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Background Twelve ocular surface disease experts convened to achieve consensus about Demodex blepharitis (DB) using a modified Delphi panel process. Methods Online surveys were administered using scaled, open-ended, true/false, and multiple-choice questions. Consensus for questions using a 1 to 9 Likert scale was predefined as median scores of 7–9 and 1–3. For other question types, consensus was achieved when 8 of 12 panellists agreed. Questions were randomized, and results of each survey informed the following survey. Results Twelve practitioners comprised the D emodex E xpert P anel on T reatment and Eyelid H ealth (DEPTH). Following 3 surveys, experts agreed that DB is chronic ( n  = 11) and recurrent ( n  = 12) and is often misdiagnosed. Consensus was achieved regarding inflammation driving symptoms (median = 7; range 7–9), collarettes as the most common sign ( n  = 10) and pathognomonic for DB (median = 9; range 8–9), and itching as the most common symptom ( n  = 12). Panellists agreed that DB may be diagnosed based on collarettes, mites, and/or patient symptoms ( n  = 10) and felt that patients unresponsive to typical therapies should be evaluated for DB ( n  = 12). Consensus about the most effective currently available OTC treatment was not reached. Conclusions The Delphi methodology proved effective in establishing consensus about DB, including signs, symptoms, and diagnosis. Consensus was not reached about the best treatment or how to grade severity. With increased awareness, eyecare practitioners can offer DB patients better clinical outcomes. A follow-up Delphi panel is planned to obtain further consensus surrounding DB treatment.

We describe an infection caused by Dirofilaria repens nematodes in California, USA. A firm nodule developed after an insect bite on a patient's eyelid. Excision with morphologic and molecular analysis confirmed D. repens infection. Our findings confirm the necessity of both molecular and histological studies to identify nematode infections.

Background/aimsTo determine demographic and clinical features of patients with Acanthamoeba keratitis (AK) that are independent risk factors both for bad outcomes and for severe inflammatory complications (SIC).MethodsA retrospective audit of medical records of AK cases at Moorfields Eye Hospital from July 2000 to April 2012, including 12 earlier surgical cases. Cases with a bad outcome were defined as those having one or more of the following: corneal perforation, keratoplasty, other surgery (except biopsy), duration of antiamoebic therapy (AAT) ≥10.5 months (the 75th percentile of the whole cohort) and final visual acuity ≤20/80. SICs were defined as having scleritis and/or a stromal ring infiltrate. Multivariable analysis was used to identify independent risk factors for both bad outcomes and SICs.ResultsRecords of 194 eyes (194 patients) were included, having bad outcomes in 93 (48%). Bad outcomes were associated with the presence of SIC, aged >34 years, corticosteroids used before giving AAT and symptom duration >37 days before AAT. The development of SIC was independently associated with aged >34 years, corticosteroids used before giving AAT and herpes simplex virus (HSV) keratitis treatment before AAT.ConclusionsThe prompt diagnosis of AK, avoidance of a misdiagnosis of HSV keratitis and corticosteroid use before the exclusion of AK as a potential cause of keratitis are essential to the provision of a good outcome for patients and for the avoidance of SIC. Older age is an unmodifiable risk factor that may reflect differences in the immune response to AK in this patient subset.

Cerebrospinal fluid (CSF) analysis is a diagnostic tool for many conditions affecting the central nervous system. Urgent indications for lumbar puncture include suspected central nervous system infection or subarachnoid hemorrhage. CSF analysis is not necessarily diagnostic but can be useful in the evaluation of other neurologic conditions, such as spontaneous intracranial hypotension, idiopathic intracranial hypertension, multiple sclerosis, Guillain-Barré syndrome, and malignancy. Bacterial meningitis has a high mortality rate and characteristic effects on CSF white blood cell counts, CSF protein levels, and the CSF:serum glucose ratio. CSF culture can identify causative organisms and antibiotic sensitivities. Viral meningitis can present similarly to bacterial meningitis but usually has a low mortality rate. Adjunctive tests such as CSF lactate measurement, latex agglutination, and polymerase chain reaction testing can help differentiate between bacterial and viral causes of meningitis. Immunocompromised patients may have meningitis caused by tuberculosis, neurosyphilis, or fungal or parasitic infections. Subarachnoid hemorrhage has a high mortality rate, and rapid diagnosis is key to improve outcomes. Computed tomography of the head is nearly 100% sensitive for subarachnoid hemorrhage in the first six hours after symptom onset, but CSF analysis may be required if there is a delay in presentation or if imaging findings are equivocal. Xanthochromia and an elevated red blood cell count are characteristic CSF findings in patients with subarachnoid hemorrhage. Leptomeningeal carcinomatosis can mimic central nervous system infection. It has a poor prognosis, and large-volume CSF cytology is diagnostic.

