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Clinical Features of Pediatric Age Herpes Simplex Virus Keratitis. Cornea 2023; 42:1099-1103. [PMID: 36921273 DOI: 10.1097/ico.0000000000003264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 01/22/2023] [Indexed: 03/17/2023]
Abstract
PURPOSE The objective of this study is to evaluate the clinical features of pediatric herpes simplex virus keratitis, its recurrence rates, and its effects on visual acuity. METHODS In this retrospective case series, records of pediatric patients (0-16 years) who presented with herpes simplex virus keratitis between January 2012 and September 2021 were evaluated. Data including age, gender, additional systemic diseases, the number of recurrences, recurrence time, treatment protocol, follow-up period, and presence of amblyopia were reviewed. RESULTS Twenty-four patients (16 females and 8 males) with a mean age of 6.6 ± 4 (1.1-15) years were included in the study. The mean follow-up time was 21 ± 19.9 (7-94) months. Four patients (16.6%) had bilateral keratitis. Including all 4 patients with bilateral involvement, a total of 10 (41.6%) patients had additional systemic diseases that cause immunodeficiency. After prophylactic antiviral treatment for at least 6 months (except for isolated epithelial keratitis), recurrence was detected in 5 (22.7%) patients, who were all immunodeficient. Among immunodeficient individuals, the recurrence rate was found to be 50%. Keratitis recurrence was significantly associated with immunodeficiency ( P = 0.03). However, type of keratitis ( P = 0.42), gender ( P = 0.47), and bilaterality ( P = 0.54) were not related with recurrence. 66.7% of the patients younger than 10 years developed amblyopia during follow-up. CONCLUSIONS In childhood, the most frequent corneal manifestation of herpes simplex virus is stromal keratitis that mostly progresses with corneal scarring, residual astigmatism, and amblyopia. The recurrence rate increases in the presence of immunosuppression. Close follow-up, rapid diagnosis, and treatment are critical for battling against amblyopia and achieving good visual prognosis.
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Atypical presentation of acanthamoeba keratitis resembling central toxic keratopathy. Am J Ophthalmol Case Rep 2022; 25:101243. [PMID: 35028488 PMCID: PMC8715135 DOI: 10.1016/j.ajoc.2021.101243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 08/25/2021] [Accepted: 12/13/2021] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To describe an atypical case of acanthamoeba keratitis with positive in vivo confocal microscopy in a non-contact lens user who presented with signs and symptoms suggestive of central toxic keratopathy. OBSERVATIONS The patient presented with bilateral, though sequential, decreased visual acuity with mild pain. Examination showed stromal haze with corneal flattening and thinning without epithelial defects. Optical coherence tonometry of the right eye revealed an inverse dome-shaped appearance of the opacity and in-vivo confocal imaging showed double-walled cysts consistent with acanthamoeba. Corneal haze, stromal loss, resolved and visual acuity improved over time. CONCLUSION AND IMPORTANCE Acanthamoeba is a rare cause of infectious keratitis that is most often associated with contact lens wear in developed countries. Typically, it presents with a unilateral decrease in visual acuity, photophobia, watering, and pain that is out of proportion to slit lamp examination findings. However, many atypical presentations have been reported in the literature. Consequently, it may be misdiagnosed, especially early in the course of the disease. This delay in diagnosis can lead to progressive ulceration and visual impairment. In addition, cyst formation can make eradication with anti-amoebic treatment especially difficult.Central toxic keratopathy is a non-inflammatory clinical syndrome of unknown etiology that is most often associated with excimer laser ablation, though other associated causes have been reported. It is characterized by a central or paracentral opacity with corneal stromal loss and resultant hyperopic shift. The opacification and stromal loss mostly resolve over the course of months with an improvement in visual acuity. This report may help physicians broaden their differential and correctly diagnose atypical presentations of amoebic infection.
