Focal Chorioretinitis Research Articles

Multifocal Tuberculosis with Pre-Extensive Drug Resistance (Clinical Case)

We present our own observation of the multifocal tuberculosis with pre-extensive drug resistance (pre-XDR-TB) development in a patient who was treated in the pulmonary tuberculosis department No. 2 of the Zaporizh­zhia’ regional phthisio-pulmonology clinical treatment and diagnostic center. Multifocal pre-XDR-TB developed in the patient 2.5 months after the initial diagnosis of destructive disseminated pulmonary tuberculosis. The patient was treated during 2 months with deforming arthrosis, which turned out to be tuberculosis of the left knee joint until the specified changes in the lungs were detected, which indicates its late diagnosis. The patient was not tested for HIV infection when tuberculosis was detected in the primary care, and after 2.5 months it was firstly found and accompanied by severe immunosuppression (CD4 lympho­cytes count was 94 cells). This fact also indicates a late diagnosis of HIV infection. As a result of untimely diagnosis and treatment of disseminated pulmonary tuberculosis in the pre-XDR-TB patient with combined HIV infection, there was a rapid generalization of a specific process with the development of multifocal tuberculosis involving not only the bronchopulmonary system, but also the left eye (focal chorioretinitis), the heart (exudative pericarditis), brain (meningoencephalitis) and the left knee joint. The presented clinical case also shows the irresponsibility of the patient to his healthy and the poor work of the family doctor in explaining to the patient the importance of timely tuberculosis treatment. Thus, in the described clinical case, a late-diagnosed HIV infection with severe immunosuppression may have been the trigger for the development of multifocal tuberculosis with extensive drug resistance in the patient and untimely treatment of disseminated pulmonary tuberculosis led to rapid generalization of the specific process. More responsible work of family doctors with tuberculosis patients is also necessary. Therefore, timely diagnosis of multifocal tuberculosis and the earliest appointment of antimycobacterial therapy will allow not only to achieve positive results in treatment, but also to prevent the complications’ development.

Идиопатическая хориоидальная неоваскуляризация на фоне COVID-19

Purpose. To present a clinical case of idiopathic chorioidal neovascularization against the background of mild COVID-19. Material and methods. Patient C. (female), 33 years old, came to the «IMC of Eye Microsurgery» on April 25, 2022 with complaints of visual impairment and metamorphopsia in the right eye for the last 14 days. The anamnesis revealed that the patient had been under outpatient treatment for COVID-19 from April 5th to April 22nd of 2022. The complaints of visual impairment appeared in the second week of the coronavirus infection. Full ophthalmological examination was performed to clarify the diagnosis. On admission: Visus OD = 0.4, Visus OS = 1.0. Еye pressure – normotony. Anterior – posterior axis OD – 24.02, OS – 24.1. There was a grayish-yellow pathological focus with indistinct boundaries and perifocal edema visualized in the macular zone of the right eye juxtafoveolarly. Optical coherence tomography revealed a hyperreflective focus with indistinct boundaries over the retinal pigment epithelium with local retinal neuroepithelial detachments. OCT-angiography revealed a pathological network of newly formed type 2 vessels. Results. Since «idiopathic chorioidal neovascularization» is a rather rare pathology, a thorough differential diagnosis with such diseases as: myopic chorioidal neovascularization, central serous chorioretinopathy complicated by CNS, presumed histoplasmosis syndrome, focal chorioretinitis was performed. Based on the results of the examination, the diagnosis was «idiopathic chorioidal neovascularization of the right eye» and intravitreal injection of Eilea in pro renata mode was recommended. One month after the second intravitreal injection of Eilea in the right eye, the visual acuity in the right eye increased to 1.0. On ophthalmoscopy, a juxtafoveolar pigmented focus was visualized. Optical coherence tomography revealed a hyperreflective focus with clear boundaries. According to OCT, there is a complete absence of neoplastic vessels. Conclusion. A particular feature of this clinical case is the possible effect of COVID-19 on the occurrence of rare forms of CHF in young patients. Retinal changes due to COVID-19 should be further investigated in prospective studies. Key words: COVID-19, chorioidal neovascularization, optical coherence tomography

Woman with black floaters in eye.

