acquired immunodeficiency syndrome retinopathy
Introduction
Introduction to Acquired Immunodeficiency Syndrome Retinopathy Acquired immunodeficiency syndrome, also known as AIDS, is a new type of viral infection that attracted worldwide attention in the 1980s. It is a serious disease caused by human immunodeficiency virus and mainly caused by cellular immunodeficiency. Therefore, it is difficult to control the conditions of pathogenic microbial infections often associated with malignant tumors, such as Kaposi sarcoma Burkitt lymphoma. The patient died in a short period of time. At present, it is not uncommon in China, and there is a trend of rapid increase. Fundus and other ocular lesions often occur in AIDS patients basic knowledge The proportion of illness: 0.0006% Susceptible people: no specific population Mode of transmission: sexual transmission, blood transmission, mother-to-child transmission Complications: herpes zoster keratitis herpes simplex keratitis bacterial corneal ulcer Kaposis sarcoma glaucoma scleritis
Cause
Acquired immunodeficiency syndrome retinopathy
(1) Causes of the disease
AIDS is caused by HIV. It is caused by the exchange of body fluids during sexual intercourse, and is transmitted by blood or other blood products contaminated with HIV. HIV is a retrovirus, and it has a shell composed of a lipid membrane. 1) The shell is embedded with two glycoproteins (GP120 and GP41), and the inside of the shell is a core composed of proteins (P18 and P24). There are two ribonucleic acid (RNA) chains in the core, which contain The genome and reverse transcriptase of the virus.
(two) pathogenesis
HIV can only replicate in the living cells of the host. HIV contains genetic genes, but it must rely on the host cells to produce new viral particles. The genetic instructions of the virus can be embedded in the ribonucleic acid genome (RNA virus) or deoxyribonucleic acid (DNA). Genomics (DNA virus), HIV is an RNA virus that has a special reverse transcriptase that allows the virus to replicate its RNA into DNA, and the replicated DNA binds to the genome of the infected host cell. The virion, which is constructed as a mature virion, is released by the host cell by germination, thereby completing the replication of the virus. Under normal conditions, the RNA is replicated by DNA. Since HIV takes the opposite step in the replication process, It is called retrovirus.
The glycoprotein GP120 on the outer shell of HIV has a special affinity with some human cells, such as CD4 T lymphocytes, macrophages and some cell surface antigen molecules of the nervous system (called CD4 or T4 receptors). HIV infection can be damaged or Killing T4 helper cells leads to a reversal of the proportion of T helper cells and T suppressor cells. In normal healthy people, the ratio of T helper cells to T suppressor cells is 1.0 to 2.0, but among AIDS patients, both The proportion decreased to less than 1.0, and the reversal of the ratio of T helper cells and T suppressor cells resulted in cellular immune dysfunction, which caused opportunistic pathogen-induced infections and unusual tumorigenesis.
Prevention
Acquired immunodeficiency syndrome retinopathy prevention
AIDS has no effective treatment at present, so it is important to prevent it. Prohibition of unfair sexual behavior is the key to prevent this disease. Blood donation or organ transplantation (including cornea) should be done in an antibody test to ensure that blood and blood products are not contaminated. Disposable syringes, tonometers, room mirrors, contact lenses, etc., after disinfection with hydrogen peroxide or 75% alcohol, to prevent iatrogenic infections.
Complication
Acquired immunodeficiency syndrome retinopathy complications Complications herpes zoster keratitis herpes simplex keratitis bacterial corneal ulcer Kaposis sarcoma glaucoma scleritis
AIDS patients may often be associated with hernia, corneal or uveal herpes zoster infection; herpes simplex keratitis; bacterial corneal ulcer; Kaposi sarcoma of the eyelid, conjunctiva, lacrimal gland; Burkitt's lymphoma, secondary glaucoma , scleritis, intraocular and extraocular muscle paralysis.
