Human-biting ticks and zoonotic tick-borne pathogens in North Africa: diversity, distribution, and trans-Mediterranean public health challenges

Coxiella burnetii is the causative agent in Q fever, a zoonotic disease. Ocular manifestations of this disease are extremely rare and have been infrequently reported. In this report, we describe a rare case of chorioretinitis in a patient incompletely treated for Q fever. We highlight the unique ocular manifestation with multimodal imaging, and the importance of a thorough history and prompt and correct treatment of the disease with systemic therapy. [ Ophthalmic Surg Lasers Imaging Retina 2024;55:xx–xx.] 

Q Fever-Associated Chorioretinitis.

Characteristics and course of known seasonal diseases of pre-coronavirus disease (COVID-19) pandemic era may or may not change during the pandemic. Labelling COVID-19 as a novel etiology for those seasonal diseases or considering it as coinfection is debatable. Appropriate investigations are required to rule out previously known etiologies before correlating it with COVID-19. Epidemic retinitis (ER) or post fever retinitis is one such entity with seasonal variation. Multiple seropositivity for various organisms has been reported for ER during pre-pandemic era. This may significantly increase during the pandemic as the possibility of coinfection with COVID-19 is high. In the absence of gold-standard tests to exclude previously reported causes of ER, one should not undermine the possible coinfection before considering ER as post-COVID-19 syndrome. A study of incidence and pattern of seasonal variation of ER before and during the pandemic is needed before presumptively associating it with COVID-19.

Comments on 'Presumed Post COVID- Infection Retinitis - Clinical and Tomographic Features of Retinitis as a Post-COVID Syndrome'.

Abstract Purpose: To describe a case of bilateral retinitis in a patient with endocarditis and a serologically confirmed Q fever. Methods: A single case report documented with multimodal imaging. Results: A 55-year-old patient with culture-negative endocarditis was referred to our department for an ocular examination. His visual acuity was 20/20 in both eyes. Fundus examination showed white retinal infiltrates with few superficial retinal hemorrhages scattered in the posterior pole. There was no staining on fluorescein angiography. Swept-source optical coherence tomography (SS-OCT) revealed increased inner retinal reflectivity with a focal area of retinal thickening. Laboratory tests showed a high titer of antibodies against Coxiella burnetii . The patient was treated with doxycycline. Two weeks later, fundus examination showed partial resolution of retinitis with inner retinal thinning in SS-OCT. Conclusions: Multifocal retinitis is an uncommon presentation of Q fever. The diagnosis should be considered, especially when associated with culture-negative infective endocarditis, highlighting the importance of routine ocular examination. 

Q Fever Endocarditis with Bilateral Multifocal Retinitis: A Case Report

As technology continues to evolve, the possibility for a wide range of dangers to people, organizations, and countries escalate globally. The United States federal government classifies types of threats with the capability of inflicting mass casualties and societal disruption as Chemical, Biological, Radiological, Nuclear, and Energetics/Explosives (CBRNE). Such incidents encompass accidental and intentional events ranging from weapons of mass destruction and bioterrorism to fires or spills involving hazardous or radiologic material. All of these have the capacity to inflict death or severe physical, neurological, and/or sensorial disabilities if injuries are not diagnosed and treated in a timely manner. Ophthalmic injury can provide important insight into understanding and treating patients impacted by CBRNE agents; however, improper ophthalmic management can result in suboptimal patient outcomes. This review specifically addresses the biological agents the Center for Disease Control and Prevention (CDC) deems to have the greatest capacity for bioterrorism. CBRNE biological agents, encompassing pathogens and organic toxins, are further subdivided into categories A, B, and C according to their national security threat level. In our compendium of these biological agents, we address their respective CDC category, systemic and ophthalmic manifestations, route of transmission and personal protective equipment considerations as well as pertinent vaccination and treatment guidelines.

Ophthalmic implications of biological threat agents according to the chemical, biological, radiological, nuclear, and explosives framework

Abstract Objective To report acute multifocal retinitis in association with serologically-proven Coxiella (C) Burnetii infection (Q fever) with endocarditis. Material and methods A single case report documented with multimodal imaging. Results A 67-year-old cattle breeder presented with a 2-week history of persistent fever, headache, and floaters in both eyes. On examination, his best-corrected visual acuity was 20/20, and there was 1+ vitreous cells in both eyes. Bilateral fundus examination showed multiple small superficial white retinal lesions scattered in the posterior pole and midperiphery associated with a few retinal hemorrhages. These retinal lesions did not stain on fluorescein angiography (FA) and showed focal hyperreflectivity and thickening primarily involving the inner retinal layers on optical coherence tomography (OCT). There also was a band-like hyper-reflective area in the middle retina consistent with paramacular acute middle maculopathy. Transthoracic echocardiogram (TTE) showed a mobile echodensity on the anterior aortic leaflet consistent with a diagnosis of endocarditis. Elisa assays performed on paired serum samples collected 2 weeks apart showed increase in antibodies against C burnetii from 60 IU/ml to 255 IU/ml. The patient was treated with doxycycline 100 mg twice a day for 18 months, with subsequent resolution of the endocarditis. Sequential ocular examinations showed gradual resolution of all acute retinal findings without visible scars. Conclusion Acute Q fever, caused by C burnetii infection, should be considered in the differential diagnosis of acute multifocal retinitis. A systematic cardiac assessment with echocardiography is essential for early diagnosis of associated endocarditis and for prompt administration of appropriate antibiotic treatment to improve clinical outcomes . 

https://joii-journal.springeropen.com/counter/pdf/10.1186/s12348-022-00295-1

Acute multifocal retinitis in a patient with Q fever (Coxiella Burnetii infection) with endocarditis

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online) 

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Acute multifocal retinitis in a patient with Q fever (Coxiella Burnetii infection) with endocarditis

Graves' orbitopathy: clinical evaluation and therapeutic aspects

Choroidal metastasis from follicular thyroid carcinoma: a case report

Optic disc drusen: an exceptional manifestation of pseudohypoparathyroidism