Etiology of Uveitis: Infection or Autoimmunity?
DOI: 10.32364/2311-7729-2026-26-2-1
Etiology of Uveitis: Infection or Autoimmunity?
E.A. Kleshcheva1,2, G.M. Chernakova1, N.V. Mel'nikova1,3, E.V. Shirshova1
1Botkin Hospital, Moscow, Russian Federation
2Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department, Moscow, Russian Federation
3Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
Aim: to evaluate the concomitant infectious profile in patients with autoimmune uveitis.
Patients and Methods: the study included 127 patients diagnosed with uveitis who were followed at the Moscow City Ophthalmological Center between 2021 and 2025. In addition to standard ophthalmic examination, all patients underwent laboratory testing including HLA-B27 genotyping, serum C-reactive protein and antistreptolysin O assessment, PCR analysis of biological fluids for DNA of seven herpesvirus types, microbiological examination of nasopharyngeal swabs, measurement of serum eosinophil cationic protein levels, as well as screening for syphilis, HIV infection, and viral hepatitis.
Results: anterior uveitis was identified in 93.7% of patients, with autoimmune inflammation accounting for 60.5% of cases. Among systemic rheumatic diseases, ankylosing spondylitis predominated (79.2%). Most patients with HLA-B27-associated uveitis had evidence of concomitant infection, including helminth infections in 76.4% of cases, streptococcal colonization (≥108 CFU/mL) in 84.8%, and herpesvirus infections in more than 30% of cases. Mixed infections were detected in 69.4% of patients, most commonly the combination of helminth and bacterial infection (48.6%). In two patients with HLA-A29-associated uveitis (birdshot chorioretinitis), no infectious background was identified; however, disease onset was temporally associated with prior coronavirus infection.
Conclusion: active concomitant infection, either isolated or mixed, was identified in the vast majority of patients with autoimmune uveitis. Infectious agents may act as triggers of autoimmune inflammation or contribute to a more severe disease course. The addition of anti-infective therapy to the comprehensive management of uveitis, alongside anti-inflammatory treatment, may contribute to long-term disease remission.
Keywords: uveitis, anterior uveitis, autoimmune uveitis, non-infectious uveitis, HLA-B27, HLA-A29, infectious uveitis, herpesviruses.
For citation: Kleshcheva E.A., Chernakova G.M., Mel'nikova N.V., Shirshova E.V. Etiology of Uveitis: Infection or Autoimmunity? Russian Journal of Clinical Ophthalmology. 2026;26(2):81–88 (in Russ.). DOI: 10.32364/2311-7729-2026-26-2-1
About the authors:
Elena A. Kleshcheva — C. Sc. (Med.), Assistant Professor, Ophthalmologist of the Moscow City Ophthalmological Center, Botkin Hospital; 5, 2nd Botkinskiy pass., Moscow, 125284, Russian Federation; Chief Specialist of the Organizational and Methodological Department for Ophthalmology, Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department; 9, Sharikopodshipnikovskaya str., Moscow, 115088, Russian Federation; ORCID iD 0000-0002-1392-3432
Galina M. Chernakova — C. Sc. (Med.), Assistant Professor, Head of the Consultative and Polyclinic Department No. 2
of Moscow City Ophthalmological Center, Botkin Hospital; 5, 2nd Botkinskiy pass., Moscow, 125284, Russian Federation; ORCID iD 0000-0002-9630-6076
Galina M. Chernakova — C. Sc. (Med.), Assistant Professor, Head of Polyclinic Department No. 2, Moscow City Ophthalmological Center, Botkin Hospital; 5, 2nd Botkinskiy pass., Moscow, 125284, Russian Federation; ORCID iD 0000-0002-9630
Natalia V. Mel'nikova — C. Sc. (Med.), Ophthalmologist of the Moscow City Ophthalmological Center, Botkin Hospital; 5, 2nd Botkinskiy pass., Moscow, 125284, Russian Federation; Assistant Professor, Assistant Professor of the Department of Ophthalmology, Russian Medical Academy of Continuous Professional Education; 2/1, Barrikadnaya str., Moscow, 125993, Russian Federation; ORCID iD 0000-0003-3917-0691
Elena V. Shirshova — Head of Ophthalmological Department No. 64 of the Moscow City Ophthalmological Center, Botkin Hospital; 5, 2nd Botkinskiy pass., Moscow, 125284, Russian Federation; ORCID iD 0009-0006- 0189-8600
Contact information: Elena A. Kleshcheva, e-mail: klelen@mail.ru
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 27.03.2026.
