CMV Retinitis Differential Diagnoses

CMV Retinitis Differential Diagnoses

The appearance of a vesicular rash in the anogenital area of a child should alert the practitioner to the possibility of herpes simplex virus (HSV) infection and potential sexual abuse. Varicella-zoster virus-associated arteritis is usually distinguished from other types of arteritis by its association with chickenpox or zoster, particularly herpes zoster ophthalmicus. These cases are consistent with a modified concept: (1) the VZV dormancy is comprised of multiple foci of infections in the sensory and autonomic ganglia, and (2) the VZV reactivation could involve co-incident activations of two or more loci. In these tissues VZV was detected by PCR. Cranial computed tomography was negative for intracerebral haemorrhage or ischaemia. [Medline]. Hiwarkar P, Gajdosova E, Qasim W, Worth A, Breuer J, Chiesa R, et al.

Frequent Occurrence of Cytomegalovirus Retinitis During Immune Reconstitution Warrants Regular Ophthalmic Screening in High-Risk Pediatric Allogeneic Hematopoietic Stem Cell Transplant Recipients. Clin Infect Dis. 2014 May 7. [Medline]. However, in the presence of focal neurological deficits, varicella zoster encephalitis should definitively be ruled out by spinal tap, even if cranial imaging studies are negative. Risk Factors for Cytomegalovirus Retinitis in Patients with Cytomegalovirus Viremia after Hematopoietic Stem Cell Transplantation. Ophthalmology.

2012 May 30. [Medline]. Mitchell SM, Membrey WL, Youle MS, et al. Cytomegalovirus retinitis after the initiation of highly active antiretroviral therapy: a 2 year prospective study. Br J Ophthalmol. 1999 Jun. 83(6):652-5.

[Medline]. Holbrook JT, Colvin R, van Natta ML, Thorne JE, Bardsley M, Jabs DA. Evaluation of the United States public health service guidelines for discontinuation of anticytomegalovirus therapy after immune recovery in patients with cytomegalovirus retinitis. Am J Ophthalmol. 2011 Oct. 152(4):628-637.e1. [Medline].

[Full Text]. Sugar EA, Jabs DA, Ahuja A, Thorne JE, Danis RP, Meinert CL. Incidence of cytomegalovirus retinitis in the era of highly active antiretroviral therapy. Am J Ophthalmol. 2012 Jun. 153(6):1016-1024.e5. [Medline].

[Full Text]. Kempen JH, Sugar EA, Lyon AT, Lewis RA, Jabs DA, Heinemann MH, et al. Risk of Cataract in Persons with Cytomegalovirus Retinitis and the Acquired Immune Deficiency Syndrome. Ophthalmology. 2012 Jul 30. [Medline]. Knox CM, Chandler D, Short GA, Margolis TP.

Polymerase chain reaction-based assays of vitreous samples for the diagnosis of viral retinitis. Use in diagnostic dilemmas. Ophthalmology. 1998 Jan. 105(1):37-44; discussion 44-5. [Medline]. Studies of Ocular Complications of AIDS (SOCA) Research Group.

Foscarnet-Ganciclovir Cytomegalovirus Retinitis Trial. 4. Visual outcomes. Studies of Ocular Complications of AIDS Research Group in collaboration with the AIDS Clinical Trials Group. Ophthalmology. 1994 Jul. 101(7):1250-61.

[Medline]. Thorne JE, Holbrook JT, Jabs DA, Kempen JH, Nichols C, Meinert CL. Effect of cytomegalovirus retinitis on the risk of visual acuity loss among patients with AIDS. Ophthalmology. 2007 Mar. 114(3):591-8. [Medline].

Holbrook JT, Jabs DA, Weinberg DV. Visual loss in patients with cytomegalovirus retinitis and acquired immunodeficiency syndrome before widespread availability of highly active antiretroviral therapy. Arch Ophthalmol. 2003 Jan. 121(1):99-107. [Medline]. Studies of Ocular Complications of AIDS (SOCA) Research Group.

Rhegmatogenous retinal detachment in patients with cytomegalovirus retinitis: the Foscarnet-Ganciclovir Cytomegalovirus Retinitis Trial. The Studies of Ocular Complications of AIDS (SOCA) Research Group in Collaboration with the AIDS Clinical Trials G. Am J Ophthalmol. 1997 Jul. 124(1):61-70. [Medline]. Kempen JH, Min YI, Freeman WR, Holland GN, Friedberg DN, Dieterich DT, et al.

Risk of immune recovery uveitis in patients with AIDS and cytomegalovirus retinitis. Ophthalmology. 2006 Apr. 113(4):684-94. [Medline]. Karavellas MP, Plummer DJ, Macdonald JC, et al. Incidence of immune recovery vitritis in cytomegalovirus retinitis patients following institution of successful highly active antiretroviral therapy.