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Neonatal herpetic stromal keratitis confirmed by polymerase chain reaction. J Fr Ophtalmol 2021; 45:e71-e73. [PMID: 34565659 DOI: 10.1016/j.jfo.2021.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 11/12/2022]
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Impact of Adherence (Compliance) to Oral Acyclovir Prophylaxis in the Recurrence of Herpetic Keratitis: Long-Term Results From a Pediatric Cohort. Cornea 2021; 40:1126-1131. [PMID: 33201055 DOI: 10.1097/ico.0000000000002578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/09/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the long-term role of adherence to oral acyclovir prophylaxis in reducing the risk for recurrent herpes simplex virus keratitis (HSK) in children. METHODS A retrospective cohort study was performed including all pediatric patients 16 years or younger) with their first HSK diagnosis and treatment at our center. Children were started on a standardized oral acyclovir prophylactic regimen after the acute phase. Adherence to prophylaxis was assessed monthly through parent interviews. The possible association between any recurrence (not only the first) and exposure to acyclovir prophylaxis was evaluated using random-effects multivariate logistic regression. RESULTS A total of 20 eyes of 17 patients (8 boys and 9 girls) were included. The mean follow-up time was 3.5 years. Adherence to acyclovir prophylaxis was registered in 100% of patients with no recurrences and in 36.4% of patients with 1 or more recurrences (P = 0.035). All other tested variables (time of follow-up, sex, age, infectious diseases, underlying hematological diseases, eye, and HSK type) did not differ between the 2 groups. The multivariate model confirmed the lower risk for recurrence in patients who were compliant to therapy (adjusted odds ratio 0.04, 95% confidence intervals 0.00-0.42, P = 0.008). No adverse effects were recorded during follow-up. CONCLUSIONS Oral acyclovir prophylaxis is a safe and an effective medical treatment for recurrent HSK and its long-term efficacy is associated with compliance to the therapy.
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Bilateral dendriform ulcer leading to an early diagnosis of tyrosinemia type 2. J AAPOS 2020; 24:120-122. [PMID: 32018000 DOI: 10.1016/j.jaapos.2019.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/16/2019] [Accepted: 12/21/2019] [Indexed: 11/18/2022]
Abstract
A 2-year-old girl with a 1-year history of photophobia presented with bilateral eye redness and was found to have dendriform corneal ulcers, which were initially managed with acyclovir ointment, without improvement. Clinical inspection revealed small cutaneous lesions on the fingers and toes. The association of pseudodendritic keratitis with palmo-plantar hyperkeratotic lesions was suspicious for tyrosinemia type 2, which was confirmed by high levels of plasmatic tyrosine (2134 μmol/L). A protein-restricted diet led to the complete resolution of the corneal and cutaneous lesions and avoided the potential toxicity of tyrosine on central nervous system.
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Corneal neovascularization in childhood keratitis. EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1379900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Long-term Outcomes of Pediatric Penetrating Keratoplasty for Herpes Simplex Virus Keratitis. Am J Ophthalmol 2017; 173:139-144. [PMID: 27746299 DOI: 10.1016/j.ajo.2016.09.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/26/2016] [Accepted: 09/28/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To analyze the characteristics and long-term outcomes of patients that underwent pediatric penetrating keratoplasty (PPK) for herpes simplex virus (HSV) keratitis. DESIGN Retrospective, interventional, consecutive case series. METHODS Observational report of outcomes and findings for 9 patients with history of HSV keratitis that underwent PPK and were followed in a single institution. Difference between the median preoperative and final best-corrected visual acuity (BCVA) was assessed and the outcomes are reported. RESULTS We included 9 eyes; median age at the moment of the PPK was 14 years. The median initial BCVA was 20/400 (range 20/60 to hand motion) and final was 20/50 (range 20/30 to 20/400) (P < .05). Follow-up was a median of 94 months. Complications in these patients included glaucoma (1), graft rejection (1), recurrence of disease (1), and amblyopia (3). No graft failures were present. CONCLUSION The long-term outcomes with PPK for HSV keratitis in children provide improvement in BCVA when not compromised by amblyopia.
