Endogenous dissemination of genital Herpesvirus hominis type 2 to the eye

Six-year study of the incidence of herpes in genital and nongenital cultures in a central Kentucky medical center patient population

Herpes infections are among the most common sexually transmitted diseases and are the most common cause of genital ulcer disease in the United States. This study addresses the changing distribution of herpes simplex virus type 1 (HSV-1) and HSV-2 in patients presenting for evaluation of herpetic infections. Viral culture results from the University of Kentucky Clinical Microbiology Laboratory were reviewed for a 6-year period (1994 through 1999). Data were collected on patient sex, site of culture, and culture result. These data were analyzed statistically to identify yearly trends. Of the 4,498 cultures analyzed, nearly equal proportions of HSV-1 (13.3%) and HSV-2 (12.0%) were detected for an overall culture positivity rate of 25.3%. Approximately two-thirds of all positive cultures were from women. Although HSV-2 remained the predominant type of genital herpes, over the 6-year span of this study, there was a trend toward increasing proportions of HSV-1 genitalis, with 31.8% of male patients and 44.8% of female patients demonstrating HSV-1 genitalis by 1999. The majority of patients with HSV in nongenital sites grew HSV-1. Although there was significant yearly variation, HSV-2 was isolated from only 9.4% of patients with nongenital HSV for the entire 6-year period. This study therefore concludes that HSV-2 remains primarily a genital pathogen, while HSV-1 is taking on an increasingly important role in causing genital ulcer disease in addition to being the primary nongenital HSV.

Antiviral activity of a D-glucosamine derivative against herpetic ulcers (HSV type 2) in rabbit cornea

Although most herpetic ocular infections in adults are caused by herpesvirus hominis type 1, several cases of culture proved HSV-2 ocular infection in adults have been described, with more severe and prolonged disease. In a screening for new antiherpetic compounds, we investigated the efficacy in vivo of a new compound, nitroderivative of D-glucosaminhydrochloride (GN-11) in comparison with D-glucosaminhydrochloride (GN), Acyclovir (ACV) and placebo against herpetic keratitis of herpes simplex type 2 in 4 x 4 eyes from 4 x 4 rabbits, respectively. ACV and GN-11 showed similar results. The treatment with GN-11 retarded the appearance of herpetic lesions, which were small and diffuse in comparison with the placebo group. A total recovery was obtained on the 12th day of the treatment. In the ACV treated group, a minimal number of small lesions appeared, but the eyes recovered normality on the 7th day of treatment. The appearance of acute herpetic keratitis was prevented by GN-11. Placebo and GN treated groups showed similar evolution, with lost vision and neurological involvement on the 7th day of infection.

Acute interstitial nephritis and iritis. Renal-ocular syndrome

Acute renal failure developed in a previously healthy woman in association with acute iritis. Renal biopsy revealed acute mononuclear interstitial nephritis. Known systemic illnesses that can present as acute renal failure and have ocular manifestations of iritis/uveitis were excluded by detailed testing and observation during a 24-month period. No cause for this renal-ocular syndrome was discovered. There was a dramatic improvement to normal renal function and complete resolution of ocular findings following a two-month course of steroid therapy.

Herpetic iridocyclitis

Twenty patients with presumptive herpetic iridocyclitis without active corneal inflammation received either topical idoxuridine 0.5% or acyclovir 3% ointment. The uveitis of all ten patients treated with acyclovir resolved within one to eight weeks. Four of ten patients treated with idoxuridine worsened but subsequently responded to topical prednisolone 0.3%. The pathogenesis of herpetic iridocyclitis is discussed with a literature review.