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.
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