title: Laboratory results in ocular viral diseases: implications in clinical-laboratory correlation.
abstract: OBJECTIVE
  To document etiology and predictive value of clinical diagnosis in laboratory confirmed viral diseases.
  
  
  METHODS
  Reports of culture-positive cases of samples collected from patients presenting from January 1987 - December 2001 were evaluated.
  
  
  RESULTS
  One thousand nine hundred and sixty-four (1964) cultures were submitted during 1987-2001. Twenty-six percent were positive (514). Human herpesvirus 1 was the most frequent agent isolated from all positive culture (56%). Adenovirus was the most common virus isolated from conjunctiva (66%), human herpesvirus 1 from lid and cornea (76%, 88%) and cytomegalovirus from vitreous (27%). Some unusual pathogens were recovered from conjunctiva as cytomegalovirus and from cornea as adenovirus, enterovirus and cytomegalovirus. Recognition of common viral syndromes was human herpesvirus 1 (88%), epidemic keratoconjunctivitis (88%), acute hemorrhagic conjunctivitis (70%) and varicella zoster virus (100%). However, some misdiagnosed cases were observed. Thirteen percent of conjunctivitis thought to be caused by herpes were due to adenovirus, 3.2% to Enterovirus, 3.2% to varicella zoster virus and 3.2% to human cytomegalovirus. Also, 5% of cases with a clinical diagnosis of herpes keratitis were caused by adenovirus and 2.7% by enterovirus. Finally, 4.8% of cases thought to be adenovirus conjunctivitis were herpes conjunctivitis.
  
  
  CONCLUSIONS
  Human herpesvirus 1 remains the most frequently isolated virus from ocular sites in general (56%). Nonherpetic corneal isolates were in decreasing order: adenovirus, enterovirus and cytomegalovirus. Clinical and laboratory correlation was less than 90%. The most misdiagnosed cases were herpes conjunctivitis and keratitis, some cases of adenovirus conjunctivitis some cases of acute hemorrhagic conjunctivitis. It is essential that a rapid and specific diagnosis is offered under atypical viral presentation for the institution of specific antiviral therapy and to avoid complications that can be a result of misdiagnosis and inappropriate treatment. Also it is important to do viral testing in order to confirm clinical diagnosis, report emerging infections, resistance and change in the epidemiology.
authors.affiliation: Universidade Federal de São Paulo, São Paulo, SP, Brasil. fbmarangon@yahoo.com.br
authors.forename: Fabiana Bogossian
authors.initials: FB
authors.lastname: Marangon
authors.forename: Darlene
authors.initials: D
authors.lastname: Miller
authors.forename: Eduardo
authors.initials: E
authors.lastname: Alfonso
mesh_terms: D001938:Brazil; D003232:Conjunctivitis, Acute Hemorrhagic / Q000175:diagnosis / Q000821:virology; D003315:Cornea / Q000821:virology; D004267:DNA Viruses / Q000302:isolation & purification; D003951:Diagnostic Errors / Q000517:prevention & control; D004770:Enterovirus / Q000302:isolation & purification; D015828:Eye Infections, Viral / Q000175:diagnosis* / Q000821:virology; D005189:False Positive Reactions; D006562:Herpes Zoster / Q000821:virology; D006801:Humans; D007637:Keratoconjunctivitis / Q000175:diagnosis* / Q000821:virology; D011237:Predictive Value of Tests; D012621:Seasons; D013997:Time Factors; D014776:Virus Cultivation