Post Fever Uveoretinal Manifestations in an Immunocompetent Individual

Abstract

Background: Post fever uveoretinal sequelae (PFURS) are the various uveoretinal manifestations seen after a systemic febrile illness in an immunocompetent individual caused by bacteria, viruses, and protozoa. These may be the result of a direct invasion by the pathogen or by indirect mechanism mediated through immune mechanisms. Method: The authors aim to review the ocular manifestations, utility of relevant diagnostic tests, management, and prognosis of PFURS. A comprehensive literature search was conducted on PubMed and Google Scholar databases with the search words “retinitis”, “choroiditis”, “neuroretinitis”, “macular edema”, “maculopathy”, “multifocal retinitis”, “chikungunya”, “dengue”, “West Nile”, “typhoid”, and “rickettsiosis”. Only articles published or translated into English language were considered. The key data were extracted, evaluated, and combined. Results: The authors search yielded 95 articles for the period between 1986 and May 2020. Painless blurring of vision was the most common symptom. Patients can have varied posterior segment manifestations, including vitritis, focal and multifocal patches of retinitis which could be unilateral or bilateral, optic nerve involvement, serous detachment at the macula, macular oedema, and localised involvement of the retinal vessels in the form of beading of the vessel wall, tortuosity, and perivascular sheathing. Conclusion: PFURS presents with a similar morphological pattern irrespective of the aetiology and follows a preset natural course before resolution. Treatment may or may not be required. Treating physicians need to be aware of this important ophthalmic condition even after complete resolution of fever.

Choroidal and central macular thickness before and after treatment in post fever retinitis

“…Post fever retinitis (PFR) is an uveitic entity following infection by viral or bacterial agents like dengue, chikungunya, typhoid, and rickettsia. [ 1 2 ]…”

“…Signs of PFR include vitritis, multifocal retinitis predominantly in the posterior pole, multiple retinal hemorrhages, macular edema and sometimes disc edema. [ 2 ]…”

“…Antibiotics (specifically doxycycline or ciprofloxacin) with or without steroids have been tried in various studies. [ 1 2 ] Improvement in the visual acuity was evident following treatment with systemic antibiotics or steroids either alone or in combination. [ 1 2 ]…”

“…[ 1 2 ] Improvement in the visual acuity was evident following treatment with systemic antibiotics or steroids either alone or in combination. [ 1 2 ]…”

Epidemic retinitis - Factors associated with poor visual outcomes

“…[ 3 ] The factors responsible for poor visual outcomes such as retinal neovascularization with vitreous hemorrhage, maculopathy, retinal thinning, macular ischemia have been reported in a few case reports and small case series. [ 4 5 6 ]…”