Microdissection combined with the polymerase chain reaction to identify potentiating viral co-infection in patients with HIV/AIDS with ocular infection.
BACKGROUND
In the presence of several coexisting infections, superimposed tissue necrosis or tissue metaplasia, it may be difficult to recognize standard histologic morphology on hematoxylin-eosin slides. Tissue microdissection combined with the polymerase chain reaction (PCR-MD) offers the advantages of high specificity and relative speed. The objective of this study was to describe the use of PCR-MD in identifying potentiating viral co-infection in patients with HIV/AIDS with retinitis and choroiditis.


METHODS
Eyes from two patients with HIV/AIDS with several ocular infections were studied by a variety of techniques, including standard histologic examination, immunochemistry, electron microscopy and in situ hybridization. PCR-MD was used to identify coexisting viral infections.


RESULTS
Histologic examination showed cytomegalovirus retinitis in both cases. Use of PCR-MD allowed the identification of Epstein-Barr virus within a zone of fulminant varicella-zoster virus retinitis in one patient. PCR-MD confirmed the presence of human herpesvirus 8 in the second patient, who had ocular lymphoma.


CONCLUSIONS
PCR-MD can be used to demonstrate coexisting viral infection in ocular specimens from patients with unusually fulminant courses. Co-infections may contribute to the observed clinical course and should be considered in patients with rapid progression or unusual presentation.
de Smet
Marc D
MD
Department of Ophthalmology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. m.d.desmet@amc.uva.nl
Shen
De Fen
DF
Pepose
Jay
J
Chan
Chi C
CC
D000328:Adult; D002648:Child; D017726:Cytomegalovirus Retinitis / Q000150:complications / Q000175:diagnosis; D004210:Dissection; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000175:diagnosis; D015353:Eye Enucleation; D015828:Eye Infections, Viral / Q000150:complications* / Q000175:diagnosis; D017809:Fatal Outcome; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis; D006566:Herpesviridae Infections / Q000150:complications / Q000175:diagnosis; D014645:Herpesvirus 3, Human / Q000302:isolation & purification; D019288:Herpesvirus 8, Human / Q000302:isolation & purification; D006801:Humans; D007124:Immunoenzyme Techniques; D017403:In Situ Hybridization; D008223:Lymphoma / Q000473:pathology; D008297:Male; D009165:Mycobacterium Infections, Nontuberculous / Q000150:complications / Q000175:diagnosis; D016133:Polymerase Chain Reaction / Q000379:methods; D019572:Retinal Neoplasms / Q000473:pathology