Disseminated herpes simplex infection with retinitis in a renal allograft recipient

An immunosuppressed recipient of a renal allograft developed bilateral necrotizing retinitis. Disseminated herpes simplex infection was documented by clinical findings and serologic and viral culture studies. Cultures and serologic tests for cytomegalovirus were negative. The evidence strongly favored the diagnosis of herpes simplex retinitis. Tapering of immunosuppressive drugs and administration of adenine arabinoside appeared to halt temporarily the progression of the disease in one eye and resulted in healing of the retinitis in the other eye. Subsequent progression of the more severely involved right eye resulted in an exudative retinal detachment and loss of vision prior to the patient's death from meningoencephalitis. Herpes simplex retinitis must be considered in the differential diagnosis of necrotizing retinitis in an immunosuppressed patient.

The role of herpesvirus type 1 thymidine kinase in experimental ocular infections

Herpesvirus type 1 thymidine-kinase-negative mutants are readily selected for in tissue culture and in humans by acyclovir, a promising antiviral agent. We investigated the ocular pathogenicity of thymidine-kinase-negative mutants in the rabbit. The natural course of untreated keratitis induced by the herpesvirus type 1 thymidine-kinase-negative strain was characterized by superficial dendrites and geographic ulcers that healed spontaneously without loss of corneal clarity. We also studied the relationship between herpesvirus type 1 thymidine-kinase activity and virulence in the rabbit with three strains of herpesvirus type 1: NIH thymidine-kinase-positive (100% thymidine-kinase activity), NIH thymidine-kinase-intermediate (25% thymidine-kinase activity), and NIH thymidine-kinase-negative (0% thymidine-kinase activity). Despite comparable ocular titers, the NIH thymidine-kinase-positive strain proved to be the most virulent, causing significantly (P less than .002) more keratitis, encephalitis, and death than the other strains.

Herpetic corneal ulcer following radial keratotomy

This is a report of a 30-year-old woman who had a herpetic corneal ulcer following radial keratotomy. Clinical applications of the results of this case reveal the following questions. (1) Can antiviral metabolites be used to prevent corneal scars, especially in the visual axis? (2) Should radial keratotomy be avoided during the vulnerable menstrual cycle period of females to prevent possible triggering of a herpetic ulcer regardless of previous herpes history?

Herpetic whitlow and ocular infection

Herpes simplex virus can involve the mouth, nose, or skin in addition to the eye. A very rare form of herpes simplex involves the fingertips (herpetic whitlow) and can be a source of diagnostic confusion. Herpes simplex can be spread by direct contact from any of these sites to the eye by cross-infection or autoinoculation. The ophthalmologist should be aware of the nonocular forms of herpes simplex.

Herpes Simplex keratitis: epidemiologic aspects

Review of medical records of 141 patients with acute epithelial herpes simplex keratitis (HSK) showed that recurrences, but not initial episodes, were more likely to happen from November through February than during other months of the year (P less than .04). Other findings included a high male to female ratio in patients older than 40 years of age (1.67:1.0; P less than .03) and a median time interval between episodes (in patients with recurrent disease) of 1.5 years. Although we identified no risk factors for frequent recurrences or for severe disease, our data support the hypothesis that nonherpetic viral respiratory infections may trigger recurrences of HSK.

Ocular disease pattern induced by herpes simplex virus is genetically determined by a specific region of viral DNA

The pattern of ocular disease produced in the rabbit eye by HSV-1 (F) and HSV-1(MP) strains and recombinants F(MP)A, F(MP)B, F(MP)C, F(MP)D, F(MP)E, and F(MP)F was studied. The characteristics of ocular herpetic disease such as morphology of dendritic ulcers, severity of epithelial disease and incidence and duration of stromal disease produced in the rabbit eye are genetically determined by the virus strain. Our studies show that transfer of a defined part of the genome of the stromal disease-producing virus, HSV-1(MP), to the genome of an epithelial disease-producing virus, HSV-1(F), yielded recombinants with one or more of the disease characteristics of the donor strain. Specifically, recombinant F(MP)D produced lesions characteristic of the donor HSV-1(MP) strain; recombinants F(MP)C and F(MP)E produced stromal disease approaching the severity of the disease produced by the donor HSV-1(MP) strain, and only recombinants F(MP)A and F(MP)B retained the typically elongate lesions of the recipient HSV-1(F), whereas the recombinant strain F(MP)F produced no disease. The viral functions pertaining to the ocular disease pattern map between 0.70 and 0.83 map units in HSV-1 DNA within the BglII F DNA fragment. The pattern of stromal disease is independent of the production of glycoprotein C and fusion of HEp-2-infected cells. The functions relating to these aspects of ocular disease segregate but are closely linked.

