Surveillance for Opportunistic Ocular Infections in Non-HIV Immunocompromised Children

Inez Wong^1,2, Caroline Chee^1,2, Stephen Teoh³, Poh-Lin Tan^1,2

¹National University Hospital, National University Health System (NUHS), Singapore
²National University Singapore (NUS)
³Tan Tock Seng Hospital, Singapore

Purpose
To investigate the diagnostic yield of screening for opportunistic ocular infections in non-HIV immunocompromised children.

Methods
Consecutive consultations in non-HIV immunocompromised individuals <21 years old performed by a pediatric ophthalmologist from January 2009 to October 2010 were prospectively recruited.

Results
Fifty-nine cases were screened, of which 38 (mean age 9.14 years,0.9-21.5) were included in the analysis. Underlying conditions included haematological malignancies in 24, of which 21 underwent bone-marrow transplant (BMT); steroid-resistant nephrotic syndrome; IL12 immunodeficiency; metastatic osteosarcoma; and 11 who received BMT for other conditions. Thirteen patients had positive pathogen test(s) from non-ocular sites. Of 10 patients with CMV-DNAemia, 2 developed progressive CMV retinitis despite pre-emptive and mulitple systemic antiviral therapy, requiring adjunctive intravitreal injections for disease control and resolution. One patient died. One case referred for candidemia was found to have chorioretinits and treated with voriconazole, but died shortly after. Another patient with disseminated cryptococcus infection involving skin and central nervous system had multifocal choroiditis which resolved with intravenous amphotericin and flucytosine. All 4 cases did NOT have ocular symptoms. One case with IL12 immunodeficiency diagnosed with mycobacterial skin infection and abdominal lymphadenopathy did not have ocular involvement.

Conclusion
The present series showed a relatively high yield of 10.5% (4/38), or 30.8% (4/13) if excluding those without positive pathogen results. Although preemptive treatment or systemic treatment for disease elsewhere may prevent or treat ocular infection, our cases with CMV retinitis which required local treatment highlights the need for timely surveillance in asymptomatic immunocompromised children with positive pathogen tests.