Yoshida Masaaki, Hariya Takehiro, Yokokura Shunji, Maruyama Kazuichi, Sato Kota, Sugita Sunao, Tomaru Yasuhiro, Shimizu Norio, Nakazawa Toru
Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan.
J Infect Chemother. 2018 Dec;24(12):1004-1008. doi: 10.1016/j.jiac.2018.06.012. Epub 2018 Jul 11.
To report the potential usefulness of multiplex polymerase chain reaction (mPCR) for diagnosing superinfection keratitis caused by herpes simplex virus-1 (HSV-1), bacteria and fungus.
Case series. Corneal scrapings were analyzed with mPCR for human herpes virus 1-8, bacterial 16S ribosomal DNA (rDNA) and fungal 28S rDNA.
Case 1 was a 69-year-old man who presented with refractory infectious keratitis. PCR examination was positive for bacterial 16S rDNA and negative for fungal 28S rDNA. HSV-1 was not examined at this time. A geographic ulcer arose after 2 months of intensive antibacterial treatment. Herpes simplex keratitis (HSK) was suspected; PCR analysis was positive for HSV-1. Corneal scrapings obtained at the initial visit were re-analyzed and found to be HSV-1 positive. Thus, it turned out that this was a case of superinfection keratitis caused by bacteria and HSV-1. Case 2 was a 60-year-old man with corneal ulcer who had received unsuccessful treatment with antibiotics. mPCR analysis was positive for HSV-1, bacterial 16S rDNA and fungal 28S rDNA. The patient was diagnosed with superinfection keratitis caused by HSV-1, bacteria and fungus. Case 3 was an 82-year-old woman who had been treated for HSK and then developed bacterial keratitis during treatment. mPCR analysis was positive for HSV-1 and bacterial 16S rDNA. The patient was diagnosed with superinfection keratitis caused by HSV-1 and bacteria.
Superinfection keratitis is hard to diagnose because of its atypical manifestation. mPCR has the potential to allow prompt diagnosis and appropriate treatment in these cases.
报告多重聚合酶链反应（mPCR）在诊断由单纯疱疹病毒1型（HSV-1）、细菌和真菌引起的混合感染性角膜炎方面的潜在用途。
病例系列研究。对角膜刮片进行mPCR分析，检测人类疱疹病毒1 - 8型、细菌16S核糖体DNA（rDNA）和真菌28S rDNA。
病例1为一名69岁男性，患有难治性感染性角膜炎。PCR检查显示细菌16S rDNA呈阳性，真菌28S rDNA呈阴性。此时未检测HSV-1。经过2个月的强化抗菌治疗后出现了地图状溃疡。怀疑为单纯疱疹病毒性角膜炎（HSK）；PCR分析显示HSV-1呈阳性。对初次就诊时获取的角膜刮片重新进行分析，发现HSV-1呈阳性。因此，这是一例由细菌和HSV-1引起的混合感染性角膜炎病例。病例2为一名60岁男性，患有角膜溃疡，使用抗生素治疗无效。mPCR分析显示HSV-1、细菌16S rDNA和真菌28S rDNA均呈阳性。该患者被诊断为由HSV-1、细菌和真菌引起的混合感染性角膜炎。病例3为一名82岁女性，曾接受HSK治疗，治疗期间继而发生细菌性角膜炎。mPCR分析显示HSV-1和细菌16S rDNA呈阳性。该患者被诊断为由HSV-1和细菌引起的混合感染性角膜炎。
混合感染性角膜炎因其非典型表现难以诊断。mPCR有潜力在这些病例中实现快速诊断并进行恰当治疗。
