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Ocular Infections in Transplant Patients

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Principles and Practice of Transplant Infectious Diseases

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Abstract

Ocular infections in transplant patients can be rapidly progressive and result in significant vision loss and morbidity. Approximately 2% of transplant patients in several large series developed serious eye infections, and the most common were viral retinitis and fungal endophthalmitis. Viral retinitis is due to cytomegalovirus, herpes simplex, or herpes zoster. A particularly fulminant form of viral retinitis, progressive outer retinal necrosis, may occur and result in blindness within 1 to a few days. Hematogenous spread of bacterial and fungal infections to the eye may result in endophthalmitis. Ocular infections that occur in non-immunocompromised patients also occur in the transplant population, and these include keratitis (infection of the cornea), herpes zoster ophthalmicus, and ocular toxoplasmosis. Invasive fungal infections involving the orbit, such as rhinocerebral mucormycosis, are seen in transplant patients as they are in other immunocompromised patients. In transplant patients, sometimes the first signs of a life-threatening systemic infection occur in the eye. Patients with fungemia, for example, may present with vision loss from fungal endophthalmitis. Eye infections in the transplant population are important to diagnose promptly both to prevent irreversible vision loss, which may occur very quickly in the immunocompromised host, and to recognize an underlying systemic infection that may be life-threatening.

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Abbreviations

AIDS:

Acquired immunodeficiency syndrome

ARN:

Acute retinal necrosis

BCG:

Bacillus Calmette-Guerin vaccine

CMV:

Cytomegalovirus

CMVR:

Cytomegalovirus retinitis

CNS:

Central nervous system

EBV:

Epstein-Barr virus

GVHD:

Graft versus host disease

HAART:

Highly active antiretroviral therapy

HIV:

Human immunodeficiency virus

HSCT:

Hematopoietic stem cell transplant

HSV:

Herpes simplex virus

HZO:

Herpes zoster ophthalmicus

IRS:

Immune recovery syndrome

PCR:

Polymerase chain reaction

PORN:

Progressive outer retinal necrosis

TB:

Tuberculosis

VZV:

Varicella zoster virus

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Author information

Authors and Affiliations

  1. Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA

    Ann-Marie Lobo

  2. Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA

    Lucia Sobrin

  3. Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Division of Infectious Diseases, Boston, MA, USA

    Marlene L. Durand

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  1. Ann-Marie Lobo
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  2. Lucia Sobrin
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  3. Marlene L. Durand
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Correspondence to Marlene L. Durand .

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Editors and Affiliations

  1. Clinical Associate Professor of Medicine, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX, USA

    Amar Safdar

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Lobo, AM., Sobrin, L., Durand, M.L. (2019). Ocular Infections in Transplant Patients. In: Safdar, A. (eds) Principles and Practice of Transplant Infectious Diseases. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-9034-4_18

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  • DOI: https://doi.org/10.1007/978-1-4939-9034-4_18

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