Varicella-Zoster Virus Is Strongly Associated with Atypical Necrotizing Herpetic Retinopathies

Abstract

Aqueous humor samples from nine patients with atypical necrotizing retinopathies of suspected viral origin, six with acute retinal necrosis syndrome (ARN), and 17 with active cytomegalovirus (CMV) retinitis underwent amplification for viral DNA of herpes simplex virus type 1 (HSV-1), varicella-zoster virus (VZV), and human CMV. VZV DNA was detected in seven of the nine aqueous humor samples from patients with atypical necrotizing retinopathies of suspected viral origin and in four of the six samples from individuals with ARN; of the two other samples from patients with ARNS, no viral DNA was found in one, and both CMV DNA and HSV-1 DNA, but not VZV DNA, were detected in one (this patient presented with bilateral ARNS 2 months after being successfully treated for CMV retinitis). Thus, VZV is likely to be the main pathogen of atypical necrotizing herpetic retinopathies. DNA amplification may be used to establish an early, sensitive, and reliable diagnosis of any form of necrotizing retinopathy in 80% of cases, irrespective of viral etiology.

Real-time polymerase chain reaction and intraocular antibody production for the diagnosis of viral versus toxoplasmic infectious posterior uveitis

“…Correct diagnoses reported in literature in patients having necrotizing retinitis yield a higher range from 57 to 89%, depending on the biological technique and the immunosuppression status [9,11]. However, it should be stressed that studies that include exclusively on the subgroup of ARN patients show positive Herpes virus PCR rates of almost 90% [7,8,10,[26][27][28][29][30]. The 87.5% (21/24) Toxoplasma-significant GWC in our study concords with other series [7][8][9].…”

Ocular Findings in Japanese Patients with Varicella-Zoster Virus Infection

“…Several ocular complications have been reported in these diseases [1,2,3,4,5,6,7,8,9]. Recently, VZV was reported as a cause of progressive outer retinal necrosis [10, 11]. To our knowledge, comparative studies of ocular findings of three diseases examined in one clinic may be uncommon.…”

HSV-1 antigens and DNA in the corneal explant buttons of patients with non-herpetic or clinically atypical herpetic stromal keratitis

“…Added to this uncertainty, we have no conception of how the presence of viral DNA in clinically healthy corneal tissue [5,8,14,27,32] is to be understood. The possibility of contamination has, of course, to be considered.…”

“…Tissue sections 30 µm thick were prepared and used for DNA extraction and amplification, as described in detail elsewhere [14]. Briefly, DNA was liberated by digesting the tissue in 100 µl of proteinase K buffer for 30 min at 60°C and for 10 min at 95°C [13,18].…”

“…Accordingly, the aetiologic diagnosis of viral diseases such as necrotizing herpetic retinopathies may be established in up to 90% of cases by analysing samples of aqueous humour [14]. In instances of recurrent stromal keratitis, however, neither antigen detection nor the amplification of viral DNA by PCR has proved to be sufficiently sensitive [16,19,37].…”