J Infect Dis. 1999 Mar. 179(3):697-700. [Medline]. Nguyen QD, Kempen JH, Bolton SG, et al. Immune recovery uveitis in patients with AIDS and cytomegalovirus retinitis after highly active antiretroviral therapy. Am J Ophthalmol.

2000 May. 129(5):634-9. [Medline]. Jabs DA, Ahuja A, Van Natta M, Lyon A, Srivastava S, Gangaputra S. Course of cytomegalovirus retinitis in the era of highly active antiretroviral therapy: five-year outcomes. Ophthalmology. 2010 Nov.

117(11):2152-61.e1-2. [Medline]. Biswas J, Madhavan HN, George AE, et al. Ocular lesions associated with HIV infection in India: a series of 100 consecutive patients evaluated at a referral center. Am J Ophthalmol. 2000 Jan. 129(1):9-15.

[Medline]. Studies of Ocular Complications of AIDS (SOCA) Research Group. Foscarnet-Ganciclovir Cytomegalovirus Retinitis Trial: 5. Clinical features of cytomegalovirus retinitis at diagnosis. Studies of ocular complications of AIDS Research Group in collaboration with the AIDS Clinical Trials Group. Am J Ophthalmol. 1997 Aug.

124(2):141-57. [Medline]. Kempen JH, Jabs DA, Wilson LA. Incidence of cytomegalovirus (CMV) retinitis in second eyes of patients with the acquired immune deficiency syndrome and unilateral CMV retinitis. Am J Ophthalmol. 2005 Jun. 139(6):1028-34.

[Medline]. Phillips AN, Lazzarin A, Gonzales-Lahoz J, et al. Factors associated with the CD4+ lymphocyte count at diagnosis of acquired immunodeficiency syndrome. The AIDS IN EUROPE Study Group. J Clin Epidemiol. 1996 Nov. 49(11):1253-8.

[Medline]. Holbrook JT, Davis MD, Hubbard LD, et al. Risk factors for advancement of cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome. Studies of Ocular Complications of AIDS Research Group. Arch Ophthalmol. 2000 Sep. 118(9):1196-204.

[Medline]. Rasmussen L, Morris S, Zipeto D, et al. Quantitation of human cytomegalovirus DNA from peripheral blood cells of human immunodeficiency virus-infected patients could predict cytomegalovirus retinitis. J Infect Dis. 1995 Jan. 171(1):177-82. [Medline].

Tufail A, Moe AA, Miller MJ, et al. Quantitative cytomegalovirus DNA level in the blood and its relationship to cytomegalovirus retinitis in patients with acquired immune deficiency syndrome. Ophthalmology. 1999 Jan. 106(1):133-41. [Medline]. Sugita S, Shimizu N, Watanabe K, Mizukami M, Morio T, Sugamoto Y, et al.

Use of multiplex PCR and real-time PCR to detect human herpes virus genome in ocular fluids of patients with uveitis. Br J Ophthalmol. 2008 Jul. 92(7):928-32. [Medline]. Musch DC, Martin DF, Gordon JF, et al. Treatment of cytomegalovirus retinitis with a sustained-release ganciclovir implant.

The Ganciclovir Implant Study Group. N Engl J Med. 1997 Jul 10. 337(2):83-90. [Medline]. Oktavec KC, Nolan K, Brown DM, Dunn JP, Livingston AG, Thorne JE. Clinical outcomes in patients with cytomegalovirus retinitis treated with ganciclovir implant.

Am J Ophthalmol. 2012 Apr. 153(4):728-33, 733.e1-2. [Medline]. Jensen OA, Gerstoft J, Thomsen HK, Marner K. Cytomegalovirus retinitis in the acquired immunodeficiency syndrome (AIDS). Light-microscopical, ultrastructural and immunohistochemical examination of a case.

Acta Ophthalmol (Copenh). 1984 Feb. 62(1):1-9. [Medline]. Pecorella I, Ciardi A, Credendino A, et al. Ocular, cerebral and systemic interrelationships of cytomegalovirus infection in a post-mortem study of AIDS patients. Eye.

1999 Dec. 13 ( Pt 6):781-5. [Medline]. Jabs DA, Van Natta ML, Holbrook JT, Kempen JH, Meinert CL, Davis MD. Longitudinal study of the ocular complications of AIDS: 2. Ocular examination results at enrollment. Ophthalmology.