Background Thelaziasis is a zoonotic disease mainly caused by Thelazia callipaeda ( Spirurida , Thelaziidae , Thelazia ), which can cause mild to severe signs and lesions, such as foreign body sensation, itching, tearing, eye pain, conjunctival bleeding, conjunctivitis, corneal ulcers, and even blindness. Thelaziasis cases have been reported mainly in agricultural areas and areas with high potential for contact with domestic animals [ 1 ]. Case presentation We report a case of Thelazia callipaeda infection in the right eye of a 41-year-old woman working in an office. The patient presented with persistent foreign body sensation, pruritus, and redness despite initial treatment with polyethylene glycol and levofloxacin eye drops. Subsequent examination revealed the presence of multiple Thelazia callipaeda worms, which were successfully removed. Postoperative treatment with gatifloxacin eye ointment resulted in significant symptom relief with no recurrence over two months. Conclusions This case highlights the thelaziasis in urban settings, emphasizing the need for ophthalmologists to consider parasitic infections in differential diagnosis even in well-maintained environments. Then, we provided an overview of human thelaziasis in China by mining publicly available databases from 2014 to 2023, suggesting a difference in regional distribution that warrants further epidemiological studies.

It is established that chronic spirochetal infection can cause slowly progressive dementia, brain atrophy and amyloid deposition in late neurosyphilis. Recently it has been suggested that various types of spirochetes, in an analogous way to Treponema pallidum, could cause dementia and may be involved in the pathogenesis of Alzheimer's disease (AD). Here, we review all data available in the literature on the detection of spirochetes in AD and critically analyze the association and causal relationship between spirochetes and AD following established criteria of Koch and Hill. The results show a statistically significant association between spirochetes and AD (P = 1.5 × 10 -17 , OR = 20, 95% CI = 8-60, N = 247). When neutral techniques recognizing all types of spirochetes were used, or the highly prevalent periodontal pathogen Treponemas were analyzed, spirochetes were observed in the brain in more than 90% of AD cases. Borrelia burgdorferi was detected in the brain in 25.3% of AD cases analyzed and was 13 times more frequent in AD compared to controls. Periodontal pathogen Treponemas ( T. pectinovorum, T. amylovorum, T. lecithinolyticum, T. maltophilum, T. medium, T. socranskii ) and Borrelia burgdorferi were detected using species specific PCR and antibodies. Importantly, co-infection with several spirochetes occurs in AD. The pathological and biological hallmarks of AD were reproduced in vitro by exposure of mammalian cells to spirochetes. The analysis of reviewed data following Koch's and Hill's postulates shows a probable causal relationship between neurospirochetosis and AD. Persisting inflammation and amyloid deposition initiated and sustained by chronic spirochetal infection form together with the various hypotheses suggested to play a role in the pathogenesis of AD a comprehensive entity. As suggested by Hill, once the probability of a causal relationship is established prompt action is needed. Support and attention should be given to this field of AD research. Spirochetal infection occurs years or decades before the manifestation of dementia. As adequate antibiotic and anti-inflammatory therapies are available, as in syphilis, one might prevent and eradicate dementia.

