title: Human herpesviruses in the cornea.
abstract: OBJECTIVE
  To determine the sensitivity and specificity of culture, immunohistochemistry (IHC), the polymerase chain reaction (PCR), and in situ hybridisation (ISH) for detecting herpes simplex virus (HSV-1) in the cornea of patients undergoing penetrating keratoplasty. To compare the incidence of HSV-1 in the cornea with that of varicella zoster virus (VZV), cytomegalovirus (CMV), and Epstein-Barr virus (EBV).
  
  
  METHODS
  The corneas of 110 patients, 52 with a documented history of herpes keratitis (HSK) and 58 with non-herpetic corneal disease, were investigated using IHC, PCR, ISH, and culture.
  
  
  RESULTS
  HSV-1 DNA and antigen were detected in 82% and 74% respectively, of corneas of patients with HSK and in 22% and 15% of corneas of patients with no history of HSK. The sensitivity of PCR and IHC was 82% and 74% with a specificity of 78% and 85%, respectively. HSV-1 DNA and antigen were found more frequently and in increased amounts in corneas of patients with a short interval between their last attack of HSK and surgery. There was a good correlation between PCR and IHC in 71%. HSV-1 was isolated by culture in 2%. Latency associated transcripts were not detected using ISH. Evidence of VZV DNA or antigen was found significantly more frequently in the corneas of patients with a history of HSK (p<0.001). No evidence of EBV or CMV was found in any cornea.
  
  
  CONCLUSIONS
  PCR and IHC are both sensitive for the detection of HSV-1 in the cornea. A combination of PCR and IHC increases the specificity for the diagnosis of HSK to 97%. HSV-1 appears to be slowly removed from the cornea. VZV and HSV-1 may co-infect the cornea.
authors.affiliation: Department of Medical Microbiology, University of Liverpool, UK.
authors.forename: S B
authors.initials: SB
authors.lastname: Kaye
authors.forename: K
authors.initials: K
authors.lastname: Baker
authors.forename: R
authors.initials: R
authors.lastname: Bonshek
authors.forename: H
authors.initials: H
authors.lastname: Maseruka
authors.forename: E
authors.initials: E
authors.lastname: Grinfeld
authors.forename: A
authors.initials: A
authors.lastname: Tullo
authors.forename: D L
authors.initials: DL
authors.lastname: Easty
authors.forename: C A
authors.initials: CA
authors.lastname: Hart
mesh_terms: D002353:Carrier State / Q000821:virology*; D003315:Cornea / Q000821:virology*; D003587:Cytomegalovirus / Q000302:isolation & purification; D018259:Herpesvirus 1, Human / Q000302:isolation & purification*; D014645:Herpesvirus 3, Human / Q000302:isolation & purification; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D007124:Immunoenzyme Techniques; D017403:In Situ Hybridization; D016849:Keratitis, Herpetic / Q000175:diagnosis* / Q000821:virology; D015948:Keratoplasty, Penetrating; D016133:Polymerase Chain Reaction / Q000379:methods; D012086:Reoperation; D012680:Sensitivity and Specificity