Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.
Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alta.
Can J Ophthalmol. 2022 Apr;57(2):90-97. doi: 10.1016/j.jcjo.2021.02.032. Epub 2021 Mar 23.
To describe the ocular manifestations of disseminated Mycobacterium chimaera infection after cardiothoracic surgery.
Retrospective, observational case series.
Patients with disseminated M. chimaera infection treated at the University of Alberta Hospital and Royal Alexandra Hospital in Edmonton, Alberta, Canada.
Seven patients (14 eyes) with systemic M. chimaera infection after aortic graft and/or valvular surgeries were reviewed for ocular involvement. Cases were identified based on histopathologic analysis of cardiac tissue, repeat positive mycobacterial blood cultures, and cerebrospinal fluid analysis. Clinical ocular findings, fundus autofluorescence, fluorescein angiography, spectral-domain optical coherence tomography (SD-OCT), and autopsy results are described.
The mean age of our patients was 63 years (range, 22-76 years). Aortic graft and/or valvular surgeries were performed between June 2015 and April 2016. The mean duration from surgery to diagnosis of infection was 27 months (range, 19-36 months). All patients exhibited white-yellowish choroidal lesions. Bilateral, multifocal choroiditis was observed in 6 patients (12 eyes), who died of disseminated M. chimaera infection despite aggressive, multiagent antimicrobial therapy. One patient had a solitary, white-yellow choroidal lesion in the left eye only. Choroidal lesions were hyperfluorescent on late-phase fluorescein angiography and corresponded to localized choroidal thickening and retinal elevation on SD-OCT.
M. chimaera infection after cardiothoracic surgery can cause life-threatening disease involving multiple organ systems. Ocular involvement is an important and possibly early clinical finding, with good correlation to systemic disease severity. Ophthalmological assessment and multimodal imaging may aid in early diagnosis and can be used to monitor disease progression.
描述心胸手术后播散性丘曼氏分枝杆菌感染的眼部表现。
回顾性观察性病例系列研究。
在加拿大阿尔伯塔省埃德蒙顿的阿尔伯塔大学医院和皇家亚历山德拉医院接受治疗的播散性丘曼氏分枝杆菌感染患者。
对 7 例（14 只眼）主动脉移植物和/或瓣膜手术后发生全身丘曼氏分枝杆菌感染的患者进行眼部受累情况回顾性分析。根据心脏组织的组织病理学分析、重复阳性分枝杆菌血培养和脑脊液分析确定病例。描述了临床眼部表现、眼底自发荧光、荧光素血管造影、谱域光学相干断层扫描（SD-OCT）和尸检结果。
我们患者的平均年龄为 63 岁（范围 22-76 岁）。主动脉移植物和/或瓣膜手术于 2015 年 6 月至 2016 年 4 月进行。从手术到感染诊断的平均时间为 27 个月（范围 19-36 个月）。所有患者均表现出白色-黄棕色脉络膜病变。6 例（12 只眼）患者出现双侧、多灶性脉络膜炎，尽管采用了积极的、多药联合抗菌治疗，但仍死于播散性丘曼氏分枝杆菌感染。1 例患者左眼仅出现孤立的白色-黄棕色脉络膜病变。脉络膜病变在晚期荧光素血管造影中呈强荧光，与 SD-OCT 上的局部脉络膜增厚和视网膜抬高相对应。
心胸手术后的丘曼氏分枝杆菌感染可引起危及生命的多器官系统疾病。眼部受累是一个重要的、可能是早期的临床发现，与全身疾病严重程度有良好的相关性。眼科评估和多模态成像可能有助于早期诊断，并可用于监测疾病进展。