A 29-year-old female presented to the emergency department with decreased visual acuity and black floaters in the left eye after an insidious progression of a febrile illness with associated myalgias, headaches, and lymphadenopathy over a 4-week period. History revealed she had eaten undercooked venison several weeks before symptom onset. She was afebrile and neurologically intact, without evidence of vitreal or retinal abnormalities on bedside ultrasound. During ophthalmologic follow-up care 2 days later, she developed left nasal visual field deficit. Ophthalmology noted optic disk edema and steroid therapy was initiated for presumed optic neuritis. Subsequent magnetic resonance imaging was negative, and she was referred to a retinal specialist who identified focal active chorioretinitis and confirmed the diagnosis with serum antibody titers (Figure 1). Toxoplasmosis chorioretinitis is one of the most frequent causes of infectious uveitis affecting the posterior segment of the eye, which can cause severe vision loss. The most common cause is ingestion of undercooked meat or water with oocytes.1-3 Infections may be asymptomatic. However, ocular symptoms can occur as a result of initial infection or reactivation of previous infection.4 The classic retinal finding is the “headlight in fog sign” noted by a focal retinitis viewed through vitreous haze.5 Diagnosis is made clinically. Serum antibody titers confirm the diagnosis. A 4- to 6-week course of trimethoprim-sulfamethoxazole is the first-line therapy for sight-threatening lesions. Other scenarios or refractory cases may require regimens of azithromycin, pyrimethamine, atovaquone, leucovorin, glucocorticoids, and/or intravitreal clindamycin injections. Lifelong suppressive antitoxoplasmosis treatment is often necessary to prevent recurrence.6

Структура клинических форм и этиологии увеитов у детей Хабаровского края

Purpose. Evaluation of the clinical and etiological structure of endogenous uveitis in children, the effectiveness of its etiological diagnosis. Material and Methods. 34 children (42 eyes) with endogenous uveitis aged 3 to 16 years: 31 children (37 eyes) have anterior uveitis, 2 (4 eyes) have intermediate uveitis, and one (1 eye) have posterior uveitis. The unilateral uveitis was observed in 26 children (76%), bilateral – in 8 children (24%). Clinically, 15 children were diagnosed with acute uveitis for the first time, 3 with exacerbation of the chronic course of eye inflammation, and 16 with a relapse of disease after prolonged remission. Ophthalmological examination, clinical and laboratory diagnostics were carried out, including immunological tests and consultations with medical subspecialists. Results. Among all examined children, 6 had uveitis without symptoms. The accompanying juvenile idiopathic arthritis was detected in 15 children with anterior uveitis, 6 had HLA-B27, 2 had an association with herpes simplex virus infection, one had systemic scleroderma, one had acute purulent unilateral sinusitis, and 6 were unable to identify etiology. Two children with intermediate uveitis had bilateral lesions; the etiological factor was the activation of herpes simplex virus. One child had acute central focal chorioretinitis of tuberculosis etiology. When an etiological factor was identified, children had etiotropic therapy along with pathogenetic. In all cases, clinical manifestations of uveitis were completely stop. Conclusion. Newly identified anterior uveitis with acute course occurred in 44% children, 9% had chronic course and 47% had the relapse after prolonged remission. The frequency of exacerbations in 12 children was up to 2 times a year and in 4 children it was more than 2 times a year. The course of anterior uveitis of mild and moderate severity occurred in 29 children and severe in 2 children. Intermediate uveitis in 2 children had moderate severity, posterior uveitis in one child had severe course. Key words: endogenous uveitis, juvenile idiopathic arthritis.

Safety and Efficacy of AAV5 Vectors Expressing Human or Canine CNGB3 in CNGB3-Mutant Dogs.

