title: Corneal herpes simplex virus type 1 superinfection in patients with recrudescent herpetic keratitis.
abstract: OBJECTIVE
  Herpetic keratitis is a common sequel of a corneal infection with herpes simplex virus (HSV)-1. Recrudescent herpetic keratitis (RHK) may result in irreversible damage to the cornea. Recurrences may be caused by reactivation of endogenous HSV-1 or reinfection with exogenous HSV-1. The objective of this study was to determine the incidence and risk factors involved of HSV-1 superinfection in patients with RHK.
  
  
  METHODS
  From 30 patients with RHK, sequential corneal HSV-1 isolates were genotyped by PCR amplification of the hypervariable regions located within the HSV-1 genes US1, US10/11, and US12. The clinical data from the patients obtained retrospectively were: ophthalmologic history, clinical picture during recurrences, number and time points of penetrating keratoplasty (PKP), and steroid or acyclovir treatment.
  
  
  RESULTS
  Whereas the sequential corneal HSV-1 isolates of 19 (63%) of 30 patients had the same genotype (designated as group 1), the sequential isolates of 11 patients (37%) were genetically different (designated as group 2). Among the clinical data analyzed, only the time point of PKP was significantly different between the patient groups. Although no patients in group 1 had undergone transplantation between samplings, 4 of 11 patients in group 2 underwent PKP during the inter-recurrence period in the same eye from which the corneal HSV-1 isolates were obtained.
  
  
  CONCLUSIONS
  The data demonstrate that RHK is frequently associated with corneal reinfection with a different HSV-1 strain and suggest that PKP is a risk factor for corneal HSV-1 superinfection.
authors.affiliation: Rotterdam Eye Hospital, Rotterdam, The Netherlands.
authors.forename: Lies
authors.initials: L
authors.lastname: Remeijer
authors.forename: Jeroen
authors.initials: J
authors.lastname: Maertzdorf
authors.forename: Johannes
authors.initials: J
authors.lastname: Buitenwerf
authors.forename: Albert D M E
authors.initials: AD
authors.lastname: Osterhaus
authors.forename: Georges M G M
authors.initials: GM
authors.lastname: Verjans
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D003315:Cornea / Q000821:virology*; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005838:Genotype; D018259:Herpesvirus 1, Human / Q000235:genetics / Q000254:growth & development* / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D016849:Keratitis, Herpetic / Q000453:epidemiology / Q000628:therapy / Q000821:virology*; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012008:Recurrence; D012307:Risk Factors; D015163:Superinfection / Q000453:epidemiology / Q000628:therapy / Q000821:virology*; D014775:Virus Activation
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D000212:Acyclovir