History
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. [26]
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.
Physical Examination
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 ophthalmologic findings may include cataract and uveitis.
Other abnormal physical findings should be documented; these include intrauterine growth retardation, microcephaly, microphthalmia, hearing defect, osteomyelitis, hepatosplenomegaly, lymphadenopathy, dermal erythropoiesis, carditis, and congenital heart disease.
Involvement of the central nervous system (CNS) 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.
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Chorioretinitis in a patients with acquired immunodeficiency syndrome (AIDS).
