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RETINA ANAMOLIES DX/WU/TX > RETINA - INFECTIOUS RETINOPATHIES > Flashcards

RETINA - INFECTIOUS RETINOPATHIES Flashcards

1
Q

what is histoplasmosis? what is the name of the species involved?

A

fungal infection caused by histoplasma capsulatum.

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2
Q

how does someone become infected w/ histoplasmosis?

A

typically infected by inhaling the fungus from bat or bird poop.

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3
Q

where is histoplasmosis most common?

A

Ohio & mississippi river valleys

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4
Q

symptoms of histoplasmosis?

A
  • asymptomatic
  • metamorphopsia if CNVM
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5
Q

signs of histoplasmosis (triad)?

A
  1. histo spots - multiple, small, yellow-white, punched out lesions.
  2. peripapillary atrophy (PPA)
  3. maculopathy (CNVM) - appears green/gray.

*** no vitritis or anterior uveitis!

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6
Q

w/u for histoplasmosis?

A
  • Amsler grid to evaluate central vision.
  • look for signs of CNV - IVFA confirms CNVM.
  • DO FA/OCT.
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7
Q

tx for histoplasmosis?

A
  • Anti-fungal tx is not helpful!

Tx aimed to control CNVM:
* Anti-VEGF – for subfoveal CNVM
* Focal laser photocoagulation – for extrafoveal CNVM

  • F/U in pts w/out CNVM but macular changes – every 6 months.
  • F/U in pts w/ no macular Dz – every 1 year
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8
Q

what is toxoplasmosis? what species causes it?

A

it a (protozoan) prasitic infetion caused by toxoplasma gondii.

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9
Q

how does someone become infected with toxoplasmosis?

A

caused by eating raw meat, exposure to cat feces or can be acquired or passed along in utero.

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10
Q

what are the 2 ways that toxoplasmosis can be acquired?

A
  • congenital - exposure to cat feces by pregnant woman leads to fetal infection.
  • acquired - most common in immunocompromised pt and most likely due to eating raw meat or unwashed produced.
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11
Q

Toxoplasma gondii can only complete its reproductive cyle in what organism?

A

cats

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12
Q

toxoplasmosis is the most common cause of what eye condition?

A

posterior uveitis
(it is necrotizing)!

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13
Q

symptoms of toxoplasmosis?

A
  • active infection - unilateral: blurry vision + red eye + floaters + uveitis + vitritis
  • inactive infection - asymptomatic
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14
Q

signs of toxoplasmosis?

A

Active/acquired case:
* present with fluffy yellow-white lesions with an overlying vitritis (headlights in the fog) - with no underlying chorioretinal scar b/c there hasn’t been enough time to scar.

Inactive/congenital:
* Sharply delineated singular macular chorioretinal scar.
* strabismic amblyopia
* nystagmus

Other ocular signs:
* cataracts
* anterior uveitis
* RD
* CNVM
* CME

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15
Q

can toxoplasmosis reacvtivate? how does it appear?

A

yes, appears as an active case: with fluffy white lesion next to past chorioretinal scar.

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16
Q

tx/managment for toxoplasmosis?

A
  • active case - pyrimethamine, sulfadiazine, folinic acid, abx; azithromycin, clindamycin, bactrim, steroids; prednisone.
  • refer to neurology to r/o encephalitis.
  • no sub-conj or sub-tenon’s injections.
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17
Q

what is toxocariasis? what species is involved?

A

it is a parasitic infection causes by the roundworm Toxocara canis.

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18
Q

how can someone get toxocariasis?

A

Children typically infected by transfer of worm eggs via contact w/ dog feces or unwashed produce or undercooked meat.

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19
Q

symptoms of toxocariasis?

A

blurry vision

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20
Q

signs of toxocariasis?

A

white signs:
* endophthalmitis
* leukocoria - 2/2 macular dragging due to posterior pole granuloma.

other signs:
* chorioretinal scar
* RD
* vitritis or papilitis

21
Q

w/u for toxocariasis?

A

Most helpful to confirm diagnosis:Toxocara (Enzyme-Linked Immunosorbent Assay) ELISA testing

22
Q

tx for toxocariasis?

A
  • inflammation - topical/oral/ sub-tenon steroid.
  • RD - repaired with surgery
23
Q

what is lyme dz? what species is involved?

A

bacterial infection caused by borrelia burgdorferi

24
Q

how does someone get lyme dz?

A

organism is transmitted to humans through the bite of a tick that has fed on an infected animal, particularly a deer or rodent.

