Chorioretinitis is a condition that causes non-specific ocular symptoms, such as blurred or otherwise impaired vision, photosensitivity, pain in the eye or redness, as well as ocular exudate [8]. The findings during fundoscopy are particularly useful in order to definitely diagnose such a condition and further examinations will help to reveal the underlying infection that initially caused chorioretinitis.

• Asymptomatic

  Two dilated ophthalmic examinations should still be considered even in asymptomatic patients with fungemia. [ncbi.nlm.nih.gov]

  Unilateral, inactive, self-limiting depigmented chorioretinitis patches without foveal involvement or retinal detachment in an asymptomatic patient should raise the suspicion of past history of HZO although rare. [medical-dictionary.thefreedictionary.com]

  The treatment of newborns with asymptomatic congenital infection is not indicated. [slideplayer.com]

• Swelling

  A 7-year-old with congenital toxoplasmosis who took pyrimethamine and sulfadiazine for reactivated chorioretinitis developed fever, severe cutaneous involvement, swelling, abdominal pain and transaminitis, persisting weeks after withholding medicines. [ncbi.nlm.nih.gov]

  What they have in common is eye inflammation and swelling that can destroy eye tissues. That destruction can lead to poor vision or blindness. The word “uveitis” is used because the swelling most often affects the part of your eye called the uvea. [dictionary.webmd.com]

  Examination of the eye fundus reveals a blister-like swelling of the macula. Fluoresceine-angiography can identify the place where leakage occurs and causes the swelling. [vryghem.eu]

• Weakness

  There are drugs to treat it for pregnant women and people with weak immune systems. [icdlist.com]

  A 33-year-old Hispanic man with HIV, presenting to the emergency department for increasing weakness, lethargy, diarrhea, abdominal pain, and blindness for the past few weeks View Case [ajnr.org]

  A 2012 Cochrane Review found weak evidence suggesting that ivermectin could result in reduced chorioretinal lesions in patients with onchocercal eye disease.[8] More research is needed to support this finding. [en.wikipedia.org]

  […] symptoms that are highly suggestive of chorioretinitis are diminished vision, spots or clouds in vision, eye burns or stings, itchiness of eye, double vision, foreign body sensation in eye, muscle swelling, elbow cramps or spasms, pus in urine, low back weakness [symcat.com]

  Autoimmune disorders, such as: Rheumatoid arthritis Sacrcoidosis Polyarteritis nodosa Granulomatosis with polyangiitis Infections, such as: Lyme disease Syphilis Tuberculosis Congenital toxoplasmosis Congenital rubella Congenital cytomegalovirus HIV/AIDS Weak [bestonlinemd.com]

• Epilepsy

  Funduscopic examination revealed a pale optic nerve and mild macular chorioretinitis. 2012) central nervous system damage mental retardation chorioretinitis blindness meningoencephalitis hydrocephalus intracranial calcifications and epilepsy with fetal [medical-dictionary.thefreedictionary.com]

  […] clinical features Petechiae and purpura (blueberry muffin rash) Fever Seizures Jaundice Hepatosplenomegaly Lymphadenopathy Pneumonitis Thrombocytopenia Second or third trimester: subclinical or mild toxoplasmosis Sequelae of congenital toxoplasmosis Epilepsy [amboss.com]

  The exclusion criteria for ivermectin use include children less than five years; pregnant women; women breastfeeding within one month of giving birth and individuals with disorders of the central nervous system (such as epilepsy). [doi.org]

• Sepsis

  […] teeth, mulberry molars) Interstitial keratitis Sensorineural deafness Saber shins VDRL or RPR Dark-field microscopy PCR Penicillin Treatment (penicillin G) of mother in early pregnancy Listeriosis Spontaneous abortion and premature birth Meningitis, sepsis [amboss.com]

  CMV. 17 CMV- continue… Clinical manifestations: 30% mortality rate Symptoms include: IUGR Microcephaly Periventricular calcifications HSM Petechiae Hearing loss Jaundice Thrombocytopenia retinitis Hypotonoia Lethargy In preterm infants may present as sepsis [slideplayer.com]

  These lesions might also represent nerve fiber layer infarctions due to sepsis related ischemia, underlying hematologic abnormalities, or fungal emboli. [healio.com]

