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Smith LM, Ismail OM, Mojica G. Ocular Manifestations of Herpes Simplex Virus in the Pediatric Population. Int Ophthalmol Clin 2022; 62:73-81. [PMID: 34965227 DOI: 10.1097/iio.0000000000000394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Abstract
Herpes simplex keratitis, caused primarily by human herpes simplex virus type 1 (HSV-1), remains the most common infectious cause of unilateral blindness and vision impairment in the industrialized world. Major advances in the care of HSV keratitis have been driven in large part by the landmark Herpetic Eye Disease Study randomized clinical trials, which were among the first in ophthalmology to reflect emerging trial conventions, including multicenter subject enrollment, double-masking, placebo controls, and a priori sample size determinations. The results of these trials now form much of the evidence basis for the management of this disease. However, management patterns in clinical practice often deviate from evidence-based care. These perceived quality gaps have given rise to the evolving field of implementation science, which is concerned with the methods of promoting the application of evidence-based medicine within routine care. To overcome variations in the quality and consistency of care for HSV keratitis, a range of clinical- and technology-based innovations are proposed. The most pressing needs include the following: a rational and tractable disease classification scheme that provides an immediate link between the anatomical localization of disease (corneal epithelial, stromal, or endothelial) and the appropriate treatment, and the actualization of an electronic medical record system capable of providing evidence-based treatment algorithms at relevant points of care. The latter would also input data to population-wide disease registries to identify implementation-rich targets for quality improvement, education, and research. These innovations may allow us to reduce the human and economic burdens of this highly morbid, and often blinding, disease.
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Abstract
Ocular diseases associated with atopic dermatitis (AD) may be sight-threatening. A general understanding of the pathophysiology, diagnosis, and treatment of atopic eye disease may assist dermatologists in knowing when to refer to ophthalmology and in co-managing these diseases with ophthalmologists. Ocular diseases associated with AD include eyelid dermatitis, keratoconjunctivitis, keratoconus, cataract, and retinal detachment. AD patients are also at higher risk for bacterial and viral ocular infections. The objective of this article is to provide a current review of ocular diseases that commonly affect AD patients. The pathogenesis, clinical manifestations, diagnosis, and treatment of ocular co-morbidities of AD will be discussed.
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Hsu DY, Shinkai K, Silverberg JI. Epidemiology of Eczema Herpeticum in Hospitalized U.S. Children: Analysis of a Nationwide Cohort. J Invest Dermatol 2017; 138:265-272. [PMID: 28927889 DOI: 10.1016/j.jid.2017.08.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/28/2017] [Accepted: 08/30/2017] [Indexed: 01/31/2023]
Abstract
Eczema herpeticum (EH) is characterized by viral infection of a preexisting inflammatory dermatosis and is associated with considerable morbidity. In this cross-sectional study, we sought to determine the incidence, risk factors, comorbidities, costs of care, length of stay, and mortality in hospitalized U.S. children with EH. The Nationwide Inpatient Sample 2002-2012, containing a 20% sample of all U.S. hospitalizations, was analyzed. We used a validated approach involving InternationalClassification of Diseases, Ninth Revision-Clinical Modification codes to identify patients primarily admitted for EH (n = 4,655 weighted). The mean annual incidence of hospitalization for EH per million children ranged from 4.03 to 7.30, increasing significantly from 2008 to 2012. EH was associated with younger age (odds ratio [95% confidence interval] for 3-4 years = 1.29 [1.02-1.64]) and nonwhite race/ethnicity (black = 2.93 [2.35-3.66], Asian= 4.41 [3.34-5.83], Native American = 2.96 [1.51-5.78]) but was less likely to occur in areas with lower income quartiles (quartile 1, 0.66 [0.53-0.84]; quartile 2, = 0.68 [0.54-0.87]; quartile 3, 0.70 [0.56-0.88]). EH was associated with atopic dermatitis (11.72 [9.48-14.49]). Increased length of stay and costs of care were associated with Asian race. Mean length of stay was 3.86 ± 0.09 days, and mean cost of care was $5,237.6 ± 160.6. Overall mortality was 0.1%. EH in hospitalized children poses a substantial burden to the health care system.
