title: Clinical and corneal microbial profile of infectious keratitis in a high HIV prevalence setting in rural South Africa.
abstract: The purpose of this investigation was to determine the clinical and corneal microbial profile of infectious keratitis in a high human immunodeficiency virus (HIV) prevalence setting in rural South Africa. Data in this cross-sectional study were collected from patients presenting with symptoms of infectious keratitis (n = 46) at the ophthalmology outpatient department of three hospitals in rural South Africa. Corneal swabs were tested for herpes simplex virus type 1 (HSV-1) and 2 (HSV-2), varicella zoster virus (VZV) and adenovirus DNA by real-time polymerase chain reaction (PCR) and for bacteria and fungi by culture. Based on clinical history, disease characteristics and laboratory results, 29 (63 %) patients were diagnosed as viral keratitis, including 14 (48 %) viral keratitis cases complicated by bacterial superinfection, and 17 (37 %) as bacterial keratitis. VZV and HSV-1 DNA was detected in 11 (24 %) and 5 (11 %) corneal swabs, respectively. Among clinically defined viral keratitis cases, a negative viral swab was predominantly (93 %) observed in cases with subepithelial inflammation and was significantly associated with an increased duration of symptoms (p = 0.003). The majority of bacteria cultured were Gram-positive (24/35), including Staphylococcus epidermidis and S. aureus. Viral aetiology was significantly associated with a history of herpes zoster ophthalmicus (p < 0.001) and a trend was observed between viral aetiology and HIV infection (p = 0.06). Twenty-one (47 %) keratitis cases were complicated by anterior uveitis, of which 18 (86 %) were HIV-infected cases with viral keratitis. The data implicate a high prevalence of herpetic keratitis, in part complicated by bacterial superinfection and/or uveitis, in HIV-infected individuals presenting with infectious keratitis in rural South Africa.
authors.affiliation: Department of Viroscience (room Ee1720a), Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.|Anova Health Institute, 12 Sherborne Road, Parktown, Johannesburg, South Africa.|Anova Health Institute, 21 Peace street, P.O. Box 2243, 0850, Tzaneen, South Africa.
authors.forename: E
authors.initials: E
authors.lastname: Schaftenaar
authors.affiliation: Anova Health Institute, 12 Sherborne Road, Parktown, Johannesburg, South Africa.|Anova Health Institute, 21 Peace street, P.O. Box 2243, 0850, Tzaneen, South Africa.|Department of Medical Microbiology, University of Pretoria, cnr Lynnwood Road and Roper Street, Hatfield, Pretoria, South Africa.
authors.forename: R P H
authors.initials: RP
authors.lastname: Peters
authors.affiliation: Rotterdam Ophthalmic Institute, Schiedamse Vest 160, 3011 BH, Rotterdam, The Netherlands.
authors.forename: G S
authors.initials: GS
authors.lastname: Baarsma
authors.affiliation: Department of Ophthalmology, VU University Medical Center, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Meenken
authors.affiliation: Anova Health Institute, 12 Sherborne Road, Parktown, Johannesburg, South Africa.|Anova Health Institute, 21 Peace street, P.O. Box 2243, 0850, Tzaneen, South Africa.
authors.forename: N S
authors.initials: NS
authors.lastname: Khosa
authors.affiliation: Department of Viroscience (room Ee1720a), Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Getu
authors.affiliation: Anova Health Institute, 12 Sherborne Road, Parktown, Johannesburg, South Africa.|Anova Health Institute, 21 Peace street, P.O. Box 2243, 0850, Tzaneen, South Africa.|School of Public Health & Family Medicine, University of Cape Town, Observatory, 7925, Cape Town, South Africa.
authors.forename: J A
authors.initials: JA
authors.lastname: McIntyre
authors.affiliation: Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine, Medicine Bünteweg 17, 30559, Hannover, Germany.
authors.forename: A D M E
authors.initials: AD
authors.lastname: Osterhaus
authors.affiliation: Department of Viroscience (room Ee1720a), Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. g.verjans@erasmusmc.nl.|Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine, Medicine Bünteweg 17, 30559, Hannover, Germany. g.verjans@erasmusmc.nl.
authors.forename: G M G M
authors.initials: GM
authors.lastname: Verjans
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification*; D001431:Bacteriological Techniques; D003315:Cornea / Q000382:microbiology* / Q000821:virology*; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000235:genetics / Q000302:isolation & purification; D005260:Female; D005658:Fungi / Q000145:classification / Q000302:isolation & purification*; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007639:Keratoconjunctivitis, Infectious / Q000453:epidemiology / Q000382:microbiology* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012424:Rural Population; D013019:South Africa / Q000453:epidemiology; D014780:Viruses / Q000145:classification / Q000302:isolation & purification*; D055815:Young Adult
chemical_list: D004279:DNA, Viral