Rapid viral diagnosis

Diagnosis and therapy of herpes zoster ophthalmicus

Studies in the basic and clinical sciences have yielded new information about the biology, infection, latency, and recurrence of the varicella-zoster virus. Contrast is made with the herpes simplex virus. The host-viral relationship is an extremely dynamic one with clinical disease being determined primarily by the host cellular immune system. The complications of herpes zoster ophthalmicus are related to multiple mechanisms including viral growth, vascular and neural damage, and the host-immune response to infection. There are several laboratory tests available for confirming the diagnosis or determining the immune status. Systemic acyclovir administered early in the course alleviates many of the symptoms of herpes zoster ophthalmicus. Acute and postherpetic neuralgia remain significant and enigmatic problems; an update of therapeutic options is offered. The role of corticosteroids in herpes zoster ophthalmicus is scrutinized along with the potential and uncertainties of a varicella-zoster virus vaccine.

Chronic hepatitis B virus infection. Viral replication and patterns of inflammatory activity: serological, clinical and histological correlations

We have studied serum and tissue markers of viral replication in 39 patients with chronic hepatitis B virus (HBV) infection and correlated these with periportal and lobular activity in liver biopsies. HBV DNA positivity correlated with the presence of hepatitis B e antigen (HBeAg, P less than 0.001) and aspartate transaminase (AST) levels (P less than 0.005). The lobular but not the periportal inflammatory activity was significantly associated with the presence of HBV DNA (P less than 0.02) and HBeAg (P less than 0.001) and with higher AST levels. The periportal activity correlated with the periportal and lobular display of beta 2-microglobulin on hepatocytes (P less than 0.001 and P less than 0.002, respectively). In patients with chronic HBV infection therefore, the lobular rather than the periportal component of activity was related to viral replication. The association of display of beta 2-microglobulin on hepatocytes with the inflammatory process, in patients with active viral replication, is consistent with the hypothesis that increased display of HLA type I enhances recognition of hepatocytes bearing viral proteins and allows lysis of immune cells.