Laboratory results in ocular viral diseases: implications in clinical-laboratory correlation.
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.
Marangon
Fabiana Bogossian
FB
Universidade Federal de São Paulo, São Paulo, SP, Brasil. fbmarangon@yahoo.com.br
Miller
Darlene
D
Alfonso
Eduardo
E
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