Purchase this article with an account.
Kaivon Pakzad-Vaezi, Macklin Nguyen, Cecilia Lee, Andrew Bryan, Kathryn L Pepple; Laboratory analysis and predictive characteristics of infectious panuveitis sampling in the Pacific Northwest. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2154.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To evaluate the results, yield, and prognostic characteristics of infectious etiological testing in panuveitis cases
Endophthalmitis/panuveitis reference laboratory database results were retrieved from 2007-2014. Polymerase chain reaction (PCR) for HSV, VZV, CMV, EBV, 16S and 28S rRNA, and bacterial and fungal culture results were recorded. Logistic regression analyses identified characteristics predicting positive results, and an algorithm for specimen handling was created in consultation with laboratory experts in light of modern detection thresholds
Of 85 patient samples sent for bacterial and fungal testing, 16 (19%) were dual positive by culture and PCR, 43 (51%) were dual negative, 10 (12%) were culture positive only, and 16 (19%) were PCR positive only. Univariate analysis of PCR samples demonstrated that surgical specimens were associated with a positive result (OR 3.34, 95% CI 1.12-10.51; p=0.03), with a trend towards positivity from vitreous taps (OR 0.37, 95% CI 0.12-1.08; p=0.08), pre-sample antibiotic use (OR 2.57, 95% CI 0.85-8.45, p=0.10), and prior eye surgery (OR 2.44, 95% CI 0.82-7.57; p=0.11). Multivariate analysis showed an association of prior eye surgery with PCR positivity (OR 4.06, 95% CI 1.12-17.25; p=0.04), and a trend for surgical samples (OR 6.19, 95% CI 0.78-62.97; p=0.09). Parameters associated with culture positivity were surgical samples (OR 2.93, 95% CI 0.99-9.08; p=0.05) and vitreous taps (OR 0.40, 95% CI 0.13-1.17; p=0.10) by univariate analysis, and surgical samples by multivariate analysis (OR 6.12, 95% CI 0.84-61.31; p=0.09). Of 112 samples sent for viral PCR, 37 (33%) were positive. Aqueous, vitreous, and vitrectomy samples were positive in 35% (18/51), 27% (10/37), and 33% (8/24), respectively. Most viral titers were very high and could be detected with low sample volumes without significant miss-rates. An algorithm for specimen handling based on infectious clinical suspicion and sample volume is presented
PCR is more likely to be positive than culture, although the importance of culture is still apparent. There is a higher likelihood of positive results in post-operative endophthalmitis cases and from surgical samples. Low sample volumes are adequate for viral PCR testing. The clinician should play an active role in guiding sample handling for PCR versus culture in light of sample volume and clinical suspicion
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
This PDF is available to Subscribers Only