Skip to main content

Advertisement

SpringerLink
Log in

Herpes simplex virus type 2 mediated acute retinal necrosis in a pediatric population: case series and review

  • Medical Ophthalmology
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Background

We report 15 eyes with herpes simples virus type 2 (HSV-2) mediated acute retinal necrosis (ARN) in order to better characterize pathogenesis, clinical course, diagnosis, and outcomes of the disease.

Methods

Retrospective observational case series of 14 patients (15 eyes) all aged 21 years or younger with acute retinal necrosis resulting from HSV-2 and examined between 1995 and 2009. Patients were diagnosed by various techniques, including polymerase chain reaction (PCR) of aqueous, vitreous, and serum, antibody determination of serum and intraocular fluids, fundoscopic exam, a therapeutic trial of antivirals active against HSV-2, or a combination thereof.

Results

Mean age of presentation was 11.7 years (range, newborn to 21.0 years) with a standard deviation of 7.0 years. Mean initial vision was 20/200 (median, 20/400; range, 20/20 to LP). Eleven patients (73.3 %) had received oral, injectable, or topical corticosteroids, and 14 (93.3 %) had received antiviral therapy. All patients were diagnosed based on evaluation of intraocular fluids and tissue by antibody determinations, culture, PCR, histopathologic examination, or a combination thereof. Mean final visual acuity was 20/400 (median, CF; range, 20/25 to LP) with worsened visual acuity in five eyes (33.3 %). Anatomically, 14 of 15 eyes had healed or improved retinal appearance.

Conclusions

In a pediatric population with acute retinal necrosis, HSV-2 should be considered as the prime candidate virus. Diagnosis of HSV-2 acute retinal necrosis is accomplished mainly by PCR of ocular specimens. Prompt diagnosis may lead to appropriate anti-viral therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Holland GN (1994) Standard diagnostic criteria for the acute retinal necrosis syndrome. Executive Committee of the American Uveitis Society. Am J Ophthalmol 117:663–667

    PubMed  CAS  Google Scholar 

  2. Ganatra JB, Chandler D, Santos C, Kuppermann B, Margolis TP (2000) Viral causes of the acute retinal necrosis syndrome. Am J Ophthalmol 129:166–172

    Article  PubMed  CAS  Google Scholar 

  3. Itoh N, Matsumura N, Ogi A, Nishide T, Imai Y, Kanai H, Ohno S (2000) High prevalence of herpes simplex virus type 2 in acute retinal necrosis syndrome associated with herpes simplex virus in Japan. Am J Ophthalmol 129:404–405

    Article  PubMed  CAS  Google Scholar 

  4. Van Gelder RN, Willig JL, Holland GN, Kaplan HJ (2001) Herpes simplex virus type 2 as a cause of acute retinal necrosis syndrome in young patients. Ophthalmology 108:869–876

    Article  PubMed  Google Scholar 

  5. Young NJ, Bird AC (1978) Bilateral acute retinal necrosis. Br J Ophthalmol 62:581–590

    Article  PubMed  CAS  Google Scholar 

  6. Tran TH, Stanescu D, Caspers-Velu L, Rozenberg F, Liesnard C, Gaudric A, Lehoang P, Bodaghi B (2004) Clinical characteristics of acute HSV-2 retinal necrosis. Am J Ophthalmol 137:872–879

    Article  PubMed  Google Scholar 

  7. Thompson WS, Culbertson WW, Smiddy WE, Robertson JE, Rosenbaum JT (1994) Acute retinal necrosis caused by reactivation of herpes simplex virus type 2. Am J Ophthalmol 118:205–211

    PubMed  CAS  Google Scholar 

  8. Tan JCH, Byles D, Stanford MR, Frith PA, Graham EM (2001) Acute retinal necrosis in children caused by herpes simplex virus. Retina 21:344–347

    Article  PubMed  Google Scholar 

  9. Falcone PM, Brockhurst RJ (1993) Delayed onset of bilateral acute retinal necrosis syndrome: a 34-year interval. Ann Ophthalmol 25:373–374

    PubMed  CAS  Google Scholar 

  10. O'Riordan DP, Golden WC, Aucott SW (2006) Herpes simplex virus infections in preterm infants. Pediatrics 118:e1612–e1620

    Article  PubMed  Google Scholar 

  11. Kimberlin DW, Whitley RJ (2005) Neonatal herpes: what have we learned. Semin Pediatr Infect Dis 16:7–16

    Article  PubMed  Google Scholar 

  12. Malouf DJ, Oates RK (1995) Herpes simplex virus infections in the neonate. J Paediatr Child Health 31:332–335

    Article  PubMed  CAS  Google Scholar 

  13. Pepose JS, Keadle TL, Morrison LA (2006) Ocular herpes simplex: changing epidemiology, emerging disease patterns, and the potential of vaccine prevention and therapy. Am J Ophthalmol 141:547–557

    Article  PubMed  Google Scholar 

  14. Davis JL, Feuer W, Culbertson WW, Pflugfelder SC (1995) Interpretation of intraocular and serum antibody levels in necrotizing retinitis. Retina 15:233–240