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Affiliation(s)
- Derek Y Hsu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kanade Shinkai
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Jonathan I Silverberg
- Departments of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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Palioura S, Kymionis G. Corneal neovascularization in childhood keratitis. EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1379900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sotiria Palioura
- Athens Vision Eye Institute, Cornea Service, Athens, Greece
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - George Kymionis
- Jules Gonin Eye Hospital, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Ophthalmology, ‘Gennimatas Hospital’, National and Kapoditrian University of Athens, Athens, Greece
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Liu S, Pavan-Langston D, Colby KA. Pediatric Herpes Simplex of the Anterior Segment. Ophthalmology 2012; 119:2003-8. [DOI: 10.1016/j.ophtha.2012.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 05/03/2012] [Accepted: 05/03/2012] [Indexed: 10/28/2022] Open
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Wilde C, Sheehan W, Shepherdson A, Patwardhan A. Disseminated mucocutaneous herpes simplex in an atopic individual. JRSM SHORT REPORTS 2011; 2:80. [PMID: 22046499 PMCID: PMC3205555 DOI: 10.1258/shorts.2011.010085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- C Wilde
- Ophthalmology Department, Royal Cornwall Hospital, Truro, Cornwall, UK
| | - W Sheehan
- Ophthalmology Department, Torbay Hospital, Torquay, Devon, UK
| | | | - A Patwardhan
- Ophthalmology Department, Royal Cornwall Hospital, Truro, Cornwall, UK
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Bilateral herpes simplex keratitis with unilateral secondary bacterial keratitis and corneal perforation in a patient with pityriasis rubra pilaris. Cornea 2009; 27:1212-4. [PMID: 19034146 DOI: 10.1097/ico.0b013e318180f0a8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report a case of bilateral herpes simplex keratitis with unilateral secondary bacterial keratitis resulting in corneal perforation in a patient with pityriasis rubra pilaris. METHODS Case report. RESULTS A 77-year-old female with pityriasis rubra pilaris was referred for a perforated corneal ulcer of the left eye. Cultures were positive in both eyes for Herpes simplex and in the left eye for Pseudomonas fluorescens and Staphylococcus aureus A microbiological cure was obtained with a combination of tectonic keratoplasty, fortified topical antibiotics, and systemic acyclovir. CONCLUSIONS Pityriasis rubra pilaris is a rare, inflammatory dermatologic disease that may predispose patients to bilateral Herpes simplex keratitis, secondary bacterial superinfection, and a tendency toward rapid stromal ulceration with risk of perforation.
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Rezende RA, Bisol T, Hammersmith K, Hofling-Lima AL, Webster GF, Freitas JF, Rapuano CJ, Laibson PR, Cohen EJ. Epithelial herpetic simplex keratitis recurrence and graft survival after corneal transplantation in patients with and without atopy. Am J Ophthalmol 2007; 143:623-8. [PMID: 17276382 DOI: 10.1016/j.ajo.2006.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2006] [Revised: 12/03/2006] [Accepted: 12/04/2006] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare the incidence of herpes simplex virus (HSV) epithelial recurrence and graft survival after penetrating keratoplasty (PK) in patients with and without self-reported atopy. DESIGN Retrospective cohort comparative study. METHODS SETTING Cornea Service, Wills Eye Hospital. STUDY POPULATION Patients who presented with previously diagnosed ocular HSV between March 2003 and March 2004 and who underwent primary PK for ocular HSV at the Cornea Service. From the 58 patients invited, 49 patients (50 eyes) were included. Nine patients were ineligible in accordance with the exclusion criteria: no active classic HSV episode before PK, immunosuppression, less than one year of follow-up, previous history of PK before presentation at the Service. Eligible patients filled out a questionnaire regarding their history of atopic disease, considering: presence of allergic rhinitis, asthma, or atopic dermatitis. Ocular history was obtained through chart review. main outcome measures: Incidence of epithelial HSV recurrences and corneal graft survival in both groups. RESULTS Each group (atopic and nonatopic) included 25 eyes. The atopic patients had a mean incidence of 0.07 episode/eye year (SD +/- 0.9) compared with 0.12/eye year (standard deviation [SD] +/- 0.21) in the nonatopics (P = .002). At 10 years of follow-up, the survival rate in the atopics was of 92% and in the nonatopics was of 79% (P = .88). CONCLUSIONS Nonatopics had significantly more epithelial recurrences after PK compared to atopics; however, both groups presented low incidences of recurrences and high graft survival rates.