Achromatopsia is an inherited retinal disorder of cone photoreceptors characterized by markedly reduced visual acuity, extreme light sensitivity, and absence of color discrimination. Approximately 50% of cases are caused by mutations in the cone photoreceptor-specific cyclic nucleotide gated channel beta subunit (CNGB3) gene. Studies in CNGB3-mutant dogs showed that subretinal injection of an AAV vector expressing human CNGB3, which has 76% amino acid identity with canine CNGB3, driven by a 2.1 kb human red cone opsin promoter (PR2.1) and packaged in AAV5 capsids (AAV5-PR2.1-hCNGB3) rescued cone photoreceptor function, but at high doses was associated with an inflammatory response (focal chorioretinitis) consistent with immune-mediated toxicity. AAV vectors containing the PR2.1 promoter packaged in AAV5 capsids and expressing either the native canine CNGB3 (AAV5-PR2.1-cCNGB3) or the human CNGB3 (AAV5-PR2.1-hCNGB3) were evaluated at different dose levels in CNGB3-mutant dogs. The vector expressing canine CNGB3 achieved somewhat better rescue of cone function but unexpectedly was associated with a greater degree of retinal toxicity than the vector expressing human CNGB3. Very low-level T-cell immune responses to some AAV or CNGB3 peptides were observed in animals that received the higher vector dose. There was a more than twofold increase in serum neutralizing antibodies to AAV in one of three animals in the low-dose group and in two of three animals in the high-dose group. No serum anti-hCNGB3 antibodies were detected in any animal. The results of this study do not support the hypothesis that the focal chorioretinitis seen with high doses of AAV5-PR2.1-hCNGB3 in the initial studies was due to an immune response to human CNGB3.

The Incidence of Ocular Tuberculosis in Australia Over the Past 10 Years (2006–2015)

ABSTRACTPurpose: To determine the incidence and clinical phenotype of ocular tuberculosis in Australia based on the mandatory jurisdictional health notification records for TB.Methods: A whole population retrospective case series (Australia). Patients diagnosed with ocular tuberculosis were identified over the past 10 years (1 January 2006 to 31 December 2015) as recorded by individual Health Department jurisdictions per mandatory health notifications. The incidence rates were calculated based on the available Australian census data. Incidence rates were age and sex standardized.Results: A total of 162 cases of ocular tuberculosis were identified across Australia over a 10-year time period. Of these, 156 participants were overseas born. The 10-year Australian incidence of ocular tuberculosis was 0.77 per 100,000 people. While there has been a downward trend in overall TB annual incidence rates from 2010 to 2015, over the same period the annual incidence of ocular TB has increased compared to the 4 previous years. Descriptive clinical data regarding the ocular manifestations of TB was available in 73/157 patients. In these 73 patients the commonest manifestations of ocular TB were unspecified uveitis (50.1%), focal, multifocal or serpiginous choroiditis or chorioretinitis (12.3%) and retinal vasculitis (11.0%). Of patients with ocular TB, 4/162 (2.47%) had associated pulmonary TB and 8/162 (4.94%) had associated systemic (non-pulmonary) TB. Systemic anti-TB therapy was administered to 161 patients.Conclusions: The annual Australian incidence of ocular tuberculosis was 0.077 per 100,000 people. Increasing notifications in the past 6 years may demonstrate increased awareness and changing diagnostic criteria of the disease in the Australian population.

A case of uveitis due to Rickettsia conorii infection in Southeastern France

We describe a case of skin rash and bilateral uveitis secondary to Rickettsia conorii infection.A 60-year-old female patient, living in the rural hinterland of Cannes, was referred to our hospital in mid-August 2012 for skin rash, fever, and arthromyalgia. Blood tests showed increased inflammatory markers, hepatic cytolysis and anicteric cholestasis.Ophthalmic examination revealed bilateral papillitis and focal chorio-retinitis. Fluoroscopic angiography demonstrated early hypofluorescence, with a few arteriolar occlusions, and subsequent hyperfluorescence and focal vasculitis.R. conorii antibodies were identified by immunofluorescence antibody test. Investigation of other infective agents and the immunological panel were negative.A 2-week course of doxycycline 200mg/day was prescribed, and fever rapidly subsided, the skin rash resolved and vision improved. Ophthalmic examination a month and a half later showed almost all retinal lesions had disappeared and inflammation markers had returned to normal.