A 68-year-old male presented with a three-month history of a painless, non-resolving mass in the left upper eyelid, unresponsive to a prior course of anti-inflammatory treatment. Orbital computed tomography (CT) revealed a well-defined, nodular soft-tissue density lesion in the lateral aspect of the orbit, adjacent to the orbital lobe of the lacrimal gland. The mass was successfully excised under local nerve block anesthesia. Histopathological examination confirmed the diagnosis of cysticercosis. Postoperative recovery was uneventful, with complete resolution of the eyelid deformity observed at the one-month follow-up. Clinical trial number Not applicable.

Jia-Fu Jiang, Rui-Ruo Jiang, Qiao-Cheng Chang Affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China Yuan-Chun Zheng Affiliation: Mudanjiang Forestry Central Hospital, Mudanjiang, P. R. China Bao-Gui Jiang Affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China Yi Sun Affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China Na Jia Affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China Ran Wei Affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China Hong-Bo Liu Affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China Qiu-Bo Huo Affiliation: Mudanjiang Forestry Central Hospital, Mudanjiang, P. R. China Hong Wang Affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China Michael E. von Fricken Affiliations Division of Infectious Disease, Duke University Medical Center, Durham, North Carolina, United States of America, Department of Global and Community Health, George Mason University, Fairfax, Virginia, United States of America ORCID logo http://orcid.org/0000-0003-2938-4549 Wu-Chun Cao * E-mail: caowc@bmi.ac.cn Affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China Citation: Jiang J-F, Jiang R-R, Chang Q-C, Zheng Y-C, Jiang B-G, Sun Y, et al. Eleven days after tick removal, she sought help at a local clinic due to fever (39.0 °C) and headache, where she received supportive treatment with compound paracetamol tablets for two days with no clinical improvement and persistent high fever up to 42.0 °C. Upon admission, a routine exam showed a body temperature of 39.5 °C, a blood pressure of 125/70 mm Hg, a pulse rate of 60 beats/min, and a respiration of 18 breaths/min. A routine blood test showed that white blood cell (WBC) (7.6 × 109/L) and red blood cell (RBC) (4.6 × 1012/L) levels were both in normal range, while the neutrophil—granulocyte proportion was substantially elevated (91.6%), along with 64.136 mg/L of C-reactive proteins (CRPs), indicating an inflammatory response. Despite the unavailability of the biting tick in this study, based on the available data, we may deduce that the parasite potentially is transmitted through tick bite, which will require additional research to confirm. [...]more efforts must be devoted to investigating the transmission and pathogenicity of Colpodella spp. in China and abroad.

PurposeOphthalmic safety observations are reported from a clinical trial comparing tafenoquine (TQ) efficacy and safety versus sequential chloroquine (CQ)/primaquine (PQ) for acute Plasmodium vivax malaria.MethodsIn an active-control, double-blind study, 70 adult subjects with microscopically confirmed P. vivax malaria were randomized (2:1) to receive 400 mg TQ × 3 days or 1500 mg CQ × 3 days then 15 mg PQ × 14 days. Main outcome measures: clinically relevant changes at Day 28 and Day 90 versus baseline in the ocular examination, color vision evaluation, and corneal and retinal digital photography.ResultsPost-baseline keratopathy occurred in 14/44 (31.8%) patients with TQ and 0/24 with CQ/PQ (P = 0.002). Mild post-baseline retinal findings were reported in 10/44 (22.7%) patients receiving TQ and 2/24 (8.3%) receiving CQ/PQ (P = 0.15; treatment difference 14.4%, 95% CI − 5.7, 30.8). Masked evaluation of retinal photographs identified a retinal hemorrhage in one TQ patient (Day 90) and a slight increase in atrophy from baseline in one TQ and one CQ/PQ patient. Visual field sensitivity (Humphrey™ 10-2 test) was decreased in 7/44 (15.9%) patients receiving TQ and 3/24 (12.5%) receiving CQ/PQ; all cases were < 5 dB. There were no clinically relevant changes in visual acuity or macular function tests.ConclusionsThere was no evidence of clinically relevant ocular toxicity with either treatment. Mild keratopathy was observed with TQ, without conclusive evidence of early retinal changes. Eye safety monitoring continues in therapeutic studies of low-dose tafenoquine (300 mg single dose).Clinical trial registrationClinicaltrials.gov identifier: NCT01290601.