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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 lesionsAbsent lesionsLocalisationVitreous lesionsAnterior lesionsKeratic lesionsOnsetSpecific treatment
Measles virusDiffuse retinal edema, small hemorrhages, exudative stellate macular lesions, attenuate vessels, optic disc edemaRetinal necrotic lesionsDiffuseNoNoPunctuate epithelial erosions and keratitisFew days after the skin rash or later with SSPENo
Rubella virusChorioretinitis, RPE detachment, bullous retinal detachmentRetinal hemorrhages, vasculitis, optic disc edemaPosterior poleMild vitreous reactionMild anterior uveitisCentral epithelial keratitisTopical or oral corticosteroids on bullous retinal detachment
Influenza virusRetinal edema, shiny vesicular dots at the termination of a capillary, small hemorrhages, serous retinal detachment, frosted branch angiitis, neuroretinitis, optic neuritis, uveal effusionRetinal necrotic lesionsMacularNoIridocyclitisInterstitial keratitis, marginal corneal ulcersOral corticosteroids for serous retinal detachment, macular edema and frosted branch angiitis
Borrelia burgdorferiMultifocal choroiditis, vasculitis, neuroretinitis, optic disc edemaRetinal necrotic lesionsDiffuse
Posterior pole if neuroretinitis
VitritisGranulomatous or non-granulomatous anterior uveitisStromal keratitisSeveral weeks after inoculationCeftriaxone
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 involvementRetinal scarringAdjacent to retinal vesselsMild to moderate vitreous reactionNoNoDoxycycline
Systemic corticosteroids
Dengue virusMaculopathy with macular edema, focal chorioretinitis, yellow subretinal dots, foveolitis, hemorrhages, venular sheathing, disc edema, vascular occlusion, exudative retinal detachment due to vascular leakageMacularVitreous hemorrhages1 week after the onset of the feverNo
Chikungunya virusMultifocal choroiditis, retinal whitening with retinal and macular edema, central retinal artery occlusion, ONH edema when optic neuritis or neuroretinitis, exudative retinal detachmentPosterior poleMild vitritisGranulomatous or non granulomatous Anterior uveitisKeratitis1 month to 1 year after diagnosisNo
West Nile VirusMultifocal chorioretinitis, linear clusters of circular deep yellowish lesions, retinal hemorrhages, vascular sheathing, occlusive vasculitis, optic disc edemaMidzone, peripheral zone, posterior pole Along retinal nerve fibersMild to moderate vitritisAnterior uveitisNoEarly, contemporary to the feverNo
CMVYellow-white areas of necrotizing retinitis, retinal hemorrhages, vascular sheathing, frosted branch angiitis, ONH edema with hemorrhages if optic neuritisPerivascular distribution, central (10%)Mild vitreous reactionMild anterior uveitisNoGanciclovir
HSVRetinal edema, ARN syndrome, macular yellowish exudative plaques, flame-shaped hemorrhages, perivenous sheathing, arteriolar narrowing, disc edema, PORN syndromeMacular, diffuseMild vitreous reactionAnterior uveitis with iris atrophy and elevated IOPDendritic stromal ulcerations or disciform keratitisAciclovir
VZVFocal chorioretinitis with exudates and necrotic lesions, occasional hemorrhages, sheathed vessels, central retinal vein occlusion, ONH edema when optic neuritis, ARN syndrome, PORN syndromeUsually peripheral, possible macular extensionVitritis when ARN syndromeAnterior uveitisPunctuate epithelial keratitisAcyclovir
Treponema pallidumMultifocal chorioretinitis, ASPPC with large pale yellowish subretinal lesion, retinitis, vasculitis (arteritis and phlebitis which can be occlusive), exudative retinal detachment, neuroretinitisMultifocal
Posterior pole when ASPPC
Vitritis or vitreous reaction to chorioretinitisGranulomatous or non- granulomatous anterior uveitis bilateral in 50%Stromal keratitisSeveral weeks after inoculationPenicillin 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