    Article  PubMed  CAS  Google Scholar 

  15. Fisher JP, Lewis ML, Blumenkranz M, Culbertson WW, Flynn HW Jr, Clarkson JG, Gass JD, Norton EW (1982) The acute retinal necrosis syndrome. Part 1: clinical manifestations. Ophthalmology 89:1309–1316

    PubMed  CAS  Google Scholar 

  16. Gargiulo F, De Francesco MA, Nascimbeni G, Turano R, Perandin F, Gandolfo E, Manca N (2003) Polymerase chain reaction as a rapid diagnostic tool for therapy of acute retinal necrosis syndrome. J Med Virol 69:397–400

    Article  PubMed  CAS  Google Scholar 

  17. Tran TH, Rozenberg F, Cassoux N, Rao NA, LeHoang P, Bodaghi B (2003) Polymerase chain reaction analysis of aqueous humour samples in necrotising retinitis. Br J Ophthalmol 87:79–83

    Article  PubMed  CAS  Google Scholar 

  18. Clarkson JG, Blumenkranz MS, Culbertson WW, Flynn HW Jr, Lewis ML (1984) Retinal detachment following the acute retinal necrosis syndrome. Ophthalmology 91:1665–1668

    PubMed  CAS  Google Scholar 

  19. Blumenkranz MS, Culbertson WW, Clarkson JG, Dix R (1986) Treatment of the acute retinal necrosis syndrome with intravenous acyclovir. Ophthalmology 93:296–300

    PubMed  CAS  Google Scholar 

  20. Aizman A, Johnson MW, Elner SG (2007) Treatment of acute retinal necrosis syndrome with oral antiviral medications. Ophthalmology 114:307–312

    Article  PubMed  Google Scholar 

  21. Blumenkranz M (1994) Acute retinal necrosis. In: Albert DM, Jakobiec FA (eds) Principles and practice of ophthalmology: Clinical practice. W.B Saunders, Philadelphia

    Google Scholar 

  22. Culbertson WW, Atherton SS (1993) Acute retinal necrosis and similar retinitis syndromes. Int Ophthalmol Clin 33:129–143

    Article  PubMed  CAS  Google Scholar 

  23. Goodpasteur EW, Teague O (1923) Transmission of the virus of herpes fibrilis along nerves in experimentally infected rabbits. J Med Res 44:139–184.7

    Google Scholar 

  24. Smith LK, Kurz PA, Wilson DJ, Flaxel CJ, Rosenbaum JT (2007) Two patients with the von Szily reaction: herpetic keratitis and contralateral retinal necrosis. Am J Ophthalmol 143:536–538

    Article  PubMed  Google Scholar 

  25. Streilein JW (2003) Ocular immune privilege: the eye takes a dim but practical view of immunity and inflammation. J Leukoc Biol 74:179–185

    Article  PubMed  CAS  Google Scholar 

  26. Atherton SS (2001) Acute retinal necrosis: insights into pathogenesis from the mouse model. Herpes 8:69–73

    PubMed  CAS  Google Scholar 

  27. Ohashi Y (1999) All for saving the visual axis. In: Streilein JW (ed) Immune response and the eye. Karger, Basel, pp 2–3

    Google Scholar 

  28. Streilein JW, Dana MR, Ksander BR (1997) Immunity causing blindness: five different paths to herpes stromal keratitis. Immunol Today 18:443–449

    Article  PubMed  CAS  Google Scholar 

  29. Atherton SS, Altman NH, Streilein JW (1989) Histopathologic study of herpes virus-induced retinitis in athymic BALB/c mice: evidence for an immunopathogenic process. Curr Eye Res 8:1179–1192

    Article  PubMed  CAS  Google Scholar 

  30. Norrild B, Shore SL, Cromeans TL, Nahmias AJ (1980) Participation of three major glycoprotein antigens of herpes simplex virus type 1 early in the infectious cycle as determined by antibody-dependent cell-mediated cytotoxicity. Infect Immun 28:38–44

    PubMed  CAS  Google Scholar 

  31. Richards JT, Kern ER, Overall JC Jr, Glasgow LA (1981) Differences in neurovirulence among isolates of Herpes simplex virus types 1 and 2 in mice using four routes of infection. J Infect Dis 144:464–471

    Article  PubMed  CAS  Google Scholar 

Download references

Financial disclosures

None.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA

    Ruwan A. Silva, Darius M. Moshfeghi, Mark S. Blumenkranz & Steven Sanislo

  2. Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL, 33136, USA

    Ruwan A. Silva, Audina M. Berrocal & Janet L. Davis

Authors
  1. Ruwan A. Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Audina M. Berrocal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Darius M. Moshfeghi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mark S. Blumenkranz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Steven Sanislo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Janet L. Davis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Janet L. Davis.

Additional information

Institutional review board approval was obtained from the Schools of Medicine of both the University of Miami and Stanford University.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Silva, R.A., Berrocal, A.M., Moshfeghi, D.M. et al. Herpes simplex virus type 2 mediated acute retinal necrosis in a pediatric population: case series and review. Graefes Arch Clin Exp Ophthalmol 251, 559–566 (2013). https://doi.org/10.1007/s00417-012-2164-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-012-2164-8

Keywords

Search

Navigation