Abstract
Introduction: Rickettsial disease is endemic in many parts in India. Ocular manifestation of the disease in pediatric patients is not known
Methodology: This observational study was conducted in children less than eighteen years diagnosed to have Probable rickettsial disease based upon Indian Academy of Pediatrics criteria. These children underwent visual acuity by Snellen’s chart and refraction, detailed anterior chamber examination by torch and slit lamp examination, dilated biomicroscopic fundus examination. Fundus fluorescein angiography was done in cases having abnormalities on biomicrocopic fundus examination.
Results: A total of 36 children were diagnosed to have probable rickettsial disease. Best corrected visual acuity (BCVA) ranged from 6/6 to 6/60. Posterior Segment changes were seen in 24 (36%) patients. Bilateral changes were seen in 18 children and unilateral in six (total of 42 eyes). Ocular examination showed 0.5–1+ AC reaction in 18/42 eyes, trace vitritis in 19/42 eyes, yellowish white lesions ranging from 1/2 DD to 3 DD along the arcades in all patients, suggestive of retinitis. Five eyes had less than 3 lesion and 14 eyes had more than three. Hemorrhage along with retinitis was seen in 35 eyes. Disc edema was seen in 15 eyes. Retinal vascular sheathing was seen in twelve eyes. Macular edema with star exudates was seen in 33 eyes.
Conclusion: Ocular manifestation are common in rickettsial disease. Detailed ocular examination should be done in all cases with Rickettsial disease.
Keywords: Rickttsial, posterior segment, scrub typhus.
References
- Dasari V KP, Murhekar MV. Rickettsial disease outbreaks in India: A Review. Ann Trop Med Public Health.(7):6.
- Alio J, Ruiz-Beltran R, Herrera I, Artola A, Ruiz-Moreno JM. Rickettsial keratitis in a case of Mediterranean spotted fever. European journal of ophthalmology. 1992;2(1):41-3.
- Pinna A, Sotgiu M, Carta F, Zanetti S, Fadda G. Oculoglandular syndrome in Mediterranean spotted fever acquired through the eye. The British journal of ophthalmology. 1997;81(2):172.
- Esgin H, Akata F. Bilateral multiple retinal hyperfluorescent dots in a presumed Rickettsia conorii infection. Retina (Philadelphia, Pa). 2001;21(5):535-7.
- Pinna A, Sechi LA, Serru A, Zanetti S, Fadda G, Carta F. Endogenous panuveitis in a patient with Rickettsia conorii infection. Acta ophthalmologica Scandinavica. 2000;78(5):608-9.
- Mendivil A, Cuartero V. Endogenous endophthalmitis caused by Rickettsia conorii. Acta ophthalmologica Scandinavica. 1998;76(1):121-2.
- Granel B, Serratrice J, Rey J, Conrath J, Disdier P, Weiller PJ. [Impaired visual acuity in Mediterranean boutonneuse fever]. Presse medicale (Paris, France : 1983). 2001;30(17):859.
- Alio J, Ruiz-Beltran R, Herrero-Herrero JI, Hernandez E, Guinaldo V, Millan A. Retinal manifestations of Mediterranean spotted fever. Ophthalmologica Journal international d'ophtalmologie International journal of ophthalmology Zeitschrift fur Augenheilkunde. 1987;195(1):31-7.
- Bloch-Michel E, Guinnepain MT, Edlinger E, Schmitt A, Herman D. [Mediterranean spotted fever: apropos of the physiopathology of uveal manifestations]. Bulletins et memoires de la Societe francaise d'ophtalmologie. 1983;95:566-70.
- Francois J. Rickettsiae in ophthalmology. Ophthalmologica Journal international d'ophtalmologie International journal of ophthalmology Zeitschrift fur Augenheilkunde. 1968;156(6):459-72.
- Verdot S, Estavoyer JM, Prost F, Montard M. [Ocular involvement in acute phase of Mediterranean boutonneuse fever]. Bulletin des societes d'ophtalmologie de France. 1986;86(3):429-31.
- Paufique L, Bonnet M, Lequin, Didierlaurent. [RETINAL VASCULAR THROMBOSES AND RICKETTSIOSES]. Bulletin des societes d'ophtalmologie de France. 1964;64:410-5.
- Rivaud C, Carrica A, Chanut G, Graveline J, Vedy J. [Early retinal manifestations of Mediterranean boutonneuse fever. Apropos of 2 cases]. Bulletin des societes d'ophtalmologie de France. 1980;80(10):961-3.
- Castanet J, Costet C, Dubois D, Lacour JP, Ortonne JP. [Optic neuropathy in Mediterranean boutonneuse fever]. Presse medicale (Paris, France : 1983). 1988;17(9):439-40.
- Khairallah M, Ladjimi A, Chakroun M, Messaoud R, Yahia SB, Zaouali S, et al. Posterior segment manifestations of Rickettsia conorii infection. Ophthalmology. 2004;111(3):529-34.
- Kahloun R, Gargouri S, Abroug N, Sellami D, Ben Yahia S, Feki J, et al. Visual loss associated with rickettsial disease. Ocular immunology and inflammation. 2014;22(5):373-8.
- Scheie HG. Ocular changes in scrub typhus; a study of 451 patients. Bulletin of the US Army Medical Department United States Army Medical Department. 1946;5:423-7.
- Kawali A, Mahendradas P, Srinivasan P, Yadav NK, Avadhani K, Gupta K, et al. Rickettsial retinitis-an Indian perspective. Journal of ophthalmic inflammation and infection. 2015;5(1):37.
- Bourla N, Alhalel A. [Ocular manifestations of rickettsial diseases]. Harefuah. 2005;144(11):772-3, 823.
- Balasundaram MB, Manjunath M, Baliga G, Kapadi F. Ocular manifestations of Rickettsia conorii in South India. Indian journal of ophthalmology. 2018;66(12): 1840-4.
- Rathi N, Kulkarni A, Yewale V. IAP Guidelines on Rickettsial Diseases in Children. Indian pediatrics. 2017;54(3) :223-9.
- Mahajan A TaVR. Scrub typhus re-emergence in Jammu. JK Sci, J Med Educ Res. 2010(12):2.
- Rathi N, Rathi A. Rickettsial infections: Indian perspective. Indian pediatrics. 2010;47(2):157-64.
Corresponding Author
Anuj Bhatti
Associate Professor, Department of Pediatrics, Government Medical College Jammu-180001
DOI: https://dx.doi.org/10.18535/jmscr/v7i5.166