25
Q

s/s of lyme dz

A

Signs and symptoms occur in 3 stages following the infectious event:
Stage 1: Early signs include a pathognomonic “bull’s eye” skin rash (typically within 3 to 30 days),

Stage 2: typically follows weeks to months after Stage 1, if left untreated. Significant ophthalmic signs usually first appear (late Stage 2 or early Stage 3), which include;
* unilateral or bilateral posterior uveitis
* papilledema,
* optic atrophy,
* optic neuritis.
* CN 7 palsy

Stage 3: The late stage of Lyme disease most commonly includes chronic Lyme arthritis of large joints

26
Q

wha cranial nerve palsy is lyme dz associated with?

A

CN 7 palsy

27
Q

w/u for lyme dz?

A

Do ELISA and western blot to confirm

28
Q

tx for lyme dz?

A
  • Lyme dz w/out neurological issues: Oral ABx – doxy 100mg po bid for 10-21 days.
  • In children, pregnant woman, and others who cant take doxy –> amoxicillin 500mg po tid or azithromycin 500mg po daily.
  • Lyme dz w/ neuro manifestations: IV ABx – ceftriaxone 2g IV daily for 2-3 wks.
  • Some symptoms may go away w/ tx but some stay.
  • F/U –> 1-3 days until improvement then weekly.
29
Q

what is CMV? what species is involved?

A
  • It is an opportunistic infection in those who are immunosuppressed (HIV).
  • herpes virus
30
Q

who gets cytomegalovirus?

A

those with CD4 counts of <50cell/mm3

31
Q

signs of CMV?

A
  • CMV retinitis - with overlying vitritis
32
Q

tx for CMV?

A
  • antiviral intravenous & intravitreal injections should be considered.
  • oral antivirals if dz improves - ganciclovir / foscarnet / cidofovir
33
Q

what is acute retinal necrosis (ARN) and progressive outer retinal necrosis sysmdrome (PORN)?

A

viral STD (herpes zoster) infection & only occur in immunocompromised pts.

34
Q

ARN & PORN occur in patients with __?

A

HIV or other immunocompromised pts

35
Q

symptoms of ARN & PORN?

A
  • unilateral blurry vision
  • floaters
36
Q

signs of ARN?

A

will start unilateral –> 30% spread to other eye.
* peripheral areas of well-demarcated white necrosis –> will spread circumferentially around the peripheral retina (spares posterior pole until late dz).
* anterior granulomatous uveitis & vasculitis
* RD - in late stage

37
Q

signs of PORN?

A
  • 1st sign - minimal anterior uveitis & vitritis followed by yellow-white retinal infiltrates.
  • 2nd sign - rapid full thickness necrosis w/ early involvment of the macula.
  • 3rd sign (late) - RD
38
Q

tx for ARN?

A

tx is aimed at sparing the other eye:
* IV antivirals + oral steroids to control inflammation.
* if unresponsive - intravitreal antiviral injections.
* for anterior uveitis - tx with topical steroid + cycloplegic
* for RD - surgically repair.

39
Q

tx for PORN?

A
  • Oral - valacyclovir & famciclovir.
  • Intravenous - acyclovir, valacyclovir, famciclovir.
  • Intravitreal - foscarnet, ganciclovir.
  • inflammation - topical steroids
  • retinal detachment - surgically
40
Q

what is cysticercosis? what species is involved?

A
  • it is a parasitic infection caused by cysticerus cellulosae.
41
Q

how do you get cysticercosis?

A

by ingesting undercooked pork

42
Q

symptoms of cysticercosis?

A
  • progressive blurry vision
  • VF defects
43
Q

signs of cysticercosis?

A
  • inflammatory retinal cysts - caused by larva in vitreous, sub-retina, anterior chamber, eyelids.
44
Q

tx for cysticercosis?

A
  • systemic (IV or oral) steroids.
  • larva should be surgically removed (vitrectomy) or lasered
45
Q

what is diffused unilateral subacute neuroretinitis? what species is involved?

A
  • infection caused by 2 worms; ancylostoma cainum (dog hook worm) or baylisascaris procyonis (raccoon intestinal worm)
46
Q

symptoms of unilateral subacute neuroretinitis?

A
  • unilateral blurry vision
47
Q

signs of unilateral subacute neuroretinitis

A
  • PR outer segment destruction –> VF defects
  • when the worm dies - retinal inflammation and scarring
  • CR atrophy
  • optic nerve pallor
48
Q

tx for unilateral subacute neuroretinitis

A
  • PRP against the worm
  • systemic steroids for retinal inflammation.

RETINA ANAMOLIES DX/WU/TX (11 decks)

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