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Table 3 Main alternative infectious diagnoses for RVFV retinitis and their characteristics

From: The challenging management of Rift Valley Fever in humans: literature review of the clinical disease and algorithm proposal

  Retinal lesions Absent lesions Localisation Vitreous lesions Anterior lesions Keratic lesions Onset Specific treatment
Measles virus Diffuse retinal edema, small hemorrhages, exudative stellate macular lesions, attenuate vessels, optic disc edema Retinal necrotic lesions Diffuse No No Punctuate epithelial erosions and keratitis Few days after the skin rash or later with SSPE No
Rubella virus Chorioretinitis, RPE detachment, bullous retinal detachment Retinal hemorrhages, vasculitis, optic disc edema Posterior pole Mild vitreous reaction Mild anterior uveitis Central epithelial keratitis Topical or oral corticosteroids on bullous retinal detachment
Influenza virus Retinal edema, shiny vesicular dots at the termination of a capillary, small hemorrhages, serous retinal detachment, frosted branch angiitis, neuroretinitis, optic neuritis, uveal effusion Retinal necrotic lesions Macular No Iridocyclitis Interstitial keratitis, marginal corneal ulcers Oral corticosteroids for serous retinal detachment, macular edema and frosted branch angiitis
Borrelia burgdorferi Multifocal choroiditis, vasculitis, neuroretinitis, optic disc edema Retinal necrotic lesions Diffuse
Posterior pole if neuroretinitis
Vitritis Granulomatous or non-granulomatous anterior uveitis Stromal keratitis Several weeks after inoculation Ceftriaxone
Doxycycline
Topical or systemic corticosteroids
Rickettsia spp. White retinal lesions adjacent to retinal vessels, serous retinal detachment, retinal sheathing, hemorrhages, vascular leakage or occlusions, optic disc edema, neuroretinitis, optic neuritis, choroidal involvement Retinal scarring Adjacent to retinal vessels Mild to moderate vitreous reaction No No Doxycycline
Systemic corticosteroids
Dengue virus Maculopathy with macular edema, focal chorioretinitis, yellow subretinal dots, foveolitis, hemorrhages, venular sheathing, disc edema, vascular occlusion, exudative retinal detachment due to vascular leakage Macular Vitreous hemorrhages 1 week after the onset of the fever No
Chikungunya virus Multifocal choroiditis, retinal whitening with retinal and macular edema, central retinal artery occlusion, ONH edema when optic neuritis or neuroretinitis, exudative retinal detachment Posterior pole Mild vitritis Granulomatous or non granulomatous Anterior uveitis Keratitis 1 month to 1 year after diagnosis No
West Nile Virus Multifocal chorioretinitis, linear clusters of circular deep yellowish lesions, retinal hemorrhages, vascular sheathing, occlusive vasculitis, optic disc edema Midzone, peripheral zone, posterior pole Along retinal nerve fibers Mild to moderate vitritis Anterior uveitis No Early, contemporary to the fever No
CMV Yellow-white areas of necrotizing retinitis, retinal hemorrhages, vascular sheathing, frosted branch angiitis, ONH edema with hemorrhages if optic neuritis Perivascular distribution, central (10%) Mild vitreous reaction Mild anterior uveitis No Ganciclovir
Foscarnet
HSV Retinal edema, ARN syndrome, macular yellowish exudative plaques, flame-shaped hemorrhages, perivenous sheathing, arteriolar narrowing, disc edema, PORN syndrome Macular, diffuse Mild vitreous reaction Anterior uveitis with iris atrophy and elevated IOP Dendritic stromal ulcerations or disciform keratitis Aciclovir
VZV Focal chorioretinitis with exudates and necrotic lesions, occasional hemorrhages, sheathed vessels, central retinal vein occlusion, ONH edema when optic neuritis, ARN syndrome, PORN syndrome Usually peripheral, possible macular extension Vitritis when ARN syndrome Anterior uveitis Punctuate epithelial keratitis Acyclovir
Treponema pallidum Multifocal chorioretinitis, ASPPC with large pale yellowish subretinal lesion, retinitis, vasculitis (arteritis and phlebitis which can be occlusive), exudative retinal detachment, neuroretinitis Multifocal
Posterior pole when ASPPC
Vitritis or vitreous reaction to chorioretinitis Granulomatous or non- granulomatous anterior uveitis bilateral in 50% Stromal keratitis Several weeks after inoculation Penicillin G
Topical or systemic corticosteroids
  1. RPE retinal pigment epithelium, ONH optic nerve hypoplasia, ARN syndrome acute retinal necrosis, PORN syndrome progressive outer retinal necrosis, ASPPC acute syphilitic posterior placoid chorioretinopathy, CMV cytomegalovirus, HSV herpes simplex viruses, VZV varicella zoster virus, SSPE subacute sclerosing panencephalitis