Emergent infectious uveitis

Abstract

Infectious causes should always be considered in all patients with uveitis and it should be ruled out first. The differential diagnosis includes multiple well-known diseases including herpes, syphilis, toxoplasmosis, tuberculosis, bartonellosis, Lyme disease, and others. However, clinicians should be aware of emerging infectious agents as potential causes of systemic illness and also intraocular inflammation. Air travel, immigration, and globalization of business have overturned traditional pattern of geographic distribution of infectious diseases, and therefore one should work locally but think globally, though it is not possible always. This review recapitulates the systemic and ocular mainfestations of several emergent infectious diseases relevant to the ophthalmologist including Rickettsioses, West Nile virus infection, Rift valley fever, dengue fever, and chikungunya. Retinitis, chorioretinitis, retinal vasculitis, and optic nerve involvement have been associated with these emergent infectious diseases. The diagnosis of any of these infections is usually based on pattern of uveitis, systemic symptoms and signs, and specific epidemiological data and confirmed by detection of specific antibody in serum. A systematic ocular examination, showing fairly typical fundus findings, may help in establishing an early clinical diagnosis, which allows prompt, appropriate management.

Keywords: Infectious Disease; Systemic Illness; Uveitis.

Figure 1

Red-free fundus photograph of the right eye of a patient with West Nile virus infection showing radial linear clustering of active deep creamy chorioretinal lesions (arrows)

Figure 2

Midphase fluorescein angiogram (a) of the left eye of a diabetic 65-year-old woman with a history of WNV infection shows multiple linear streaks, which follow the course of retinal nerve fibres (b) Schema showing that linear streaks closely follow the course of retinal nerve fibres

Figure 3

Fundus photograph of the right eye of a patient with Rift valley fever shows active retinitis in the macular region. The presence of retinal hemorrhages should be noted. (Courtesy: E Abboud)

Figure 4

(a) Fundus photograph; (b) fluorescein angiogram; (c) and optical coherence tomogram of the right eye showing dengue maculopathy manifesting as severe retinal vasculitis with serous retinal detachment. Fundal examination showed macular hemorrhages, macular vasculitis with sheathing of predominantly the venules. The fundal fluorescein angiogram demonstrates prominent vascular leakage. optical coherence tomogram shows the presence of severe neurosensory retinal detachment. (Courtesy, Soon-Phaik Chee)

Figure 5

(a) Fundus photograph; (b) and optical coherence tomogram showing dengue foveolitis in the left eye. (c) before fundus. Fundus photograph showed an elevated orange spot at the fovea. The optical coherence tomogram demonstrated a focal thickening of the outer neurosensory retina-retinal pigment epithelial layer (Courtesy, Soon-Phaik Chee)

Figure 6

Fundus photograph (a) of the right eye of a patient with chikungunya showing neuroretinitis, multifocal retinitis and serous retinal detachment. Fluorescein angiography; (b) shows hyperfluorescence of the retinal lesion and optic disc leakage. Fundus photograph of the right eye taken six months after presentation; (c) shows resolution of fundus findings. The presence of temporal disc pallor should be noted. (Courtesy, Padmamalini Mahendradas)

Figure 7

Fundus photograph of the right eye of a patient with Mediterranean spotted fever shows multifocal retinitis, with white retinal lesions of small size adjacent to retinal vessels

Figure 8

Color fundus photograph of the left eye of a patient with Mediterranean spotted fever shows a temporal juxtavascular white retinal lesion with associated serous retinal detachment and a macular star

Figure 9

Fluorescein angiography of a patient with Mediterranean spotted fever shows retinal vascular leakage