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Differential Diagnosis of Infectious Choroiditis

  • Alessandro Invernizzi
Living reference work entry

Abstract

Choroiditis can be defined as an inflammatory process affecting the choroid. The main cause of inflammation can range from an autoimmune reaction targeting specific ocular antigens to an immune response against an exogenous agent infecting the eye. Understanding the nature of the underlying pathological condition is mandatory for a proper management of the patient. The process that leads to find the correct diagnosis is mainly constituted by three steps linked to each other: medical history collection, clinical picture evaluation, and targeted exams (including ocular imaging and systemic tests). The aim of this chapter is to provide clinicians a schematic algorithm based on these steps to collect and properly interpret useful information for the work-up of infectious choroiditis, in order to differentiate them from noninfectious forms and to eventually identify the causative agent.

Keywords

Retinal Pigment Epithelium Choroidal Thickening Spectral Domain Optical Coherence Tomography Retinal Pigment Epithelium Indocyanine Green Angiography 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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  1. Adl MA, LeHoang P, Bodaghi B. Use of fluorescein angiography in the diagnosis and management of uveitis. Int Ophthalmol Clin. 2012;52(4):1–12.CrossRefPubMedGoogle Scholar
  2. Aguilar GL, Blumenkrantz MS, Egbert PR, McCulley JP. Candida endophthalmitis after intravenous drug abuse. Arch Ophthalmol. 1979;97(1):96–100.CrossRefPubMedGoogle Scholar
  3. Ang M, Wong W, Ngan CC, Chee SP. Interferon-gamma release assay as a diagnostic test for tuberculosis-associated uveitis. Eye (Lond). 2012;26(5):658–65.CrossRefGoogle Scholar
  4. Atmaca LS, Simsek T, Atmaca Sonmez P, Sonmez K. Fluorescein and indocyanine green angiography in ocular toxoplasmosis. Graefes Arch Clin Exp Ophthalmol. 2006;244(12):1688–91.CrossRefPubMedGoogle Scholar
  5. Auer C, Bernasconi O, Herbort CP. Indocyanine green angiography features in toxoplasmic retinochoroiditis. Retina. 1999;19(1):22–9.CrossRefPubMedGoogle Scholar
  6. Bourdin C, Busse A, Kouamou E, Touafek F, Bodaghi B, Le Hoang P, Mazier D, Paris L, Fekkar A. PCR-based detection of Toxoplasma gondii DNA in blood and ocular samples for diagnosis of ocular toxoplasmosis. J Clin Microbiol. 2014;52(11):3987–91.CrossRefPubMedPubMedCentralGoogle Scholar
  7. Butler NJ, Furtado JM, Winthrop KL, Smith JR. Ocular toxoplasmosis II: clinical features, pathology and management. Clin Experiment Ophthalmol. 2013;41(1):95–108.CrossRefPubMedGoogle Scholar
  8. Cunningham Jr ET, van Velthoven ME, Zierhut M. Spectral-domain-optical coherence tomography in uveitis. Ocul Immunol Inflamm. 2014;22(6):425–8.CrossRefPubMedGoogle Scholar
  9. Davis JL. Ocular syphilis. Curr Opin Ophthalmol. 2014;25(6):513–8.CrossRefPubMedGoogle Scholar
  10. Deuter CM, Kötter I, Wallace GR, Murray PI, Stübiger N, Zierhut M. Behçet’s disease: ocular effects and treatment. Prog Retin Eye Res. 2008;27(1):111–36.CrossRefPubMedGoogle Scholar
  11. Goldenberg D, Goldstein M, Loewenstein A, Habot-Wilner Z. Vitreal, retinal, and choroidal findings in active and scarred toxoplasmosis lesions: a prospective study by spectral-domain optical coherence tomography. Graefes Arch Clin Exp Ophthalmol. 2013;251(8):2037–45.CrossRefPubMedGoogle Scholar
  12. Gupta V, Gupta A, Rao NA. Intraocular tuberculosis – an update. Surv Ophthalmol. 2007;52(6):561–87.CrossRefPubMedGoogle Scholar
  13. Herbort CP, Mantovani A, Bouchenaki N. Indocyanine green angiography in Vogt-Koyanagi-Harada disease: angiographic signs and utility in patient follow-up. Int Ophthalmol. 2007;27(2–3):173–82.CrossRefPubMedGoogle Scholar
  14. Herbort CP, Rao NA, Mochizuki M. Members of Scientific Committee of First International Workshop on Ocular Sarcoidosis. International criteria for the diagnosis of ocular sarcoidosis: results of the first International Workshop on Ocular Sarcoidosis (IWOS). Ocul Immunol Inflamm. 2009;17(3):160–9.CrossRefPubMedGoogle Scholar
