A search for gram-negative enteric micro-organisms in acute anterior uveitis: association of klebsiella with recent onset of disease, HLA-B27, and B7 CREG.

Faecal samples obtained from patients with acute anterior uveitis (AAU) and healthy controls unconnected with hospitals were examined for the presence of Gram-negative micro-organisms reported to be associated with AAU. There was an increased recovery of Klebsiella spp. from AAU patients seen in the first and in the second week after onset of symptoms when compared with patients presenting three to four weeks after onset of symptoms (p less than 0.025 and p less than 0.05 respectively) or with healthy control subjects (p less than 0.005 and p less than 0.05 respectively). By the third to fourth week there was no difference in klebsiella recovery between AAU patients and controls. The increased faecal recovery of klebsiella in the first two weeks was predominantly in HLA-B27 positive patients or patients possessing antigens which cross-react with B27, namely, HLA-B7 CREG. The patients with faecal cultures positive for klebsiella had a higher mean ESR than patients with negative faecal cultures (p less than 0.05). Although there was an increase in recovery of faecal klebsiella from AAU patients with spondylarthritis when compared with AAU patients without arthritis, the difference was not statistically significant. These results suggest that some klebsiella micro-organisms may play a role in the aetiopathogenesis of AAU associated with HLA-B27 or HLA-B7 CREG.