Treatment Strategies for Neuroretinitis: Current Options and Emerging Therapies

AbstractPurpose of reviewTo explore and critically appraise the published data on the current and emerging treatment modalities for neuroretinitis.Recent findingsThe optimum treatment strategy for neuroretinitis due toBartonella henselae in immunocompetent individuals is not clear and a matter of debate. The role of systemic corticosteroids in infectious neuroretinitis and the optimum immunosuppressive regimen for use in recurrent idiopathic neuroretinitis also remains ill defined.SummaryThere is no class 1 evidence to support a specific treatment strategy for neuroretinitis. For uncomplicatedB. henselae–associated neuroretinitis in immunocompetent patients, initiation of antibiotic and corticosteroid therapy remains controversial. In patients with severe vision loss and/or moderate to severe systemic symptoms, a 4- to 6-week regimen of doxycycline or azithromycin with rifampin may provide some b enefit. The routine use of systemic corticosteroids in infectious neuroretinitis is not recommended. Targeted antimicrobial agents should be instituted in cases of neuroretinitis due to specific infectious etiologies (e.g., syphilis, Lyme disease, tuberculosis). Azathioprine may be beneficial in cas es of recurrent idiopathic neuroretinitis. There is a need for collaborative, multicenter prospective studies to provide definitive guidelines regarding the use of antibiotics and corticosteroids and to evaluate future therapies in infectious and recurrent idiopathic neuroretinitis.
Source: Current Treatment Options in Neurology - Category: Neurology Source Type: research

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Discussion Facial nerve palsy has been known for centuries, but in 1821 unilateral facial nerve paralysis was described by Sir Charles Bell. Bell’s palsy (BP) is a unilateral, acute facial paralysis that is clinically diagnosed after other etiologies have been excluded by appropriate history, physical examination and/or laboratory testing or imaging. Symptoms include abnormal movement of facial nerve. It can be associated with changes in facial sensation, hearing, taste or excessive tearing. The right and left sides are equally affected but bilateral BP is rare (0.3%). Paralysis can be complete or incomplete at prese...
Source: PediatricEducation.org - Category: Pediatrics Authors: Tags: Uncategorized Source Type: news
Authors: Melenotte C, Drancourt M, Gorvel JP, Mège JL, Raoult D Abstract Post-infectious chronic fatigue syndrome is a public health problem. Etiologies and physiopathological mechanisms are unknown. Some viruses are known to be involved in post-infectious chronic fatigue syndrome, but the role of bacterial infection is still questioned, especially in cases of post-treatment Lyme disease syndrome where subjective symptoms are regularly attributed to the presence of the dormant bacterium without scientific evidence. However, the medical experience of recalcitrant infections, relapses, and reactivations questi...
Source: Medecine et Maladies Infectieuses - Category: Infectious Diseases Tags: Med Mal Infect Source Type: research
A 23-year-old woman presented with a 2-week history of progressive blurring of vision in her left eye, associated with fever, fatigue, and myalgia. The patient had a pet cat and reported incidents of being scratched. Her fundus examination revealed optic disc edema and macular satellite exudates/star bilaterally (Figure). Laboratory test results revealed a normal complete blood count and liver enzymes. Screening results for human immunodeficiency virus, Lyme disease, syphilis, and tuberculosis were negative.
Source: Mayo Clinic Proceedings - Category: Internal Medicine Authors: Tags: Medical images Source Type: research
Conclusions:Focal neurologic deficits are not a common early presentation of IE. The visual field cut in this case was typical for a retinal artery occlusion and represented an embolic event. The diplopiawas likely caused by the thalamic infarct, with involvement of the corticomesencephalic tract. In characteristic fashion for IE, time required for bacterial culture growth was lengthy. Prompt recognition of focal deficits in a patient with signs and symptoms of systemic inflammation may allow for earlier recognition of IE.Study Supported by:Disclosure: Dr. Stephens has nothing to disclose. Dr. Frattalone has nothing to disclose.