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Affiliation(s)
- Renata A Rezende
- Department of Ophthalmology, Federal University of Sao Paulo (UNIFESP), R. Botucatu, Spain, Brazil
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Hwang JS, Wee WR, Lee JH, Kim MK. Clinical Analysis of Herpetic Keratitis in Korea. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2007. [DOI: 10.3341/jkos.2007.48.9.1212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Joon Seo Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
| | - Won Ryang Wee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
| | - Jin Hak Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Bundang Hospital, Gyeonggi, Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
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Rezende RA, Bisol T, Hammersmith K, Rapuano CJ, Lima ALH, Webster GF, Freitas JF, Laibson PR, Cohen EJ. Efficacy of oral antiviral prophylaxis in preventing ocular herpes simplex virus recurrences in patients with and without self-reported atopy. Am J Ophthalmol 2006; 142:563-7. [PMID: 17011845 DOI: 10.1016/j.ajo.2006.05.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2005] [Revised: 04/05/2006] [Accepted: 05/10/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To compare the efficacy of oral antiviral prophylactic treatment for herpes simplex virus (HSV) recurrences in patients with and without self-reported atopy. DESIGN Retrospective cohort comparative study. METHODS setting: Cornea Service, Wills Eye Hospital. study population: Patients who presented with previously diagnosed ocular HSV between March 2003 and March 2004. From 244 patients invited, 54 patients (58 eyes) were included. One hundred and ninety patients were excluded according to exclusion criteria: no active episode during follow-up, immunosuppression, less than one year of follow-up, or previous history of penetrating keratoplasty. The Questionnaire regarding history of atopic disease, considers: presence of allergic rhinitis, asthma or atopic dermatitis, and chart review of ocular history. main outcome measures: Incidence of all types of HSV recurrences with and without antiviral prophylaxis within each group and between groups. HSV episodes were classified into infectious, inflammatory, and mixed for analysis. RESULTS Atopic/nonatopic (P value): mean follow-up without prophylaxis 8.1 (+/- 8.2)/7.3 years (+/- 8.6) (P = .71); mean follow-up with prophylaxis 2.9 (+/- 2.3)/2.6 years (+/- 2.2) (P = .51); the effect of prophylaxis significantly reduced the all recurrences in both groups except in the inflammatory recurrences in the atopic group and in the mixed recurrences in both groups. Prophylaxis decreased infectious episodes by 44% in nonatopic and 76% in atopics and decreased inflammatory manifestations by 69% in the nonatopic group and 8% in the atopic group. CONCLUSION Antiviral prophylaxis for HSV recurrences was more effective in reducing infections in atopics and less effective in reducing inflammatory episodes in atopics versus nonatopics.
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Affiliation(s)
- Renata A Rezende
- Cornea Service, Wills Eye Hospital, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Abstract
Eczema herpeticum is an acute, disseminated herpes simplex virus infection which remains a feared complication of eczematous skin diseases, especially atopic dermatitis. The vesicular and erosive clinical picture is often accompanied by systemic signs and symptoms. Why some atopic patients experience multiple attacks of eczema herpeticum and others never have the disorder remains a mystery. Patients with severe or untreated atopic dermatitis are more likely to be affected. The pathogenesis appears to involve a complex interplay of factors, including demasking of binding sites for the virus through the dermatitis, failure to up-regulate antiviral proteins and a lack of plasmacytoid dendritic cells. Treatment of choice is systemic acyclovir therapy.
