Search PubMed⌕ Search

PubMed · 8154528

Linear endotheliitis.

Abstract

We treated six eyes of five patients with linear endotheliitis. This entity appears clinically as a line of keratic precipitates on the corneal endothelium that progresses centrally and is accompanied by peripheral stromal and epithelial edema. All five patients had ocular pain, redness, and photophobia. One eye had an episode of a dendritic lesion typical of herpes simplex. Two eyes had a history of cataract extraction before developing linear endotheliitis. We treated all patients aggressively with a combination of corticosteroids and antiviral agents. Complete resolution of inflammation and edema occurred in all cases. Four patients required the use of oral acyclovir to control the inflammation and prevent recurrence of the disease. Linear endothelitis is a distinct form of endotheliitis that may be associated with herpes simplex virus, and treatment included corticosteroid and antiviral therapy.

Explore related subjects

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

T W Olsen, D R Hardten, R S Meiusi, E J Holland. 1994-04-15. Linear endotheliitis.. https://doi.org/10.1016/s0002-9394(14)70006-6

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

Acyclovir-resistant genital herpes among persons attending sexually transmitted disease and human immunodeficiency virus clinics.

BACKGROUND: Genital herpes is epidemic in the United States; long-term acyclovir therapy is common; and long-term use of antimicrobials in suppressive doses favors development of resistance. OBJECTIVE: To determine the prevalence of and risk factors for acyclovir-resistant genital herpes. METHODS: We identified and attempted to enroll all patients 18 years or older with suspected genital herpes who attended 22 sexually transmitted disease and human immunodeficiency virus (HIV) clinics in the United States between October 1996 and April 1998. We conducted standardized interviews of all consenting patients. Lesions were cultured, and isolates were typed as herpes simplex virus (HSV) 1 or HSV-2 and tested for acyclovir sensitivity (using a 50% inhibitory concentration of 2 microg/mL) by plaque reduction, which was independently confirmed. RESULTS: Herpes simplex virus was isolated from 2088 of 3602 patients, and 90.2% of isolates were HSV-2. Fifteen isolates, all HSV-2, were acyclovir resistant. Three (0.18%) of 1644 HIV-negative patients had acyclovir-resistant isolates (95% confidence interval [CI], 0.04%-0.5%); resistance was associated with oral (P<.006) and topical (P<.001) acyclovir use. Twelve (5.3%) of 226 HIV-positive patients yielded resistant HSV isolates (95% CI, 2.8%-9.1%); resistance was associated with oral acyclovir use (P<.001), duration of the current episode (P<.001), history of recurrent genital herpes (P<.01), and low CD4 cell count (P<.05). CONCLUSIONS: In the 15 years following licensure of acyclovir, resistance to the drug remains low among immunocompetent patients. However, 5% of HIV-positive patients had resistant HSV-2 isolates. Continued surveillance is essential to monitor changes in acyclovir resistance and to characterize the clinical and public health importance of acyclovir-resistant HSV.

Acyclovir↗

Prevention of herpes simplex virus eye disease: a cost-effectiveness analysis.

OBJECTIVES: To estimate the cost of treating herpes simplex virus (HSV) eye disease, and to evaluate the incremental cost-effectiveness of chronic suppressive antiviral prophylaxis for reducing ocular HSV recurrences. METHODS: An economic decision-tree model was used on follow-up data from 703 patients with prior ocular HSV disease who were enrolled in a Herpetic Eye Disease Study multicenter clinical trial that evaluated the prolonged use of oral acyclovir. Costs were based on wholesale drug prices, Medicare fees, and national health surveys. Incremental cost-effectiveness ratios for all patients and for patients with prior stromal keratitis were calculated as the additional net cost of acyclovir prophylaxis compared with the number of cases of ocular herpes prevented during 12 months. One- and 2-way sensitivity analyses evaluated the effect of different treatment costs and recurrence risks. RESULTS: Approximately 17.7 US dollars million is expended annually to treat the estimated 59,000 new and recurrent episodes of HSV eye disease occurring among 29,000 individuals each year in the United States. Chronic suppressive oral acyclovir costs 8532 US dollars per ocular HSV episode averted. The incremental cost per infection averted would decline by up to 51% if antiviral prophylaxis were more effective and by up to 87% if patients had a higher recurrence risk. Targeting prophylaxis to patients with a history of stromal keratitis is not more cost-effective than providing oral acyclovir for patients with any prior HSV eye disease. CONCLUSIONS: Herpetic eye disease is costly to treat and prevent. Because prophylactic oral acyclovir is not a cost-effective option for all patients with previous HSV eye disease, therapeutic decisions must be made on a case-by-case basis.

Acyclovir↗

[Opportunistic infections in patients with inflammatory bowel disease undergoing immunosuppressive therapy].

Immunosuppressive agents (azathioprine, methotrexate) are increasingly being used in the treatment of inflammatory bowel disease. The use of immunosuppressive agents is associated with a greater risk of opportunistic infections, the most frequent of which are those caused by cytomegalovirus and varicella zoster virus. We present four cases of opportunistic infections due to Herpesviruses in patients undergoing immunosuppressive treatment with azathioprine for Crohn's disease. We also review the literature published on this topic. Two patients presented cutaneous varicella complicated by pneumonia and esophagitis respectively, one patient had cutaneous herpes zoster and the other had fatal pneumonia possibly caused by the Herpesvirus. In the first three the clinical course of the infection was favorable after withdrawing immunosuppressant treatment and initiating treatment with aziclovir. In patients Crohn's disease azathioprine treatment increases the risk of opportunistic infection by Herpesvirus. However, in the absence of other factors that increase immunosuppression, these infections usually have a benign course with specific antiviral therapy.

Acyclovir↗