Clinical and corneal microbial profile of infectious keratitis in a high HIV prevalence setting in rural South Africa
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Date
Authors
Schaftenaar, E.
Peters, Remco P.H.
Baarsma, G.S.
Meenken, C.
Khosa, N.S.
Getu, S.
McIntyre, J.A.
Osterhaus, A.D.M.E.
Verjans, G.M.G.M.
Journal Title
Journal ISSN
Volume Title
Publisher
SpringerOpen Journal
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.
Description
Keywords
Microbial profile, High human immunodeficiency virus (HIV), Rural South Africa
Sustainable Development Goals
Citation
Schaftenaar, E, Peters, RPH, Baarsma, GS, Meenken, C, Khosa, NS, Getu, S, McIntyre, JA, Osterhaus, ADME & Verjans, GMGM 2016, 'Clinical and corneal microbial profile of infectious keratitis in a high HIV prevalence setting in rural South Africa', European Journal of Clinical Microbiology and Infectious Diseases, vol. 35, pp. 1403-1409.