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Pediatric Herpes Simplex of the Anterior Segment. Ophthalmology 2012; 119:2003-8. [DOI: 10.1016/j.ophtha.2012.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 05/03/2012] [Accepted: 05/03/2012] [Indexed: 10/28/2022] Open
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Un cas de primo-infection herpétique oculaire. J Fr Ophtalmol 2012; 35:359.e1-4. [DOI: 10.1016/j.jfo.2011.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 03/30/2011] [Accepted: 04/06/2011] [Indexed: 11/28/2022]
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Aspects actuels du traitement des kératites herpétiques. J Fr Ophtalmol 2012; 35:292-307. [DOI: 10.1016/j.jfo.2011.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Revised: 09/26/2011] [Accepted: 10/05/2011] [Indexed: 01/18/2023]
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Abstract
BACKGROUND Blindness studies have shown that keratitis complicated by the use of traditional eye medications is a major factor of childhood blindness in developing countries. Most cases of such keratitis were presumably due to nutritional causes or bacterial infection. The patterns of outcome that are seen in hospitals may be different. OBJECTIVE To determine the clinical types of keratitis seen in children at a tertiary hospital and compare with other reports. METHOD A retrospective analysis was conducted using the records of children who presented with keratitis to the eye unit of the University College Hospital, Ibadan, Nigeria, over a three-year period from January 2003 to December 2005. Information obtained were the demographic data, the etiological type of keratitis and visual outcome of management. RESULT Ninety-five patients with keratitis seen during this three-year period were children. Of these, 47 (49.5%) patients had presumed herpes simplex keratitis; 78.9% of children with herpes simplex keratitis presented with combined epithelial and stromal disease; 21 (22.1%) had keratitis that was associated with a recent measles infection and protein calorie malnutrition. Fifteen (15.8%) had keratitis associated with phlyctenular keratoconjunctivitis, eight (8.4%) patients had bacterial/fungal keratitis, while four (4.2%) had vernal ulcers. Both the right and left eyes were affected in 47.6% and 52.4% of cases, respectively. Bilateral keratitis occurred in eight of the children with measles, and six patients with herpes simplex keratitis. Fifty-nine eyes had visual acuity recorded after the keratitis healed. Of these, the visual outcome was very poor in six (20.0%) eyes with herpes simplex keratitis and eight (100%) eyes with bacterial/fungal keratitis. All eyes with suppurative keratitis associated with measles developed dense corneal scars or were perforated. CONCLUSION Herpes simplex keratitis was the leading cause of keratitis in children seen at this tertiary hospital, and clinical presentations do not differ from those reported in other populations. Very poor visual outcome was associated with all types of keratitis except those with herpes keratitis. Blindness studies may underrepresent the burden of herpes simplex keratitis in the location of this study.
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Abstract
Ocular inflammation in children is of substantial epidemiologic importance, particularly since uveitis in children produces more vision loss than it does in adults. This is partially because there is a higher rate of posterior uveitis in childhood uveitis than in the adult population. Treatment of ocular inflammation in children, ranging from conjunctivitis to keratitis to scleritis to uveitis, depends, of course, on whether or not the problem is microbial, traumatic, malignant, or autoimmune. Most of the cases that are vision threatening are autoimmune, and corticosteroids represent the mainstay of short-term therapy. However, abundant evidence exists which shows that all too often imprudent, prolonged use of corticosteroids is employed with resultant iatrogenic damage, including cataract, glaucoma, and secondary infection.A new paradigm for treating ocular inflammation (uveitis in particular) is espoused in this article. It is based on a limited tolerance to corticosteroid use and a more proactive approach to corticosteroid-sparing immunomodulatory therapy in an effort to induce a durable remission off all corticosteroids.
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Abstract
PURPOSE To describe the spectrum and recurrence of herpes simplex virus (HSV) keratitis in children and adolescents. DESIGN Retrospective cohort study. METHODS Twenty-three patients younger than age 16 years were diagnosed with HSV keratitis at one institution. RESULTS All children presented with dendritic or punctate epithelial keratitis, and stromal keratitis occurred concurrently with epithelial keratitis in 14 patients (61%). Six patients (26%) had bilateral HSV keratitis. Eleven patients (48%) developed recurrent HSV keratitis at a median of 15 months after the first documented episode. Amblyopia occurred in three children. CONCLUSION Children with herpetic keratitis may have bilateral ocular involvement and are at risk for recurrent keratitis and amblyopia.
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Abstract
Pediatric microbial keratitis is a rare but potentially devastating condition. The condition is similar to adult microbial keratitis, but is often characterized by a more severe inflammatory response. The micro-organisms that cause microbial keratitis in children are similar to the causative agents in adults, with herpes simplex and bacteria being the predominant causative agents, and fungi being less frequent. Of the bacterial pathogens, Pseudomonas aeruginosa, Staphylococcus aureus and alpha-hemolytic streptococci are common. The risk factors for pediatric keratitis include colonization of the eyes during birth and trauma to the cornea. Certain microbial factors involved in microbial keratitis are common to all micro-organisms, including adhesion to the cornea, penetration into the cornea, destruction of the corneal stroma (usually by microbial and/or host proteases), and recruitment of white blood cells to help defend the eye. Specific inflammatory responses that occur during pediatric microbial keratitis are not known in detail, but it is likely that cytokines and polymorphonuclear leucocytes are major factors, as they are in adult microbial keratitis. Treatment for pediatric microbial keratitis is usually the same as treatment for adult microbial keratitis; topical application of antimicrobial agents initially, followed by application of anti-inflammatory agents. With pediatric microbial keratitis, extra care must be taken to ensure nontoxicity due to blood adsorption. New microbial keratitis treatments are being developed and these mainly focus on new antimicrobials, antivirulence agents (such as vaccination against microbial toxins) or specific anti-inflammatory agents. There remains a clear need for increased research into the specific responses during microbial keratitis in children which will help progress new therapies as well as the development of new antimicrobials, especially new antifungal therapies.
