Yue Fu, Yang Hui
Department of Fundus Medicine/Neuroophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China.
Neuroophthalmology. 2025 Apr 2;49(3):218-223. doi: 10.1080/01658107.2024.2424204. eCollection 2025.
Scrub typhus, caused by Orientia tsutsugamushi infection, manifests with fever, rash, eschar, pneumonia, hepatosplenomegaly, and lymphadenopathy. We conducted a review of the ocular manifestations post-infection and found a high incidence (67%) during the recovery phase (2-4 weeks), particularly prevalent in the tropical Tsutsugamushi triangle. Despite China, only three cases of optic neuritis had been reported, suggesting its rarity due to early antibiotic administration, we present the first documented case of binocular optic neuroretinitis due to Orientia tsutsugamushi infection in China. Ophthalmologic screenings should be conducted for patients with systemic scrub typhus infection to rule out ocular involvement. Based on previous literature and our case findings, whether scrub typhus affects the anterior or posterior segment of the eye may be determined by different strains of the pathogen, and this in turn influences the visual prognosis. Early initiation of antibiotics effectively eradicated the pathogens. Studies have indicated that delayed immune inflammation, rather than direct infection, may be the underlying pathogenesis of ocular manifestations. Early and comprehensive corticosteroid therapy during secondary ocular inflammation has shown to effectively curb disease progression and preserve visual function.
恙虫病由恙虫东方体感染引起，表现为发热、皮疹、焦痂、肺炎、肝脾肿大和淋巴结病。我们对感染后的眼部表现进行了综述，发现恢复期（2 - 4周）发病率很高（67%），在热带恙虫病三角区尤为普遍。除中国外，仅报告了3例视神经炎病例，提示由于早期使用抗生素该病较为罕见，我们报告了中国首例因恙虫东方体感染导致双眼视神经视网膜炎的病例。应对全身性恙虫病感染患者进行眼科筛查，以排除眼部受累情况。根据既往文献和我们的病例发现，恙虫病是否影响眼部的前段或后段可能由病原体的不同菌株决定，而这反过来又会影响视觉预后。早期使用抗生素可有效根除病原体。研究表明，延迟的免疫炎症而非直接感染可能是眼部表现的潜在发病机制。在继发性眼部炎症期间早期进行全面的皮质类固醇治疗已显示可有效抑制疾病进展并保留视觉功能。
