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Clinical & Experimental Optometry Sep 2021Syphilis is a sexually transmitted, systemic, inflammatory disease caused by the spirochaete, . The natural history of untreated syphilis progresses through four...
Syphilis is a sexually transmitted, systemic, inflammatory disease caused by the spirochaete, . The natural history of untreated syphilis progresses through four distinct stages: primary, secondary, latent, and tertiary syphilis. Ocular involvement can occur at any stage of syphilis and any part of the eye can be affected. With the exception of syphilitic posterior placoid chorioretinitis, the diverse manifestations of ocular syphilis have few distinct features that can be used to assist in clinical diagnosis. Therefore, ocular syphilis should always be a part of the differential diagnosis of most, if not all, ocular infectious and inflammatory presentations. Specifically, uveitis presentations, high-risk sexual history, illicit drug use history, treatment failure, prior history of syphilis should prompt further diagnostic workup for ocular syphilis. A presumptive diagnosis of ocular syphilis relies on serological testing, both treponemal and nontreponemal tests. All patients with ocular syphilis should have their cerebrospinal fluids tested for the co-existence of neurosyphilis and their blood tested for human immunodeficiency virus co-infection. In the United States, Centers for Disease Control and Prevention recommend that ocular syphilis be managed according to its treatment guidelines for neurosyphilis, with parenteral aqueous crystalline penicillin G the drug of choice. With the timely diagnosis and appropriate treatment, ocular syphilis is curable. However, delayed diagnosis of ocular syphilis may result in long-term visual impairment. Delayed diagnosis occurs because of its diverse presentations mimicking other ocular diseases, and failure of the clinician to order serological testing. With the recent worldwide resurgence of ocular syphilis, clinicians should be familiar with the manifestation, diagnosis, and treatment of ocular syphilis.
Topics: Chorioretinitis; Endophthalmitis; Eye Infections, Bacterial; Humans; Syphilis
PubMed: 33831337
DOI: 10.1080/08164622.2021.1906848 -
International Ophthalmology Jan 2022This review aims to summarize the current knowledge concerning the clinical features, diagnostic work-up and therapeutic approach of ocular toxoplasmosis focusing mainly... (Review)
Review
PURPOSE
This review aims to summarize the current knowledge concerning the clinical features, diagnostic work-up and therapeutic approach of ocular toxoplasmosis focusing mainly on the postnatally acquired form of the disease.
METHODS
A meticulous literature search was performed in the PubMed database. A supplementary search was made in Google Scholar to complete the collected items.
RESULTS
Ocular toxoplasmosis is one of the most frequent infectious etiologies of posterior uveitis. It typically presents with retinochoroiditis. Setting an accurate diagnosis depends to a considerable degree on detecting characteristic clinical characteristics. In addition to the evaluation of clinical features, the diagnosis of toxoplasmosis relies at a large degree on serologic testing. The detection of the parasite DNA in the aqueous or vitreous humor can provide evidence for a definitive diagnosis. The current mainstay for the treatment, if necessary, is the use of oral antibiotic with systemic corticosteroids. Recent evidence suggests other therapeutic approaches, such as intravitreal antibiotics can be used.
CONCLUSION
Recent developments in the diagnostic and therapeutic approach have contributed to preventing or limiting vision loss of patients suffering from ocular toxoplasmosis. Further studies are required to provide a better understanding of epidemiology, pathogenesis, diagnosis, and treatment with a significant impact on the management of this challenging clinical entity.
Topics: Chorioretinitis; Eye; Humans; Toxoplasma; Toxoplasmosis, Ocular; Uveitis, Posterior
PubMed: 34370174
DOI: 10.1007/s10792-021-01994-9 -
Journal of Investigative Medicine High... 2019Coccidioidomycosis is an invasive fungus found primarily in the soil of Southwestern United States, Mexico, and Central America. Primary disease mostly presents as a...
Coccidioidomycosis is an invasive fungus found primarily in the soil of Southwestern United States, Mexico, and Central America. Primary disease mostly presents as a pulmonary disease although multiple organ systems can be affected through lymphohematogenous dissemination, with ocular seeding extremely rare. When present, the anterior segment structures are most commonly affected. Isolated choroid and/or vitreal disease has been reported infrequently. This is a case of chorioretinitis with vitreal involvement.
Topics: Adult; Chorioretinitis; Coccidioides; Coccidioidomycosis; Eye Infections, Fungal; Humans; Male; Tomography, Optical Coherence; Tomography, X-Ray Computed; Vitreous Body
PubMed: 31597500
DOI: 10.1177/2324709619881561 -
American Journal of Ophthalmology Case... Mar 2022To present a case of subretinal abscess associated with pneumonia and meningitis caused by in an immunocompetent host.
PURPOSE
To present a case of subretinal abscess associated with pneumonia and meningitis caused by in an immunocompetent host.
OBSERVATIONS
A 37-year-old man presented with sub-acute painless unilateral vision loss and a white submacular elevation. Systemic evaluation revealed a lung lesion and cerebrospinal fluid evidence of infection.
CONCLUSIONS AND IMPORTANCE
While has been well described as a cause of chorioretinitis in immunocompetent and immunocompromised hosts, this report demonstrates that is a related uncommon pathogen to be considered in similar presentations. Submacular surgical debridement may be challenging and OCT imaging may be helpful to detect full-thickness retinal necrosis.