Posterior segment involvement in cat-scratch disease: A case series

Cat-scratch disease (CSD) is a systemic infectious disease. The most well-known posterior segment presentation is neuroretinitis with a macular star. In this study, we present a case series emphasising the heterogeneity of the disease and the various posterior segment manifestations. A retrospective case series of consecutive patients presenting with posterior segment CSD, over a 5-year period (2010 to 2015), at two ophthalmological centres in Midi-Pyrénées. Twelve patients (17 eyes) were included, of whom 11 (92%) presented with rapidly decreasing visual acuity, with 6 of these (50%) extremely abrupt. CSD was bilateral in 5 (42% of all patients). Posterior manifestations were: 12 instances of optic nerve edema (100%), 8 of focal chorioretinitis (67%) and only 6 of the classic macular edema with macular star (25% at first examination, but 50% later). Other ophthalmological complications developed in three patients; one developed acute anterior ischemic optic neuropathy, one a retrohyaloid hemorrhage and one a branch retinal artery occlusion, all secondary to occlusive focal vasculitis adjacent to focal chorioretinitis. Classical neuroretinitis with macular star is not the only clinical presentation of CSD. Practitioners should screen for Bartonella henselae in all patients with papillitis or focal chorioretinitis.

The role of serological titres in the diagnosis of ocular toxoplasmosis.

The role of serological titres in the diagnosis of ocular toxoplasmosis.

Bilateral papillitis and unilateral focal chorioretinitis as the presenting features of syphilis

BackgroundSyphilis is a multisystem bacterial infection caused by Treponema pallidum. The incidence of infection in the United States has risen by more than 75% since the year 2000, when it was at a low of 2.1 per 100,000 people. Ocular involvement may occur in any stage of infection and may present in a variety of ways, with posterior uveitis being the most common manifestation. We report a case of ocular syphilis infection with an unusual presentation of bilateral non-granulomatous panuveitis with papillitis and unilateral focal chorioretinitis.FindingsThis is a retrospective case report with literature review. A 39-year-old Caucasian female presented with a 2-week history of bilateral ocular flashes and left eye pain. Dilated fundus examination revealed mild optic disc edema in both eyes, the right eye more than the left. In the left eye, there was an area of retinal elevation and whitening involving the peripheral retina. Fluorescein angiography, B-scan ultrasonography, and ocular coherence tomography were performed, and laboratory tests were ordered based on the clinical presentation. After rapid plasma reagin (RPR) and fluorescent treponemal antibody absorption (FTA-Abs) were positive, syphilitic uveitis was confirmed, and the patient was admitted for a 14-day course of high-dose intravenous penicillin G.ConclusionsThe first signs and symptoms of syphilis may be ocular, which can lead to a diagnostic challenge. A high index of suspicion is the key for early diagnosis of ocular syphilis. Prompt treatment with intravenous penicillin G is highly effective in resolving the infection.

FOCAL CHORIORETINITIS IN THAILAND

To report the clinical features of patients with focal chorioretinitis (FCR), as well as toxoplasma serology. We included 25 (4%) consecutive patients with FCR of 593 with uveitis. Controls consisted of 127 patients with posterior and panuveitis and clinical features other than FCR. Results of enzyme-linked immunosorbent assay for anti-Toxoplasma gondii immunoglobulin G (IgG) and IgM, demographic data, and clinical features of patients were registered. Positive anti-T. gondii IgG levels were observed in 21 of 25 patients (84%) with FCR in contrast to 14 of 127 patients (11%) with non-FCR (P < 0.001, Fisher test). The IgG levels >600 IU were found in 19 of 25 patients (76%) with FCR and in none of the patients with non-FCR (P < 0.001). All cases had unilateral involvement. Ocular features consisting of FCR and vitritis were present in all patients, but associated chorioretinal atrophic scars were not commonly seen (7/25 eyes; 28%). Retinal vasculitis was found in 9 of 25 eyes (36%) and affected solely the arteries. The majority of patients with FCR in Thailand exhibit highly positive anti-T. gondii IgG levels suggesting the presence of active systemic infection, which is also consistent with the absence of old scars. The absence of old scars and retinal arteritis were the features distinct from typical ocular toxoplasmosis lesions reported in the European and the U.S. series.

