Herpes Simplex Virus Keratitis in a University Tertiary Referral Centre – Clinical Features and Surgical Approaches

Abstract Purpose To assess prevalence, clinical manifestations, required keratoplasties, follow-up, and outcome in patients with Herpes Simplex Virus Keratitis (HSK) attending a University Tertiary Referral Center. Design Retrospective (12 years), descriptive, observational study. Methods A total of 817 eyes with clinical diagnosis of HSK from 779 patients were classified by the type of presentation. We gathered data on the visual acuity, refraction, IOP, and required surgical procedures. Results Stromal involvement including scars represented the most common diagnosis in our department and the main indication of penetrating keratoplasty (PKP). Epithelial keratitis (16%) presented with the best visual acuity at the first visit. Necrotizing keratitis represented 17% of the patients, 78% of whom required PKP; this group also had the worst visual acuity at first examination and was the main indication for emergency PKP. Among all eyes, 288 (35%) required PKP. A total of 230 (28%) PKPs were elective procedures and 58 (7%) PKPs were performed as emergency procedures. Two patients with quiet endothelial decompensations after recurrent HSV endotheliitis were treated with DMEK and had good visual outcomes without HSV recurrence at last follow-up. Conclusions HSK is a prevalent disease with severe consequences when not treated appropriately and on time. Even when making an accurate diagnosis, the disease can be extremely aggressive, with all the implications it brings to the patients and health system. Elective PKP had better outcomes in terms of visual acuity and clear graft percentage compared to emergency PKP.

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Herpes Simplex Virus Proctitis Masquerading as Rectal Cancer

Diseases ◽

10.3390/diseases7020036 ◽

2019 ◽

Vol 7 (2) ◽

pp. 36 ◽

Cited By ~ 2

Author(s):

Folusakin Ayoade ◽

Jose Armando Gonzales Zamora ◽

Youley Tjendra

Keyword(s):

Rectal Cancer ◽

Herpes Simplex Virus ◽

Herpes Simplex ◽

Clinical Manifestations ◽

Herpes Simplex Virus 1 ◽

Rectal Pain ◽

Colorectal Mucosa ◽

Rectal Mass ◽

Simplex Virus

Herpes simplex virus (HSV) is the leading cause of proctitis in HIV-infected individuals. However, no cases of rectal masses secondary to HSV infection have been reported to date. Herein, we present the case of a 45-year-old man with HIV infection who developed rectal pain and bleeding, along with dysuria and voiding difficulty. Colonoscopy revealed proctitis and a rectal mass with features concerning for rectal cancer. Histologic sections of the rectal mass biopsy demonstrated colorectal mucosa with viral cytopathic changes, ulceration, granulation tissue, marked inflammatory infiltrate, and fibrinopurulent exudate. Immunohistochemistry for herpes simplex virus-1 was positive in epithelial cells demonstrating a viral cytopathic effect. The patient was treated with valacyclovir for 3 weeks, which led to complete resolution of his symptoms. Follow-up sigmoidoscopy at 6 months did not show any masses. Our case illustrates the importance of considering HSV in the differential diagnosis of rectal masses. We advocate the routine use of viral immunohistochemistry for the evaluation of rectal tumors, especially in patients with clinical manifestations and endoscopic findings consistent with proctitis.

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Faculty Opinions recommendation of Surveillance network for herpes simplex virus resistance to antiviral drugs: 3-year follow-up.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1017039.201955 ◽

2004 ◽

Author(s):

Rhoda Ashley Morrow

Keyword(s):

Herpes Simplex Virus ◽

Herpes Simplex ◽

Virus Resistance ◽

Antiviral Drugs ◽

Surveillance Network ◽

Simplex Virus

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Plasma Amyloid-β in Relation to Antibodies Against Herpes Simplex Virus, Cytomegalovirus, and Chlamydophila pneumoniae

Journal of Alzheimer s Disease Reports ◽

10.3233/adr-210008 ◽

2021 ◽

pp. 1-7

Author(s):

Karin Lopatko Lindman ◽

Bodil Weidung ◽

Jan Olsson ◽

Maria Josefsson ◽

Anders Johansson ◽

...

