Clinical aspects of ocular leptospirosis in New Caledonia (South Pacific)

Purpose: The incidence of leptospirosis is very high in New Caledonia (aver age annual incidence rate: 180/100 000 of the population). To investigate t he role of pathogenic leptospires as an aetiological agent of ocular diseas es, we report the results of a 5-year survey in New Caledonia. Methods: We reviewed 13 patients (corresponding to 17 investigated patholog ic eyes) retrospectively. The selection of patients was based on epidemiolo gical data, initial clinical examination, biological confirmation of leptos pirosis according to reference procedures and a specific polymerase chain r eaction assay. The anatomic criteria of uveitis and the criteria describing the evolution of the disease were those recommended by the international U veitis Study Group. Results: Consequent rates of optic neuritis (65%), posterior uveitis (35%), secluded pupil (24%), interstitial keratitis (18%) and pars planitis (12%) were found. Our rates of recurrence (46%) and of ophthalmic complications (82%) were substantial: some symptoms indicated brain involvement. The fina l visual damage was severe in 35% of eyes. Conclusions: Microagglutination and polymerase chain reaction hybridization are complementary tests for the diagnosis of Leptospira-induced ophthalmic lesions. Before deciding on treatment, one must consider the ability of vi rulent leptospires to persist in immunologically privileged sites such as a queous humor; cerebrospinal fluid and eukaryotic cells. Polymerase chain re action is a useful tool for the diagnosis of Leptospira-induced ocular comp lications, which are probably misdiagnosed ii based only on routine laborat ory tests. It enables early diagnosis and early specific treatment that now consists of quinolone and cyclines.