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A relationship between varicella-zoster virus-specific delayed hypersensitivity and varicella-zoster virus-induced anterior uveitis.
Arch Ophthalmol. 2002 Sep; 120(9):1183-8.AO

Abstract

BACKGROUND

We recently reported that acute retinal necrosis in humans develops in a setting where delayed hypersensitivity (DH) to the varicella-zoster virus (VZV) antigen was absent, implying that virus-specific DH mitigates against acute retinal necrosis.

OBJECTIVE

To determine whether a similar correlation exists for patients with anterior uveitis caused by VZV.

DESIGN

Using VZV and purified protein derivative (PPD) antigens to evaluate DH, we skin tested patients with acute, VZV-induced anterior uveitis (herpes zoster ophthalmicus [ZO-AU]) (n = 12), those with uveitis caused by VZV in the absence of dermatitis (zoster sine herpete [ZSH-AU]) (n = 3), and age-matched patients whose ophthalmic herpes zoster was unassociated with uveitis as controls (n = 7). Varicella-zoster virus-induced anterior uveitis was diagnosed by polymerase chain reaction methods and serum antibody titration. Serum samples were collected and analyzed for anti-VZV antibody titers. Anterior uveitis activity was assessed clinically. Delayed hypersensitivity skin tests were repeated in patients with zoster sine herpete 3 months after onset, when ocular recovery had taken place.

RESULTS

All patients with VZV-induced skin disease alone (control group) displayed intense DH when tested with VZV and PPD antigens. By contrast, only 4 (33%) of 12 patients with ZO-AU had a positive DH to VZV, whereas 11 (91.6%) of these patients displayed positive PPD skin reactions. The clinical intensity of anterior uveitis correlated negatively with VZV DH responses (P<.05). Serum anti-VZV and anti-herpes simplex virus antibody titers were comparable in DH-positive VZV cases and in DH-negative patients with uveitis. Patients with uveitis and ZSH-AU also displayed absent VZV-specific DH, although their PPD responses were normal.

MAIN OUTCOME MEASURES

Varicella-zoster virus-specific DH, PPD-specific DH, VZV-specific antibody titration, and intraocular pressure in patients with ZO-AU.

CONCLUSIONS

Absence (or loss) of DH reactivity to VZV antigens seems to be a concomitant feature of VZV uveitis of high intensity, implying that virus-specific DH may interfere with the emergence of VZV-induced anterior uveitis, as it does for acute retinal necrosis.

CLINICAL RELEVANCE

In a clinical setting, absence of virus-specific DH to anterior uveitis caused by VZV may not only reveal a possible pathogenic mechanism, but a negative DH response may prove useful in diagnosing ZSH-AU in the acute stage.

Authors+Show Affiliations

Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, 1163, Tate-machi, Hachioji-city, Tokyo, 193-8639, Japan. tkezuka@tokyo-med.ac.jpNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

12215092

Citation

Kezuka, Takeshi, et al. "A Relationship Between Varicella-zoster Virus-specific Delayed Hypersensitivity and Varicella-zoster Virus-induced Anterior Uveitis." Archives of Ophthalmology (Chicago, Ill. : 1960), vol. 120, no. 9, 2002, pp. 1183-8.
Kezuka T, Sakai J, Minoda H, et al. A relationship between varicella-zoster virus-specific delayed hypersensitivity and varicella-zoster virus-induced anterior uveitis. Arch Ophthalmol. 2002;120(9):1183-8.
Kezuka, T., Sakai, J., Minoda, H., Takeuchi, M., Keino, H., Streilein, J. W., & Usui, M. (2002). A relationship between varicella-zoster virus-specific delayed hypersensitivity and varicella-zoster virus-induced anterior uveitis. Archives of Ophthalmology (Chicago, Ill. : 1960), 120(9), 1183-8.
Kezuka T, et al. A Relationship Between Varicella-zoster Virus-specific Delayed Hypersensitivity and Varicella-zoster Virus-induced Anterior Uveitis. Arch Ophthalmol. 2002;120(9):1183-8. PubMed PMID: 12215092.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A relationship between varicella-zoster virus-specific delayed hypersensitivity and varicella-zoster virus-induced anterior uveitis. AU - Kezuka,Takeshi, AU - Sakai,Jun-Ichi, AU - Minoda,Hiroshi, AU - Takeuchi,Masaru, AU - Keino,Hiroshi, AU - Streilein,J Wayne, AU - Usui,Masahiko, PY - 2002/9/7/pubmed PY - 2002/9/27/medline PY - 2002/9/7/entrez SP - 1183 EP - 8 JF - Archives of ophthalmology (Chicago, Ill. : 1960) JO - Arch. Ophthalmol. VL - 120 IS - 9 N2 - BACKGROUND: We recently reported that acute retinal necrosis in humans develops in a setting where delayed hypersensitivity (DH) to the varicella-zoster virus (VZV) antigen was absent, implying that virus-specific DH mitigates against acute retinal necrosis. OBJECTIVE: To determine whether a similar correlation exists for patients with anterior uveitis caused by VZV. DESIGN: Using VZV and purified protein derivative (PPD) antigens to evaluate DH, we skin tested patients with acute, VZV-induced anterior uveitis (herpes zoster ophthalmicus [ZO-AU]) (n = 12), those with uveitis caused by VZV in the absence of dermatitis (zoster sine herpete [ZSH-AU]) (n = 3), and age-matched patients whose ophthalmic herpes zoster was unassociated with uveitis as controls (n = 7). Varicella-zoster virus-induced anterior uveitis was diagnosed by polymerase chain reaction methods and serum antibody titration. Serum samples were collected and analyzed for anti-VZV antibody titers. Anterior uveitis activity was assessed clinically. Delayed hypersensitivity skin tests were repeated in patients with zoster sine herpete 3 months after onset, when ocular recovery had taken place. RESULTS: All patients with VZV-induced skin disease alone (control group) displayed intense DH when tested with VZV and PPD antigens. By contrast, only 4 (33%) of 12 patients with ZO-AU had a positive DH to VZV, whereas 11 (91.6%) of these patients displayed positive PPD skin reactions. The clinical intensity of anterior uveitis correlated negatively with VZV DH responses (P<.05). Serum anti-VZV and anti-herpes simplex virus antibody titers were comparable in DH-positive VZV cases and in DH-negative patients with uveitis. Patients with uveitis and ZSH-AU also displayed absent VZV-specific DH, although their PPD responses were normal. MAIN OUTCOME MEASURES: Varicella-zoster virus-specific DH, PPD-specific DH, VZV-specific antibody titration, and intraocular pressure in patients with ZO-AU. CONCLUSIONS: Absence (or loss) of DH reactivity to VZV antigens seems to be a concomitant feature of VZV uveitis of high intensity, implying that virus-specific DH may interfere with the emergence of VZV-induced anterior uveitis, as it does for acute retinal necrosis. CLINICAL RELEVANCE: In a clinical setting, absence of virus-specific DH to anterior uveitis caused by VZV may not only reveal a possible pathogenic mechanism, but a negative DH response may prove useful in diagnosing ZSH-AU in the acute stage. SN - 0003-9950 UR - https://www.unboundmedicine.com/medline/citation/12215092/A_relationship_between_varicella_zoster_virus_specific_delayed_hypersensitivity_and_varicella_zoster_virus_induced_anterior_uveitis_ L2 - https://jamanetwork.com/journals/jamaophthalmology/fullarticle/vol/120/pg/1183 DB - PRIME DP - Unbound Medicine ER -