Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Chorioretinitis Clinical Presentation

  • Author: Ayesha Mirza, MD; Chief Editor: Russell W Steele, MD  more...
 
Updated: Oct 04, 2015
 

History

See the list below:

  • In most individuals with chorioretinitis (CR), the history may or may not aid in establishing causal agents. For example, in patients with chorioretinitis associated with congenital infections, eliciting the maternal history of primary viral or flulike illnesses during pregnancy is usually not easy. Dietary habits (preference of raw meat) and pet care (cleaning cat litter box) may imply toxoplasmosis or contact with kittens (catscratch disease). Lack of immunizations in a pregnant woman may also provide some clues to the diagnosis (eg, rubella). On the other hand, a pregnant woman with symptomatic West Nile viral meningoencephalitis may be readily diagnosed using historical, epidemiologic, and laboratory data.
  • Many maternal primary infections due to cytomegalovirus (CMV), rubella, herpes simplex virus (HSV), and syphilis occur insidiously and may not be clinically apparent. A  retrospective study reported that the clinical manifestations of syphilitic chorioretinitis include impaired vision, shadow blocking, or photopsia of one or both eyes.[15]
  • A recent history that includes strabismus, vision loss, and CNS involvement in a toddler exposed to raccoon waste or who has a newly acquired puppy suggests zoonotic roundworm larval infestation (Baylisascaris or Toxocara). These children have an increased risk of developing visceral larva migrans and ocular larva migrans.
  • Parinaud oculoglandular syndrome (fever, follicular conjunctivitis, ipsilateral preauricular lymphadenitis), neuroretinitis, and focal retinochoroiditis in children or young adults exposed to kittens may suggest infection due to Bartonella henselae (catscratch disease), especially if they were scratched.
Next

Physical

If the inflammation is unilateral, the child may squint, favor the "good eye," or report blurred vision or an inability to see objects. Older children with chorioretinitis may present with photophobia and clumsiness with poor walking balance. The "red eye" phenomenon in snapshots of a child with chorioretinitis may reveal incongruency.

  • Include an ophthalmologic examination as part of a detailed physical examination.
  • A pediatric ophthalmologist should perform a thorough examination of all visible components of the eye in an infant in whom any congenital infection is suspected.
    • This examination is electively performed and is documented with photographs of the abnormalities in the lens, uvea, and retina and an age-appropriate assessment of vision, visual acuity, and fields.
    • Ophthalmologic examination is also an integral part of monitoring treatment efficacy and disease progress.
    • Ophthalmologic examination can reveal exudative "cotton balls" (ie, focal atrophic and pigmented scars of the retina). Vitreous inflammations can manifest as transient floating opacities. However, these findings are common in all patients with chorioretinitis regardless of the etiology.
  • Other abnormal physical findings should be documented; these include intrauterine growth retardation, microcephaly, microphthalmia, cataract, uveitis, hearing defect, osteomyelitis, hepatosplenomegaly, lymphadenopathy, dermal erythropoiesis, carditis, and congenital heart disease.
  • CNS involvement may include abnormal muscle tone, changes in reflexes, or both. A complete neurological examination is warranted.
  • If amnionitis is suspected at delivery, thorough examination and culture of amniotic fluid and placenta may elicit the pathogen.
Previous
Next

Causes

See the list below:

  • Congenital infection
    • In immunocompetent children, chorioretinitis is usually associated with congenital infection; acquired infection is a less likely cause.
    • T gondii and CMV are the leading causes of congenital infections associated with chorioretinitis.
    • Viral etiologies include vertical or perinatal infections, including HSV, rubella, varicella, Epstein-Barr virus (EBV), lymphocytic choriomeningitis virus (LCMV), and, possibly flavivirus. With the recent increase in the incidence of congenital infection after being at a nadir since 1991, syphilis should be considered in an infant born with chorioretinitis whose mother has untreated or inadequately treated syphilis, particularly if she also has human immunodeficiency virus infection (HIV).[16, 17]
    • Distinguishing these infections from perinatal transmission of other viral illnesses, including HSV, hepatitis B, and HIV is important.
    • The risk of intrauterine infection is highest in infants of women with primary infection and is much less with recurrent infections.
  • Acquired chorioretinitis in immunocompetent children: Some children who ingest embryonated T canis or Baylisascaris procyonis eggs may develop visceral larva migrans or ocular larva migrans. Another acquired infection that may lead to chorioretinitis is B henselae.[18] More than 90% of patients with catscratch disease have a history of recent contact with a cat, often a kitten, and 50-87% of these patients have been scratched.
  • Immunocompromised children
    • Chorioretinitis may be associated with systemic infection due to a vast array of pathogens. Any of the infections discussed above may be seen; however, the presentation in an immunocompromised individual may be atypical.
    • Other infections may include congenital or acquired Lyme disease, Yersinia enterocolitica, and Mycobacterium tuberculosis (MTB).[19, 20]
    • Invasive fungal infections may result from Candida,Cryptococcus species, and histoplasmosis.[21]
    • A species of blackfly (Simulium species) can transmit onchocerciasis (in tropical Africa, Yemen, Saudi Arabia, and parts of Latin America).[22]
  • Noninfectious disease
Previous
 
