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.
Department of Ophthalmology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. m.d.desmet@amc.uva.nl
Marc D
MD
de Smet
De Fen
DF
Shen
Jay
J
Pepose
Chi C
CC
Chan
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