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Affiliation(s)
- H C Rerinck
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, Frauenlobstrasse 9-11, 80337 München
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Rezende RA, Hammersmith K, Bisol T, Lima ALH, Webster GF, Freitas JF, Rapuano CJ, Laibson PR, Cohen EJ. Comparative study of ocular herpes simplex virus in patients with and without self-reported atopy. Am J Ophthalmol 2006; 141:1120-1125. [PMID: 16765682 DOI: 10.1016/j.ajo.2006.01.072] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2005] [Revised: 01/18/2006] [Accepted: 01/20/2006] [Indexed: 11/23/2022]
Abstract
PURPOSE To compare the characteristics of ocular herpes simplex virus (HSV) in patients with and without atopy. DESIGN Retrospective cohort comparative study. METHODS Patients who presented at the Cornea Service, Wills Eye Hospital, between March 2003 and March 2004 who had been previously diagnosed in the same institution as having ocular HSV diagnosis or were just diagnosed as having the disease were asked to complete a study questionnaire that enabled categorization into atopic and nonatopic. In April 2005, 223 patients who agreed to be in the study had their charts reviewed, and 125 patients were excluded according to exclusion criteria: immunosuppression, follow-up less than one year, previous history of penetrating keratoplasty (PK) out of the Cornea Service, and no active HSV episode during follow-up. MAIN OUTCOME MEASURES Incidence of all types of HSV recurrences. SECONDARY OUTCOME MEASURES Bilaterality, visual loss, need for PK , and secondary bacterial infection in both groups. HSV episodes were classified into infectious, inflammatory, and mixed for analysis. RESULTS Ninety eight patients (110 eyes) were included in the study. Atopic/nonatopic (P value): the mean follow-up was 11.6 (+/- 10.6)/8.8 years (+/- 8.4) (P = .14); the mean incidence of HSV episodes per year of follow-up was: total episodes 0.32 (+/- 0.36)/0.28 (+/- 0.33) (P = .14), infectious 0.16 (+/- 0.22)/0.10 (+/- 0.14) (P < .01), inflammatory 0.11 (+/- 0.19)/0.11 (+/- 0.19) (P < .01), and mixed 0.09 (+/- 0.20)/0.07 (+/- 0.16) (P = .06); bilateral HSV was present in 9/3 patients (P = .22); the mean loss of vision was four lines of Snellen in both groups; PK was performed in 14 of 16 eyes (P = .45); secondary bacterial infection was present in two of four eyes (P = .26). CONCLUSIONS Atopic patients had considerably more infectious and fewer inflammatory episodes when compared with nonatopics.
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Affiliation(s)
- Renata A Rezende
- Department of Ophthalmology, Federal University of Sao Paulo (UNIFESP), Brazil.
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Santmyire-Rosenberger BR, Nigra TP. Psoriasis herpeticum: Three cases of Kaposi's varicelliform eruption in psoriasis. J Am Acad Dermatol 2005; 53:52-6. [PMID: 15965420 DOI: 10.1016/j.jaad.2005.01.140] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Kaposi's varicelliform eruption (KVE), first described in 1887 by Moritz Kaposi, refers to a disseminated cutaneous infection with herpesvirus type 1 or 2, vaccinia virus, or coxsackievirus A16 in a patient with another underlying dermatosis. When herpesvirus type 1 or 2 is the pathogenic virus, the term "eczema herpeticum" is used, independent of the underlying dermatologic diagnosis that preceded the eruption. KVE is most often seen in patients with underlying atopic dermatitis, but has also been seen in association with other papulosquamous and acantholytic disorders. However, eczema herpeticum rarely occurs in patients with psoriasis. OBSERVATIONS We present the clinical and laboratory findings of three patients in whom KVE developed during inpatient hospitalization for a psoriatic flare. These patients each had comorbidities that may have increased susceptibility to KVE. CONCLUSIONS KVE may rarely occur in patients with psoriasis. Erythroderma, systemic sepsis, therapy with immunosuppressant drugs, such as methotrexate and systemic steroids, and therapy with systemic retinoids may possibly increase susceptibility to KVE.
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Abstract
A learning module based around the case of a man with ezema who presents with a rash around his ear and eye. Test your knowledge with our online quiz
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Abstract
Approximately 70% of the population in the western world become infected with the herpes simplex virus type 1 (HSV-1) by the second decade of life. This review discusses the role of the HSV-1 as a potential occupational hazard for dental workers, focusing on herpes labialis, herpetic whitlow and keratitis. The risks associated with the dental treatment of patients with HSV-1, both from the perspective of the clinician and the patient are presented. Procedures for minimising the impact of HSV-1 within the dental practice, in particular infection control, delivery of treatment and patient education, are addressed. The management options for recurrent herpes labialis are also reviewed.
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Affiliation(s)
- M A O Lewis
- Dental School, University of Wales College of Medicine, Cardiff, UK.
