Department of Ophthalmology, JJM Medical College, Davanagere, Karnataka, India.
Prasad Netralaya, Udupi, Karnataka, India.
Indian J Ophthalmol. 2021 May;69(5):1167-1171. doi: 10.4103/ijo.IJO_2748_20.
The aim of this work was to study the ocular manifestations and its management in spotted fever and typhus group of rickettsial disease.
A retrospective analysis of 50 patients with serologically confirmed Rickettsial disease. In all patients, relevant history, investigations and treatment details were collected and they underwent complete ophthalmic evaluation including measurement of best-corrected visual acuity, anterior segment examination and dilated fundus examination.
Mean age was 12.5 ± 8.99 years. Of the 50 patients, 40 patients were ≤18 years of age and 27 (54%) had ocular involvement. Out of 27 patients, bilateral involvement was seen in 10 patients. Most of the patients had no ocular symptoms. Ocular findings included, Retinal vasculitis 6 (22.22%); macular edema 4 (14.81%); vasculitis with macular edema 1 (3.7%); Retinitis 7 (25.92%); Papilloedema 6 (22.22%); Papilloedema with 6 cranial nerve palsy 1 (3.7%); Isolated 6 cranial nerve palsy 1 (3.7%) and optic neuritis 1 (3.7%). Ocular involvement was more common in double antigen group (68%) than spotted fever group (50%) or Scrub typhus group (21%) (P = 0.01). Ocular involvement was seen in 94% of the patients with CNS involvement. Cases with bilateral involvement (P = 0.01), pediatric age group (P = 0.01) and CNS involvement (P = 0.02) had poor visual outcome.
Rickettsioses patients can have ocular manifestations with predominant posterior segment involvement during acute phase of illness. Ocular involvement was more common in the double antigen group. For any patient who presents with fever and rash living in endemic area, ophthalmic evaluation should be part of routine checkup during the acute phase of illness associated with less frequent ocular symptoms.
本研究旨在探讨斑点热和斑疹伤寒群立克次体病的眼部表现及其治疗方法。
对 50 例血清学确诊的立克次体病患者进行回顾性分析。所有患者均采集相关病史、检查和治疗详细资料，并进行全面眼科评估，包括最佳矫正视力测量、眼前节检查和散瞳眼底检查。
平均年龄为 12.5±8.99 岁。50 例患者中，40 例年龄≤18 岁，27 例（54%）有眼部受累。27 例患者中，10 例为双眼受累。大多数患者无眼部症状。眼部表现包括视网膜血管炎 6 例（22.22%）；黄斑水肿 4 例（14.81%）；血管炎伴黄斑水肿 1 例（3.7%）；视网膜炎 7 例（25.92%）；视乳头水肿 6 例（22.22%）；视乳头水肿伴 6 颅神经麻痹 1 例（3.7%）；单纯 6 颅神经麻痹 1 例（3.7%）和视神经炎 1 例（3.7%）。双抗原组（68%）眼部受累较斑点热组（50%）或恙虫病组（21%）更为常见（P=0.01）。有中枢神经系统受累的患者中 94%有眼部受累。双眼受累（P=0.01）、儿科年龄组（P=0.01）和中枢神经系统受累（P=0.02）的患者视力预后较差。
立克次体病患者在疾病急性期可出现以眼后段受累为主的眼部表现。双抗原组眼部受累更为常见。对于任何在流行地区出现发热和皮疹的患者，在疾病急性发作期间，眼部评估应作为常规检查的一部分，且这些患者的眼部症状不太频繁。