Chorioretinitis associated with weber-christian disease.

To report the association between Weber-Christian disease and an intraocular inflammation. Case report. We report the case of a 62-year-old woman who presented with a granulomatous panuveitis and focal chorioretinitis accompanied by systemic signs of Weber-Christian disease, which is an idiopathic relapsing nodular panniculitis, confirmed by a biopsy showing a lobular panniculitis in a nodule of the arm. The evolution was favorable under long-term oral prednisolone administration. Ocular involvement is a rare feature of Weber-Christian Disease. Neverthless, fat tissue examination should be considered in presence of an ocular inflammation of unknown origin and a skin biopsy can be helpful in this context.

Ocular Inflammatory Signs Observed in a Cohort of Spanish Patients with Behçet Disease and Ocular Inflammation

To study the clinical characteristics of a cohort of Spanish patients diagnosed with Behcet disease and who also presented ocular inflammation. Thirty cases of Behçet disease were studied retrospectively. The authors studied age distribution, distribution by sex, clinical course, laterality, type of uveitis, secondary glaucoma, corneal involvement, hypopyon, iris-lens synechiae, secondary cataract, cystoid macular edema (CME), and papillitis (optic neuritis). Fourteen of the patients were men and 16 were women (ratio 0.875:1). The mean age of the patients was 35.24 years (+/-10.917; 21-61 years). In 23 patients, the disease course was recurrent. In 9 patients, the disease manifested unilaterally. In 5 patients showing unilateral onset, the contralateral eye became affected. In 2 of the 30 patients, uveitis exclusively affected the anterior segment. In 8 patients, uveitis was solely posterior. There was one case of intermediate uveitis. The remaining 19 patients showed panuveitis. Three had focal chorioretinitis. One had diffuse chorioretinitis. Fifteen showed signs of diffuse vasculitis. Eight patients showed focal vasculitis. Women were slightly more affected than men, although the authors found no significant correlation between sex and the clinical variables examined. Apart from one unexpected case of intermediate uveitis, the observations are similar to those reported for other patient series.

Usefulness of Aqueous Humor Analysis for the Diagnosis of Posterior Uveitis

To assess the clinical usefulness of aqueous fluid analysis for the diagnosis and treatment of patients suspected of having infectious posterior uveitis (PU). Case-control study. From 2002 through 2005, 152 eyes from 152 patients with active PU (16 of whom were immunosuppressed) underwent diagnostic aqueous testing. As controls, 20 patients with Fuchs' heterochromic uveitis and 20 patients with age-related cataract were included. Aqueous samples were examined by real-time polymerase chain reaction (PCR) and by pathogen-specific analysis of intraocular antibody production (Goldmann-Witmer coefficient [GWC]) for herpes simplex virus (HSV), varicella zoster virus (VZV), cytomegalovirus (CMV), and the parasite Toxoplasma gondii. Results of aqueous analysis and any adverse effects of aqueous sampling. Correlations between the results of aqueous testing and clinical characteristics as well as the treatment of patients. Of 152 patients, 44 (29%) had positive results for at least one diagnostic assay (37/136 [28%] immunocompetent and 7/16 [44%] immunocompromised patients). None of the controls had positive results using PCR or GWC. A positive result was obtained predominantly in patients with focal chorioretinitis (37/87 [40%]) and in extensive retinitis (7/9 [78%]), whereas in multifocal chorioretinitis, neuroretinitis, and retinal vasculitis only a few samples demonstrated positive results (2/19, 1/29, and 0/10, respectively). Of 37 immunocompetent PU patients with positive results, 28 (76%) cases were caused by T. gondii, whereas viral infections were most common in immunocompromised patients (5/7 [71%]). In immunocompetent and toxoplasmosis PU patients, GWC was the most informative assay (34/37 [92%] and 28/30 [93%], respectively), in contrast to immunosuppressed patients (PCR positive in 5/7 and GWC positive in 4/7). Independent of the immune status of patients, positive PCR results were observed more frequently in viral infections than in toxoplasmosis (P<0.001). As a consequence of aqueous analysis, change of treatment was necessary in 36 patients (24%). None of the patients experienced complications during or after aqueous sampling. Despite the posterior location of inflammation, aqueous analyses with PCR and GWC for HSV, VZV, CMV, and T. gondii revealed an infectious cause in 29% of patients with PU.