 
Contributor Information and Disclosures
Author

Ayesha Mirza, MD Associate Professor, Pediatric Infectious Diseases, University of Florida College of Medicine Jacksonville

Ayesha Mirza, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, HIV Medicine Association

Disclosure: Nothing to disclose.

Coauthor(s)

Diana E Guinazu, MD Fellow in Pediatric Infectious Diseases, University of Florida College of Medicine

Diana E Guinazu, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Mark R Schleiss, MD Minnesota American Legion and Auxiliary Heart Research Foundation Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Itzhak Brook, MD, MSc Professor, Department of Pediatrics, Georgetown University School of Medicine

Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, Society for Ear, Nose and Throat Advances in Children, American Federation for Clinical Research, Surgical Infection Society, Armed Forces Infectious Diseases Society

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Quoc V Nguyen, MD, to the original writing and development of this article.

References
  1. Koevary SB. Ocular involvement in patients infected by the West Nile virus. Optometry. 2005 Oct. 76(10):609-12. [Medline].

  2. Zinkernagel MS, Bolinger B, Krebs P, Onder L, Miller S, Ludewig B. Immunopathological basis of lymphocytic choriomeningitis virus-induced chorioretinitis and keratitis. J Virol. 2009 Jan. 83(1):159-66. [Medline]. [Full Text].

  3. Stagno S, Britt W, et al. Cytomegalovirus Infections. Remington J, Klein J, Wilson C, eds. Infectious Diseases of the Fetus and Newborn Infant. 6th ed. Philadelphia, PA: Elsevier; 2006. 739-81.

  4. Hall BR, Oliver GE, Wilkinson M. A presentation of longstanding toxoplasmosis chorioretinitis. Optometry. 2009 Jan. 80(1):23-8. [Medline].

  5. Wise ME, Sorvillo FJ, Shafir SC, Ash LR, Berlin OG. Severe and fatal central nervous system disease in humans caused by Baylisascaris procyonis, the common roundworm of raccoons: a review of current literature. Microbes Infect. 2005 Feb. 7(2):317-23. [Medline].

  6. Egli A, Bergamin O, Mullhaupt B, et al. Cytomegalovirus-associated chorioretinitis after liver transplantation: case report and review of the literature. Transpl Infect Dis. 2008 Feb. 10(1):27-43. [Medline].

  7. Khairallah M, Chee SP, Rathinam SR, Attia S, Nadella V. Novel infectious agents causing uveitis. Int Ophthalmol. 2010 Oct. 30(5):465-83. [Medline].

  8. Greydanus DE, Noble KG, Hofmann AD. Chorioretinitis in the adolescent: two case presentations with discussion. Pediatrics. 1977 Dec. 60(6):884-92. [Medline].

  9. Nassetta L, Kimberlin D, Whitley R. Treatment of congenital cytomegalovirus infection: implications for future therapeutic strategies. J Antimicrob Chemother. 2009 May. 63(5):862-7. [Medline]. [Full Text].

  10. Lopez A, Dietz VJ, Wilson M, Navin TR, Jones JL. Preventing congenital toxoplasmosis. MMWR Recomm Rep. 2000 Mar 31. 49:59-68. [Medline].

  11. Elsheikha HM. Congenital toxoplasmosis: priorities for further health promotion action. Public Health. 2008 Apr. 122(4):335-53. [Medline].

  12. Rothova A. Ocular manifestations of toxoplasmosis. Curr Opin Ophthalmol. 2003 Dec. 14(6):384-8. [Medline].

  13. Freeman K, Tan HK, Prusa A, et al. Predictors of retinochoroiditis in children with congenital toxoplasmosis: European, prospective cohort study. Pediatrics. 2008 May. 121(5):e1215-22. [Medline].

  14. Toxocariasis. CDC. accessed July 17, 2009. Available at http://www.cdc.gov/ncidod/diseases/submenus/sub_toxocariasis.htm.

