RESUMO
Resumo A Síndrome de Good é uma síndrome paraneoplásica caracterizada pela associação de timoma e hipogamaglobulinemia, cursando com imunossupressão. Relatamos um caso raro de retinite por citomegalovírus em paciente com esta síndrome.
Abstract Good syndrome is a paraneoplastic syndrome characterized by the association of thymoma and hypogammaglobulinemia, with immunosuppression. We report a rare case of cytomegalovirus retinitis in a patient with this syndrome.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Timoma/complicações , Retinite por Citomegalovirus/etiologia , Agamaglobulinemia/complicações , Retina/diagnóstico por imagem , Doenças Retinianas/diagnóstico por imagem , Timoma/imunologia , Imunoglobulina G/sangue , Acuidade Visual , Ganciclovir/administração & dosagem , Ganciclovir/uso terapêutico , Retinite por Citomegalovirus/diagnóstico , Retinite por Citomegalovirus/tratamento farmacológico , Citomegalovirus/imunologia , Agamaglobulinemia/imunologia , Técnicas de Diagnóstico Oftalmológico , Administração IntravenosaRESUMO
PURPOSE: To characterize the immunologic profile in aqueous humor (AqH) of HIV-infected individuals with cytomegalovirus retinitis (CMVr) or ocular syphilis and to assess if AqH and plasma represent independent cytokine compartments. METHODS: Concentrations of 27 cytokines in AqH and plasma of HIV-infected individuals with CMVr (n = 23) or ocular syphilis (n = 16) were measured by multiplex assay. Cytokine profiles of both groups were compared. RESULTS: Individuals with CMVr had higher plasma concentrations of interleukin (IL)-7, IL-8, IL-10, interferon (IFN)-γ, IFN-α2, G-CSF, IP-10 and IL-1α; as well as higher AqH concentrations of IL-1α, IP-10 and GM-CSF than those with ocular syphilis. AqH and plasma levels correlated only for IP-10 in both ocular infections. CONCLUSIONS: Individuals with CMVr had higher plasma cytokine levels than those with ocular syphilis. The immunologic profiles in AqH and plasma are independent. Therefore, AqH cytokine concentrations cannot be inferred from plasma cytokine concentrations in the population studied.
Assuntos
Humor Aquoso/metabolismo , Citocinas/sangue , Retinite por Citomegalovirus/sangue , Infecções Oculares Bacterianas/sangue , Infecções por HIV/sangue , Sífilis/sangue , Adulto , Humor Aquoso/virologia , Contagem de Linfócito CD4 , Feminino , Humanos , Masculino , RNA Viral/genética , Carga ViralRESUMO
Cytomegalovirus retinitis is one of the ocular manifestations of AIDS. The objective of the present study was to determine possible associations of class I and II HLA antigens and alleles in patients with AIDS and cytomegalovirus retinitis (CMV-R) with and without macular involvement. Method: The study population consisted of 22 patients with AIDS and CMV-R with macular involvement (Group I), 19 patients with AIDS and CMV-R without macular involvement (Group II), and 202 individuals with negative serology for human immunodeficiency virus (Group III - control). Class I HLA antigens were typed by classical serology. Class II alleles were identified using sequence-specific oligonucleotide primers hybridized with amplified DNA. Results: HLA-DRB1*14 and HLA-DRB1*10 specificities were more frequent among patients with macular involvement, possibly indicating greater susceptibility to this condition. In contrast, the HLA-B35 antigen may be associated with protection against macular involvement since it was significantly more frequent among patients without this involvement. Conclusions: The HLA-DRB1*14 and HLA-DRB1*10 alleles may favor the development of CMV-R with macular involvement, whereas the HLA-B35 subtype may be associated with protection against macular involvement...
Assuntos
Humanos , Masculino , Infecções Oportunistas Relacionadas com a AIDS , Retinite por CitomegalovirusRESUMO
HIV-related eye disease can be classified as retinal HIV microangiopathy, opportunistic infections, neuro-ophthalmic manifestations and unusual malignancies. There is a 52-100% lifetime accumulative risk of HIV patients developing eye problems. Seventy-seven per cent of patients with ocular manifestations of HIV had CD4 counts < 200 cells/µL. Cytomegalovirus (CMV) is the most prevalent opportunistic infection, however, Africa has a low incidence of this, and more commonly squamous cell carcinoma, compared to the western hemisphere. Due to highly active antiretroviral therapy (HAART), the anti-CMV therapy may be discontinued if the CD4+ T cell count is > 100 cells/µL for a minimum of three months. Despite HAART, patients with a CD4 count < 50 cells/µL have a similar risk of developing CMV retinitis as compared to the pre-HAART era. Opportunistic infections include CMV, herpetic retinopathy (progressive outer retinal necrosis - PORN), less commonly toxoplasmosis, pneumocystis and cryptococcus. Malignancies associated with HIV include Kaposi's sarcoma and conjunctival squamous cell carcinoma. Cranial nerve palsies, optic disc swelling and atrophy are characteristic neuro-ophthalmic features. They usually occur secondary to meningitis/encephalitis (from cryptococcus and tuberculosis). With the advent of HAART, new complications have developed in CMV retinitis: immune recovery uveitis (IRU) and cystoid macula oedema (CMO). Immune recovery uveitis occurs in 71% of patients if HAART is started before the induction of the anti-CMV treatment. However, this is reduced to 31% if HAART is started after the induction treatment. Molluscum contagiosum and Kaposi's sarcoma can spontaneously resolve on HAART. Highly active anti-retroviral therapy has reduced the frequencies of opportunistic infections and improved the remission duration in HIV patients.
