Warren K, Goldstein E, Hung V S, Koehler J E, Richardson W
Department of Ophthalmology, Kansas University School of Medicine, Kansas City, USA.
Arch Ophthalmol. 1998 Jul;116(7):937-40. doi: 10.1001/archopht.116.7.937.
A patient with the acquired immunodeficiency syndrome developed bilateral retinitis due to a Bartonella (formerly Rochalimaea) henselae infection. A retinal biopsy was performed when severe and progressive retinal infection failed to respond to empirical treatment for cytomegalovirus and Toxoplasma gondii. The biopsy specimen was stained with routine histopathological stains and the Steiner silver stain. Ribosomal DNA was extracted from formalinfixed, paraffin-embedded retinal tissue and amplified with the polymerase chain reaction assay, using Bartonella-specific primers. The amplified DNA fragment was cloned and sequenced. Staining with hematoxylin-eosin revealed tufts of proliferating vascular endothelium with numerous fusiformappearing cells, consistent with a diagnosis of bacillary angiomatosis. A Steiner silver stain revealed numerous small bacilli in the biopsy specimen. Amplification of DNA extracted from the tissue produced a fragment of 16S ribosomal DNA of the expected size; sequencing of the DNA fragment revealed that the infection was caused by B henselae. The retinal infection was treated with minocycline, doxycycline, and ciprofloxacin with improvement in visual acuity in the ensuing 12 weeks. To our knowledge, this is the first human immunodeficiency virus-infected patient with retinitis due to B henselae who was diagnosed by the identification of silver-staining bacilli and amplification and sequencing of B henselae with a polymerase chain reaction assay using a biopsy specimen of retinal tissue. Retinal biopsy is indicated, despite its potential for serious complications, in patients with acquired immunodeficiency syndrome who have a progressive, sight-threatening retinitis that is undiagnosed and unresponsive to therapy.
一名获得性免疫缺陷综合征患者因汉赛巴尔通体（原罗卡利马氏体）感染而发生双侧视网膜炎。当严重且进行性的视网膜感染对巨细胞病毒和弓形虫的经验性治疗无反应时，进行了视网膜活检。活检标本用常规组织病理学染色和施泰纳银染色。从福尔马林固定、石蜡包埋的视网膜组织中提取核糖体DNA，并用聚合酶链反应分析，使用巴尔通体特异性引物进行扩增。扩增的DNA片段被克隆并测序。苏木精-伊红染色显示增生的血管内皮细胞簇，有许多梭形细胞，符合杆菌性血管瘤病的诊断。施泰纳银染色显示活检标本中有许多小杆菌。从组织中提取的DNA扩增产生了预期大小的16S核糖体DNA片段；DNA片段测序显示感染是由汉赛巴尔通体引起的。视网膜感染用米诺环素、多西环素和环丙沙星治疗，在随后的12周内视力有所改善。据我们所知，这是首例因汉赛巴尔通体导致视网膜炎的人类免疫缺陷病毒感染患者，通过对视网膜组织活检标本进行银染杆菌鉴定以及用聚合酶链反应分析对汉赛巴尔通体进行扩增和测序而确诊。对于患有进行性、威胁视力且未确诊及治疗无效的视网膜炎的获得性免疫缺陷综合征患者，尽管视网膜活检有发生严重并发症的风险，但仍建议进行该检查。
