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Epidemic of unilateral panuveitis in children from Brazilian Amazonia: clinical and etiological aspects in seven patients

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Abstract

Objectives To describe clinical presentation and results of diagnostic and therapeutic procedures in seven children from an epidemic of panuveitis in the Brazilian Amazonia, as well as environmental analysis and etiological aspects involved. Methods Patients underwent full pediatric and ophthalmic examinations, B-scan, ultrasound biomicroscopy, and serological tests. Ocular samples were thoroughly analyzed, including two enucleation specimens. Environmental investigation encompassed water, soil, and river fauna. Results All patients had bathed in the waters of a regional river, the Araguaia. Six of them presented with intermediate uveitis, with snowbanking. Five had cataract and four showed inferior endothelial opacity, with localized anterior synechiae. One showed total leukoma, with flat anterior chamber. Only two had active uveitis, one of them with anterior chamber nodule. Serology revealed high prevalence of anti-Toxocara canis immunoglobulin G (IgG) antibodies. In three cases, vitreous and lens samples disclosed spicules of freshwater sponges Drulia uruguayensis and D. ctenosclera, also detected in the waters of the river. Conclusion Freshwater sponge spicules could be potential new etiological agents of ocular pathology, but further studies are needed, considering the heterogeneity of the ocular lesions and results of serological and environmental studies.

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Abbreviations

BCVA:

Best-corrected visual acuity

ELISA:

Enzyme-linked immunosorbent assay

FBS:

Fetal bovine serum

IOL:

Intraocular lens

KP:

Keratic precipitates

MEM:

Minimum Eagle medium

OD:

Right eye

OS:

Left eye

PAS:

Periodic acid Schiff

PBS:

Phosphate buffered saline

PCR:

Polymerase chain reaction

RFLP:

Restriction fragment length polymorphism

TES:

Toxocara excretion-secretion antigen

UBM:

Ultrasound biomicroscopy

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Acknowledgements

The authors thank Dr. Marco Antônio Tanure for help in anterior segment photography and surgery, Dr. Valênio Perez França for oculoplastic surgery, Dr. Breno Lino and Dr. Célia Andrade for echography and ultrasound biomicroscopy, respectively, and Christiane Goveia for technical support. The authors are also grateful to the Laboratory of Virology of Instituto de Ciências Biológicas da UFMG and to Instituto Adolpho Lutz. Dr. Fernando Oréfice had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. This work was supported by Universidade Federal de Minas Gerais (UFMG), Fundação Oswaldo Cruz (FIOCRUZ), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Secretaria de Saúde de Tocantins and Ministério da Saúde – Brazil.

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Authors and Affiliations

  1. Hospital São Geraldo/HC – Universidade Federal de Minas Gerais – UFMG, Rua Espírito Santo, 1634/102, Belo Horizonte, MG, 30.160-031, Brazil

    Daniel Vítor Vasconcelos-Santos, Fernando Oréfice & Priscilla Jane Ayres Almeida

  2. Reference Hospital/Secretary of Health, Augustinopolis, TO, Brazil

    Carlos Franklin Fonseca & Leandro Moulin Alencar

  3. Department of Pathology, Instituto Oswaldo Cruz – IOC/FIOCRUZ, Rio de Janeiro, Brazil

    Henrique Leonel Lenzi & Marcelo Pelajo-Machado

  4. Zoobotanic Foundation, Porto Alegre, RS, Brazil

    Cecília Volkmer-Ribeiro

  5. Universidade Federal de São Carlos – UFSCar, Sao Carlos, SP, Brazil

    Twiggy Cristina Alves Batista

  6. Faculdade de Medicina da Universidade de São Paulo – USP, Sao Paulo, SP, Brazil

    Pedro Paulo Chieffi

  7. Instituto de Medicina Tropical de São Paulo, Sao Paulo, SP, Brazil

    Susana Zevallos Lescano

  8. Laboratório de Helmintoses Intestinais – Instituto René Rachou/FIOCRUZ, Belo Horizonte, MG, Brazil

    Roberta Lima Caldeira & Omar dos Santos Carvalho

  9. Moorfields Eye Hospital, London, UK

    Carlos Eduardo Pavesio

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  1. Daniel Vítor Vasconcelos-Santos
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  2. Fernando Oréfice
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  5. Priscilla Jane Ayres Almeida
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  8. Cecília Volkmer-Ribeiro
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  9. Twiggy Cristina Alves Batista
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  11. Susana Zevallos Lescano
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  12. Roberta Lima Caldeira
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  13. Omar dos Santos Carvalho
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  14. Carlos Eduardo Pavesio
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Corresponding author

Correspondence to Fernando Oréfice.

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Vasconcelos-Santos, D.V., Oréfice, F., Fonseca, C.F. et al. Epidemic of unilateral panuveitis in children from Brazilian Amazonia: clinical and etiological aspects in seven patients. Int Ophthalmol 30, 113–125 (2010). https://doi.org/10.1007/s10792-009-9294-y

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  • DOI: https://doi.org/10.1007/s10792-009-9294-y

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