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Clinical and corneal microbial profile of infectious keratitis in a high HIV prevalence setting in rural South Africa.

Clinical and corneal microbial profile of infectious keratitis in a high HIV prevalence setting in rural South Africa.
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Schaftenaar E, Peters RP, Baarsma GS, Meenken C, Khosa NS, Getu S, McIntyre JA, Osterhaus AD, Verjans GM,


Schaftenaar E, Peters RP, Baarsma GS, Meenken C, Khosa NS, Getu S, McIntyre JA, Osterhaus AD, Verjans GM, (click to view)

Schaftenaar E, Peters RP, Baarsma GS, Meenken C, Khosa NS, Getu S, McIntyre JA, Osterhaus AD, Verjans GM,

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European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology 2016 05 2835(9) 1403-9 doi 10.1007/s10096-016-2677-x

Abstract

The purpose of this investigation was to determine the clinical and corneal microbial profile of infectious keratitis in a high human immunodeficiency virus (HIV) prevalence setting in rural South Africa. Data in this cross-sectional study were collected from patients presenting with symptoms of infectious keratitis (n = 46) at the ophthalmology outpatient department of three hospitals in rural South Africa. Corneal swabs were tested for herpes simplex virus type 1 (HSV-1) and 2 (HSV-2), varicella zoster virus (VZV) and adenovirus DNA by real-time polymerase chain reaction (PCR) and for bacteria and fungi by culture. Based on clinical history, disease characteristics and laboratory results, 29 (63 %) patients were diagnosed as viral keratitis, including 14 (48 %) viral keratitis cases complicated by bacterial superinfection, and 17 (37 %) as bacterial keratitis. VZV and HSV-1 DNA was detected in 11 (24 %) and 5 (11 %) corneal swabs, respectively. Among clinically defined viral keratitis cases, a negative viral swab was predominantly (93 %) observed in cases with subepithelial inflammation and was significantly associated with an increased duration of symptoms (p = 0.003). The majority of bacteria cultured were Gram-positive (24/35), including Staphylococcus epidermidis and S. aureus. Viral aetiology was significantly associated with a history of herpes zoster ophthalmicus (p < 0.001) and a trend was observed between viral aetiology and HIV infection (p = 0.06). Twenty-one (47 %) keratitis cases were complicated by anterior uveitis, of which 18 (86 %) were HIV-infected cases with viral keratitis. The data implicate a high prevalence of herpetic keratitis, in part complicated by bacterial superinfection and/or uveitis, in HIV-infected individuals presenting with infectious keratitis in rural South Africa.

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