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.
Highlights
Infectious keratitis is a major cause of ocular morbidity worldwide and the most common cause of unilateral corneal blindness in low-resource settings [1]
The aim of the current study 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
This study reports on the clinical and corneal microbial profile of infectious keratitis in patients presenting to the ophthalmology outpatient department of three hospitals in a high HIV prevalence setting in rural South Africa
Summary
Infectious keratitis is a major cause of ocular morbidity worldwide and the most common cause of unilateral corneal blindness in low-resource settings [1]. The estimated population incidence of infectious keratitis in these settings is up to 800 per 100,000/year, which is about 70 times higher than in highresource settings [1]. As visual outcome depends on the prompt initiation of targeted antimicrobial treatment [2, 3]. The spectrum of keratitis-associated pathogens is diverse and includes viruses, bacteria, fungi and protozoa. The clinical picture and aetiology of infectious keratitis varies geographically, as it is subject to both environmental and host factors [1, 2]. Eur J Clin Microbiol Infect Dis (2016) 35:1403–1409
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