Revised 17.04.2026.
Accepted 30.04.2026.
2. Панова И.Е., Дроздова Е.А. Увеиты: руководство для врачей. М.: Медицинское информационное агентство; 2014.Panova I.E., Drozdova E.A. Uveitis: a guide for physicians. Moscow: Medical Information Agency; 2014 (in Russ.).
3. Чеснокова Н.Б., Катаргина Л.А., Павленко Т.А., Безнос О.В. Биомаркеры в слезной жидкости при увеите. Вестник офтальмологии. 2025;141(4):88–95. DOI: 10.17116/oftalma202514104188Chesnokova N.B., Katargina L.A., Pavlenko T.A., Beznos O.V. Biomarkers in tear fluid in uveitis. Russian Annals of Ophthalmology. 2025;141(4):88–95 (in Russ.). DOI: 10.17116/oftalma202514104188
4. Hou S., Kijlstra A., Yang P. Molecular Genetic Advances in Uveitis. Prog Mol Biol Transl Sci. 2015;134:283–298. DOI: 10.1016/bs.pmbts.2015.04.009
5. Zlatanović G., Veselinović D., Cekić S. et al. Ocular manifestation of rheumatoid arthritis-different forms and frequency. Bosn J Basic Med Sci. 2010;10(4):323–327. DOI: 10.17305/bjbms.2010.2680
6. Huerva V., Sánchez M.C., Canto L.M. Post-streptococcal syndrome uveitis. Acta Ophthalmol Scand. 2007;85(2):223–224. DOI: 10.1111/j.1600-0420.2006.00796.x
7. Gear A.J., Venables P.J., Edwards J.M. et al. Rheumatoid arthritis, juvenile arthritis, iridocyclitis and the Epstein-Barr virus. Ann Rheum Dis. 1986;45(1):6–8. DOI: 10.1136/ard.45.1.6
8. Gugliesi F., Pasquero S., Griffante G. et al. Human Cytomegalovirus and Autoimmune Diseases: Where Are We? Viruses. 2021;13(2):260. DOI: 10.3390/v13020260
9. Houen G., Trier N.H. Epstein-Barr Virus and Systemic Autoimmune Diseases. Front Immunol. 2021;11:587380. DOI: 10.3389/fimmu.2020.587380
10. Каспаров А.А. Офтальмогерпес. М.: Медицина; 1994.Kasparov A.A. Oftal'mogerpes. Moscow: Meditsina; 1994 (in Russ.).