  15. Herbort CP, Papadia M, Mantovani A. Classification of choroiditis based on inflammatory lesion process rather than fundus appearance: enhanced comprehension through the ICGA concepts of the iceberg and jellyfish effects. Klin Monbl Augenheilkd. 2012;229(4):306–13.CrossRefPubMedGoogle Scholar
  16. Hsu CT, Kerrison JB, Miller NR, Goldberg MF. Choroidal infarction, anterior ischemic optic neuropathy, and central retinal artery occlusion from polyarteritis nodosa. Retina. 2001;21(4):348–51.CrossRefPubMedGoogle Scholar
  17. Invernizzi A, Mapelli C, Viola F, Cigada M, Cimino L, Ratiglia R, Staurenghi G, Gupta A. Choroidal granulomas visualized by enhanced depth imaging optical coherence tomography. Retina. 2015;35(3):525–31.CrossRefPubMedGoogle Scholar
  18. Ishihara K, Hangai M, Kita M, Yoshimura N. Acute Vogt-Koyanagi-Harada disease in enhanced spectral-domain optical coherence tomography. Ophthalmology. 2009;116(9):1799–807.CrossRefPubMedGoogle Scholar
  19. Margolis R. Diagnostic vitrectomy for the diagnosis and management of posterior uveitis of unknown etiology. Curr Opin Ophthalmol. 2008;19(3):218–24.CrossRefPubMedGoogle Scholar
  20. Mehta H, Sim DA, Keane PA, Zarranz-Ventura J, Gallagher K, Egan CA, Westcott M, Lee RW, Tufail A, Pavesio CE. Structural changes of the choroid in sarcoid- and tuberculosis-related granulomatous uveitis. Eye (Lond). 2015;29(8):1060–8.CrossRefGoogle Scholar
  21. Nazari Khanamiri H, Rao NA. Serpiginous choroiditis and infectious multifocal serpiginoid choroiditis. Surv Ophthalmol. 2013;58(3):203–32.CrossRefPubMedGoogle Scholar
  22. Pichi F, Ciardella AP, Cunningham Jr ET, Morara M, Veronese C, Jumper JM, Albini TA, Sarraf D, McCannel C, Voleti V, Choudhry N, Bertelli E, Giuliari GP, Souied E, Amer R, Regine F, Ricci F, Neri P, Nucci P. Spectral domain optical coherence tomography findings in patients with acute syphilitic posterior placoid chorioretinopathy. Retina. 2014;34(2):373–84.CrossRefPubMedGoogle Scholar
  23. Sagoo MS, Mehta H, Swampillai AJ, Cohen VM, Amin SZ, Plowman PN, Lightman S. Primary intraocular lymphoma. Surv Ophthalmol. 2014;59(5):503–16.CrossRefPubMedGoogle Scholar
  24. Sen HN, Bodaghi B, Hoang PL, Nussenblatt R. Primary intraocular lymphoma: diagnosis and differential diagnosis. Ocul Immunol Inflamm. 2009;17(3):133–41.CrossRefPubMedPubMedCentralGoogle Scholar
  25. Sharma K, Gupta V, Bansal R, Sharma A, Sharma M, Gupta A. Novel multi-targeted polymerase chain reaction for diagnosis of presumed tubercular uveitis. J Ophthalmic Inflamm Inf. 2013;3(1):25.CrossRefGoogle Scholar
  26. Shields CL, Manalac J, Das C, Saktanasate J, Shields JA. Review of spectral domain-enhanced depth imaging optical coherence tomography of tumors of the retina and retinal pigment epithelium in children and adults. Indian J Ophthalmol. 2015a;63(2):128–32.CrossRefPubMedPubMedCentralGoogle Scholar
  27. Shields CL, Manalac J, Das C, Saktanasate J, Shields JA. Review of spectral domain enhanced depth imaging optical coherence tomography of tumors of the choroid. Indian J Ophthalmol. 2015b;63(2):117–21.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Silpa-Archa S, Lee JJ, Foster CS. Ocular manifestations in systemic lupus erythematosus. Br J Ophthalmol. 2015;100(1):135–41.CrossRefPubMedGoogle Scholar
  29. Yeh S, Forooghian F, Wong WT, Faia LJ, Cukras C, Lew JC, Wroblewski K, Weichel ED, Meyerle CB, Sen HN, Chew EY, Nussenblatt RB. Fundus autofluorescence imaging of the white dot syndromes. Arch Ophthalmol. 2010;128(1):46–56.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer (India) Pvt. Ltd. 2016

Authors and Affiliations

  1. 1.Uveitis and Ocular Infectious Diseases Service – Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco”Luigi Sacco Hospital, University of MilanMilanItaly

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