Improving polymerase chain reaction diagnostic rates for herpes simplex keratitis: results of a pilot study.

Background: Laboratory confirmation is crucial for diagnosis and management of herpes simplex virus (HSV) keratitis. However, the sensitivity of polymerase chain reaction (PCR) in keratitis is low (25%) compared with that of mucocutaneous disease (75%). We developed an educational intervention aimed at improving the diagnostic yield of PCR. Methods: The medical records of keratitis cases seen at the emergency department of a London tertiary ophthalmic referral hospital over two distinct periods, before and after an educational program on swab technique, were reviewed retrospectively. Results: A total of 252 HSV cases were included. Increases in the laboratory-confirmed diagnosis of HSV-1 were observed, in both first presentations (11.1%-57.7%) and recurrent cases (20%-57.6%). The rate of positive HSV-1 PCR in eyes with an epithelial defect increased from 19% pre-intervention to 62% post intervention. Notably, 3% were positive for varicella zoster virus DNA, and there was a single case of Acanthamoeba keratitis. Conclusion: Our results suggest that, with proper swabbing technique, PCR may be more sensitive than previously reported.

Increased incidence of adult gonococcal keratoconjunctivitis at two tertiary eye hospitals in Western Europe: clinical features, complications and antimicrobial susceptibility.

BACKGROUND: Gonorrhoea is on the rise: between 2021 and 2022, a 50% and a 33% increase in diagnoses was seen, respectively, in England and the Netherlands. A concurrent rise in gonococcal keratoconjunctivitis (GKC) is a serious concern due to the potentially devastating visual complications. METHODS: This is a retrospective case series of adult GKC from two Western European tertiary ophthalmology centres between 2017 and July 2023. The clinical features, ocular complications and antimicrobial susceptibilities are reported within. RESULTS: An increased incidence was recorded at both centres, with 11 confirmed cases in the first 7 months of 2023, compared with ≤3 per year in 2017-2022. CONCLUSION: The notable increase of GKC cases in our centres in 2023 may indicate a rise across Western Europe. Enhanced, sustained, national surveillance of GKC is essential to establish incidence and antimicrobial susceptibility, to inform treatment guidelines and guide appropriate public health response.

Monkeypox as an emerging infectious disease: the ophthalmic implications.

The 2022 outbreak of monkeypox is of worldwide significance. There has been a rapid escalation in case numbers despite efforts to contain it and the WHO has declared it a Public Health Emergency of International Concern. To date, over 51 257 laboratory-confirmed cases have been reported, the majority in non-endemic countries, with 3279 in the UK. It is vital for ophthalmologists to understand this disease and the risk it poses. Human monkeypox is a zoonotic disease caused by the monkeypox virus, a double-stranded DNA virus in the Orthopoxvirus genus of the Poxviridae family. Other orthopoxviruses include variola (smallpox), cowpox and vaccinia; all of which have significant ocular sequelae. Transmission occurs from an animal reservoir (unknown, likely rodents) to a human host, leading to secondary human-to-human spread. During the recent outbreak, a higher incidence has been found in gay, bisexual or other men who have sex with men. Clinical diagnosis may be challenging as presentation can mimic common ophthalmic diseases. A thorough history is key to identifying potential cases. Ophthalmic manifestations may include preseptal cellulitis, conjunctivitis and keratitis. The oral antiviral agent tecovirimat, which was developed to treat smallpox, is the mainstay of treatment. Trifluorothymidine (trifluridine) eye-drops can be used for ophthalmic involvement. In addition, smallpox vaccines have provided some cross-immunity. Ocular monkeypox should be managed by infectious diseases specialists, in consultation with ophthalmologists to provide the expertise needed to treat potentially vision-threatening complications. This outbreak highlights the need for healthcare providers to implement appropriate infection control measures and be familiar with the identification and treatment of both cutaneous and ocular disease.

Isolated endogenous Fusarium endophthalmitis in an immunocompetent adult after a thorn prick to the hand.

PURPOSE: To report the case of an immunocompetent adult presenting with endogenous Fusarium endophthalmitis. OBSERVATIONS: A woman in her thirties presented with symptoms and signs of a unilateral anterior uveitis. After initial improvement with topical corticosteroids, she continued to develop a panuveitis with an associated drop in vision to counting fingers. A vitreous biopsy confirmed Fusarium solani by 18S rRNA fungal gene detection and PCR sequencing. Despite treatment with pars plana vitrectomy, intravitreal amphotericin B and systemic voriconazole her visual outcome was poor. Detailed review of her antecedent history revealed the route of acquisition to be a thorn prick to the hand two weeks prior to presentation. CONCLUSIONS AND IMPORTANCE: This patient's endophthalmitis most likely resulted from cutaneous inoculation of Fusarium solani with subsequent hematogenous spread. Endogenous Fusarium endophthalmitis is well recognized in the immunocompromised but is very rarely seen in the immunocompetent. This case highlights the importance of thorough history-taking and consideration of fungal endophthalmitis in the differential diagnosis of a treatment-refractory uveitis.