• Pneumonia

  An immunodeficient patient, 34 years old, receiving systemic antifungal treatment for 1 month for invasive aspergillosis with necrotizing pneumonia and brain metastasis, who presented with blurred vision in his left eye. [ncbi.nlm.nih.gov]

  Quiz (7 or more correct More information Recurrent or Persistent Pneumonia Recurrent or Persistent Pneumonia Lower Respiratory Tract Dr T Avenant Recurrent or Persistent Pneumonia Definitions Recurrent pneumonia more than two episodes of pneumonia in [docplayer.net]

  We present the case of 10-year-old girl with AIDS who initially presented with pneumonia. She was treated for pneumonia and thereafter started on ART as her CD4 count was low. [academic.oup.com]

  The disease, which typically manifests as a self-limiting community-acquired pneumonia, was initially described in the late 1800s and thought to be of protozoan etiology (and hence the etymology of Coccidia) but was later identified as a dimorphic fungus [hindawi.com]

  […] skin lesions (granulomatosis infantiseptica) Bacterial culture Ampicillin and gentamicin Avoidance of unpasteurized dairy products Avoidance of cold deli meats Varicella zoster virus (VZV) IUGR, premature birth Chorioretinitis, cataract Encephalitis Pneumonia [amboss.com]

• Aspiration

  His Mantoux test was positive (25 mm × 25 mm induration), QuantiFERON-TB Gold was test positive, aqueous aspirate was positive for Mycobacterium tuberculosis genome, negative for viruses and toxoplasma, and hence he was initiated on four-drug antitubercular [ncbi.nlm.nih.gov]

  Fine needle aspirate (FNA) biopsy revealed a poorly differentiated neuroendocrine carcinoma. [bmcophthalmol.biomedcentral.com]

  Discussion Congenital CMV infection can result from maternal primary and reactivated infection or reinfection of different strains of CMV during pregnancy, whereas perinatal infection transmitted by aspiration of genital secretions or maternal blood occurs [academic.oup.com]

• Hypertension

  In dogs, common causes include: Hypertension Polycythemia vera Parasites - Toxoplasma spp - Brucella canis - Cuterebra spp - Toxocara canis - Trypanosoma cruzi Fungal infections - Cryptococcus neoformans - Coccidioides spp - Acremonium spp References [vetbook.org]

  Benign 401.0 Hypertension, Malignant 401.9 Hypertension, Unspecified 340 Multiple Sclerosis 135 Sarcoidosis VISION 367.51 Accommodation, Paresis of 367.53 Accommodation, Spasm of 368.02 Amblyopia, Deprivation 368.03 Amblyopia, Refractive 368.01 Amblyopia [vdocuments.mx]

  If these chorioretinal findings were seen in patients with diabetes, hypertension, or bacteremia, as was true in 20 patients (33.3%), they were classified as possible ocular candidiasis. [reliasmedia.com]

  In addition to macular haemorrhage arising from diabetes and exudative AMD, it can also occur secondary to vascular diseases such as arteriosclerosis, hypertension, retinal artery or retinal vein occlusion, macular telangiectasia, retinal macroaneurysm [medical-dictionary.thefreedictionary.com]

• Vascular Disease

  In a 7-year-old African girl, who presented with chorioretinitis and subsequently developed JSSc we discuss the possible association of chorioretinitis with JSSc and the putative implications of scleroderma vascular disease in the development of this [ncbi.nlm.nih.gov]

  In addition to macular haemorrhage arising from diabetes and exudative AMD, it can also occur secondary to vascular diseases such as arteriosclerosis, hypertension, retinal artery or retinal vein occlusion, macular telangiectasia, retinal macroaneurysm [medical-dictionary.thefreedictionary.com]

  […] retinal vascular sheathing, retinal vascular leakage on fluorescein angiography (FA), and, rarely, occlusive retinal vasculitis. [healio.com]

  Eye symptoms can be treated as follows: Steroids may have a role in the acute management of many vasculitides, collagen vascular diseases, or sarcoidosis; in some infectious processes (eg, MTB); or in some cases infections caused by Toxoplasma species [emedicine.medscape.com]

• Blurred Vision

  An immunodeficient patient, 34 years old, receiving systemic antifungal treatment for 1 month for invasive aspergillosis with necrotizing pneumonia and brain metastasis, who presented with blurred vision in his left eye. [ncbi.nlm.nih.gov]