2007 Apr. 114(4):787-93. [Medline]. Jabs DA, Van Natta ML, Thorne JE, et al. Course of cytomegalovirus retinitis in the era of highly active antiretroviral therapy: 2. Second eye involvement and retinal detachment. Ophthalmology.
CMV Retinitis Differential Diagnoses

2004 Dec. 111(12):2232-9. [Medline]. Macdonald JC, Torriani FJ, Morse LS, et al. Lack of reactivation of cytomegalovirus (CMV) retinitis after stopping CMV maintenance therapy in AIDS patients with sustained elevations in CD4 T cells in response to highly active antiretroviral therapy. J Infect Dis. 1998 May.

177(5):1182-7. [Medline]. Althaus C, Loeffler KU, Schimkat M, et al. Prophylactic argon laser coagulation for rhegmatogenous retinal detachment in AIDS patients with cytomegalovirus retinitis. Graefes Arch Clin Exp Ophthalmol. 1998 May. 236(5):359-64.

[Medline]. Martin DF, Dunn JP, Davis JL, et al. Use of the ganciclovir implant for the treatment of cytomegalovirus retinitis in the era of potent antiretroviral therapy: recommendations of the International AIDS Society-USA panel. Am J Ophthalmol. 1999 Mar. 127(3):329-39. [Medline].

Lim JI, Wolitz RA, Dowling AH, et al. Visual and anatomic outcomes associated with posterior segment complications after ganciclovir implant procedures in patients with AIDS and cytomegalovirus retinitis. Am J Ophthalmol. 1999 Mar. 127(3):288-93. [Medline]. Agarwal A, Kumari N, Trehan A, Khadwal A, Dogra MR, Gupta V, et al.

Outcome of cytomegalovirus retinitis in immunocompromised patients without Human Immunodeficiency Virus treated with intravitreal ganciclovir injection. Graefes Arch Clin Exp Ophthalmol. 2014 Feb 21. [Medline]. Whitley RJ, Jacobson MA, Friedberg DN, et al. Guidelines for the treatment of cytomegalovirus diseases in patients with AIDS in the era of potent antiretroviral therapy: recommendations of an international panel. International AIDS Society-USA.

Arch Intern Med. 1998 May 11. 158(9):957-69. [Medline]. Studies of Ocular Complications of AIDS (SOCA) Research Group. Cytomegalovirus (CMV) culture results, drug resistance, and clinical outcome in patients with AIDS and CMV retinitis treated with foscarnet or ganciclovir. Studies of Ocular Complications of AIDS (SOCA) in collaboration with the AIDS Clinical Trial Gr.

J Infect Dis. 1997 Jul. 176(1):50-8. [Medline]. Drew WL, Ives D, Lalezari JP, et al. Oral ganciclovir as maintenance treatment for cytomegalovirus retinitis in patients with AIDS. Syntex Cooperative Oral Ganciclovir Study Group.

N Engl J Med. 1995 Sep 7. 333(10):615-20. [Medline]. Holland GN, Buhles WC Jr, Mastre B, Kaplan HJ. A controlled retrospective study of ganciclovir treatment for cytomegalovirus retinopathy. Use of a standardized system for the assessment of disease outcome.

UCLA CMV Retinopathy. Study Group. Arch Ophthalmol. 1989 Dec. 107(12):1759-66. [Medline]. Kuppermann BD, Quiceno JI, Flores-Aguilar M, et al.

Intravitreal ganciclovir concentration after intravenous administration in AIDS patients with cytomegalovirus retinitis: implications for therapy. J Infect Dis. 1993 Dec. 168(6):1506-9. [Medline]. Brown F, Banken L, Saywell K, Arum I. Pharmacokinetics of valganciclovir and ganciclovir following multiple oral dosages of valganciclovir in HIV- and CMV-seropositive volunteers.

Clin Pharmacokinet. 1999 Aug. 37(2):167-76. [Medline]. Stalder N, Sudre P, Olmari M, et al. Cytomegalovirus retinitis: decreased risk of bilaterality with increased use of systemic treatment. Swiss HIV Cohort Study Group.

Clin Infect Dis. 1997 Apr. 24(4):620-4. [Medline]. Spector SA, Busch DF, Follansbee S, et al. Pharmacokinetic, safety, and antiviral profiles of oral ganciclovir in persons infected with human immunodeficiency virus: a phase I/II study. AIDS Clinical Trials Group, and Cytomegalovirus Cooperative Study Group.

J Infect Dis. 1995 Jun. 171(6):1431-7. [Medline]. Spector SA, McKinley GF, Lalezari JP, et al. Oral ganciclovir for the prevention of cytomegalovirus disease in persons with AIDS. Roche Cooperative Oral Ganciclovir Study Group.

