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Sarah D. Atkinson, Victoria E. McGilligan, Jonathan E. Moore, Mohammad Tallouzi, Susan Feeney, Anant Sharma, Sunil Shah, Jonathan Jackson, David G. Frazer, Tara C. Moore; A Comparison Of The Clinical And Molecular Diagnosis Of Herpes Simplex Keratitis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6630.
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© ARVO (1962-2015); The Authors (2016-present)
A comparison of the clinical and molecular diagnosis of Herpes Simplex Keratitis (HSK).
Conjunctival swabs were obtained from 146 participants. The cohort consisted of participants with typical dendrite presentation of HSK (n=54), various atypical presentations of HSK (n=38), old cases of HSK (n=17) and other ocular conditions or a normal ocular surface (n=37). Samples were processed for the detection of viral DNA: HSV1; HSV2; Varicella Zoster Virus (VZV) and Adenovirus (ADV) using two real time PCR methods.
Participants who displayed clinical signs of typical or atypical HSK were positive for HSV1 in 46% and 8% of cases respectively, when using primers against the GpD region of the virus. When the samples were retested with primers against the GpB region, four additional participants were positive for HSV1. Three participants (6%) diagnosed with typical HSK and three (8%) with atypical HSK were positive for ADV DNA. Antiviral use by participants at the time of sampling was shown to significantly effect the PCR results of this study, suggesting viral clearance prior to sampling (p<0.05). All non-clinically diagnosed HSK control participants were negative for HSV1 DNA. Sample quantity was confirmed by testing for housekeeping control genes. PCR results from in vitro control investigations of HSV1 and 2 infected corneal rims and conjunctival epithelial cells were 100% positive for infected and 100% negative for uninfected samples when assessed using both PCR methods.
This study demonstrated a moderate level of agreement (kappa = 0.485, p<0.0001) between the clinical and molecular diagnosis of typical cases of HSK. Twenty percent (n=11) of the typical HSK cases presented remained without a definitive diagnosis. Results indicate that other ocular surface infections with similar presentations should be considered when making a clinical diagnosis and for molecular diagnosis when using PCR, the use of an antiviral at the time of sampling and the variability between the primers used for the detection of HSV1 DNA should be deliberated.
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