 2016 Jennifer Babik, MD, PhD Division of Infec3ous Diseases University of California, San Francisco Disclosures None 1 2/18/16 Learning Objec3ves

More information

Infectious Retina. The Fight Against HIV/AIDS?? HAART. Common Posterior Segment Manifestations 1/8/2019. Raman Bhakhri, OD, FAAO Assistant Professor

Infectious Retina. The Fight Against HIV/AIDS?? HAART. Common Posterior Segment Manifestations 1/8/2019. Raman Bhakhri, OD, FAAO Assistant Professor Infectious Retina Raman Bhakhri, OD, FAAO Assistant Professor No Disclosures Disclosure Statement: Nothing to disclose Common Posterior Segment Manifestations o HIV Retinopathy o Cytomegalovirus (CMV)

More information

Prof Dr Najlaa Fawzi

Prof Dr Najlaa Fawzi 1 Prof Dr Najlaa Fawzi is an acute highly infectious disease, characterized by vesicular rash, mild fever and mild constitutional symptoms. is a local manifestation of reactivation of latent varicella

More information

Test Requested Specimen Ordering Recommendations

Test Requested Specimen Ordering Recommendations Microbiology Essentials Culture and Sensitivity (C&S) Urine C&S Catheter Surgical (excluding kidney aspirates) Voided Requisition requirements o Specific method of collection MUST be indicated o Indicate

More information

Infections in immunocompromised host

Infections in immunocompromised host Infections in immunocompromised host Immunodeficiencies Primary immunodeficiencies Neutrophil defect Humoral: B cell defect Humoral: Complement Cellular: T cells Combined severe immunodeficiency Secondary

More information

Non-Traumatic Neuro Emergencies

Non-Traumatic Neuro Emergencies Department of Radiology University of California San Diego Non-Traumatic Neuro Emergencies John R. Hesselink, M.D. Nontraumatic Neuroemergencies 1. Acute focal neurological deficit 2. Worst headache of

More information

Viruses. Poxviridae. DNA viruses: 6 families. Herpesviridae Adenoviridae. Hepadnaviridae Papovaviridae Parvoviridae

Viruses. Poxviridae. DNA viruses: 6 families. Herpesviridae Adenoviridae. Hepadnaviridae Papovaviridae Parvoviridae Viruses DNA viruses: 6 families Poxviridae Herpesviridae Adenoviridae Hepadnaviridae Papovaviridae Parvoviridae Human herpesviruses Three subfamilies (genome structure, tissue tropism, cytopathologic effect,

More information

8/7/12. Anterior Seg Grand Rounds Case III. New Advances in the Management of Viral Eye Disease. Slit lamp exam: Sign: 68 y.o.

8/7/12. Anterior Seg Grand Rounds Case III. New Advances in the Management of Viral Eye Disease. Slit lamp exam: Sign: 68 y.o. New Advances in the Management of Viral Eye Disease Anterior Seg Grand Rounds Case III 68 y.o. Caucasian female!! Dr.Paul Karpecki!! Corneal Services and Ocular Disease Research!! Koffler Vision Group

More information

Rhegmatogenous retinal detachment in uveitis

Rhegmatogenous retinal detachment in uveitis De Hoog et al. Journal of Ophthalmic Inflammation and Infection (2017) 7:22 DOI 10.1186/s12348-017-0140-5 Journal of Ophthalmic Inflammation and Infection ORIGINAL ARTICLE Open Access Rhegmatogenous retinal

More information

Infectious Retina Raman Bhakhri, OD, FAAO Assistant Professor SCCO/MBKU

Infectious Retina Raman Bhakhri, OD, FAAO Assistant Professor SCCO/MBKU Infectious Retina Raman Bhakhri, OD, FAAO Assistant Professor SCCO/MBKU rbhakhri@ketchum.edu Please silence all mobile devices and remove items from chairs so others can sit. Unauthorized recording of

More information

ESCMID Online Lecture Library. by author. CASE PRESENTATION ECCMID clinical grand round May Anat Stern, MD Rambam medical center Haifa, Israel

ESCMID Online Lecture Library. by author. CASE PRESENTATION ECCMID clinical grand round May Anat Stern, MD Rambam medical center Haifa, Israel CASE PRESENTATION ECCMID clinical grand round May 2014 Anat Stern, MD Rambam medical center Haifa, Israel An 18 years old Female, from Ukraine, diagnosed with acute lymphoblastic leukemia (ALL) in 2003.

