中华眼底病杂志

中华眼底病杂志

增强对感染性和感染相关性视神经炎的认识提高早期正确诊断及治疗水平

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感染性和感染相关性视神经炎(ON)是ON的一个重要类型。感染性ON为病原体蔓延、血行播散等途径直接侵犯视神经所致;感染相关性ON为病原体感染所触发的免疫机制所致。感染性和感染相关性ON临床特征表现为非典型性ON,包括进行性视力下降,持续性眼痛或头痛,糖皮质激素治疗无效甚至加重病情。眼底表现为视盘肿胀伴视盘周围出血或视神经视网膜炎;可同时伴有葡萄膜炎表现。由于该类患者首诊眼科时常缺乏全身感染表现,容易将其误诊为其他类型的视神经病变而误治;尤其是单纯大剂量糖皮质激素治疗可能导致非常严重的后果。因此,如何早期正确诊断感染性和感染相关性ON应引起眼科医生足够重视。

Infectious and infection-related optic neuritis is an important type of optic neuritis. Infectious optic neuritis is caused by direct spread of pathogenic organism to optic nerve from local infection or blood transmission. Infection-related optic neuritis is caused by pathogens-induced immune allergic reaction. They present with atypical clinical features of optic neuritis, including progressive vision loss, persistent eye pain or headache, ineffectiveness or even worse of glucocorticoid therapy. Fundus manifestations include optic disc swelling with peripapillary hemorrhage or neuro-retinitis, and the feature of concurrent uveitis. When these patients first visit ophthalmic clinics, they often lack signs of systemic infection, thus it is easy to misdiagnose them as other types of optic neuropathy and mistakenly treat them. In particular, high-dose glucocorticoid therapy can lead to very serious consequences. Therefore, how to correctly diagnose infectious and infection-related optic neuritis in the early stages are very important for ophthalmologists and need to be seriously kept in our mind.

关键词: 感染/病因; 视神经炎/诊断; 视神经炎/治疗; 述评

Key words: Infection/etiology; Optic neuritis/diagnosis; Optic neuritis/therapy; Editorial

引用本文: 姜利斌, 刘文冬. 增强对感染性和感染相关性视神经炎的认识提高早期正确诊断及治疗水平. 中华眼底病杂志, 2017, 33(5): 449-452. doi: 10.3076/cma.j.issn.1005-1015.2017.05.003 复制