Keyword(s):

Herpes Simplex Virus ◽

Herpes Simplex ◽

Antimicrobial Properties ◽

Amyloid Β ◽

Chlamydophila Pneumoniae ◽

Immunosorbent Assays ◽

Simplex Virus ◽

Ig G ◽

Xmap Technology

Background: Amyloid-β (Aβ), the key constituent of Alzheimer’s disease (AD) plaques, has antimicrobial properties. Objective: To investigate the association between plasma Aβ and antibodies against the AD-related pathogens herpes simplex virus (HSV), cytomegalovirus (CMV), and C. pneumoniae. Methods: Plasma from 339 AD cases, obtained on average 9.4 years (±4.00) before diagnosis, and their matched controls were analyzed for Aβ40 and Aβ42 concentrations with Luminex xMAP technology and INNOBIA plasma Aβ-form assays. Enzyme-linked immunosorbent assays were utilized for analyses of anti-HSV immunoglobulin (Ig) G, anti-HSV1 IgG, anti-HSV2 IgG, anti-CMV IgG, and anti-C. pneumoniae IgG. Follow-up samples were available for 163 of the cases. Results: Presence and levels of anti-HSV1 IgG, anti-HSV2 IgG, anti-CMV IgG, and anti-C. pneumoniae IgG did not correlate with concentrations of Aβ42 or Aβ40 in cases or controls. Conclusion: Levels of plasma Aβ were not associated with antibodies against different AD-related Spathogens.

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Experimental investigation of herpes simplex virus latency.

Clinical Microbiology Reviews ◽

10.1128/cmr.10.3.419 ◽

1997 ◽

Vol 10 (3) ◽

pp. 419-443 ◽

Cited By ~ 186

Author(s):

E K Wagner ◽

D C Bloom

Keyword(s):

Herpes Simplex Virus ◽

Herpes Simplex ◽

Animal Models ◽

Latent Infection ◽

Cultured Cells ◽

Early Stage ◽

Clinical Manifestations ◽

Cis Acting ◽

Virus Latency ◽

Simplex Virus

The clinical manifestations of herpes simplex virus infection generally involve a mild and localized primary infection followed by asymptomatic (latent) infection interrupted sporadically by periods of recrudescence (reactivation) where virus replication and associated cytopathologic findings are manifest at the site of initial infection. During the latent phase of infection, viral genomes, but not infectious virus itself, can be detected in sensory and autonomic neurons. The process of latent infection and reactivation has been subject to continuing investigation in animal models and, more recently, in cultured cells. The initiation and maintenance of latent infection in neurons are apparently passive phenomena in that no virus gene products need be expressed or are required. Despite this, a single latency-associated transcript (LAT) encoded by DNA encompassing about 6% of the viral genome is expressed during latent infection in a minority of neurons containing viral DNA. This transcript is spliced, and the intron derived from this splicing is stably maintained in the nucleus of neurons expressing it. Reactivation, which can be induced by stress and assayed in several animal models, is facilitated by the expression of LAT. Although the mechanism of action of LAT-mediated facilitation of reactivation is not clear, all available evidence argues against its involving the expression of a protein. Rather, the most consistent models of action involve LAT expression playing a cis-acting role in a very early stage of the reactivation process.