11. Cunningham Е.Т. Jr, Pichi F., Mahajan V.B., Rosenbaum J.T. Genetics of Uveitis. Ocular Immunology and Inflammation. 2012;29(2):215–218. DOI: 10.1080/09273948.2021.1910430
12. Standardization of Uveitis Nomenclature (SUN) Working Group. Classification Criteria for Spondyloarthritis/HLA-B27-Associated Anterior Uveitis. Am J Ophthalmol. 2021;228:117–125. DOI: 10.1016/j.ajo.2021.03.049
13. Годзенко А.А., Шеремет Н.Л., Насонов Е.Л. Увеит при спондилоартрите: современные возможности противовоспалительной терапии. Научно-практическая ревматология. 2025;63(2):146–157. DOI: 10.47360/1995-4484-2025-146-157Godzenko A.A., Sheremet N.L., Nasonov E.L. Uveitis in spondyloarthritis: current possibilities of anti-inflammatory therapy. Rheumatology Science and Practice. 2025;63(2):146–157 (in Russ.). DOI: 10.47360/1995-4484-2025-146-157
14. Wakefield D., Clarke D., McCluskey P. Recent Developments in HLA B27 Anterior Uveitis. Front Immunol. 2021;11:608134. DOI: 10.3389/fimmu.2020.608134
15. Ten Berge J.C., Schreurs M.W.J., van Daele P.L.A., Rothova A. Autoimmunity in uveitis. Acta Ophthalmol. 2018;96(5):481–485. DOI: 10.1111/aos.13652
16. Silva C.L.M. Purinergic signaling in schistosomal infection. Biomed J. 2016;39(5):316–325. DOI: 10.1016/j.bj.2016.06.006
17. Di Virgilio F., Giuliani A.L. Purinergic signalling in autoimmunity: A role for the P2X7R in systemic lupus erythematosus? Biomed J. 2016;39(5):326–338. DOI: 10.1016/j.bj.2016.08.006
18. McSorley H.J., Gaze S., Daveson J. et al. Suppression of inflammatory immune responses in celiac disease by experimental hookworm infection. PLoS One. 2011;6(9):e24092. DOI: 10.1371/journal.pone.0024092
19. Chen Z., Andreev D., Oeser K. et al. Th2 and eosinophil responses suppress inflammatory arthritis. Nat Commun. 2016;7:11596. DOI: 10.1038/ncomms11596
20. Ohashi A., Murayama M.A., Miyabe Y. et al. Streptococcal infection and autoimmune diseases. Front Immunol. 2024;15:1361123. DOI: 10.3389/fimmu.2024.1361123
21. Daruich A., Matet A., Moulin A. et al. Mechanisms of macular edema: Beyond the surface. Prog Retin Eye Res. 2018;63:20–68. DOI: 10.1016/j.preteyeres.2017.10.006
22. Vastert S.J., Bhat P., Goldstein D.A. Pathophysiology of JIA-associated uveitis. Ocul Immunol Inflamm. 2014;22(5):414–423. DOI: 10.3109/09273948.2014.926937
23. Медицинская вирусология: Руководство. Под ред. Д.К. Львова. М.: Медицинское информационное агентство; 2013.Medical Virology: A Guide. Lvov D.K., ed. Moscow: Medical Information Agency; 2013 (in Russ.).
24. Wildner G., Bansal R., Ayyadurai N. et al. Pathogenesis of Bacterial Uveitis. Ocul Immunol Inflamm. 2023;31(7):1396–1404. DOI: 10.1080/09273948.2022.2155842
25. Herbort C.P. Jr, Pavésio C., LeHoang P. et al. Why birdshot retinochoroiditis should rather be called ‘HLA-A29 uveitis'? Br J Ophthalmol. 2017;101(7):851–855. DOI: 10.1136/bjophthalmol-2016-309764
26. Трошина Е.А., Юкина М.Ю., Нуралиева Н.Ф., Мокрышева Н.Г. Роль генов системы HLA: от аутоиммунных заболеваний до COVID-19. Проблемы эндокринологии. 2020;66(4):9–15. DOI: 10.14341/probl12470Troshina E.A., Yukina M.Yu., Nuralieva N.F., Mokrysheva N.G. The role of HLA genes: from autoimmune diseases to COVID-19. Problems of Endocrinology. 2020;66(4):9–15 (in Russ.). DOI: 10.14341/probl12470
27. Hösel K., Chasan B., Tode J. et al.Effect of intravitreal injection of anti-interleukin (IL)-6 antibody in experimental autoimmune uveitis in mice. J Ophthalmic Inflamm Infect. 2024;14(1):57. DOI: 10.1186/s12348-024-00441-x
28. Samudre S.S., Lattanzio F.A. Jr, Williams P.B., Sheppard J.D.Jr. Comparison of topical steroids for acute anterior uveitis. J Ocul Pharmacol Ther. 2004;20(6):533–547. DOI: 10.1089/jop.2004.20.533
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