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Ocular manifestations of Rickettsia conorii in South India

PURPOSE: Among the major groups of rickettsiosis, the commonly reported diseases in India are: (a) Typhus group induced—scrub typhus, murine flea-borne typhus; (b) Spotted fever group induced—Indian tick typhus; and (c) Q fever. Though many scrub typhus outbreaks have been reported from India, only...

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Autores principales: Balasundaram, Manohar B, Manjunath, M, Baliga, Girish, Kapadi, Forum
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6256869/
https://www.ncbi.nlm.nih.gov/pubmed/30451192
http://dx.doi.org/10.4103/ijo.IJO_420_18
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author Balasundaram, Manohar B
Manjunath, M
Baliga, Girish
Kapadi, Forum
author_facet Balasundaram, Manohar B
Manjunath, M
Baliga, Girish
Kapadi, Forum
author_sort Balasundaram, Manohar B
collection PubMed
description PURPOSE: Among the major groups of rickettsiosis, the commonly reported diseases in India are: (a) Typhus group induced—scrub typhus, murine flea-borne typhus; (b) Spotted fever group induced—Indian tick typhus; and (c) Q fever. Though many scrub typhus outbreaks have been reported from India, only one outbreak of spotted fever—serologically proven Indian tick typhus (Rickettsia conorii)—has been reported. We report for the first time ocular manifestations of serologically proven R. conorii infection in a cluster of patients. METHODS: In this retrospective study, case records patients with serologically proven Indian tick typhus (Rickettsia conorii) were reviewed for clinical manifestations and treatment outcomes. RESULTS: In the months of February to April 2016, a cluster of 12 patients (23 eyes) visited us with defective vision. Examination showed multifocal retinitis; mostly bilateral; patients had a history of fever approximately 4 weeks prior to onset of symptoms. After excluding other causes of multifocal retinitis, a diagnosis of rickettsial retinitis was made after Weil–Felix test (WFT) was significantly positive, and enzyme-linked immunosorbent assay was positive for R. conorii. Course of the disease, visual outcome, and investigations are discussed. Doxycycline along with oral corticosteroids was effective in treating the condition. CONCLUSION: Systematic fundus examination should be part of the routine evaluation of any patient who presents with fever and/or skin rash living in or returning from a specific endemic area. Clinical clues to diagnosing ocular rickettsiosis could be multifocal retinitis predominantly involving the posterior pole and macular involvement in the form of serous macular detachment or macular hard exudates. A positive WFT still serves as a useful and cheap diagnostic tool for laboratory diagnosis of rickettsial disease. Doxycycline along with oral corticosteroids was effective in treating the condition.
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spelling pubmed-62568692018-12-15 Ocular manifestations of Rickettsia conorii in South India Balasundaram, Manohar B Manjunath, M Baliga, Girish Kapadi, Forum Indian J Ophthalmol Original Article PURPOSE: Among the major groups of rickettsiosis, the commonly reported diseases in India are: (a) Typhus group induced—scrub typhus, murine flea-borne typhus; (b) Spotted fever group induced—Indian tick typhus; and (c) Q fever. Though many scrub typhus outbreaks have been reported from India, only one outbreak of spotted fever—serologically proven Indian tick typhus (Rickettsia conorii)—has been reported. We report for the first time ocular manifestations of serologically proven R. conorii infection in a cluster of patients. METHODS: In this retrospective study, case records patients with serologically proven Indian tick typhus (Rickettsia conorii) were reviewed for clinical manifestations and treatment outcomes. RESULTS: In the months of February to April 2016, a cluster of 12 patients (23 eyes) visited us with defective vision. Examination showed multifocal retinitis; mostly bilateral; patients had a history of fever approximately 4 weeks prior to onset of symptoms. After excluding other causes of multifocal retinitis, a diagnosis of rickettsial retinitis was made after Weil–Felix test (WFT) was significantly positive, and enzyme-linked immunosorbent assay was positive for R. conorii. Course of the disease, visual outcome, and investigations are discussed. Doxycycline along with oral corticosteroids was effective in treating the condition. CONCLUSION: Systematic fundus examination should be part of the routine evaluation of any patient who presents with fever and/or skin rash living in or returning from a specific endemic area. Clinical clues to diagnosing ocular rickettsiosis could be multifocal retinitis predominantly involving the posterior pole and macular involvement in the form of serous macular detachment or macular hard exudates. A positive WFT still serves as a useful and cheap diagnostic tool for laboratory diagnosis of rickettsial disease. Doxycycline along with oral corticosteroids was effective in treating the condition. Medknow Publications & Media Pvt Ltd 2018-12 /pmc/articles/PMC6256869/ /pubmed/30451192 http://dx.doi.org/10.4103/ijo.IJO_420_18 Text en Copyright: © 2018 Indian Journal of Ophthalmology http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Balasundaram, Manohar B
Manjunath, M
Baliga, Girish
Kapadi, Forum
Ocular manifestations of Rickettsia conorii in South India
title Ocular manifestations of Rickettsia conorii in South India
title_full Ocular manifestations of Rickettsia conorii in South India
title_fullStr Ocular manifestations of Rickettsia conorii in South India
title_full_unstemmed Ocular manifestations of Rickettsia conorii in South India
title_short Ocular manifestations of Rickettsia conorii in South India
title_sort ocular manifestations of rickettsia conorii in south india
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6256869/
https://www.ncbi.nlm.nih.gov/pubmed/30451192
http://dx.doi.org/10.4103/ijo.IJO_420_18
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