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

Int Ophthalmol. 2010 Apr;30(2):113-25. doi: 10.1007/s10792-009-9294-y. Epub 2009 Jan 23.

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.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Animals
  • Antibodies, Helminth / immunology
  • Brazil / epidemiology
  • Child
  • Disease Outbreaks*
  • Female
  • Humans
  • Lens, Crystalline / parasitology
  • Male
  • Panuveitis / epidemiology
  • Panuveitis / etiology*
  • Panuveitis / pathology
  • Panuveitis / physiopathology*
  • Porifera
  • Rivers / parasitology
  • Toxocara canis / immunology
  • Vision, Low / diagnosis
  • Vision, Low / parasitology
  • Vitreous Body / parasitology

Substances

  • Antibodies, Helminth