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Abstract
PURPOSE To review the clinical characteristics and visual outcomes of patients with bilateral herpetic keratitis. DESIGN Retrospective, noncomparative, observational case series. PATIENTS AND METHODS A retrospective review of medical records of 544 patients with herpes simplex virus (HSV) eye disease treated between January 1996 and September 2001 was performed at the Department of Ophthalmology, University of Minnesota. Seven patients (1.3%) with bilateral herpetic keratoconjunctivitis were identified. RESULTS In these seven patients, the age at the initial onset of corneal disease ranged from 7 weeks to 46 years, with a median of 18 years and a mean of 19.3 years. Five patients had systemic atopy, and two patients had severe ocular rosacea. Systemic immune disorders were noted in two patients. Recurrent blepharoconjunctivitis was noted in 8 eyes (57%), epithelial keratitis in 12 eyes (85.7%), stromal keratitis in 9 eyes (64.3%), necrotizing stromal keratitis in 5 eyes (35.7%), and progressive endotheliitis in 2 eyes (14.2%). Corneal complications included opacification, neovascularization, and corneal thinning or perforation. Penetrating keratoplasty was performed in 1 eye, in which endophthalmitis subsequently developed and which required enucleation. Four patients with continued use of oral antiviral prophylaxis (acyclovir 400 mg twice daily) since September 1999 showed significant decreases in recurrence. The average remission in these four patients was 1.7 years. The visual acuity at the last follow-up was 20/40 or worse in 6 eyes (42.8%). CONCLUSIONS In contrast to unilateral HSV keratitis, our patients with bilateral herpetic corneal infections had underlying atopy or immune deviations and evinced more protracted clinical courses. Long-term prophylactic antiviral treatment has reduced the incidence of recurrence in this group of patients.
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Affiliation(s)
- Paula Márcia F Souza
- Department of Ophthalmology, University of Minnesota, 516 Delaware Street SE, Minneapolis, MN 55455, USA
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Affiliation(s)
- Yoshitsugu Inoue
- Department of Ophthalmology, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka, Japan 565 0871
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Abstract
PURPOSE To review the changing epidemiology of herpes simplex disease and correlate it with the epidemiology of ocular herpes simplex disease. METHOD A review of pertinent reports in the world literature about the epidemiology of herpes simplex and specifically about ocular herpes simplex. RESULTS In developed countries, many individuals are reaching adolescence and adulthood without prior herpesvirus infection. Herpes simplex genital infection is increasing at a rapid rate in sexually active adolescents and adults, with about one in six adults now infected in the United States. Similar statistics are confirmatory worldwide in developed countries. Active herpes simplex infection is a risk factor for acquisition of human immunodeficiency virus. The Herpetic Eye Disease Study, as well as prior studies from Moorfields Eye Hospital and the Mayo Clinic in Rochester, Minnesota, provides us with the epidemiology of ocular herpes simplex. Recent studies suggest an older age of onset and perhaps overall more severe ocular disease as compared with the older literature. CONCLUSIONS Herpes simplex is a significant health concern at present with genital infections increasing in epidemic proportions. This is also reflected in a rise in the incidence of neonatal herpes. Herpes simplex virus type 1 (HSV-1) infection is being acquired for the first time in an older age group. A significant and increasing proportion of genital herpes is caused by HSV-1. Serologic studies are no longer as useful in distinguishing orofacial herpes from genital herpes. More acute retinal necrosis syndrome cases are associated with HSV-2. Speculation about the future of ocular herpes is made based on this changing epidemiology.
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Affiliation(s)
- T J Liesegang
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida 32224, USA.
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Yao YF, Inoue Y, Kase T, Uchihori Y, Mori Y, Ohashi Y. Clinical characteristics of acyclovir-resistant herpetic keratitis and experimental studies of isolates. Graefes Arch Clin Exp Ophthalmol 1996; 234 Suppl 1:S126-32. [PMID: 8871163 DOI: 10.1007/bf02343061] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND We treated two patients with dendritic keratitis that did not respond to acyclovir (ACV) ointment therapy. Their systemic immune status was normal: however, one patient had a long history of atopic disease and the other had previously undergone topical corticosteroid treatment. HSV-1 was isolated from the patients and inoculated into animals to investigate its viral pathogenicity and latent infection. METHODS HSV-1 isolates from the patients were tested for drug sensitivity to acyclovir, ganciclovir, idoxuridine, trifluridine, foscarnet and interferon-beta in vitro. In in vivo studies, bilateral corneas of two New Zealand white rabbits and 10 BALB/c mice in each of four groups were infected by the respective viral isolates. The extent of corneal epithelial and/or stromal lesions produced by the viruses was evaluated. The trigeminal ganglial tissues of the mice were examined for viral latent infection by co-culture with Vero cells. RESULTS Herpetic keratitis in both patients was characterized by prolonged clinical course, succeeded by various types of corneal lesions and ocular complications. In in vitro studies, the two HSV-1 isolates demonstrated cross-resistance to ACV, ganciclovir and/or idoxuridine. Both strains demonstrated weakly virulent corneal epithelial and/or stromal lesions in rabbits and mice. One isolate displayed delayed advent but prolonged course of epithelial lesions in rabbits. The latent infection incidences of the isolates in mice trigeminal ganglia were 6.25% (1/16) and 0% (0/18) respectively. CONCLUSION Topical immune depression may induce ACV-resistant HSV-1 infection in the cornea, with a prolonged course in association with ocular complications. The prolonged infectious course of the viral isolates in the animal study partially supported the clinical demonstrations in the patient. The existence of latent infection by one ACV-resistant HSV-1 in its animals may indicate the possibility of its recurrence. Trifluridine may be an alternative choice for treating corneal epithelial lesions caused by ACV-resistant HSV-1.