More information

Shingles prophylaxis acyclovir

Shingles prophylaxis acyclovir Shingles prophylaxis acyclovir Search 27-2-2018 Detailed Acyclovir dosage information for adults and TEENren. Includes dosages for Herpes Simplex - Suppression, Herpes Simplex Labialis, Herpes Zoster.

More information

Image of Ebola viruses exiting host cells HUMAN VIRUSES & THE LIMITATION OF ANTIVIRAL DRUG AGENTS

Image of Ebola viruses exiting host cells HUMAN VIRUSES & THE LIMITATION OF ANTIVIRAL DRUG AGENTS Image of Ebola viruses exiting host cells HUMAN VIRUSES & THE LIMITATION OF ANTIVIRAL DRUG AGENTS APRIL 2017 Infectious viruses are a global health threat Since the approval of the first antiviral drug

More information

Retinal Vein Occlusion (RVO) Treatment pathway- Northeast England. Retinal Vein Occlusion (RVO) with Macular oedema (MO)

Retinal Vein Occlusion (RVO) Treatment pathway- Northeast England. Retinal Vein Occlusion (RVO) with Macular oedema (MO) Retinal Vein Occlusion (RVO) Treatment pathway- Northeast England (Royal Victoria Infirmary, Sunderland Eye Infirmary, James Cook University Hospital, Darlington Memorial Hospital, University Hospital

More information

Viral Diseases. T Bamdad, PhD, Tarbiat Modares University

Viral Diseases. T Bamdad, PhD, Tarbiat Modares University Viral Diseases 1 Categorizing viral infections by the organ system most commonly affected (eg, lungs, GI tract, skin, liver, CNS, mucous membranes) can be clinically useful, although certain viral disorders

More information

Antiviral Drugs. Munir Gharaibeh MD, PhD, MHPE School of Medicine, The University of Jordan November 2018

Antiviral Drugs. Munir Gharaibeh MD, PhD, MHPE School of Medicine, The University of Jordan November 2018 Antiviral Drugs Munir Gharaibeh MD, PhD, MHPE School of Medicine, The University of Jordan November 2018 Viruses Viruses are the smallest infective agents, consisting of nucleic acid (DNA or RNA) enclosed

More information

Image of Ebola viruses exiting host cells HUMAN VIRUSES & THE LIMITATION OF ANTIVIRAL DRUG AGENTS

Image of Ebola viruses exiting host cells HUMAN VIRUSES & THE LIMITATION OF ANTIVIRAL DRUG AGENTS Image of Ebola viruses exiting host cells HUMAN VIRUSES & THE LIMITATION OF ANTIVIRAL DRUG AGENTS MAY 2017 1 Infectious viral pathogens are a significant global health threat to mankind 2 Since the approval

More information

Non-reproductive tissues and cells Recommending authority/ association

Non-reproductive tissues and cells Recommending authority/ association Colour key Minimum requirements as set out in Directive 2004/23/EC More stringent - legy binding More stringent - recommended Not legy binding and not recommended Tested pathogen Donor test/ technique

More information

Op#c Nerve Head & Re#nal Imaging

Op#c Nerve Head & Re#nal Imaging Op#c Nerve Head & Re#nal Imaging Dr Cesar Carrillo October, 2014 Vien#ane/NOC **Disclaimer** The images contained in this presenta5on are not my own, they can be found on the web OUTLINE Indica5ons Confocal

More information

Diagnosis of uveitis, how to proceed?

