ORIGINAL ARTICLES: Improving polymerase chain reaction diagnostic rates for herpes simplex keratitis: results of a pilot study

Digital Journal of Ophthalmology Pub Date : 2024-02-12 DOI:10.5693/djo.01.2024.01.002

Alice L. Milligan, Jeremy J. Hoffman, Yan Ning Neo, Su-yin Koay

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Abstract

BackgroundLaboratory confirmation is crucial for diagnosis and management of herpes simplex virus (HSV) keratitis. However, the sensitivity of polymerase chain reaction (PCR) in keratitis is low (25%) compared with that of mucocutaneous disease (75%). We developed an educational intervention aimed at improving the diagnostic yield of PCR. MethodsThe medical records of keratitis cases seen at the emergency department of a London tertiary ophthalmic referral hospital over two distinct periods, before and after an educational program on swab technique, were reviewed retrospectively. ResultsA total of 252 HSV cases were included. Increases in the laboratory-confirmed diagnosis of HSV-1 were observed, in both first presentations (11.1%-57.7%) and recurrent cases (20%-57.6%). The rate of positive HSV-1 PCR in eyes with an epithelial defect increased from 19% pre-intervention to 62% post intervention. Notably, 3% were positive for varicella zoster virus DNA, and there was a single case of Acanthamoeba keratitis. ConclusionOur results suggest that, with proper swabbing technique, PCR may be more sensitive than previously reported.

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原创文章：提高单纯疱疹性角膜炎的聚合酶链反应诊断率：试点研究的结果

背景实验室确诊对于单纯疱疹病毒（HSV）角膜炎的诊断和治疗至关重要。然而，聚合酶链反应（PCR）在角膜炎中的灵敏度（25%）低于粘膜病（75%）。我们制定了一项教育干预措施，旨在提高 PCR 的诊断率。方法回顾性审查了伦敦一家三级眼科转诊医院急诊科在开展拭子技术教育项目前后两个不同时期接诊的角膜炎病例的病历。在初诊病例（11.1%-57.7%）和复发病例（20%-57.6%）中，HSV-1 的实验室确诊率均有所上升。上皮缺损眼的 HSV-1 PCR 阳性率从干预前的 19% 上升到干预后的 62%。值得注意的是，水痘带状疱疹病毒 DNA 阳性率为 3%，还有一例阿卡阿米巴角膜炎病例。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Digital Journal of Ophthalmology

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