Bartonella henselae as a cause of optical nerve neuritis

Bartonella henselae is included into the group of gram-negative bacteria that can cause not so rare disease known as cat-scratch disease (CSD). This disease is characterized by the specific general symptoms, and the complications in the eyes can be manifested in the form of neuroretinitis, follicular conjunctivitis and focal chorioretinitis. In this paper clinical and epidemiological characteristics of a patient with ophthalmologic complications caused by Bartonella henselae are described. We indicate diagnostic possibilities and the criteria for making the diagnosis. We presented a 42-year-old female patient with CSD symptoms, and with a registered neuritis as an ophthalmologic complication. Two weeks after the occurrence of a scratch on the hand after the contact with a cat, there was a slight lymphadenopathy of the axial area of the left side, accompanied by light febrility and weakness. A week after these symptoms occuring, the patient complained of a reduction of the visual acuity in her left eye. The established visual acuity in the left eye was 0.1 with ophthalmological findings of a light edema of the optical disk and a partial star-like edema in the nasal half of the macula. Central scotoma was present, with the extension of the blind spot and the constriction of central isopter of the left eye visual field. Fluorescein biomicroscopy revealed an intensive leaking of fluoresceins at the level of optical disk and macular region in an early arterial phase, without the appearance of pathological phenomena at the level of retinal blood vessels. With the application of doxycyline 100 mg two times a day, and systemic application of prednisolone (at the initial doses of 120 mg), after a two-week period, there was a full recovery of the visual acuity, out the optical disk edema, and the presence of light edema in the left eye macula receded. The complete disappearance of the edema in the macula was registered four weeks following the application of the therapy. Cat-scratch disease can be recognized by means of characteristic general symptoms, and it must be considered in persons with ophthalmologic picture of neuroretinitis. In spite of the good prognosis for the general condition of a patient, it is advised to apply antibiotic therapy in the cases where ophthalmologic complications appear. We recommend the application of doxycyline 100 mg two times a day, for a month. When pronounced edema of the optical disk and edema in the macula are present, a systematic application of corticosteroids is necessary.

Meningococcal group B meningitis associated with a focal chorioretinitis

Meningococcal group B meningitis associated with a focal chorioretinitis

FUNGAL RETINITIS AND ENDOPHTHALMITIS

Fungi constitute a prominent and diverse group of microorganisms. Despite their ubiquitous nature, only a limited number of fungal species produce infections of the eye, and an even smaller number cause fungal retinitis or endophthalmitis. These organisms are responsible for significant ocular morbidity, neverthe- less, and the prevalence of endogenous fungal retinitis and endophthalmitis is increasing because of the growing number of iatrogenically induced infections.87 It is practically impossible to discuss fungal retinitis separately from fungal endophthalmitis. Fungal retinitis, in most cases, is an endogenous infection that reaches the eye by way of the bloodstream. On reaching the eye, fungi usually lodge in the choroid or retina, producing choroiditis, retinitis, or chorioretinitis. When this initial focus of infection extends into the vitreous to produce inflammation, which may involve the entire internal structure of the eye, endophthalmitis results. The major causes of fungal retinitis are Candida species, Aspergillus species, Blastomyces dermatitidis, Coccidioides immitis, Cryptococcus neoformans, Histoplasma capsulatum, Pseudallescheria boydii, and Sporothrix schenckii. Although most of these organisms may produce endophthalmitis, they may also present as a focal chorioretinitis or a granuloma in the eye.87