N Engl J Med. 1996 Jun 6. 334(23):1491-7. [Medline]. Spector SA, Weingeist T, Pollard RB, et al. A randomized, controlled study of intravenous ganciclovir therapy for cytomegalovirus peripheral retinitis in patients with AIDS. AIDS Clinical Trials Group and Cytomegalovirus Cooperative Study Group.

J Infect Dis. 1993 Sep. 168(3):557-63. [Medline]. Lalezari JP, Holland GN, Kramer F, et al. Randomized, controlled study of the safety and efficacy of intravenous cidofovir for the treatment of relapsing cytomegalovirus retinitis in patients with AIDS. J Acquir Immune Defic Syndr Hum Retrovirol.

1998 Apr 1. 17(4):339-44. [Medline]. Studies of Ocular Complications of AIDS (SOCA) Research Group. Parenteral cidofovir for cytomegalovirus retinitis in patients with AIDS: the HPMPC peripheral cytomegalovirus retinitis trial. A randomized, controlled trial. Studies of Ocular complications of AIDS Research Group in Collaboration with the AIDS Clini.

Ann Intern Med. 1997 Feb 15. 126(4):264-74. [Medline]. Drusano GL, Aweeka F, Gambertoglio J, et al. Relationship between foscarnet exposure, baseline cytomegalovirus (CMV) blood culture and the time to progression of CMV retinitis in HIV- positive patients. AIDS.

1996 Sep. 10(10):1113-9. [Medline]. Studies of Ocular Complications of AIDS (SOCA) Research Group. Morbidity and toxic effects associated with ganciclovir or foscarnet therapy in a randomized cytomegalovirus retinitis trial. Studies of ocular complications of AIDS Research Group, in collaboration with the AIDS Clinical Trials Group. Arch Intern Med.

1995 Jan 9. 155(1):65-74. [Medline]. Studies of Ocular Complications of AIDS (SOCA) Research Group. Combination foscarnet and ganciclovir therapy vs monotherapy for the treatment of relapsed cytomegalovirus retinitis in patients with AIDS. The Cytomegalovirus Retreatment Trial. The Studies of Ocular Complications of AIDS Research Group in Collaborat.

Arch Ophthalmol. 1996 Jan. 114(1):23-33. [Medline]. Studies of Ocular Complications of AIDS (SOCA) Research Group. MSL-109 adjuvant therapy for cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome: the Monoclonal Antibody Cytomegalovirus Retinitis Trial. The Studies of Ocular Complications of AIDS Research Group.

AIDS Clinical Trials Group. Arch Ophthalmol. 1997 Dec. 115(12):1528-36. [Medline]. Walsh JC, Jones CD, Barnes EA, et al. Increasing survival in AIDS patients with cytomegalovirus retinitis treated with combination antiretroviral therapy including HIV protease inhibitors.

AIDS. 1998 Apr 16. 12(6):613-8. [Medline]. Martin DF, Kuppermann BD, Wolitz RA, et al. Oral ganciclovir for patients with cytomegalovirus retinitis treated with a ganciclovir implant. Roche Ganciclovir Study Group.

N Engl J Med. 1999 Apr 8. 340(14):1063-70. [Medline]. Holland GN, Vaudaux JD, Jeng SM, Yu F, Goldenberg DT, Folz IC, et al. Characteristics of untreated AIDS-related cytomegalovirus retinitis. I.

Findings before the era of highly active antiretroviral therapy (1988 to 1994). Am J Ophthalmol. 2008 Jan. 145(1):5-11. [Medline]. Holland GN, Vaudaux JD, Shiramizu KM, Yu F, Goldenberg DT, Gupta A, et al. Characteristics of untreated AIDS-related cytomegalovirus retinitis.

II. Findings in the era of highly active antiretroviral therapy (1997 to 2000). Am J Ophthalmol. 2008 Jan. 145(1):12-22. [Medline]. Jabs DA, Enger C, Dunn JP, et al.

Cytomegalovirus retinitis and viral resistance: 3. Culture results. CMV Retinitis and Viral Resistance Study Group. Am J Ophthalmol. 1998 Oct. 126(4):543-9. [Medline].

Jabs DA, Enger C, Forman M, et al. Incidence of foscarnet resistance and cidofovir resistance in patients treated for cytomegalovirus retinitis. The Cytomegalovirus Retinitis and Viral Resistance Study Group. Antimicrob Agents Chemother. 1998 Sep. 42(9):2240-4. [Medline].

Jacobson MA, Wilson S, Stanley H, et al. Phase I study of combination therapy with intravenous cidofovir and oral ganciclovir for cytomegalovirus retinitis in patients with AIDS. Clin Infect Dis. 1999 Mar. 28(3):528-33. [Medline].

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