Polymerase chain reaction and Goldmann-Witmer coefficient analysis are complimentary for the diagnosis of infectious uveitis.
OBJECTIVE
To determine the relative contribution of the analysis of intraocular antibody production and the polymerase chain reaction (PCR) in aqueous humor (AH) to the diagnosis of infectious uveitis.


METHODS
Retrospective case-control study.


METHODS
Paired AH and serum samples from 230 patients suspected of infectious uveitis were examined for intraocular antibody production against herpes simplex virus (HSV), varicella zoster virus (VZV), and Toxoplasma gondii by calculating the Goldmann-Witmer coefficient (GWC). In addition, AH samples were investigated by real-time PCR to determine the presence of microbial DNA.


RESULTS
Positive results were obtained in 54 cases (23%): 13 HSV (24%), 16 VZV (30%), and 25 T gondii (46%). Of these, 23 (43%) were positive for both GWC and PCR, 26 (48%) only for GWC, and 5 (9%) only for PCR. With PCR as the sole diagnostic approach, a correct diagnosis of the infectious etiology would have been missed in 34% of cases for the herpes viruses and in 64% for T gondii. Analysis of the relationship between a positive laboratory diagnosis and the time of sampling after onset of ocular disease demonstrated that intraocular antibody production was found throughout the course of the diseases. Viral DNA was more readily detected early in infection. In contrast, T gondii nucleic acid was not detected until 3 weeks after onset of ocular disease.


CONCLUSIONS
Analysis of intraocular antibody production contributed considerably to the etiological diagnosis of infectious uveitis, most notably of ocular toxoplasmosis early after onset of disease. Therefore, both PCR and GWC determination might be performed for comprehensive diagnosis of intraocular infections.
De Groot-Mijnes
Jolanda D F
JD
Department of Virology, Eijkman-Winkler Center, and F.C. Donders Institute of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands. j.d.f.degroot@azu.nl
Rothova
Aniki
A
Van Loon
Anton M
AM
Schuller
Margje
M
Ten Dam-Van Loon
Ninette H
NH
De Boer
Joke H
JH
Schuurman
Rob
R
Weersink
Annemarie J L
AJ
D000818:Animals; D000913:Antibodies, Protozoan / Q000032:analysis; D000914:Antibodies, Viral / Q000032:analysis; D001082:Aqueous Humor / Q000276:immunology* / Q000469:parasitology / Q000821:virology; D016022:Case-Control Studies; D016054:DNA, Protozoan / Q000032:analysis; D004279:DNA, Viral / Q000032:analysis; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods*; D015822:Eye Infections, Parasitic / Q000175:diagnosis* / Q000469:parasitology; D015828:Eye Infections, Viral / Q000175:diagnosis* / Q000821:virology; D014645:Herpesvirus 3, Human / Q000235:genetics / Q000276:immunology; D006801:Humans; D016133:Polymerase Chain Reaction / Q000379:methods*; D012189:Retrospective Studies; D018139:Simplexvirus / Q000235:genetics / Q000276:immunology; D014122:Toxoplasma / Q000235:genetics / Q000276:immunology; D014605:Uveitis / Q000175:diagnosis* / Q000469:parasitology / Q000821:virology
D000913:Antibodies, Protozoan; D000914:Antibodies, Viral; D016054:DNA, Protozoan; D004279:DNA, Viral