Approach to neurodevelopmental and neurologic complications in pediatric HIV infection

Neurodevelopmental delays in infants and neuropsychologic deficits in older children have been documented in 75% to 90% of children with HIV infection. Common neurologic and/or developmental findings include15: 1. Mental and motor delays 2. Loss of previously acquired milestones 3. Acquired microcephaly 4. Progressive bilateral pyramidal tract signs 5. Short-term memory problems and attentional difficulties in older children The neurologic dysfunction in pediatric HIV infection is believed to represent an active and primary infection of the brain by HIV. In addition, factors such as in utero exposure to drugs, long-term hospitalizations, and chaotic social environments have an effect on neurologic function. HIV infection probably occurs early and is persistent. In children with perinatal infection, the clinical signs of neurologic dysfunction may appear as early as 2 months of age and as late as 5 years or longer. Although the clinical picture of progressive encephalopathy most commonly has been noted in children with documented HIV infection and symptomatic disease, it has been reported to be the initial manifestation of AIDS as well. Although the natural history of this finding is not known, longitudinal studies suggest that after a period of normal development, three distinct neurologicdevelopmental courses can be followed1: rapid progression; steady, subacute progression; or stepwise decline with relatively stable periods. In the last category, it has been well documented that some pediatric HIV-infected patients experience an indolent course with variable periods of time during which no new milestones are acquired but without the loss of attained milestones. Other presentations of neurologic disease may be related to opportunistic infection or central nervous system tumors. Reactivated latent or opportunistic infections and primary lymphoma of the brain are not so common in HIV-infected children as in adults. They do occur, however, and should be watched for. Tuberculosis, toxoplasmosis, and cytomegalovirus are the most common opportunistic infections. Clinical manifestations are varied; patients often have focal neurologic signs, seizures, or chorioretinitis. Children with HIV infection can develop neurologic illness, as can any other child. Thus clinical suspicion of nonHIV-related neurologic disease should be fully assessed and appropriately managed by accepted pediatric neurology standards. In addition, many of the children at risk for HIV infection are also at risk for developmental delays and deficits by virtue of the fact that they have been exposed to drugs in utero and are growing up in deprived social environments.

ENZYME‐LINKED IMMUNOSORBENT ASSAY (ELISA) FOR SEROLOGICAL DIAGNOSIS OF TOXOPLASMIC CHORIORETINITIS

To make a definite serological diagnosis of ocular toxoplasmosis we determined the ratio of toxoplasma IgG antibody levels in the aqueous humour and serum by using a new four‐layer modification of ELISA, and the ratio of total IgG in serum and aqueous by using single redial immunodiffusion plates. We used the product of these ratios as a coefficient (C) to characterize the antibody activity in aqueous as compared with that of serum. The C value was close to 1 (below 3.5) in seropositive normal cataract patients. In patients with recurrent active focal chorioretinitis the C value was elevated indicating intraocular antibody production; in other forms of posterior uveitis the C value was normal. Parallel determination of mumps virus IgG antibody levels in aqueous and serum confirmed without IgG determination the intraocular toxoplasma antibody production. This test is valuable if the aetiology of the fundal lesion is in doubt.

Experimental hematogenous endophthalmitis caused by Candida albicans.

For a rabbit model of hematogenous endophthalmitis caused by Candida, 80 New Zealand white rabbits were given intravenous injections of 10-5 Candida albicans. Two weeks after infection 88 percent of infected rabbits had ocular lesions with clinical appearance identical to that of human lesions. Cultures of the chorioretina and kidneys averaged 10-4.3 and 10-3.9 organisms per g of tissue, respectively, three days after infection and remained positive for 38 days. Ninety-five percent of rabbits with positive cultures of the chorioretina had positive cultures from other organs. The ocular lesions were focal chorioretinitis characterized by a combination of granulomatous and acute suppurative reactions. Hematogenous endophthalmitis caused by Candida in the rabbit is a useful model for study of the pathogenesis and treatment of the disease in humans.