Which lab studies are performed in the workup of herpes simplex virus (HSV) keratitis?

Updated: Jan 18, 2019
  • Author: Jim C Wang (王崇安), MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Epithelial scrapings with Giemsa stain may show multinucleated giant cells, resulting from coalescence of infected corneal epithelial cells and intranuclear viral inclusions. However, negative cytology results do not exclude HSV infection.

Viral cultures obtained within several days of onset of disease and prior to antiviral therapy have a sensitivity of up to 70% and also allow for identification of the HSV subtypes. Various techniques (eg, conventional tube culture, shell vial assay, suspension infection method) are available.

HSV-antigen detection tests, such as the enzyme-linked virus-inducible system (ELVIS), are very specific for detecting herpes infection, but they are limited by their lower sensitivity. Cell culture for confirmation of HSV is recommended when the ELVIS test result is negative.

PCR assay using tear samples, corneal epithelium, anterior chamber tap, or corneal buttons may detect viral DNA in cases of herpetic keratitis or keratouveitis. However, it does not distinguish between latent or active HSV infections.

A study by Inoue et al indicated that an immunochromatographic assay (ICGA) kit developed for the identification of HSV is clinically useful in the diagnosis of HSV epithelial keratitis. The investigators found that the ICGA had moderate sensitivity and high specificity, showing positive results for 35 out of 75 patients (46.7%) diagnosed with epithelial keratitis and negative results for 39 out of 39 patients (100%) who did not have the disease. [19]

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