Las enfermedades oculares relacionadas con el VIH pueden clasificarse como microangiopatía retiniana por VIH, infecciones oportunistas, manifestaciones neuro-oftálmicas, y tumores inusuales. Hay un riesgo acumulativo de por vida de 52-100% de que los pacientes con VIH desarrollen problemas oculares. Setenta y siete por ciento de los pacientes con manifestaciones oculares por VIH tenían conteos de CD4 < 200 células/µL. El citomegalovirus (CMV) es la infección oportunista más frecuente. Sin embargo, África tiene una baja incidencia de CVM, siendo en cambio más común el carcinoma de células escamosas, en comparación con el hemisferio occidental. Debido a la terapia antiretroviral altamente activa (TAAA), la terapia anti-CMV puede suspenderse si el conteo de células CD4+ T es > 100 células/µL por un mínimo de tres meses. A pesar de la terapia TAAA, los pacientes con un conteo de CD4 < 50 células/µL tienen un riesgo similar de desarrollar retinitis por CMV en comparación con la era pre-TAAA. Las infecciones oportunistas incluyen CMV, retinopatía herpética (necrosis retiniana progresiva externa - PORN), y menos comúnmente toxoplasmosis, pneumocistosis, y cryptococcus. Los tumores malignos asociados con el VIH incluyen el sarcoma de Kaposi y el carcinoma de células escamosas de conjuntiva. La parálisis del nervio craneal, la inflamación del disco óptico, así como la atrofia, son características neuro-oftálmicas típicas. Generalmente se presentan de forma secundaria en los casos de meningitis, encefalitis (cryptococcus y tuberculosis). Con el advenimiento de TAAA, se han desarrollado nuevas complicaciones de la retinitis por CMV, a saber, la uveitis por recuperación inmunológica (IRU por su sigla en inglés) y el edema macular cistoide (EMC). La uveitis por recuperación inmunológica ocurre en 71% de los pacientes si la terapia TAAA se comienza antes de la inducción del tratamiento anti-CMV. Sin embargo, esta cantidad se reduce a un 31% si TAAA se inicia después del tratamiento de inducción. El molusco contagioso y el sarcoma de Kaposi pueden desaparecer espontáneamente con el TAAA. La terapia anti-retroviral altamente activa ha reducido las frecuencias de las infecciones oportunistas, y mejorado la duración de la remisión en pacientes con VIH.
Assuntos
Humanos , Infecções por HIV/complicações , Infecções Oportunistas Relacionadas com a AIDS/virologia , Oftalmopatias/virologia , Infecções por HIV/tratamento farmacológico , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Oftalmopatias/classificaçãoRESUMO
OBJETIVO: Avaliar as condições oftalmológicas atuais de pacientes com síndrome da imunodeficiência adquirida (SIDA), previamente avaliados por oftalmologista, levando em consideração algumas características gerais relacionada com essa doença. MÉTODOS: Estudo observacional de 42 pacientes com SIDA, subdivididos em dois grupos: Grupo I: 8 pacientes com SIDA e diagnóstico prévio de retinite por citomegalovírus; Grupo II: 34 pacientes com SIDA sem retinite por citomegalovírus. Os dados gerais relacionados com a SIDA foram obtidos pela análise dos prontuários médicos. RESULTADOS: A maioria dos pacientes apresentou acuidade visual no melhor olho entre logMAR 0,0 (68,3 por cento) e 0,1 (26,9 por cento). Prescrição óptica para longe beneficiou 39,4 por cento dos pacientes do Grupo II mas nenhum dos paciente do Grupo I. Presbiopia foi corrigida em 27,3 por cento no Grupo II e 12,5 por cento no Grupo I. Não foram encontradas manifestações oculares atuais relacionadas a SIDA em nenhum dos grupos. As alterações fundoscópicas encontradas em 10 pacientes foram todas alterações cicatriciais de retinite/retinocoroidite, sendo 7 (16,7 por cento) pacientes pertencentes ao Grupo I e 3 (7,1 por cento) pacientes pertencentes ao Grupo II. CONCLUSÃO: Dez (24,4 por cento) pacientes apresentaram alteração visual decorrente do envelhecimento. Com exceção dos pacientes com cicatrizes prévias de retinite ou retinocoroidite, todos os outros participantes estavam em boas condições oftalmológicas e a maioria dos mesmos se encontrava em recuperação imunológica, devido ao uso da terapia anti-retroviral de alta potência.
PURPOSE: To evaluate the ophthalmologic conditions of patients with AIDS, with long-term follow-up, previously evaluated by an ophthalmologist, considering general conditions related with AIDS. METHODS: Observational study of 42 patients with AIDS divided into two groups: Group I: 8 patients with previous AIDS-related cytomegalovirus retinitis, Group II: 34 patients with AIDS without cytomegalovirus retinitis. Each patient had been submitted to one ophthalmologic examination. General data of the patients were obtained from the medical records. RESULTS: The majority of the patients presented visual acuity in the best eye between logMAR 0.0 (68.3 percent) and 0.1 (26.9 percent). Optic prescription for refractive errors benefited 39.4 percent of the patients in Group II but none of the patients in Group I. Presbyopia was corrected in 27.3 percent of Group II and in 12.5 percent of Group I patients. No current ocular AIDS-related manifestations were detected in any group. Ocular posterior segment alterations, all of them consisting of retinitis / retinochoroiditis scars, were found in 10 patients, 7 (16.7 percent) belonging to Group I and 3 (7.1 percent) to Group II. CONCLUSION: Ten (24.4 percent) patients presented visual alteration due to age. Except for the patients presenting previous retinitis and retinochoroiditis, all the other patients were in good ophthalmic conditions and most of them were in immunologic recovery due to the use of highly active antiretroviral therapy.