Diagnosis of uveitis, how to proceed? EOS meeting Cairo, 2018 Diagnosis of uveitis, how to proceed? Mohamed G.A Saleh Lecturer of Ophthalmology Assiut University Size of the problem 15/100000 in US every year. 10% of blindness Prevalence varies

More information

ACUTE LIVER FAILURE IN A 61-YEAR-OLD MAN. 11/29/18 Muhammad Ahmed, MD

ACUTE LIVER FAILURE IN A 61-YEAR-OLD MAN. 11/29/18 Muhammad Ahmed, MD ACUTE LIVER FAILURE IN A 61-YEAR-OLD MAN 11/29/18 Muhammad Ahmed, MD H&P 61-year-old male with a history of chronic ethanol use (4-6 beers/day x decades), hypertension, and a family history of hemochromatosis

More information

Introduction. Case Report

Introduction. Case Report Case Reports Acute retinal necrosis (ARN) in the context of neonatal HSV-2 exposure and subconjunctival dexamethasone: case report and literature review Lindsay McGrath, MBBS, ab Marion Woods, MD, FRACP,

More information

Deep Trouble. Thomas Stone, MD Retina Associates of Kentucky River City Retina Conference May 15, 2014

Deep Trouble. Thomas Stone, MD Retina Associates of Kentucky River City Retina Conference May 15, 2014 Deep Trouble Thomas Stone, MD Retina Associates of Kentucky River City Retina Conference May 15, 2014 History 20 yo WM Decreased vision OU, OD>OS Sudden onset blurred central vision 12 days prior 4 days

More information

Slide 4. Slide 5. Slide 6

Slide 4. Slide 5. Slide 6 Slide 1 Slide 4 Demographics El Paso Eye Care Border Healthcare-Based Grand Rounds Derek N. Cunningham, O.D. 80-90% Mexican-Americans Diabetes Hypertension Hyperlipidemia Obesity 70% uninsured High poverty

More information

How and Why Should we Care? Muge R. Kesen, MD Retina Specialty Institute (RSI)

How and Why Should we Care? Muge R. Kesen, MD Retina Specialty Institute (RSI) How and Why Should we Care? Muge R. Kesen, MD Retina Specialty Institute (RSI) Disclosure No financial interest or relationships to disclose. Objectives Overview of different types of uveitis Diagnostic

More information

Ophthalmology. Juliette Stenz, MD

Ophthalmology. Juliette Stenz, MD Ophthalmology Juliette Stenz, MD Required Slide Disclosures NO SIGNIFICANT FINANCIAL, GENERAL, OR OBLIGATION INTERESTS TO REPORT Required Slide At the end of this session, students will be able to: 1.

More information

Past ocular history. DME Case 1. Patient presents blurred VA. Hemoglobin A1c 11.5% -- patient states sugars have not been in good control

Past ocular history. DME Case 1. Patient presents blurred VA. Hemoglobin A1c 11.5% -- patient states sugars have not been in good control Past ocular history Patient presents blurred VA DME Case 1 Hemoglobin A1c 11.5% -- patient states sugars have not been in good control PDR with macular edema OU Rishi Singh MD Cleveland Clinic OD OS 1

More information

Viral Infections. Chicken Pox 5/21/2018

Viral Infections. Chicken Pox 5/21/2018 Napa Valley Dermatopathology Meeting 2018 - Select Infections & Infestations Whitney A. High, MD, JD, MEng whitney.high@ucdenver.edu Professor of Dermatology & Pathology Vice-Chairman, Dermatology Director

More information

Necrotizing herpetic retinopathy in an immune-compromised pediatric patient with minimal signs of inflammation: case report

Necrotizing herpetic retinopathy in an immune-compromised pediatric patient with minimal signs of inflammation: case report Choi et al. BMC Ophthalmology (2016) 16:85 DOI 10.1186/s12886-016-0253-x CASE REPORT Open Access Necrotizing herpetic retinopathy in an immune-compromised pediatric patient with minimal signs of inflammation:

More information

UNDERSTAND MORE ABOUT UVEITIS UVEITIS

UNDERSTAND MORE ABOUT UVEITIS UVEITIS UNDERSTAND MORE ABOUT UVEITIS UVEITIS Uveitis What is uveitis? Uveitis is inflammation of the uvea, the middle layer of your eye. The eye is shaped much like a tennis ball, with three different layers

More information

Index. Note: Page numbers of article titles are in boldface type.