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1. 中华医学会眼科学分会神经眼科学组. 视神经炎诊断和治疗专家共识(2014)[J]. 中华眼科杂志, 2014, 50(6): 459-462. DOI: 10.3760/cma.j.issn.0412-4081.2014.06.013.Neuro-ophthalmology Group, Ophthalmology Branch of Chinese Medical Association. Expert consensus of diagnosis and treatment of optic neuritis [J]. Chin J Ophthalmol, 2014, 50(6): 459-462. DOI: 10.3760/cma.j.issn.0412-4081.2014.06.013.
2. Miller NR, Subramanian PS, Patel VR. Walsh and Hoyt’s clinical neuro-ophthalmology the essentials [M]. 3rd eds. Baltimore: Lippincott Williams & Wilkins, 2016: 130-144.
3. 姜利斌, 王倩, 魏文斌.视神经炎分类与鉴别诊断 [J]. 眼科, 2013, 22(6): 364-369.Jiang LB, Wang Q, Wei WB. Types and differential diagnosis of optic neuritis [J]. Ophthalmol CHN, 2013, 22(6): 364-369.
4. Davis EJ, Rathinam SR, Okada AA, et al. Clinical spectrum of tuberculous optic neuropathy [J]. J Ophthalmic Inflamm Infect, 2012, 2(4): 183-189. DOI: 10.1007/s12348-012-0079-5.
5. Patel SS, Saraiya NV, Tessler HH, et al. Mycobacterial ocular inflammation: delay in diagnosis and other factors impacting morbidity [J]. JAMA Ophthalmol, 2013, 131(6): 752-758. DOI: 10.1001/jamaophthalmol.2013.71.
6. Ji L, Lou YL, Wu ZX, et al. Usefulness of interferon-γ release assay for the diagnosis of sputum smear-negative pulmonary and extra-pulmonary TB in Zhejiang Province, China [J]. Infect Dis Poverty, 2017, 6(1): 121. DOI: 10.1186/s40249-017-0331-1.
7. Ang M, Htoon HM, Chee SP. Diagnosis of tuberculous uveitis: clinical application of an interferon-gamma release assay [J]. Ophthalmol, 2009, 116(7): 1391-1396. DOI: 10.1016/j.ophtha.2009.02.005.
8. Kokkada SB, Barthakur R, Natarajan M, et al. Ocular side effects of antitubercular drugs :a focus on prevention, early detection and management [J]. Kathmandu Univ Med J, 2005, 3(4): 438-441.
9. Wang ZM, Kanoh N, Dai CF et al. Isolated sphenoid sinus disease: an analysis of 122 cases [J]. Ann Otol Rhinol Laryngol, 2002, 111(4): 323-327.
10. Lee LA, Huang CC, Lee TJ. Prolonged visual disturbance secondary to isolated sphenoid sinus disease [J]. Laryngoscope, 2004, 114(6): 986-990.
11. 曹珊珊, 李红阳, 徐全刚, 等. 以视神经炎为首发的神经梅毒的临床观察[J]. 中华眼科杂志, 2016, 52(12): 898-904. DOI: 10.3760/cma.j.issn.0412-4081.2016.12. 006.Cao SS, Li HY, Xu QG, et al. Clinical features of neurosyphilis with optic neuritis as an initial finding [J]. Chin J Ophthalmol, 2016, 52(12): 898-904. DOI: 10.3760/cma.j.ssn.0412-4081.2016.12.006.
12. Sahin O, Ziaei A. Clinical and laboratory characteristics of ocular syphilis, co-infection, and therapy response [J]. Clin Ophthalmol, 2015, 10: 13-28. DOI: 10.2147/OPTH.S94376.
13. 马开富, 刘胜武. 梅毒血清学诊断实验方法研究进展[J]. 国际检验医学杂志, 2012, 33 (1): 63-66. DOI: 10.3969/j.issn.1673-4130.2012.01.027.Ma KF, Liu SW. The research progress of the serologic tests for syphilis [J]. Int Lab Med, 2012, 33 (1): 63-66. DOI: 10.3969/j.issn.1673-4130.2012.01.027.
14. 樊尚荣, 梁丽芬.2015年美国疾病控制中心性传播疾病诊断和治疗指南(续)——梅毒的诊断和治疗指南[J]. 中国全科医学, 2015, 18(27): 3260-3264. DOI: 10.3969/j.issn.1007-9572.2015.27.002.Fan SR, Liang LF. CDC 2015 guideline for the diagnosis and treatment of syphilis[J]. Chinese General Practice, 2015, 18(27): 3260-3264. DOI: 10.3969/j.issn.1007-9572.2015.27.002.
15. Belum GR, Belum VR, Chaitanya Arudra SK, et al. The Jarisch-Herxheimer reaction: revisited[J]. Travel Med Infect Dis, 2013, 11(4): 231-237. DOI: 10.1016/j.tmaid.2013.04.001.
16. Rigi M, Khan K, Smith SV, et al. Evaluation and management of the swollen optic disk in cryptococcal meningitis[J]. Surv Ophthalmol, 2017, 62(2): 150-160. DOI: 10.1016/j.survophthal.2016.10.004.
17. Chen H, Zhang Q, Tan S, et al. Update on the application of optic nerve sheath fenestration[J]. Restor Neurol Neurosci, 2017, 35(3): 275-286. DOI: 10.3233/RNN-160693.
18. Mansour AM.Cytomegalovirus optic neuritis[J]. Curr Opin Ophthalmol, 1997, 8(3): 55-58.
19. Rim K, Nesrine A, Imen K, et al. Infectious optic neuropathies: a clinical update [J]. Eye Brain, 2015, 7: 59-81. DOI: 10.2147/EB.S69173.
20. Chi SL, Stinnett S, Eggenberger E, et al. Clinical characteristics in 53 patients with cat scratch optic neuropathy [J]. Ophthalmology, 2012, 119(1): 183-187. DOI: 10.1016/j.ophtha.2011.06.042.
21. 陈兰兰, 姜利斌.儿童视神经炎诊治的现状与进展[J]. 中华眼科杂志, 2014, 50(12): 1-4. DOI: 10.3760/cma.j.issn.0412-4081.2014.12.019.Chen LL, Jiang LB. Current status and progress in diagnosis and treatments of pediatric optic Neuritis [J]. Chin J Ophthalmol, 2014, 50(12): 1-4. DOI: 10.3760/cma.j.issn.0412-4081.2014.12.019.