PubMed: 35112022
DOI: 10.1016/j.ajoc.2022.101283 -
American Journal of Ophthalmology Aug 2021To determine classification criteria for birdshot chorioretinitis.
PURPOSE
To determine classification criteria for birdshot chorioretinitis.
DESIGN
Machine learning of cases with birdshot chorioretinitis and 8 other posterior uveitides.
METHODS
Cases of posterior uveitides were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on diagnosis, using formal consensus techniques. Cases were split into a training set and a validation set. Machine learning using multinomial logistic regression was used on the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the infectious posterior uveitides / panuveitides. The resulting criteria were evaluated on the validation set.
RESULTS
One thousand sixty-eight cases of posterior uveitides, including 207 cases of birdshot chorioretinitis, were evaluated by machine learning. Key criteria for birdshot chorioretinitis included a multifocal choroiditis with (1) the characteristic appearance of a bilateral multifocal choroiditis with cream-colored or yellow-orange, oval or round choroidal spots ("birdshot" spots); (2) absent to mild anterior chamber inflammation; and (3) absent to moderate vitreous inflammation; or multifocal choroiditis with positive HLA-A29 testing and either classic "birdshot spots" or characteristic imaging on indocyanine green angiography. Overall accuracy for posterior uveitides was 93.9% in the training set and 98.0% (95% confidence interval 94.3, 99.3) in the validation set. The misclassification rates for birdshot chorioretinitis were 10% in the training set and 0% in the validation set.
CONCLUSIONS
The criteria for birdshot chorioretinitis had a low misclassification rate and seemed to perform sufficiently well for use in clinical and translational research.
Topics: Birdshot Chorioretinopathy; Choroid; Consensus; Female; Fluorescein Angiography; Fundus Oculi; Humans; Machine Learning; Male; Middle Aged; Retina
PubMed: 33845003
DOI: 10.1016/j.ajo.2021.03.059 -
American Journal of Ophthalmology Case... Mar 2022Acanthamoeba chorioretinitis is a rare manifestation of the parasitic infection, and reported cases often result in enucleation. Surgical removal of Acanthamoeba...
PURPOSE
Acanthamoeba chorioretinitis is a rare manifestation of the parasitic infection, and reported cases often result in enucleation. Surgical removal of Acanthamoeba chorioretinitis has not been previously described. We report a surgical case of Acanthamoeba chorioretinitis spread from keratitis that ultimately resulted in a disease-free outcome.
OBSERVATIONS
A healthy 80-year-old male with a history of keratoconus requiring a penetrating keratoplasty in the fellow eye presented with a severe corneal ulcer clinically consistent with Acanthamoeba keratitis. He ultimately required a penetrating keratoplasty and improved clinically until he developed vitritis on post-operative month 1 and was diagnosed with endophthalmitis. B-scan ultrasound demonstrated vitreous opacities and a large retinal mass that reduced in size following serial intravitreal injections of antibiotics, oral antibiotics, and a limited pars plana vitrectomy. He underwent a repeat pars plana vitrectomy 6 weeks later and a retinal mass in the mid-periphery with an associated tractional retinal detachment was noted. A localized retinectomy was performed around the lesion which was excised entirely, and silicone oil was instilled. Pathology of the lesion showed acute and chronic granulomatous necrotizing inflammation with the presence of several definitive amoebic organisms and numerous cells suspicious for amoebae. The patient was maintained on oral antibiotics by the Infectious Disease Service and was disease-free 1-year post-infection.
CONCLUSIONS AND IMPORTANCE
Acanthamoeba chorioretinitis is a rare, devastating disease and often leads to enucleation. We present a surgical case showing control of the infection utilizing a surgical retinectomy. Aggressive local therapy and a multidisciplinary approach with the Infectious Disease Service may lead to a successful outcome.
PubMed: 35243145
DOI: 10.1016/j.ajoc.2022.101388 -
Vaccines Nov 2020Ocular manifestations are a feature of West Nile virus infection. They mostly occur in association with severe neuroinvasive disease. Linear chorioretinitis is... (Review)
Review
Ocular manifestations are a feature of West Nile virus infection. They mostly occur in association with severe neuroinvasive disease. Linear chorioretinitis is suggestive of the diagnosis and may raise diagnostic suspicion when associated with evocative systemic signs, and in an epidemic context. Various other less specific inflammatory ocular manifestations have been reported, including anterior uveitis, occlusive retinal vasculitis, optic neuritis, and diplopia. The pathophysiology of ocular disease remains unclear, but it reflects the neuroinvasiveness of the disease. Although ocular involvement most often resolves without visual sequelae, some patients may have permanent loss of vision, adding to the need for the development of a specific treatment and/or vaccines.
PubMed: 33147758
DOI: 10.3390/vaccines8040641 -
The British Journal of Ophthalmology Nov 1990Chickenpox infection in an adult was complicated by peripheral chorioretinitis and treated with oral acyclovir. Similarities of this case to the recently proposed mild...
Chickenpox infection in an adult was complicated by peripheral chorioretinitis and treated with oral acyclovir. Similarities of this case to the recently proposed mild type of acute retinal necrosis syndrome are discussed.
Topics: Acyclovir; Administration, Oral; Adult; Chickenpox; Chorioretinitis; Female; Humans
PubMed: 2223711
DOI: 10.1136/bjo.74.11.698