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Ocular Infections in Transplant Patients

  • Ann-Marie Lobo
  • Lucia Sobrin
  • Marlene L. DurandEmail author
Chapter

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.

Keywords

Ocular infection Endophthalmitis Viral retinitis Acute retinal necrosis Ocular toxoplasmosis Chorioretinitis Ocular tuberculosis Uveitis Keratitis Mucormycosis 

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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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Ann-Marie Lobo
    • 1
  • Lucia Sobrin
    • 2
  • Marlene L. Durand
    • 3
    Email author
  1. 1.Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear InfirmaryUniversity of Illinois at ChicagoChicagoUSA
  2. 2.Department of Ophthalmology, Harvard Medical SchoolMassachusetts Eye and Ear InfirmaryBostonUSA
  3. 3.Department of Medicine, Harvard Medical SchoolMassachusetts General Hospital, Division of Infectious DiseasesBostonUSA

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