Syphilitic retinitis presentations: punctate inner retinitis and posterior placoid chorioretinitis
Eva DeVienceSidney A. SchechetMarcia CarneyMona KaleemStephen J. DeVienceLuke ChangMichael GerboDavid M. Hinkle
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Chorioretinitis
Fundus (uterus)
A new noninvasive technique for observing structures in the living eye has been developed: the technique is based on intravenous application of specific antibodies, labeled with fluorescein. The immunologically marked substructures of the fundus of the eye, the only transparent organ in mammals, are photographed directly using high speed film. Combined with a digital image processor to enhance low contrast contours, this technique can be used for diagnostic purposes, as shown in rabbits with experimental toxoplasmic chorioretinitis.
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Retinitis and chorioretinitis (uveitis) are usually due to an infection. By far their most frequent cause is a late recurrence of congenital toxoplasmosis, a disease which can be diagnosed clinically and which, in the absence of therapeutic errors, generally follows a favourable course. Among other types of uveitis, cytomegalovirus retinitis is fairly frequent in immunocompromised subjects.
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Purpose: To raise awareness regarding presentation of toxoplasmic chorioretinitis late in life, and to discuss the invasive diagnostic options.Patients/Methods: Case report.Results: A 62-year-old patient presenting with posterior vitritis and a focus of retinitis was misdiagnosed and treated with antivirals and corticosteroids. Relapse after initial stabilization justified a vitreous tap for culture and DNA detection of a number of infectious agents, leading to the correct diagnosis of T.gondii infection.Conclusions: Ocular sampling may be necessary to secure timely diagnosis and treatment of atypical retinitis. Acquired ocular toxoplasmosis may be under-recognized as a cause of infectious posterior uveitis and caution should be applied when administering steroids without a definite diagnosis.
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Toxoplasma gondii-Associated Bilateral Panuveitis and Encephalitis after Bone Marrow Transplantation
Toxoplasmosis is one of the most common causes of infectious retinitis in both immunocompetent and immunocompromised individuals [1]. Toxoplasmic chorioretinitis in immunocompetent patients can be diagnosed clinically due to its typical presentation as a monocular, focal, necrotizing chorioretinitis lesion, sometimes adjacent to an older pigmented chorioretinal scar. However, in immunocompromised patients the clinical appearances of ocular toxoplasma infection can vary widely and thus be diagnostically challenging [2].
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We tried to evaluate prevalence and characteristics of Iranian HIV infected patients with retinitis due to opportunistic infections. In this cross sectional study, we evaluated 106 HIV infected patients via indirect ophthalmoscopy and slit lamp examination by 90 lens to find retinitis cases. General information and results of ophthalmologic examination were analyzed. Prevalence of retinitis due to opportunistic infections was 6.6%: cytomegalovirus (CMV) retinitis 1.88%, toxoplasmosis retinochoroiditis 1.88% and tuberculosis chorioretinitis 2.83%. CD4 count was higher than 50 cell/µlit in both cases with CMV retinitis. Along with increasing survival in the HIV infected patients, the prevalence of complications such as ocular manifestation due to opportunistic infections are increasing and must be more considered.
Chorioretinitis
Cytomegalovirus retinitis
Toxoplasmosis
AIDS-Related Opportunistic Infections
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Toxoplasmosis chorioretinitis is commonly diagnosed by an ophthalmologist through the evaluation of the fundus images of a patient. Early detection of these lesions may help to prevent blindness. In this article we present a data set of fundus images labeled into three categories: healthy eye, inactive and active chorioretinitis. The dataset was developed by three ophthalmologists with expertise in toxoplasmosis detection using fundus images. The dataset will be of great use to researchers working on ophthalmic image analysis using artificial intelligence techniques for the automatic detection of toxoplasmosis chorioretinitis.
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Purpose: To evaluate the accuracy of clinical examinations and serial fundus photographic readings in determining the response of cytomegalovirus retinitis to antiviral therapy in patients with acquired immune deficiency syndrome. Methods: Fifty two consecutive patients with cytomegalovirus retinitis who were prospectively evaluated over a 30-month period for a minimum of 6 months (or until death) were included in this study. There was a total of 708 patient visits. The clinical evaluations included indirect ophthalmoscopy, fundus drawings, 60° fundus photographs, and a comparison of the photographs with those of the previous visit. The fundus photographs were reevaluated in a blinded fashion. Cytomegalovirus retinitis was classified as active (progression of border since last examination), intermediate (border activity without progression), healed (no activity since last visit), or normal (no retinitis). Results: Using the photographic data as the measure of cytomegalovirus retinitis activity, the sensitivity and specificity of clinical assessments were determined. The sensitivity and specificity of clinical versus photographic evaluations varied with retinitis status. In healed retinitis the sensitivity of the clinical examination was 98%, and the specificity was 83%. In cases of border opacification without progression the sensitivity was 80%, and the specificity was 96%. In cases of clinically active retinitis the sensitivity was 63% with a specificity of 100%. Clinical detection of active retinitis and border opacification without progression was reduced when potential problems were present that made visualization of the retinitis border difficult, such as smoldering retinitis, progressive retinal destruction without border opacification, poor media, or fundus pigmentation. Conclusions: Progressive retinal destruction and visual loss can occur in patients with cytomegalovirus retinitis despite antiviral therapy. Examining the patient through indirect ophthalmoscopy only can result in failure to detect subtle changes.
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To review a case of toxoplasmosis chorioretinitis mimicking cytomegalovirus retinitis in an immunocompromised patient following bone marrow transplantation.Retrospective chart review of a 14-year-old female who had a history of leukemia and allogeneic bone marrow transplants prior to her ocular symptoms.Anterior chamber fluid analysis was positive for Toxoplasma gondii. The patient responded well when cytomegalovirus retinitis treatment was switched to intravitreal clindamycin with systemic sulfadiazine and prednisone.This case demonstrates the challenges of diagnosing and treating retinal infections in immunocompromised patients as they may present with atypical findings that mimic other pathologies and may have contraindications against standard treatment.
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Opportunistic infection
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In Brief Purpose: The purpose was to study the congenital cytomegalovirus (CMV), which is the most common cause for congenital infection in the United States, affecting nearly 40,000 infants per year. There is no widely accepted treatment protocol for congenital CMV infection despite recent clinical trials with antiviral medications ganciclovir and valganciclovir. Methods: We present a case report of an infant with severe congenital CMV infection with presentation of chorioretinitis in both eyes at 5 months of age. Results: The child did not receive treatment with ganciclovir during hospitalization after birth despite severe manifestations of CMV infection. Treatment was again withheld after diagnosis of retinitis because of immunocompetent status, potential side effects of ganciclovir treatment, and location of retinitis in the retinal periphery of both eyes. The retinitis resolved during a period of 3 months. Conclusion: This case shows that CMV retinitis in infants with congenital CMV infection can be delayed in presentation and can resolve without treatment. It shows the need for more consistent monitoring for chorioretinitis in infants with congenital CMV infection. A case report is presented of delayed presentation of cytomegalovirus chorioretinitis in a child with severe congenital cytomegalovirus infection.
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