The Species Composition of Microbiota and Biological Properties of Dominant Bacterial Species in the Lacrimal Fluid in Patients with Endogenous Uveites

The purpose: to study the species composition of the lacrimal fluid microbiota in patients with endogenous uveitis and the biological properties of dominant species of bacteria.Patients and Methods. A bacteriological study of the lacrimal fluid of 107 patients (114 eyes) with endogenous uveitis and 28 practically healthy persons (control) was carried out. The research was performed using the conventional methods. The isolated microorganisms were identified up to the species. We studied the main biological properties of bacteria — the presence of persistence and virulence factors of isolated dominant species.The results. 43 strains of various types of bacteria were isolated from the lacrimal fluid of patients with uveitis, bacteria of the genus Staphylococcus prevailed, S. aureus was isolated in 23.3 % of cases, and the remaining strains were representatives of coagulase-negative staphylococci. The species composition of the bacteria isolated from practically healthy individuals did not differ in essence. Isolated strains of S. aureus had a significant set of virulence factors. All isolates lysed sheep red blood cells, 80 % of the cultures had lecithovitellase and 60 % — DNA-se activity. Representatives of coagulase-negative staphylococci were characterized only by hemolytic activity. In the study of persistence factors, it was found that all the studied strains of S. aureus and the vast majority of representatives of coagulase-negative staphylococci isolated from tears were resistant to lysozyme. Biofilm formation was more typical for S. aureus strains 90 % versus 34.4 % for representatives of coagulase-negative staphylococci (t = 2.194, p = 0.034). Similar patterns were found in relation to complement resistance, 90 % of S. aureus cultures and 37.5 % of coagulase-negative staphylococci (t = 2.055; p = 0.046).Conclusion. Among the microorganisms isolated from the lacrimal fluid, Staphylococcus bacteria prevailed, from which S. cohnii was most often isolated. S. aureus to a greater extent than coagulase-negative staphylococci had a certain set of virulence and persistence factors. The microbiocenosis of the lacrimal fluid of patients with endogenous uveitis did not differ from practically healthy individuals. The presence of S. aureus in lacrimal fluid is a risk factor for the development of endogenous uveitis in cases of chronic oral and ENT organ diseases.

Endogenous uveitis as deuteropathy оf secondary acute infectious endocarditis

Uveitis is a heterogeneous polyetiological immune-mediated disease. Its common feature is inflammation of the choroid. The total prevalence of uveitis of various etiologies in the population varies from 15 to 38 people per 100 000. The cause of this pathology can be any infectious or somatic diseases (both endo- and exogenous in nature), when the body’s immune system is activated. The prevalence of the most common endogenous uveitis, caused by secondary foci of infection, is about 3% of the total number of diseases of this etiology. Uveitis, caused by Streptococcus bacteria, affects eyes due to dissemination from the foci of infection, being transmitted through the blood and lymph vessels. An important stage in the clinical diagnosis of uveitis is the determination of the etiological factor, which allows using of pathogenetic treatment regimens. The diagnosis is performed based on the totality of signs characterizing the specificity of the inflammatory process. Treatment and diagnosis of inflammation of the choroid are still one of the urgent tasks of modern ophthalmology.

Structure of Clinical Forms and Etiology of Uveitis in Children of the Khabarovsk Krai

