PURPOSE: Herpetic keratitis is a common sequel of a corneal infection with herpes simplex virus (HSV)-1. Recrudescent herpetic keratitis (RHK) may result in irreversible damage to the cornea. Recurrences may be caused by reactivation of endogenous HSV-1 or reinfection with exogenous HSV-1. The objective of this study was to determine the incidence and risk factors involved of HSV-1 superinfection in patients with RHK. METHODS: From 30 patients with RHK, sequential corneal HSV-1 isolates were genotyped by PCR amplification of the hypervariable regions located within the HSV-1 genes US1, US10/11, and US12. The clinical data from the patients obtained retrospectively were: ophthalmologic history, clinical picture during recurrences, number and time points of penetrating keratoplasty (PKP), and steroid or acyclovir treatment. RESULTS: Whereas the sequential corneal HSV-1 isolates of 19 (63%) of 30 patients had the same genotype (designated as group 1), the sequential isolates of 11 patients (37%) were genetically different (designated as group 2). Among the clinical data analyzed, only the time point of PKP was significantly different between the patient groups. Although no patients in group 1 had undergone transplantation between samplings, 4 of 11 patients in group 2 underwent PKP during the inter-recurrence period in the same eye from which the corneal HSV-1 isolates were obtained. CONCLUSIONS: The data demonstrate that RHK is frequently associated with corneal reinfection with a different HSV-1 strain and suggest that PKP is a risk factor for corneal HSV-1 superinfection.

Acyclovir/therapeutic use, Adolescent, Adult, Aged, Antiviral Agents/therapeutic use, Cornea/*virology, DNA, Viral/analysis, Female, Genotype, Herpesvirus 1, Human/genetics/*growth & development/isolation & purification, Humans, Incidence, Keratitis, Herpetic/epidemiology/therapy/*virology, Keratoplasty, Penetrating, Male, Middle aged, Polymerase Chain Reaction, Recurrence, Research Support, Non-U.S. Gov't, Risk Factors, Superinfection/epidemiology/therapy/*virology, Virus Activation
hdl.handle.net/1765/9830
Investigative Ophthalmology & Visual Science
Erasmus MC: University Medical Center Rotterdam

Remeijer, L, Maertzdorf, J, Buitenwerf, J, Osterhaus, A.D.M.E, & Verjans, G.M.G.M. (2002). Corneal herpes simplex virus type 1 superinfection in patients with recrudescent herpetic keratitis. Investigative Ophthalmology & Visual Science. Retrieved from http://hdl.handle.net/1765/9830