  15. Yang B, Xiao J, Li X, Luo L, Tong B, Su G. Clinical manifestations of syphilitic chorioretinitis: a retrospective study. Int J Clin Exp Med. 2015. 8 (3):4647-55. [Medline].

  16. Woods CR. Congenital syphilis-persisting pestilence. Pediatr Infect Dis J. 2009 Jun. 28(6):536-7. [Medline].

  17. [Guideline] New York State Department of Health. Ophthalmologic complications of HIV infection. New York (NY): New York State Department of Health; 2004 Jan.

  18. Reed JB, Scales DK, Wong MT, Lattuada CP Jr, Dolan MJ, Schwab IR. Bartonella henselae neuroretinitis in cat scratch disease. Diagnosis, management, and sequelae. Ophthalmology. 1998 Mar. 105(3):459-66. [Medline].

  19. Mikkila H, Seppala I, Leirisalo-Repo M, Immonen I, Karma A. The etiology of uveitis: the role of infections with special reference to Lyme borreliosis. Acta Ophthalmol Scand. 1997 Dec. 75(6):716-9. [Medline].

  20. Babu RB, Sudharshan S, Kumarasamy N, Therese L, Biswas J. Ocular tuberculosis in acquired immunodeficiency syndrome. Am J Ophthalmol. 2006 Sep. 142(3):413-8. [Medline].

  21. Andreola C, Ribeiro MP, de Carli CR, Gouvea AL, Curi AL. Multifocal choroiditis in disseminated Cryptococcus neoformans infection. Am J Ophthalmol. 2006 Aug. 142(2):346-8. [Medline].

  22. Ament CS, Young LH. Ocular manifestations of helminthic infections: onchocersiasis, cysticercosis, toxocariasis, and diffuse unilateral subacute neuroretinitis. Int Ophthalmol Clin. 2006 Spring. 46(2):1-10. [Medline].

  23. Chalumeau M, Monnet D, Brezin AP, et al. Chorioretinal lesions as the unique feature of complete chronic granulomatous disease in an 8-year-old girl. Eur J Pediatr. 2007 Oct. 166(10):1069-70. [Medline].

  24. Rigante D, Stabile A, Minnella A, et al. Post-inflammatory retinal dystrophy in CINCA syndrome. Rheumatol Int. 2009 May 8. [Medline].

  25. Weiss HA. Uveitis and Chrorioretinitis. Long S, ed. Principles and Practice of Pediatric Infectious Diseases. 3rd ed Edition. 2008. 504-8.

  26. Johannessen JK, Christiansen I, Schmidt DR, Petersen E, Hansen SH. Simultaneous determination of pyrimethamine, sulfadiazine and N-acetyl-sulfadiazine in plasma for monitoring infants in treatment of congenital toxoplasmosis. J Pharm Biomed Anal. 2005 Jan 4. 36(5):1093-8. [Medline].

  27. Accorinti M. Ocular bartonellosis. Int J Med Sci. 2009. 6(3):131-2. [Medline]. [Full Text].

  28. Patel SJ, Petrarca R, Shah SM, et al. Atypical Bartonella hensalae chorioretinitis in an immunocompromised patient. Ocul Immunol Inflamm. 2008 Jan-Feb. 16(1):45-9. [Medline].

  29. Shah CP, McKey J, Spirn MJ, Maguire J. Ocular candidiasis: a review. Br J Ophthalmol. 2008 Apr. 92(4):466-8. [Medline].

  30. Breit SM, Hariprasad SM, Mieler WF, Shah GK, Mills MD, Grand MG. Management of endogenous fungal endophthalmitis with voriconazole and caspofungin. Am J Ophthalmol. 2005 Jan. 139(1):135-40. [Medline].

  31. Khan FA, Slain D, Khakoo RA. Candida endophthalmitis: focus on current and future antifungal treatment options. Pharmacotherapy. 2007 Dec. 27(12):1711-21. [Medline].

  32. Osthoff M, Hilge R, Schulze-Dobold C, Bogner JR. Endogenous endophthalmitis with azole-resistant Candida albicans--Case report and review of the literature. Infection. 2006 Oct. 34(5):285-8. [Medline].

  33. Prasad AG, Van Gelder RN. Presumed ocular histoplasmosis syndrome. Curr Opin Ophthalmol. 2005 Dec. 16(6):364-8. [Medline].

  34. Wallon M, Kodjikian L, Binquet C, et al. Long-term ocular prognosis in 327 children with congenital toxoplasmosis. Pediatrics. 2004 Jun. 113(6):1567-72. [Medline].

Previous
Next
 
Chorioretinitis in a patients with acquired immunodeficiency syndrome (AIDS).
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.