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Atypical herpes simplex keratitis: frequency, clinical presentations and treatment results

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Abstract

Aims

To determine herpes simplex virus (HSV) DNA positivity in corneal scraping samples obtained from patients with microbial keratitis whose findings were not specific for HSV keratitis and to evaluate these particular cases with respect to clinical features and antiviral treatment results.

Methods

Records of patients with microbial keratitis treated in a tertiary eye care hospital within the 3-year period were evaluated retrospectively. Real-time polymerase chain reaction (PCR) was used to identify HSV DNA. Smear slides were evaluated by light microscopy. Patients with typical presentations and histories of HSV keratitis were excluded.

Results

Two hundred and seventy-six eyes of 276 patients were included in the study. HSV-1 DNA was detected in 25 eyes (9%). In these 25 eyes, the initial diagnosis was fungal or bacterial keratitis. The mean symptom duration was 20 ± 14 days (2–60 days). The risk factors were ocular surgery (20%), blepharitis (16%), trauma (8%) and contact lens wear (4%); however, the majority of patients did not have any specific cause for keratitis (52%). Clinical features were variable and not typical for any particular etiology. Culture and microscopic examinations revealed bacteria and/or fungi in 6 patients in addition to herpes infection. Antiviral treatment was successful in 72% of patients.

Conclusion

Herpetic corneal infections can present without typical dendritic or geographic ulcers and may be masked by other infections. Real-time PCR is a useful method for rapid and definitive diagnosis. HSV infection should be considered for microbial keratitis without specific risk factors, with negative culture results and poor response to antimicrobial agents.

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Funding

This study was funded by government.

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Authors and Affiliations

  1. Ophthalmology Department, Faculty of Medicine, Balcali Hospital, Cukurova University, 01380, Saricam, Adana, Turkey

    Elif Erdem, İbrahim İnan Harbiyeli, Oğuzhan Oruz, Meltem Yağmur & Reha Ersöz

  2. Virology Department, Faculty of Medicine, Balcali Hospital, Cukurova University, 01380, Saricam, Adana, Turkey

    Gökhan Öztürk & Fügen Yarkın

  3. Pathology Department, Faculty of Medicine, Balcali Hospital, Cukurova University, 01380, Saricam, Adana, Turkey

    Arbil Açıkalın

Authors
  1. Elif Erdem
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  2. İbrahim İnan Harbiyeli
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  3. Gökhan Öztürk
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  4. Oğuzhan Oruz
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  5. Arbil Açıkalın
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  6. Meltem Yağmur
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  7. Reha Ersöz
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  8. Fügen Yarkın
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Corresponding author

Correspondence to Elif Erdem.

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Conflict of interest

All authors declare that they have no conflict of interest for this study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Management algorithm for atypical herpetic keratitis (DOCX 144 kb)

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Erdem, E., Harbiyeli, İ.İ., Öztürk, G. et al. Atypical herpes simplex keratitis: frequency, clinical presentations and treatment results. Int Ophthalmol 40, 659–665 (2020). https://doi.org/10.1007/s10792-019-01226-1

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  • DOI: https://doi.org/10.1007/s10792-019-01226-1

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