• Retinal Characteristics of Patients With Yellow Fever

    By Lynda Seminara
    Selected and Reviewed By: Neil M. Bressler, MD, and Deputy Editors

    Journal Highlights

    JAMA Ophthalmology, September 2019

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    Two outbreaks of yellow fever (YF) occurred recently in Southeastern Brazil. To better understand the retinal changes that accompany this virus, Brandão-de-Resende et al. studied patient data collected during the outbreaks. Among patients with YF, retinopathy was observed in 20%. The most common retinal findings were superficial hemorrhage, retinal nerve fiber layer (RNFL) infarct, and grayish outer retinal lesions. Systemic findings associated with retinopathy were low platelet counts and elevated levels of serum aspartate aminotransferase, total bilirubin, arterial lactate, and serum creatinine. Even though retinopathy is common in YF, the authors said, it may be overlooked, especially if virus sever­ity precludes careful ophthalmoscopic examination.

    This cross-sectional study was per­formed at a referral center for infec­tious diseases in Southeastern Brazil. Data were collected for 94 patients suspected of having YF, all of whom had undergone ophthalmic exams. Collected data included demographics, clinical findings, lab results, and the presence or absence of retinopathy.

    Of the 94 participants, 64 were confirmed to have YF. Their mean age was 47 years (range, 38-56 years), and 12 patients (19%) were female. Twenty eyes (16%; 13 patients) had retinop­athy at the time of yellow fever. The most common fundus changes in these 20 eyes were RNFL infarcts (n = 11), superficial hemorrhage (n = 7), and grayish deep lesions (n = 6). The RNFL infarcts and superficial hemorrhages (but not the grayish lesions) resembled those of other flavivirus infections. Lab findings noted in these patients included aspartate aminotransferase >3,000 U/L (p < .001), total bilirubin >2.3 mg/dL (p < .001), serum creatinine >2.0 mg/dL (p = .003), arterial lactate >17.1 per mg/dL (p = .03), and platelet count <94 × 103/μL (p = .004). Retinopathy was most common in patients whose YF was severe. Overall, it was not associated with arterial hypertension, diabetes, international normalized ratio, or death.

    This study demonstrates the wide range of retinal changes that may occur with YF. Further research would be needed to determine whether the findings have clinical or prognostic rele­vance, said the authors, who stressed the importance of ophthalmic screen­ing in patients with YF. (Also see related commentary by Jessica G. Shantha, MD, Steven Yeh, MD, and Nisha Acharya, MD, in the same issue.)

    The original article can be found here.