  Chorioretinitis in people is caused by infection acquired in utero with symptoms including blurred vision, photophobia, and loss of central vision. gondii infection may cause chorioretinitis, abortion or nervous system problems in the newborn, and T. [medical-dictionary.thefreedictionary.com]

  Symptoms include eye pain, blurred vision, sensitivity to light and excessive tear production. [healthengine.com.au]

• Visual Impairment

  Fulminant chorioretinitis and irreversible visual impairment can be the consequence of ocular fundus colonization. [ncbi.nlm.nih.gov]

  Apart from visual impairment, Chorioretinitis can also cause eye pain, sensitivity to light, and excessive tearing. The best way to treat Chorioretinitis is by way of steroids. [epainassist.com]

  New visual acuity loss: any case of visual impairment or blindness. New visual impairment: deterioration of visual acuity with best correction in either eye to less than 6/18 during the study period. [doi.org]

  Focal or diffuse mottled whitish lesions admixed with variably sized pigmented deposits in the optic fundus of congenital rubella and Cockayne’s progeria syndrome, which are not associated with visual impairment DiffDx Peripheral retinal fundus in women [medical-dictionary.thefreedictionary.com]

• Central Scotoma

  A 34-year-old pregnant woman with a history of poor visual acuity in her left eye, secondary to an undetermined cause, developed an acute painless central scotoma and blurred vision in the right eye. [ncbi.nlm.nih.gov]

  Case summary A 44-year-male visited our clinic for central scotoma in the left eye. The visual acuity was 20/25 in the right eye and 20/40 in the left eye. [synapse.koreamed.org]

  Over the following months as he regained his mental faculties he complained to family members of decreased vision and central scotomas, worse in his left eye than right. [doi.org]

  Confrontational fields were full with the exception of a central scotoma in the left eye. Slit-lamp examination of the anterior segment was normal in both eyes, as was the dilated fundus examination in the right eye. [reviewofophthalmology.com]

• Nystagmus

  Clinical Presentation: Confusion, disorientation, apathy, withdrawal, cranial neuropathies, and nystagmus Ventriculoencephalitis is the most common form of CNS involvement in CMV infection and is characterized by ependymitis along the inner surface of [ajnr.org]

  See nystagmus. chorioretinitis inflammation of the choroid and retina. Occurs in canine distemper and Histophilus somni septicemia. congenital chorioretinitis reported in foals born to mares that had respiratory disease during pregnancy. [medical-dictionary.thefreedictionary.com]

  Nystagmus, strabismus, and limited vision are often present. The majority (up to 90%) of individuals have significant retinal disease. The retinal vascular pattern is anomalous with tortuosity in some areas and absence of vessels in others. [disorders.eyes.arizona.edu]

• Cerebral Calcification

  The 4 Cs of congenital toxoplasmosis: Cerebral calcifications, Chorioretinitis, hydroCephalus, and Convulsions! [amboss.com]

The first step towards a successful diagnosis is a thorough medical history and physical exam. Patients with chorioretinitis usually present, if they are symptomatic, with acute symptomatology that includes pain in the eye, blurred vision, the sensitivity of the eye to light, or dark spots that float in their visual field. The pupil may display irregular borders and the vitreous membrane may be clouded. Loss of vision of the one eye is the ultimate stage, which indicates an irreversible condition.

Fundoscopy is an extremely useful tool towards the diagnosis of chorioretinitis. Tissues may appear blurred and the retina is expected to be considerably hyporeflective. The observation of the vascular network can also reveal a hemorrhagic tendency, vasculitis, and exudate. When the condition is progressing, the involvement of the anterior segment can lead to various pathological alterations, such as miosis, corneal edema, cataract, and hypopyon.

Except for the examination of the eye and retina, the diagnosis of chorioretinitis needs to be accompanied by the defining of etiology. Therefore, blood laboratory testing is mandatory, in order to pinpoint the cause of infection. More specifically:

• Routine blood testing is used to detect pathological levels of erythrocytes, white blood cells, and platelets. It is a first step that can direct the physician towards the accurate diagnosis.
• Liver function tests: SGOT/SGPT, ALP, γ-GT, bilirubin, albumin and protein levels are paramount in order to evaluate the condition of the liver, whose functionality is in many instances impaired by congenital infections.
• Renal function.
• Possible immunosuppression: An individual that may be affected by chorioretinitis due to an undiagnosed HIV infection requires testing. The PCR method can be used to accurately diagnose the disease in newborns; other than that, affected individuals may have decreased levels of CD4+ T cells and hypergammaglobulinemia.