Index. Note: Page numbers of article titles are in boldface type. Note: Page numbers of article titles are in boldface type. A AAP. See American Academy of Pediatrics (AAP) Acyclovir dosing in infants, 185 187 American Academy of Pediatrics (AAP) COFN of, 199 204 Amphotericin

More information

Non-reproductive tissues and cells

Non-reproductive tissues and cells Colour key Minimum requirements as set out in Directive 2004/23/EC and its technical Directives (particularly 2006/17/EC) More stringent -legally binding, applies for all donations and all donor profiles

More information

Clinical Aspect and Application of Laboratory Test in Herpes Virus Infection. Masoud Mardani M.D,FIDSA

Clinical Aspect and Application of Laboratory Test in Herpes Virus Infection. Masoud Mardani M.D,FIDSA Clinical Aspect and Application of Laboratory Test in Herpes Virus Infection Masoud Mardani M.D,FIDSA Shahidhid Bh BeheshtiMdi Medical lui Universityit Cytomegalovirus (CMV), Epstein Barr Virus(EBV), Herpes

More information

Case #1: 68 M with floaters OS

Case #1: 68 M with floaters OS Case #1: 68 M with floaters OS Point-of-Care Ocular Sonography for the Emergency Department Nate Teismann MD Dept of Emergency Medicine, UCSF Topics in EM 2012 Acute onset of dark spots in L eye 2 days

More information

Q: (picture of typical dendrite) What is the differential diagnosis and describe this entity? How would you treat and why?

Q: (picture of typical dendrite) What is the differential diagnosis and describe this entity? How would you treat and why? Q: (picture of typical dendrite) What is the differential diagnosis and describe this entity? How would you treat and why? Etiology/Risks: Critical symptoms: HSV is transmitted by direct contact of epidermis

More information

5/9/2018. Bone marrow failure diseases (aplastic anemia) can be cured by providing a source of new marrow

5/9/2018. Bone marrow failure diseases (aplastic anemia) can be cured by providing a source of new marrow 5/9/2018 or Stem Cell Harvest Where we are now, and What s Coming AA MDS International Foundation Indianapolis IN Luke Akard MD May 19, 2018 Infusion Transplant Conditioning Treatment 2-7 days STEM CELL

More information

Antimicrobial prophylaxis for transplant recipients. Peter Chin-Hong, MD MAS February 4, 2015

Antimicrobial prophylaxis for transplant recipients. Peter Chin-Hong, MD MAS February 4, 2015 Antimicrobial prophylaxis for transplant recipients Peter Chin-Hong, MD MAS February 4, 2015 Objective To list and understand the approach to three prevention strategies used to prevent infections in transplant

More information

Knox County Health Department. COMMUNICABLE DISEASE REPORT: March 2018 YTD

Knox County Health Department. COMMUNICABLE DISEASE REPORT: March 2018 YTD COMMUNICABLE DISEASE REPORT: March This report contains informaon regarding suspected, probable, and confirmed cases of the diseases listed and are subject to change. Ohio Disease Reporng System (ODRS)

More information

Knox County Health Department. COMMUNICABLE DISEASE REPORT: January 2018 YTD

Knox County Health Department. COMMUNICABLE DISEASE REPORT: January 2018 YTD COMMUNICABLE DISEASE REPORT: January This report contains informaon regarding suspected, probable, and confirmed cases of the diseases listed and are subject to change. Ohio Disease Reporng System (ODRS)