Symptom
Acquired immunodeficiency syndrome retinopathy symptoms common symptoms HIV infection weight loss persistent fever night sweat immunodeficiency diarrhea lymphadenopathy edema
The incubation period varies from infection to short one year, several years or even more than 10 years (average 4.5 years), persistent fever, night sweats, diarrhea, weight loss, lymphadenopathy, TH cell reduction, TH cells and TS cells. Inversion of the ratio, due to low cellular immune function, the patient is highly susceptible to pathogenic microorganisms in harmless conditions, resulting in multiple organs, multiple systemic infections and associated malignant tumors.
According to reports in the literature, AIDS has 40% to 92.3% of ocular lesions, of which fundus damage is more common.
Fundus damage can occur in HIV infection itself, or in secondary infections of conditionally pathogenic microorganisms.
The infection caused by HIV itself is mainly characterized by cotton velvet plaques, mostly located in the shallow layer of the retina near the posterior vascular arch of the fundus or around the optic disc, one or more, appearing quietly, disappearing within 4 to 6 weeks, and then disappearing. A new lesion occurs in different parts. The cotton velvet plaque is an inflammatory occlusion of the retinal capillary anterior artery, causing focal ischemia, hypoxia, axoplasmic block, and neurofibrillary degeneration of the nerve fiber layer. FFA is The leukoplakia (including disappearance) is a filling defect, and sometimes there is a flaming hemorrhage at the posterior fundus and a white center bleeding plaque. Capillary occlusion around the fovea of the macula can also cause macular edema. Exudation, radial microcapsule-like wrinkles and star-shaped plaques arranged along the Henle fiber, HIV forms irreversible immunodeficiency, causing various pathogenic microorganisms (virus, bacteria, fungi, protozoa) infectious fundus diseases Such as cytomegalovirus retinitis, toxoplasma retinal choroiditis, fungal (candida, cryptococcal, etc.) chorioretinitis, mycobacterial choroid Retinitis and so on.
The incidence of cytomegalovirus retinitis in AIDS patients is as high as 12% to 46% (in addition to patients with malignant tumors and immunosuppressive drugs after organ transplantation), usually seen in the late stage of the disease, but can also be prior to Before the appearance of other lesions in the whole body, at the beginning, the progress was slow, and there was no obvious damage to the central vision. The patient often had no feeling, or only the mosquitoes. Under the ophthalmoscope, there was a blurred boundary near the peripheral fundus or the posterior pole of the vascular arch. Yellow-white scattered granular or gray-white flocculent turbidity, gradually expanding fusion, extensive retinal edema, exudation and flaming hemorrhage, macular star-shaped spots, so that the fundus is broken cheese and tomato sauce.
Toxoplasmic retinochoroiditis is caused by the passage of the short ciliary artery into the choroidal retina or from the cerebrospinal fluid to the optic disc. The fundus manifestation is the same as that of the general asthmatic Toxoplasma gondii retinitis, but the inflammatory response is acute. , often due to aqueous humor, vitreous opacity and can not be satisfied with the fundus.
Examine
Examination of acquired immunodeficiency syndrome retinopathy
Laboratory immunological examinations are extremely important for determining the diagnosis, including the absolute value of peripheral blood lymphocytes, TH and TS cell values and their ratios; HIV isolation, detection of HIV antigens and nucleic acids or reverse transcriptase.
In the case of cytomegalovirus retinitis, FFA examination showed a large non-perfusion area in the retina, and there were a lot of leakage in the wall of the venous and venous. The lesion continued to increase, and the optic disc was congested and edema, the retinal exudation was detached, and the visual acuity was completely lost.
Diagnosis
Diagnosis and diagnosis of acquired immunodeficiency syndrome retinopathy
Clinically, based on medical history, high-risk groups, systemic multi-system symptoms and signs, repeated multiple or one conditional pathogenic microbial infection, combined with rare Kaposi sarcoma, Pneumocystis pneumonia, etc., can make a diagnosis of AIDS.