As far as imaging modalities are concerned, they are employed depending on the suspicions that exist for each patient. Every imaging modality can contribute to the diagnosis of an underlying pathology in an individual, including chest radiographs and computerized tomography scans for a tuberculosis infection, a magnetic resonance imaging scan or an ultrasonographic scan in the case of a potential congenital infection, etc. A skin biopsy can also be useful to detect blueberry muffin infant syndrome in cases of babies with a possible underlying toxoplasmosis.

• Toxoplasma Gondii

  To report a case of chorioretinitis as the earliest manifestation of Toxoplasma gondii infection acquired through donor after kidney transplantation. [ncbi.nlm.nih.gov]

  Toxoplasmosis is a parasitic disease caused by the protozoan Toxoplasma gondii. [sciencephoto.com]

  Keywords : Toxoplasma gondii, Myositis © 2008 Elsevier Masson SAS. All Rights Reserved. EM-CONSULTE.COM is registrered at the CNIL, déclaration n° 1286925. [em-consulte.com]

  Abstract Chorioretinitis due to Toxoplasma gondii in the adult is generally a late sequela of congenital infection (1). [annals.org]

• Central Scotoma

  A 34-year-old pregnant woman with a history of poor visual acuity in her left eye, secondary to an undetermined cause, developed an acute painless central scotoma and blurred vision in the right eye. [ncbi.nlm.nih.gov]

  Case summary A 44-year-male visited our clinic for central scotoma in the left eye. The visual acuity was 20/25 in the right eye and 20/40 in the left eye. [synapse.koreamed.org]

  Over the following months as he regained his mental faculties he complained to family members of decreased vision and central scotomas, worse in his left eye than right. [doi.org]

  Confrontational fields were full with the exception of a central scotoma in the left eye. Slit-lamp examination of the anterior segment was normal in both eyes, as was the dilated fundus examination in the right eye. [reviewofophthalmology.com]

Treatment of chorioretinitis comprises various pharmaceutical and invasive options aimed at the eradication of the underlying cause. Corticosteroids, antimicrobial agents and antiviral medications can all be used selectively, depending on the actual cause of chorioretinitis. Treating the underlying disease is paramount, in order to avoid considerable loss of vision that might occur if the infection remains untreated.

Specifically, medication options are individualized depending on the type of infection present and may include the following:

• Ganciclovir, foscarnet, valganciclovir, and cidofovir are employed in cases of an underlying CMV infection. Various other agents, such as maribavir, are being currently tested for their potential use against some strains of CMV [9].
• Fomivirsen is used to treat CMV chorioretinitis in an immunodeficient person who is affected by the acquired immunodeficiency syndrome (AIDS).
• Pyrimethamine, prednisone, sulfadiazine and folinic acid are useful medications against toxoplasmosis. Note that the folinic acid is not an antiparasitic drug itself, but it is used to prevent bone marrow toxicity, caused by pyrimethamine. Because of their potential toxicity, pyrimethamine and sulfadiazine levels need to be monitored regularly, via high-performance liquid chromatography testing of the plasma.

Except for the medications that can be used to effectively remove the agent causing the original infection, various other invasive techniques may be required under some circumstances. Vitrectomy is reserved for those individuals who are diagnosed with fibrosis of the vitreous membrane and it is usually a second-line treatment that ensues, after the failure of pharmaceutical therapy.

Chorioretinitis is not a fatal disease and is curable if the appropriate treatment is administered. The extent of the residual damage it may lead to greatly depends on the exact location of the lesion and the existence of timely workup and treatment. In general, the presence of a lesion on the retina implies that a scar will definitely form, but peripheral scars usually cause no visual impairment. Centrally located retinal lesions will cause a visual impairment of different extent, depending on lesion characteristics.

The timely diagnosis and treatment of congenital conditions such as a CMV infection or toxoplasmosis reduce the possibilities of extensive residual damage to the retina and, subsequently, to an individual's vision.

Chorioretinitis is usually caused by an infection with an agent that is vertically passed from mother to child during pregnancy or childbirth. Toxoplasmosis and cytomegalovirus are the primary culprits behind the inflammatory, infectious process, while other parasites and fungi could also lead to such ocular manifestations [1] [2]. During the course of an individual's postnatal life, various other pathogens could infect the eye area and lead to the disorder. Only on rare occasions have non-infectious inflammatory diseases been incriminated for causing chorioretinitis, both in newborns and adults.