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Clinical Manifestations and Treatment Modalities in Herpes Simplex Virus of the Ocular Anterior Segment

International Ophthalmology Clinics ◽

10.1097/00004397-200404430-00012 ◽

2004 ◽

Vol 44 (3) ◽

pp. 103-133 ◽

Cited By ~ 14

Author(s):

Bilal Faiz Khan ◽

Deborah Pavan-Langston

Keyword(s):

Herpes Simplex Virus ◽

Herpes Simplex ◽

Anterior Segment ◽

Clinical Manifestations ◽

Treatment Modalities ◽

Simplex Virus

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Herpes-Simplex-Virus 1 pneumonia in the immunocompromised host: High-resolution CT patterns in correlation to outcome and follow-up

European Journal of Radiology ◽

10.1016/j.ejrad.2011.03.014 ◽

2012 ◽

Vol 81 (4) ◽

pp. e415-e420 ◽

Cited By ~ 8

Author(s):

H. Brodoefel ◽

M. Vogel ◽

D. Spira ◽

C. Faul ◽

R. Beck ◽

...

Keyword(s):

Herpes Simplex Virus ◽

Herpes Simplex ◽

High Resolution ◽

Immunocompromised Host ◽

Herpes Simplex Virus 1 ◽

High Resolution Ct ◽

Simplex Virus

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Safety and tolerability of intratumorally administered OH2, an oncolytic herpes simplex virus 2, in patients with advanced solid tumors: A phase I dose escalation clinical study.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.3139 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 3139-3139

Author(s):

Jing Huang ◽

Bo Zhang ◽

Jialin Tang ◽

Qing Chang ◽

Rui Zhang ◽

...

Keyword(s):

Herpes Simplex Virus ◽

Herpes Simplex ◽

Solid Tumors ◽

Dose Escalation ◽

Oncolytic Viruses ◽

Potential Clinical Benefit ◽

Oncolytic Herpes Simplex Virus ◽

Systemic Treatments ◽

Simplex Virus

3139 Background: There have been limited reports concerning treatment outcomes of oncolytic viruses in solid tumors other than melanoma. OH2 is a genetically engineered oncolytic herpes simplex virus type 2 designed to selectively amplify in tumor cells and express GM-CSF to enhance tumor-specific immune responses. Methods: We conducted an open-label, single-center, phase 1 study. Eligible pts were 18-75 years of age; had histologically confirmed advanced solid tumor; had progressed after standard systemic treatments. Pts were required to have tumor(s) deemed safe to inject, with a longest diameter of at least 0.5cm. Other eligibility criteria included measurable lesion as per RECIST v1.1; ECOGPS score of 0-1 and adequate organ functions. A 3+3 dose-escalation strategy was used in the study and 3 dose levels (106, 107 and 108 CCID50/mL) of OH2 were assessed. OH2 was administered intratumorally every 3 weeks for the first cycle and every 2 weeks.Treatment may continue afterwards in ptswith potential clinical benefit at the discretion of the investigators. The primary objective was the safety and tolerability of OH2 injection as defined by the dose limiting toxicities (DLTs) within the first 3 weeks of therapy, and the maximum tolerated dose (MTD). Secondary objectives included efficacy and immunogenicity of OH2. Results: 11 pts were enrolled between April 17, 2019 and November 4, 2019. The median follow-up duration was 8.36 months (95%CI: 5.64-11.08). OH2 was well-tolerated as no DLTs were reported and no MTD reached. Before the end of the DLT assessment period,1 pt withdrew consent, and 1 pt died of arrhythmia unrelated to OH2, with negative OH2 DNA copies in serum, urine and saliva samples. Most treatment-related adverse events (TRAEs) observed were of grade 1-2, except that 1 pt in the 108 CCID50/mL group developed grade 3 fever. The most common TRAEs were fever (n =5) and blood bilirubin level increase (n = 4). There were no grade 4 or 5 TRAEs. One pt(rectal cancer) had PR and 2 (appendix cancer and ovarian cancer) had SD as per RECIST v1.1. One patient (esophageal cancer) achieved iPR as per iRECIST criteria. The duration of follow-up for the 2 responders were 9.70 months and 8.36 months, respectively, and both had ongoing responses. Notably, regression of a non-injected lesion was observed in 1 patient. Conclusions: OH2 had a favorable safety profile with no DLTs and MTD. The dose expansion study in selected tumor types is currently underway. Clinical trial information: NCT03866525 .

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