rifampin and Retinal-Diseases

Certain polycyclic compounds with a coplanar ring structure (phenothiazines, thioxanthenes, 4-aminoquinolines, and amitriptyline), monocyclic sympathomimetic amines, and other drugs become concentrated in the eyes of animals following acute or chronic systemic administration. Some are known to cross the placental barrier and accumulate in the fetal eye. Following drug withdrawal, these substances disappear relatively slowly from ocular tissues compared with other tissues. The main reason for the accumulation of these compounds seem to be their affinity for the melanin of the uveal tract and pigment epithelium and they therefore do not accumulate in the eyes of albino animals. The mechanism of uptake by melanin probably involves a "charge transfer" reaction involving the transfer of an electron from drug to melanin, which acts as an "electron trap" and in consequence binds the donor compound firmly. The accumulation of a nontoxic drug in the eye is not necessarily of clinical significance, but ocular damage can occur in patients on long-term tricyclic agents when the amount, duration, and frequency of dosage are sufficiently high. The most serious form of ocular damage is pigmentary retinopathy, which, if caused by chloroquine, is irreversible. In contrast, phenothiazine retinopathy is reversible. Lesions may also be produced in anterior structures of the eye, usually the cornea and lens, by both chloroquine and the phenothiazines, but they are of a relatively minor nature. Possible mechanisms for the oculotoxicity of the phenothiazines and antimalarials are discussed, particularly in relation to melanin.

Topics: Amitriptyline; Animals; Chloroquine; Cornea; Eye; Eye Diseases; Female; Haplorhini; Humans; Lens, Crystalline; Phenothiazines; Pregnancy; Retinal Diseases; Rifampin; Structure-Activity Relationship; Thioxanthenes; Time Factors

The characteristic clinical presentation of cat scratch disease is subacute regional lymphadenopathy; nevertheless, 5-25% of Bartonella henselae infections may present an atypical or systemic form, with potential eye involvement. We describe three clinical cases of ocular bartonellosis in two adolescents and one young adult, who had close contact with cats; all of them presented persistent fever ranging from 15 to 21 days, and two of them developed a sudden unilateral loss of visual acuity associated with optic neuritis. The other patient presented retinal choroiditis and unilateral retinal microgranulomas, with normal visual acuity. Patients received macrolides as sole antimicrobial or in association with rifampin, and one patient was additionally treated with systemic corticoids. The outcome was favorable in two patients; one patient developed a permanent visual deficit. Ocular bartonellosis must be suspected in patients with close contact to cats or with cat scratches whom develop persistent fever and sudden loss of visual acuity.

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Bartonella henselae; Cat-Scratch Disease; Child; Choroid Diseases; Eye Infections, Bacterial; Female; Humans; Male; Optic Neuritis; Retinal Diseases; Rifampin; Visual Acuity

To present the clinical, histopathological, and molecular biologic findings in fifteen cases of ocular tuberculosis (TB) in patients with acquired immune deficiency syndrome (AIDS).. Retrospective, observational, noncomparative case series of HIV-infected patients with ophthalmic complaints and/or with advanced disease (CD4+ cell count < 200), seen between the years 1993 to 2005 at tertiary care ophthalmic and AIDS care hospitals.. Each patient underwent a complete ophthalmic examination and relevant laboratory and radiologic investigations and was treated accordingly. The study was carried out in this cohort to describe the ocular manifestations of TB. The main outcome measures were to describe the clinical course histopathologic and molecular biologic features of ocular lesions attributable to tuberculosis in AIDS patients in our center.. Ocular TB was seen in 15 (1.95%) out of 766 consecutive cases of HIV/AIDS. Nineteen eyes of 15 patients were affected. Four cases (26.66%) had bilateral presentation. Presentations of ocular TB included choroidal granulomas in 10 eyes (52.63%), subretinal abscess in seven eyes (36.84%), worsening to panophthalmitis in three eyes, conjunctival tuberculosis, and panophthalmitis each in one eye (5.26%). All cases had evidence of pulmonary tuberculosis. Coexistent central nervous system (CNS) tuberculosis was seen in two cases and one case had abdominal tuberculosis. CD4+ cell counts were done in 14 patients; the count ranged from 14 to 560 cells/microl--mean 160.85 cells/microl.. Ocular TB in AIDS is relatively rare and can occur even at CD4+ cell counts greater than 200 cells/microl. It can have varied presentations with severe sight-threatening complications.

Topics: Abscess; Adolescent; Adult; AIDS-Related Opportunistic Infections; Antitubercular Agents; CD4 Lymphocyte Count; Child; Conjunctival Diseases; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Male; Middle Aged; Panophthalmitis; Pyrazinamide; Retinal Diseases; Retrospective Studies; Rifampin; Tuberculosis, Central Nervous System; Tuberculosis, Ocular; Tuberculosis, Pulmonary

A 54-year-old Chinese woman with miliary choroidal tuberculosis was followed for more than three years. She had had tuberculous meningitis for about one month before an ophthalmologic examination for blurred vision OU. There were 50 to 60 choroidal tubercles OU which were located mostly at the posterior poles including the macular areas. The meningitis and tubercular lesions resolved with antituberculous medications. In a series of fundus photographs and fluorescein angiograms, a macular subretinal neovascularization was noted in association with the tubercular lesions which resulted in disciform maculopathy. To the best of our knowledge, this case had the largest number of tubercles reported in this century, and the association of macular subretinal neovascularization with choroidal tuberculosis has never been reported.

Topics: Choroid; Ethambutol; Female; Fluorescein Angiography; Fundus Oculi; Humans; Isoniazid; Macula Lutea; Middle Aged; Neovascularization, Pathologic; Photography; Retina; Retinal Diseases; Rifampin; Tuberculosis, Meningeal; Tuberculosis, Ocular; Visual Acuity