Source: Neurology - Category: Neurology Authors: Tags: Autoimmunity with Infection, Syphilis, Lyme, Tuberculosis, and other Bacteria Source Type: research
Conclusions:Mycoplasma infection should be considered in cases of brainstem skew deviation with associated encephalitis. In these cases, administration of azithromycin and IvIG can lead to rapid clinical improvement.Disclosure: Dr. Lin has nothing to disclose. Dr. Levin has nothing to disclose. Dr. Gupta has nothing to disclose. Dr. Urday has nothing to disclose. Dr. Albin has nothing to disclose. Dr. Venna has nothing to disclose.
Source: Neurology - Category: Neurology Authors: Tags: Autoimmunity with Infection, Syphilis, Lyme, Tuberculosis, and other Bacteria Source Type: research
Conclusions:New-onset focal neurological deficits in immunocompromised patients with basal ganglia and cerebellar lesions may be infectious or neoplastic in etiology. Previously described pathogens associated with this presentation include Cryptoccocus, Candida, Toxoplasmosis, Mycobacterium, Coccidioides, Nocardia, and Listeria. Our case demonstrates unusual microbiology, with Klebsiella and Curvularia species as likely causative organisms. Awareness of these uncommon causes of CNS infection may allow for more prompt diagnosis and treatment.Disclosure: Dr. Das has nothing to disclose. Dr. Pohlen has nothing to disclose. Dr...
Source: Neurology - Category: Neurology Authors: Tags: Autoimmunity with Infection, Syphilis, Lyme, Tuberculosis, and other Bacteria Source Type: research
Conclusions:The current clinical observation serves to remind clinicians of the challenges faced in diagnosing brain ring-enhancing lesions, especially in patients with pre-existing brain disorders. Furthermore, it highlights the difficulty in treating invasive fungal infections in immunocompromised hosts. More studies are needed to establish the incidence and clinical course of invasive fungal infections in patients with sarcoidosis and infliximab therapy.Disclosure: Dr. Van Sanford has nothing to disclose. Dr. Obeidat has nothing to disclose. Dr. Zabeti has received personal compensation for activities with Biogen, Genzy...
Source: Neurology - Category: Neurology Authors: Tags: Autoimmunity with Infection, Syphilis, Lyme, Tuberculosis, and other Bacteria Source Type: research
Conclusions:LE is an uncommon manifestation of neurosyphilis requiring prompt recognition and treatment. It can present with a clinical syndrome and MRI appearance similar to other causes of LE. In contrast to autoimmune/paraneoplastic LE, brain PET imaging reveals hypometabolism of the affected temporal lobe and may be a useful adjunct.Disclosure: Dr. Al-Louzi has nothing to disclose. Dr. Mason has nothing to disclose. Dr. Rondeau has nothing to disclose. Dr. Rubin has nothing to disclose. Dr. Lyons has nothing to disclose. Dr. Bhattacharyya has received personal compensation for activities with Advance Medical.
Source: Neurology - Category: Neurology Authors: Tags: Autoimmunity with Infection, Syphilis, Lyme, Tuberculosis, and other Bacteria Source Type: research
Conclusions:Neuroimaging findings of neurosyphilis commonly are cerebral infarctions, leptomeningeal enhancement or nonspecific white matter lesions. Less common features on a fluid-attenuated inversion recovery (FLAIR) sequences are cortical atrophy and mesial temporal parenchymal signal changes. It is prudent to keep Neurosyphilis in differential of mesial temporal lobe white matter changes as early diagnosis and treatment results in better prognosis.Study Supported by: NoneDisclosure: Dr. Tiwana has nothing to disclose. Dr. Ahmed has nothing to disclose.
Source: Neurology - Category: Neurology Authors: Tags: Autoimmunity with Infection, Syphilis, Lyme, Tuberculosis, and other Bacteria Source Type: research
Conclusions:This case series illustrates important features currently attributed to neurosyphilis, which remains an important disease in Neurology, especially in some epidemiological risk groups.Disclosure: Dr. Borges has nothing to disclose. Dr. Germiniani has nothing to disclose. Dr. Koslyk has nothing to disclose. Dr. Teive has nothing to disclose.
Source: Neurology - Category: Neurology Authors: Tags: Autoimmunity with Infection, Syphilis, Lyme, Tuberculosis, and other Bacteria Source Type: research
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