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MESH Headings
- Acyclovir/pharmacology
- Acyclovir/therapeutic use
- Administration, Topical
- Adult
- Animals
- Antiviral Agents/pharmacology
- Antiviral Agents/therapeutic use
- Cornea/drug effects
- Cornea/innervation
- Cornea/virology
- Culture Techniques
- Disease Models, Animal
- Drug Resistance, Microbial
- Fluorescent Antibody Technique, Indirect
- Herpesvirus 1, Human/drug effects
- Herpesvirus 1, Human/isolation & purification
- Herpesvirus 1, Human/pathogenicity
- Humans
- Idoxuridine/pharmacology
- Idoxuridine/therapeutic use
- Keratitis, Dendritic/drug therapy
- Keratitis, Dendritic/pathology
- Keratitis, Dendritic/virology
- Male
- Mice
- Mice, Inbred BALB C
- Microbial Sensitivity Tests
- Ointments
- Rabbits
- Trigeminal Ganglion/drug effects
- Trigeminal Ganglion/pathology
- Trigeminal Ganglion/virology
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Affiliation(s)
- Y F Yao
- Department of Ophthalmology, Osaka University Medical School, Japan
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Affiliation(s)
- V N Sehgal
- Department of Dermatology and Venereology, Lady Hardinge Medical College and Associated SK and KSC Hospital, New Delhi, India
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Higgins CR, Schofield JK, Tatnall FM, Leigh IM. Natural history, management and complications of herpes labialis. J Med Virol 1993; Suppl 1:22-6. [PMID: 8245888 DOI: 10.1002/jmv.1890410506] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Infection with herpes simplex virus (HSV) is a common worldwide problem. Primary infection with HSV-1 rarely causes significant problems although widespread involvement in atopic eczema can be life-threatening as may associated encephalitis. Keratoconjunctivitis, pharyngitis and hepatitis can also complicate primary infection. Twenty to 40% of the population at some stage have recurrent orolabial infections with HSV although in only 1% of these cases is this recurrence severe. Recurrent erythema multiforme appears to be associated with HSV-65% of patients are thought to have preceding herpes labialis. Many primary and recurrent infections with HSV-1 require little more than topical antiseptic therapy to control secondary infection. Systemic acyclovir, however, is indicated in various situations including complicated primary infection, infection in neonates, eczema herpeticum, HSV infections in the immunocompromised, and recurrent erythema multiforme. In the latter, prophylactic treatment with 6 months acyclovir appears to be effective.
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Affiliation(s)
- C R Higgins
- Department of Dermatology, Royal London Hospital, England
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Abstract
Over the past two decades, the recognition of viral enzymes and proteins that can serve as molecular targets of drugs has revolutionized the treatment of viral infections. Beginning with acyclovir, a number of systemically administered agents which are both relatively safe and effective for the treatment of herpetic infections and human immunodeficiency virus (HIV) infections have become widely available. Because of increased numbers of herpes virus infections, as well as the rising epidemic of HIV infections, the ophthalmologist is, more likely than ever before to be involved in the treatment of severe and frequent ocular infections caused by herpes viruses. In addition, the acute retinal necrosis (ARN) syndrome has been demonstrated to be caused by herpes viruses and a once rare retinal infection caused by cytomegalovirus is common in patients with the acquired immunodeficiency syndrome (AIDS). In this article, four systemic antiviral drugs (Vidarabine, Acyclovir, Ganciclovir, and Foscarnet) that have demonstrated usefulness in the treatment of ophthalmic disease are reviewed in detail with regard to their mechanisms, applications, effectiveness, and side effects.
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Affiliation(s)
- S A Teich
- Department of Ophthalmology, Mount Sinai School of Medicine, New York, New York
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