Features of Diagnostics and Complex Approach to Therapy of Herpetic Keratitis

Objective. To determine the characteristics of drug therapy in patients with herpetic keratitis (HK), based on laboratory diagnosis.

Material and methods. 49 patients with clinical symptoms of HK were included in the study. The conjunctival cells were used as a material for laboratory diagnosis of adenovirus and enterovirus infection by polymerase chain reaction (PCR) and for microbiological examination. Herpesvirus DNA in tears, saliva, urine and blood was determined using PCR (for varicella-zoster virus (VZV) and human herpesvirus type 7 (HHV-7)) and real-time PCR (for herpes simplex virus types 1 and 2 (HSV-1,2), Epstein-Barr virus (VEB), cytomegalovirus (CMV) and human herpesvirus type 6 (HHV-6). Tear and urine were examined for the presence of DNA of obligate intracellular parasites (chlamydia, ureaplasma, and mycoplasma) by PCR.

Results. Сlinical picture of HK was presented by superficial (57.1 %, n = 28) and deep forms of corneal inflammation (42.9 %, n = 21). The results of laboratory diagnostics of herpetic infection had showed replication of herpesviruses in all examined patients. Genetic material of herpesviruses in lacrimal fluid was found in half of the examined patients (51 %), in saliva — in 67,3 % of cases. Viruria was observed in 21 patients (42.9 %), viraemia in 6 (12.2 %). DNA of intracellular parasites in lacrimal fluid was detected in 18.4 % of patients and in urine — in 12.2 % of patients. Bacteriological sowing of the conjunctiva scrape was positive in 75.5 % of cases.

Conclusion. Instrumental diagnostics (visometry, biomicroscopy) of HK should be supplemented with laboratory research of activity of not only herpesvirus infection, but also bacterial pathogens. Positive results of microbiological sowing of conjunctival scrapers allow to approach reasonably the prescription of antimicrobial drugs in patients with HK. 

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