Ocular manifestations associated with murine typhus.

Abstract

To characterise and analyse ocular manifestations associated with acute murine typhus (MT), an infectious disease caused by Rickettsia typhi. Nine consecutive patients (18 eyes) with serologically confirmed MT at the acute stage were enrolled in this prospective, non-comparative study. All patients underwent complete ophthalmic examination, including dilated biomicroscopic fundus examination, fundus photography, fluorescein angiography (FA) and indocyanine green (ICG) angiography. Of nine patients, eight (88.9%) had bilateral ocular involvement related to MT, with (n = 3) or without (n = 5) associated ocular symptoms. Findings included mild vitreous inflammation (10 eyes; 55.6%), white retinal lesions (nine eyes; 50%), retinal haemorrhages (four eyes; 22.2%), retinal vascular leakage (seven eyes; 38.9%), hypofluorescent choroidal dots on FA and/or ICG angiography (11 eyes; 61.1%), optic-disc swelling (two eyes; 11.1%), optic neuritis (one eye; 5.6%) and optic-disc staining (11 eyes; 61.1%). All ocular findings had a self-limited course. Ocular involvement is frequently observed in acute MT. A systematic fundus examination, complemented by angiography in selected cases, may be helpful in establishing an early clinical diagnosis of the disease while serological testing is pending.