More information

Vanderbilt Eye Institute Clinical Trials

Vanderbilt Eye Institute Clinical Trials April, 2010 Vanderbilt Eye Institute Clinical Trials Ophthalmology Actively Recruiting Studies For information on our clinical trials and other studies, please contact: Sandy Owings, COA, CCRP Clinic Director

More information

Imaging in uveitis. Anthony Hall

Imaging in uveitis. Anthony Hall Imaging in uveitis Anthony Hall Causes of Vision Loss in Uveitis 1. Cystoid macular oedema 26% 2. Cataract 19% 3. Glaucoma 11% 4. Permanent macular damage 5% Rothova et al BJO 1996; 80: 332-336 Macular

More information

Evaluation of posterior segment manifestations following typhoid fever-a clinical study

Evaluation of posterior segment manifestations following typhoid fever-a clinical study Original Research Article DOI: 10.18231/2395-1451.2018.0092 Evaluation of posterior segment manifestations following typhoid fever-a clinical study Pavana Acharya 1, Lakshmi Bomalapura Ramamurthy 2,*,

More information

Title. CitationJapanese Journal of Ophthalmology, 50(6): Issue Date Doc URL. Rights. Type. File Information

Title. CitationJapanese Journal of Ophthalmology, 50(6): Issue Date Doc URL. Rights. Type. File Information Title Chronic panuveitis and scleritis in a patient with c Author(s)Saito, Wataru; Saito, Akari; Namba, Kenichi; Kase, S CitationJapanese Journal of Ophthalmology, 50(6): 558-561 Issue Date 2006 Doc URL

More information

Objectives. Non-Traumatic Muscle Pathologies. Abnormal Muscle Signal Intensity. Inflammatory Myositis. Polymyostis / Dermatomyositis.

Objectives. Non-Traumatic Muscle Pathologies. Abnormal Muscle Signal Intensity. Inflammatory Myositis. Polymyostis / Dermatomyositis. Non-Traumatic Muscle Pathologies Ali Naraghi Division of Musculoskeletal Radiology Joint Department of Medical Imaging University of Toronto Objectives Define the range of non-traumatic pathologies affecting

More information

Zika Virus Basics. Flaviviridae Flavivirus Disease Vector Vaccine *Dengue (serotypes 1-4) Zika Virus Basics. Zika Virus Transmission Cycle

Zika Virus Basics. Flaviviridae Flavivirus Disease Vector Vaccine *Dengue (serotypes 1-4) Zika Virus Basics. Zika Virus Transmission Cycle Zika: Infection,, and Protection Roxanne P. Liles, Ph.D., MLS(ASCP) CM Assistant Professor of Biology Louisiana State University at Alexandria 318-473-6518 rliles@lsua.edu Zika Virus Basics Virion: Enveloped

More information

Herpesviruses: The Tired, the Rashy, and the Ubiquitous

Herpesviruses: The Tired, the Rashy, and the Ubiquitous Herpesviruses: The Tired, the Rashy, and the Ubiquitous M. Anthony Moody, MD Associate Professor Pediatric Infectious Diseases Chief Medical Officer Duke Human Vaccine Institute Duke University Medical

More information

Condition: Herpes Zoster Ophthalmicus (HZO)

Condition: Herpes Zoster Ophthalmicus (HZO) Condition: Herpes Zoster Ophthalmicus (HZO) Description: Herpes zoster represents a reactivation of the varicella zoster virus (VZV) which leads to characteristic skin lesions and, in many cases, ocular

More information

Herpes Zoster Ophtalmicus in a HIV positive patient: A Case Report

Herpes Zoster Ophtalmicus in a HIV positive patient: A Case Report ISPUB.COM The Internet Journal of Neurology Volume 9 Number 2 Herpes Zoster Ophtalmicus in a HIV positive patient: A Case Report G Lopez Bejerano, Y Graza Fernandez Citation G Lopez Bejerano, Y Graza Fernandez..