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Abstract
PURPOSE To review the changing epidemiology of herpes simplex disease and correlate it with the epidemiology of ocular herpes simplex disease. METHOD A review of pertinent reports in the world literature about the epidemiology of herpes simplex and specifically about ocular herpes simplex. RESULTS In developed countries, many individuals are reaching adolescence and adulthood without prior herpesvirus infection. Herpes simplex genital infection is increasing at a rapid rate in sexually active adolescents and adults, with about one in six adults now infected in the United States. Similar statistics are confirmatory worldwide in developed countries. Active herpes simplex infection is a risk factor for acquisition of human immunodeficiency virus. The Herpetic Eye Disease Study, as well as prior studies from Moorfields Eye Hospital and the Mayo Clinic in Rochester, Minnesota, provides us with the epidemiology of ocular herpes simplex. Recent studies suggest an older age of onset and perhaps overall more severe ocular disease as compared with the older literature. CONCLUSIONS Herpes simplex is a significant health concern at present with genital infections increasing in epidemic proportions. This is also reflected in a rise in the incidence of neonatal herpes. Herpes simplex virus type 1 (HSV-1) infection is being acquired for the first time in an older age group. A significant and increasing proportion of genital herpes is caused by HSV-1. Serologic studies are no longer as useful in distinguishing orofacial herpes from genital herpes. More acute retinal necrosis syndrome cases are associated with HSV-2. Speculation about the future of ocular herpes is made based on this changing epidemiology.
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Abstract
PURPOSE To evaluate the use of oral acyclovir in pediatric patients with herpes simplex virus (HSV) keratitis. DESIGN Retrospective noncomparative case series. PARTICIPANTS Seven pediatric patients seen at the University of Minnesota Hospitals and Clinics with herpes simplex virus (HSV) infectious epithelial keratitis between January 1992 and October 1998. Patient ages ranged from 6 weeks to 5 years at time of presentation with a median of 1.7 and mean of 1.9 years. INTERVENTION All patients received oral acyclovir; six of seven patients also received topical antiviral medications. Three of seven patients had topical antiviral therapy fail before being placed on oral acyclovir, and the remaining four patients were placed on oral acyclovir primarily. RESULTS All patients showed resolution of HSV infectious epithelial keratitis. Three patients have been maintained on prophylactic dosage of oral acyclovir because of recurrent disease or because they have been chronically treated with topical corticosteroids for immune stromal keratitis. All patients tolerated acyclovir well, and there were no adverse reactions. CONCLUSIONS Oral acyclovir is useful in treating HSV infectious epithelial keratitis in pediatric patients. It is beneficial in treating infectious epithelial keratitis and prophylactically either while treating with topical corticosteroids for immune stromal keratitis or for preventing recurrent infectious epithelial keratitis.
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Abstract
A novel multiplex nested polymerase chain reaction (PCR) assay was designed and evaluated for routine diagnosis of herpes simplex virus (HSV) infections in patients with either putative HSV infection of the central nervous system or suspected HSV keratitis. Single-tube amplification of HSV type 1 (HSV-1) or type 2 (HSV-2) DNA extracted from cerebrospinal fluid (CSF) or from keratectomy specimens was followed by differentiation of the virus type-specific PCR products either by agarose gel analysis or by DNA enzyme immunoassay. Among 417 CSF specimens obtained from 395 consecutive patients with clinically suspected HSV infection, 11 (2.6%) were positive for HSV-1 DNA and four (1.0%) probes were positive for HSV-2 DNA. None of the specimens was positive for both HSV-1 and HSV-2 DNA. The genome of HSV-2 was detected in a CSF sample obtained from a woman with meningoencephalitis and genital herpes. The presence of PCR inhibitors was detected in six of 111 (5.4%) reconstructed CSF samples. Inhibition could be removed following extraction with a commercial kit. HSV-1 DNA, but no HSV-2 DNA, was detected in corneal buttons obtained from patients with suspected herpetic keratitis. No contamination has been recorded during the 2-year routine use of this test, which has met the specific requirements of a diagnostic laboratory.
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