PMID- 27871762 OWN - NLM STAT- MEDLINE DCOM- 20170718 LR - 20220331 IS - 1549-4713 (Electronic) IS - 0161-6420 (Linking) VI - 124 IP - 2 DP - 2017 Feb TI - Clinical and Histopathologic Ocular Findings in Disseminated Mycobacterium chimaera Infection after Cardiothoracic Surgery. PG - 178-188 LID - S0161-6420(16)31456-7 [pii] LID - 10.1016/j.ophtha.2016.09.032 [doi] AB - PURPOSE: To investigate and characterize clinical and histopathologic ocular findings in patients with disseminated infection with Mycobacterium chimaera, a slow-growing nontuberculous mycobacterium (NTM), subsequent to cardiothoracic surgery. DESIGN: Observational case series. PARTICIPANTS: Five white patients (10 eyes). METHODS: Analysis of clinical ocular findings, including visual acuity, slit-lamp biomicroscopy, spectral-domain optical coherence tomography (SD OCT), fundus autofluorescence (FAF), and fluorescein angiography/indocyanine green (ICG) angiography findings, of patients with a disseminated M. chimaera infection. Biomicroscopic and multimodal imaging findings were compared with the histopathology of 1 patient. MAIN OUTCOME MEASURES: Clinical and histopathologic ocular findings of M. chimaera. RESULTS: The mean age of the 5 male patients, diagnosed with endocarditis or aortic graft infection, was 57.8 years. Clinical ocular findings included anterior and intermediate uveitis, optic disc swelling, and white-yellowish choroidal lesions. Multifocal choroidal lesions were observed bilaterally in all patients and were hyperfluorescent on fluorescein angiography, hypofluorescent on ICG angiography, and correlated with choroidal lesions on SD OCT. The extent of choroidal lesions varied from few in 2 patients to widespread miliary lesions in 3 patients leading to localized choroidal thickening with elevation of the overlying retinal layers. Spectral-domain optical coherence tomography through regressing lesions revealed altered outer retinal layers and choroidal hypertransmission. The ocular findings were correlated with the course of the systemic disease. Patients with few choroidal lesions had a favorable outcome, whereas all patients with widespread chorioretinitis died of systemic complications of M. chimaera infection despite long-term targeted antimicrobial therapy. Ocular tissue was obtained from 1 patient at autopsy. Necropsy of 2 eyes of 1 patient revealed prominent granulomatous lymphohistiocytic choroiditis with giant cells. CONCLUSIONS: M. chimaera infection subsequent to cardiothoracic surgery is a novel entity that has been recently described. It involves multiple organ systems and can cause life-threatening disseminated disease. The ocular manifestations documented using multimodal imaging allow us to use the eye as a window to the systemic infection. CI - Copyright (c) 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved. FAU - Zweifel, Sandrine A AU - Zweifel SA AD - Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. Electronic address: sandrine.zweifel@usz.ch. FAU - Mihic-Probst, Daniela AU - Mihic-Probst D AD - Institute of Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. FAU - Curcio, Christine A AU - Curcio CA AD - Department of Ophthalmology, University of Alabama School of Medicine, Birmingham, Alabama. FAU - Barthelmes, Daniel AU - Barthelmes D AD - Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; The Save Sight Institute, The University of Sydney, Sydney, Australia. FAU - Thielken, Andrea AU - Thielken A AD - Institute of Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. FAU - Keller, Peter M AU - Keller PM AD - Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland; Swiss National Center for Mycobacteria, University of Zurich, Institute of Medical Microbiology, Zurich, Switzerland. FAU - Hasse, Barbara AU - Hasse B AD - Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. FAU - Boni, Christian AU - Boni C AD - Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. LA - eng PT - Case Reports PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20161118 PL - United States TA - Ophthalmology JT - Ophthalmology JID - 7802443 SB - IM CIN - Ophthalmology. 2018 May;125(5):e33. PMID: 29681302 CIN - Ophthalmology. 2018 May;125(5):e33-e34. PMID: 29681303 MH - Aged MH - *Cardiopulmonary Bypass MH - Chimera MH - Endocarditis, Bacterial/complications MH - Eye/microbiology MH - Eye Diseases/*etiology/microbiology/pathology/physiopathology MH - Eye Infections, Bacterial/*etiology/microbiology MH - Female MH - Fluorescein Angiography MH - Humans MH - Immunohistochemistry MH - Male MH - Middle Aged MH - Mycobacterium/*isolation & purification MH - Mycobacterium Infections/*complications/etiology MH - *Postoperative Complications MH - Tomography, Optical Coherence MH - Visual Acuity EDAT- 2016/11/23 06:00 MHDA- 2017/07/19 06:00 CRDT- 2016/11/23 06:00 PHST- 2016/06/07 00:00 [received] PHST- 2016/09/23 00:00 [revised] PHST- 2016/09/26 00:00 [accepted] PHST- 2016/11/23 06:00 [pubmed] PHST- 2017/07/19 06:00 [medline] PHST- 2016/11/23 06:00 [entrez] AID - S0161-6420(16)31456-7 [pii] AID - 10.1016/j.ophtha.2016.09.032 [doi] PST - ppublish SO - Ophthalmology. 2017 Feb;124(2):178-188. doi: 10.1016/j.ophtha.2016.09.032. Epub 2016 Nov 18.