The exact prevalence of chorioretinitis has not been established; however, it is known that congenital toxoplasmosis (CTP) is one of its leading causes. Congenital toxoplasmosis is not so common amongst newborns in the United States, due to maternal care, monitoring, and informative campaigns: it is believed that approximately 2,000 cases occur annually [3]. Other countries, primarily European, perform screening tests for the disease and report higher frequencies of CTP [4] [5].

If left untreated, congenital toxoplasmosis is expected to cause chorioretinitis in a 20% of the children affected by it by the age of 5 or 6 years old, with the majority of the children experiencing impaired vision unilaterally [6].

The uveal tract comprises the choroid, ciliary body, and iris. Each ocular condition is defined according to the structure mainly affected by it and an infection leading to inflammation of the posterior uveal tract is usually referred to as choroiditis. The retina rarely remains unaffected, which is the reason why the term chorioretinitis is used interchangeably with choroiditis [7].

Not every pathogen causes inflammation of the same extent; individuals affected by toxoplasmosis are usually diagnosed with panuveitis or bilateral regional or widespread chorioretinitis. Toxocara canis leads to isolated choroidal lesions and vascular damage. An interesting fact is that although the lesions caused by a CMV infection may be indistinguishable from those caused by toxoplasmosis, the retinal inflammation remains clinically stable and is usually not progressive in the case of CMV.

Chorioretinitis is a condition that is caused by an infection, either localized or systemic. Therefore, preventive measures include following basic hygienic guidelines and maintaining good health, so that the organism will be able to fight infections. Specifically, otherwise healthy individuals are advised to consult an ophthalmologist any time they experience ocular symptoms, such as blurred vision, red or edematous eyes. Patients affected by diseases or conditions that greatly affect their immune system are particularly advised to follow their physician's advice closely, with regard to their protection against possible infections.

Chorioretinitis is an inflammation of the retina and choroid, as opposed to the term choroiditis which implies an inflammation restricted to the choroid alone. The condition usually develops as a result of an infection, either localized to the ocular area or even systemic. Congenital toxoplasmosis, cytomegalovirus, other parasites and viruses, and fungi can cause various types of infection that may ultimately lead to an inflammatory response of the eye and, subsequently, chorioretinitis.

Congenital chorioretinitis is often diagnosed in newborns and may produce no symptomatology; nevertheless, it can occur at any age, both in immunocompetent and immunocompromised patients. The vitreous membrane is a structure that may as well be affected by the inflammatory process. The symptoms occurring as a result of chorioretinitis are non-pathognomonic and comprise distortion of vision, erythematous eyes, excessive exudate and sensitivity to light. A careful and thorough medical history, physical examination and eye examination including fundoscopy are indispensable so that an accurate diagnosis can be reached. Upon diagnosing chorioretinitis, the underlying cause must be detected and further laboratory tests and imaging modalities are implemented towards this target.

Chorioretinitis requires immediate ophthalmological consultation and proper treatment because persistent inflammation might interfere with retinal function and endanger retinal perfusion, thus leading to impaired vision, depending on the expansion of the lesion. Each case of chorioretinitis is individualized, and various types of drugs may be used in order to treat the underlying cause including antiviral and antiparasitic agents.

Chorioretinitis is an inflammation of the choroid and retina of the eye. The choroid is the layer of the eye that contains the vessels and the retina is the inner coat of the eye, which is extremely photosensitive. The inflammation is, in the majority of the cases, a result of an infection or, rarely, it might be caused by an inflammatory process that affects the organism, without the involvement of an infectious microorganism.

The two types of infection that most commonly lead to chorioretinitis are congenital toxoplasmosis and CMV infection. These infections could be passed down from the infected mother to the fetus during pregnancy. Other than these, the West Nile virus, fungi, and some parasites can also lead to the same inflammatory process. Chorioretinitis causes manifestations such as blurred vision or dark spots in one's visual field, sensitivity to light, red and puffy eyes.

An ophthalmologist needs to be consulted once an individual experience symptoms that could be related to chorioretinitis, because prolonged inflammation can lead to partial or total loss of vision, depending on the damaged ocular region. Various medications are used to treat the underlying infection, such as antiviral and antiparasitic drugs.

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