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