More information

Management of uveitis

Management of uveitis Management of uveitis DR. ANUPAMA KARANTH Anti-inflammatory agents -itis = inflammation Treatment : stop inflammation Use anti-inflammatory drugs Most potent of such agents : Corticosteroids Corticosteroids

More information

There is no direct financial or proprietary interest in any companies, products or services mentioned in this presentation.

There is no direct financial or proprietary interest in any companies, products or services mentioned in this presentation. 1 The content of this COPE Accredited CE Presentation was prepared independently by Michael Cooper, OD without input from members of the ophthalmic community. Dr. Cooper is affiliated with Allergan, Alcon

More information

Clinical Information on West Nile Virus (WNV) Infection

Clinical Information on West Nile Virus (WNV) Infection Clinical Information on West Nile Virus (WNV) Infection Introduction In 1999, West Nile Virus (WNV), an Old World flavivirus, producing a spectrum of disease including severe meningoencephalitis, appeared

More information

Condition: Herpes Simplex Keratitis

Condition: Herpes Simplex Keratitis Condition: Herpes Simplex Keratitis Description: Herpes simplex infection is very common but usually remains latent. When the virus is reactivated it travels along the trigeminal nerve to cause local infection

More information

Foodborne Pathogens. Haley Oliver Assistant Professor Department of Food Science Purdue University

Foodborne Pathogens. Haley Oliver Assistant Professor Department of Food Science Purdue University Foodborne Pathogens Haley Oliver Assistant Professor Department of Food Science Purdue University Foodborne Disease Disease resul>ng from the consump>on of food contaminated with: Pathogenic protozoa Bacteria

More information

Infection Basics. Lecture 12 Biology W3310/4310 Virology Spring 2016

Infection Basics. Lecture 12 Biology W3310/4310 Virology Spring 2016 Infection Basics Lecture 12 Biology W3310/4310 Virology Spring 2016 Before I came here I was confused about this subject. Having listened to your lecture, I am still confused but at a higher level. ENRICO

More information

number Done by Corrected by Doctor

number Done by Corrected by Doctor number 34 Done by حسام ابو عوض Corrected by Waseem Alhaj Doctor مالك الزحلف Antiviral Chemotherapy (chemotherapy is another way of saying drugs بنحب نتفلسف وهيك.(بس When dealing with viruses we are entering

More information

Laboratory Services and Networks Your priorities?

Laboratory Services and Networks Your priorities? 12th Meeting Caribbean National Epidemiologists and Laboratory Directors September 17th-19th, 2014 POS, Trinidad and Tobago Laboratory Services and Networks Your priorities? Dr Cristina Gutierrez Laboratory

More information

Eye infections. Hossain Jabbari, MD, MPH, ID & TM Infectious Diseases Dept., Digestive Diseases Research Institute (DDRI) TUMS

Eye infections. Hossain Jabbari, MD, MPH, ID & TM Infectious Diseases Dept., Digestive Diseases Research Institute (DDRI) TUMS Eye infections Hossain Jabbari, MD, MPH, ID & TM Infectious Diseases Dept., Digestive Diseases Research Institute (DDRI) TUMS Eye: An overview Eye: An overview The eye is one of the most complex parts

More information

Doc, I See a Donut in My Vision : An Optometrist s Guide to a Rare Cause of Choroidal Neovascular Membrane

Doc, I See a Donut in My Vision : An Optometrist s Guide to a Rare Cause of Choroidal Neovascular Membrane Doc, I See a Donut in My Vision : An Optometrist s Guide to a Rare Cause of Choroidal Neovascular Membrane Linda Pham, OD, Tobin Ansel, OD, Nancy Shenouda-Awad, OD, FAAO, West Haven VA Medical Center Abstract

More information

Non-reproductive tissues and cells

Non-reproductive tissues and cells Ministry of Health: Institute for Transplantation and Biomedicine / Colour key VIRAL HIV 1 and HIV 2 Hepatitis B Minimum requirements as set out in Directive 2004/23/EC More stringent - legy binding More

More information