Pseudodendritic keratitis and systemic tyrosinemia

Three children (6 eyes) with systemic tyrosinemia who presented with a diagnosis of herpes simplex keratitis are described. Two of the patients underwent extensive treatment for herpes simplex keratitis until their defects in tyrosine metabolism were discovered. All three children responded favorably to a low-tyrosine diet. These cases illustrate the typical corneal findings of the Richner-Hanhart syndrome (pseudodendritic keratitis, hyperkeratotic skin lesions of the palms and sole without mental retardation). The findings in these three patients were similar to those cases previously reported in the literature except none had mental retardation. The ophthalmologist confronted with a young child with bilateral dendritiform keratitis should request evaluation of the serum tyrosine levels.

Herpes simplex keratitis in renal transplant recipients

Herpes simplex epithelial keratitis developed in four renal transplant recipients while they were receiving high-dose systemic corticosteroid and immunosuppressive therapy. In all cases the presentation was atypical, and in two cases the course was protracted, leading to some visual loss from corneal scarring and opacification. With the immunocompromised patient it is important to seek early ophthalmologic consultation when even minor ocular symptoms develop.

Unilateral inferior altitudinal hemianopsia, Argyll Robertson pupil and dendritic keratitis in a young patient with herpes zoster

The authors describe a young patient with herpes zoster and discuss the etiopathogenesis of the complications which included unilateral inferior altitudinal hemianopsia, Argyll Robertson pupil and dendritic keratitis.

Herpes infections in the immunosuppressed host

Very recent studies indicate that a primitive immune system plays an important role in resisting herpesvirus infections in the mouse. This system appears to be reflected by the NK cell assay and preliminary data suggest that this test reflects resistance in man to herpesvirus infections. We propose that ths system may be responsible for resistance to reactivated herpesvirus infections and its suppression might result in clinically apparent disease. Studies in our laboratory are currently aimed at evaluating this possibility.

Endogenous dissemination of genital Herpesvirus hominis type 2 to the eye

A 33-year-old man developed Herpesvirus hominis type 2 (HVH-2) eye disease following a herpetic lesion of the penis. The sequence of ocular involvement suggested that the virus had been transmitted endogenously from the genital lesion: granulomatous iritis was followed by interstitial keratitis and then by dendritic keratitis. Recurrent bacterial ulcers ultimately required a conjunctival flap. The course of this man's ocular disease as well as those of other reported cases of HVH-2 adult eye infections appeared to be more severe and prolonged than that of the average patient with ocular herpes type 1 infection.

Steroids' effects on the infectious corneal ulcer

Since the introduction of corticosteroids into the ophthalmic field, the side effects of steroids in inducing cataracts and glaucoma have been well discussed. This drug family has also changed the etiology and invasiveness of corneal ulcers and has been responsible for many cases of corneal complications. The purpose of this paper is to summarize the clinical manifestations of infectious corneal ulcers and the effects that steroids have on their etiology, course and prognosis.

Varicella dendritic keratitis

A 7-year-old boy and a 3-year-old girl suffered from unilateral disciform keratitis and iritis associated with varicella. While they were treated with topical corticosteroid, idoxuridine, and atropine drops, dendritic lesions typical of herpes zoster appeared four months after the onset of eruptive skin lesions. Using the direct immunofluorescent method, we showed varicella-zoster virus antigen in the epithelial cells scraped from the dendritic lesion.

Keratitis dendritica. An epidemiological investigation

One hundred and seven outbreaks of dendritic keratitis have been registered by the ophthalmologists over a 2-year-period in a region with a population of approximately 446 000 persons. The incidence was found to be 12/100 000/year. The average age of our sample was 46.5 years with the same age distribution for males and females, and with a non-significant predominance of males. No seasonal variation of dendritic keratitis was observed. 50% of the patients had previously suffered from dendritic keratitis. In 25% of the patients the onset of the disease had been preceded by an infectious disease, while 6% were on local steroid therapy for non-dendritic eye diseases prior to the dendritic outbreak.