Purpose. Evaluation of the clinical and etiological structure of endogenous uveitis in children, the effectiveness of its etiological diagnosis. Material and Methods. 34 children (42 eyes) with endogenous uveitis aged 3 to 16 years: 31 children (37 eyes) have anterior uveitis, 2 (4 eyes) have intermediate uveitis, and one (1 eye) have posterior uveitis. The unilateral uveitis was observed in 26 children (76%), bilateral – in 8 children (24%). Clinically, 15 children were diagnosed with acute uveitis for the first time, 3 with exacerbation of the chronic course of eye inflammation, and 16 with a relapse of disease after prolonged remission. Ophthalmological examination, clinical and laboratory diagnostics were carried out, including immunological tests and consultations with medical subspecialists. Results. Among all examined children, 6 had uveitis without symptoms. The accompanying juvenile idiopathic arthritis was detected in 15 children with anterior uveitis, 6 had HLA-B27, 2 had an association with herpes simplex virus infection, one had systemic scleroderma, one had acute purulent unilateral sinusitis, and 6 were unable to identify etiology. Two children with intermediate uveitis had bilateral lesions; the etiological factor was the activation of herpes simplex virus. One child had acute central focal chorioretinitis of tuberculosis etiology. When an etiological factor was identified, children had etiotropic therapy along with pathogenetic. In all cases, clinical manifestations of uveitis were completely stop. Conclusion. Newly identified anterior uveitis with acute course occurred in 44% children, 9% had chronic course and 47% had the relapse after prolonged remission. The frequency of exacerbations in 12 children was up to 2 times a year and in 4 children it was more than 2 times a year. The course of anterior uveitis of mild and moderate severity occurred in 29 children and severe in 2 children. Intermediate uveitis in 2 children had moderate severity, posterior uveitis in one child had severe course. Key words: endogenous uveitis, juvenile idiopathic arthritis.

Importance of Epstein–Barr virus infection in pathogenesis of proliferative complications in children with endogenous uveitis

Endogenous uveitis (EU) in children is a multifactorial sight-threatening disease that reduces patient’s quality of life. Proliferative syndrome (PS) coupled to developing adhesions, opacity of vitreous body, epiretinal and preretinal membranes is one of the most serious EU complications, with yet-unknown pathogenesis. Among the numerous trigger factors, a role for infections, particularly human herpes group-driven, is proposed. The goal of the study was to assess a potential role of Herpes simplex viruses type 1 (HSV-1), Herpes simplex viruses type 2 (HSV-2), Epstein–Barr virus (EBV) and Cytomegalovirus (CMV) played in the PS pathogenesis in children with endogenous uveitis. 112 patients aged 3–17 years (mean age 10 years) with (93 patients)/without PS (19 children) were examined. IgM and IgG antibodies (markers of chronic and active infection) against HSV-1/2, EBV and CMV were detected by ELISA. A significantly increased PS rate in infected vs. uninfected children was revealed solely for EBV infection (p = 0.03), but not for HSV-1/2 (p > 0.05) or CMV-positive patients (p > 0.05). However, PS emergence in EBV-negative patients also suggests that some factors might contribute to proliferation in intraocular inflammation. In addition, level of serum IL-8 and IL-6 were assessed by multiplex analysis in 28 children. It was found that IL-8 was detected in all patients, with great individual fluctuations (5.6–2743 pg/ml). Enhanced systemic IL-8 level tended to rise in patients with more prominent proliferation and serological markers of EBV reactivation. However, serum IL-6 was detected by about 2-fold less often reaching up to 55% cases (variation of individual indices 1.3–35.5 pg/ml). A correlation between PS severity, EBV infection activity and systemic IL-6 level was not observed. Further studies evaluating a role of EBV infection in PS pathogenesis pediatric endogenous uveitis are necessary, as it may underlie a rationale for including antiherpetic drugs into a combination therapy.

To the endogenous uveitis classification

Endogenous uveitis classification importance is obvious due to the large variety of etiological factors and pathogenesis and treatment complexities. Most proposed classifications are based on the description of signs offered in the form of plain text, and available individual schemes do not cover all necessary issues. The recommended classification scheme of endogenous uveitis consists of five sections: etiology, clinical type (pathogenesis), localization, clinical course and the phase of activity. In contrast to the classifications proposed by other authors it is supplemented by the etiologic (additional scheme) and pathogenetic (clinical pathogenic type) parts. Classification allows the clinical diagnosis to reflect the process history taking into account the pathogenic and clinical types of the disease (granulomatous or focal, and nongranulomatous or toxico-allergical uveitis) and to determine the rational therapy.