Silvana Vianello1,2, Gláucio Silva de Souza3, Maurício Maia2,4, Rubens Belfort2, João Rafael de Oliveira Dias2. 1. Centro de Estudo da Visão, Juiz de Fora, Minas Gerais, Brazil. 2. Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil. 3. Santa Casa de Misericórdia de Juiz de Fora, Department of General Surgery, Juiz de Fora, Minas Gerais, Brazil. 4. Brazilian Institute of Fight Against Blindness, Assis and Presidente Prudente, São Paulo, Brazil.
Abstract
Importance: Yellow fever virus (YFV) is a reemerging, potentially lethal arboviral disease that has been occurring recently in Africa and South America. Poor levels of immunization have facilitated the viral spread in southeastern Brazil, leading to an unprecedented outbreak that started in late 2016. Although human cases have been linked to sylvatic mosquitoes, the concern is that YFV may spread to urban centers infested with Aedes aegypti and Aedes albopictus mosquitoes and start a true urban cycle. Objective: To describe the ocular findings in patients with acute YFV infection. Design, Setting, Participants: Two adults with an acute YFV infection in southeastern Brazil underwent an ophthalmologic and ocular ultrasonographic examination in early 2018. Main Outcomes and Measures: Ocular findings in patients with acute YFV infection. Results: Both patients presented with increased choroidal thickness bilaterally seen on ocular ultrasonography. A man in his late 50s who had not been vaccinated previously also presented with bilateral, midperipheral, 360° choroidal detachment and yellowish subretinal lesions. After clinical deterioration and liver transplant, the man died. A woman in her early 30s who had been vaccinated previously for YFV presented with increased retinal venous congestion bilaterally. She was discharged with mild conjunctival chemosis and icterus. Conclusions and Relevance: These reports describe different patterns of ocular findings associated with YFV acute infection. However, the exact mechanism involved in the retinal and choroidal findings remains unclear.
Importance: Yellow fever virus (YFV) is a reemerging, potentially lethal arboviral disease that has been occurring recently in Africa and South America. Poor levels of immunization have facilitated the viral spread in southeastern Brazil, leading to an unprecedented outbreak that started in late 2016. Although human cases have been linked to sylvatic mosquitoes, the concern is that YFV may spread to urban centers infested with Aedes aegypti and Aedes albopictus mosquitoes and start a true urban cycle. Objective: To describe the ocular findings in patients with acute YFV infection. Design, Setting, Participants: Two adults with an acute YFV infection in southeastern Brazil underwent an ophthalmologic and ocular ultrasonographic examination in early 2018. Main Outcomes and Measures: Ocular findings in patients with acute YFV infection. Results: Both patients presented with increased choroidal thickness bilaterally seen on ocular ultrasonography. A man in his late 50s who had not been vaccinated previously also presented with bilateral, midperipheral, 360° choroidal detachment and yellowish subretinal lesions. After clinical deterioration and liver transplant, the man died. A woman in her early 30s who had been vaccinated previously for YFV presented with increased retinal venous congestion bilaterally. She was discharged with mild conjunctival chemosis and icterus. Conclusions and Relevance: These reports describe different patterns of ocular findings associated with YFV acute infection. However, the exact mechanism involved in the retinal and choroidal findings remains unclear.
Authors: Jader da C Cardoso; Marco A B de Almeida; Edmilson dos Santos; Daltro F da Fonseca; Maria A M Sallum; Carlos A Noll; Hamilton A de O Monteiro; Ana C R Cruz; Valeria L Carvalho; Eliana V Pinto; Francisco C Castro; Joaquim P Nunes Neto; Maria N O Segura; Pedro F C Vasconcelos Journal: Emerg Infect Dis Date: 2010-12 Impact factor: 6.883