Association of Ocular Inflammation and Rubella Virus Persistence
Association of Ocular Inflammation and Rubella Virus Persistence
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DOI：
10.1001/jamaophthalmol.2018.6185
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发表时间：
2019-04-01
影响因子：
8.1
通讯作者：
Thuy Doan
中科院分区：
文献类型：
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作者：
Gonzales, John A.;Hinterwirth, Armin;Thuy Doan
宏基因组深度测序（MDS）表明，持续和活动性风疹病毒（RV）感染与富氏异色虹膜睫状体炎（FHI）有关。目的评价MDS在鉴别葡萄膜炎患者RV感染中的应用价值。设计、环境和参与者本病例系列评估了美国三级葡萄膜炎转诊中心经MDS诊断为rv相关葡萄膜炎的6例患者。既往RV感染。临床检查结果、裂隙灯摄影、角膜共聚焦成像和从RNA测序中获得的感染性病原体基因组。结果6名白人男性（年龄36-61岁）被MDS诊断为rv相关性葡萄膜炎。3例患者表现出与葡萄膜炎相关的虹膜异色。另外3例患者的典型FHI特征较少，表现为前玻璃体炎。3例患者行活体角膜共聚焦显微镜检查，其中2例可见星状角膜沉淀，内皮浸润，点状孔洞，细胞间边界扩大。在这3例患者中，1例患者表现出内皮细胞的多态性和多巨细胞。结论和相关性这些研究结果表明，持续性RV感染与复发性或慢性前或中前葡萄膜炎以及角膜内皮细胞损伤有关。眼科医生应考虑RV感染是高血压前、中期葡萄膜炎的潜在原因。
IMPORTANCE Metagenomic deep sequencing (MDS) demonstrates that persistent and active rubella virus (RV) infection is associated with Fuchs heterochromic iridocyclitis (FHI).OBJECTIVE To assess the utility of MDS in identifying RV infection in patients with uveitis.DESIGN, SETTING, AND PARTICIPANTS This case series assessed 6 patients diagnosed by MDS with RV-associated uveitis at a tertiary uveitis referral center in the United States.EXPOSURES Prior RV infection.MAIN OUTCOMES AND MEASURES Clinical examination findings, slitlamp photography, corneal confocal imaging, and infectious pathogen genome obtained from RNA sequencing.RESULTS Six white men (age range, 36-61 years) were diagnosed with RV-associated uveitis by MDS. Three patients exhibited iris heterochromia associated with their uveitis in classic FHI fashion. The other 3 patients had less classic FHI features and exhibited anterior vitritis. Three patients had in vivo corneal confocal microscopy, with 2 demonstrating stellate keratic precipitates in addition to endothelial infiltration, spotlike holes, and enlarged intercellular boundaries. Of these 3 patients, 1 patient exhibited polymorphism and polymegathism of the endothelial cells.CONCLUSIONS AND RELEVANCE These findings suggest that persistent RV infection is associated with recurrent or chronic anterior or anterior-intermediate uveitis as well as corneal endothelial cell damage. Ophthalmologists should consider RV infection as a potential cause of hypertensive anterior and intermediate uveitis.