Latency and other consequences of infection of the nervous system with herpes simplex virus.
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Biomedical subjects
Publications and source records attributed to A B Tullo.
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Experimental herpes simplex keratitis in the mouse produced a rapid fall in both corneal sensitivity and levels of corneal substance P (SP). This finding supports the association of SP with sensory neurones and shows that such levels can be used as an indication of damage to neurones resulting, for example, from infection with HSV. However, the delay in recovery of SP compared to the more rapid and complete recovery of sensitivity suggests that SP in the cornea is not directly involved in mediation of the blink reflex.
The substance P content of the cornea of the adult mouse has been determined by radioimmunoassay. Sympathectomy did not reduce corneal substance P levels. However substance P levels were reduced by 42% following surgical denervation and by 80% following neonatal capsaicin treatment, suggesting that corneal substance P is contained in the peripheral terminals of small diameter sensory neurones. In some mice capsaicin treatment reduced corneal sensitivity; it also resulted in marked corneal vascularization. These effects could not be ascribed to the reduction in corneal substance P.
In both non-immune and immune mice infected with herpes simplex virus the incidence of latent infection of the trigeminal ganglion was related to the severity of ocular virus infection. During primary infection, virus was shown to travel via the ophthalmic part of the ganglion to reach the brainstem, from where centrifugal spread resulted in latent infection of neurones in the trigeminal ganglion which did not serve the site of inoculation. Primary infection also resulted in latent infection of the superior cervical ganglion. Shedding of virus occurred rarely in the tears of animals which had recovered from primary disease. In immune mice, spread of virus resulted in a much lower incidence of latent infection and that occurred only in ophthalmic neurones.
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Latent infection of the trigeminal ganglion following ocular and labial herpes simplex in the mouse was investigated. Latent infection of the ophthalmic part of the trigeminal ganglion followed subclinical ocular infection. When primary infection resulted in severe eye disease, latent infection was subsequently demonstrated not only in ophthalmic parts of the ganglion but also in parts which did not serve the eye. Primary infection of the lip resulted in latent infection of the mandibular part of the trigeminal ganglion, but also of maxillary and ophthalmic parts. Previous infection by herpes simplex virus in a non-ocular site necessitated a hundred-fold increase in the amount of virus required to initiate keratitis which resulted in a much lower incidence of latent infection and only in the ophthalmic part of the ganglion. The results are interpreted to explain how latent infection of the ophthalmic part may precede and provide a source of virus for symptomatic eye disease. Such latent infection is most likely to arise from previous subclinical ocular infection or primary infection in a non-ocular site.
Thirteen definite and 3 probable cases of chlamydial eye infection were diagnosed in young adults attending the Bristol Eye Hospital between June 1978 and May 1980, and incidence of about 1 case per 44000 per year in the 15 to 44-year-old community served by this hospital, and 1 per 100000 in the total population of this community. These patients presented with a sub-acute follicular conjunctivitis or kerato-conjunctivitis, which had usually been present for several weeks and had often failed to respond to topical chloramphenicol treatment before presentation. Sera obtained from 14 patients, all had chlamydial antibody titres of 64 or more. Over the same period of time, an estimated 2500 patients per year from the same community attended the Venereology Department at the Bristol Royal Infirmary with genital chlamydial infections. These figures suggest that chlamydial infection of the eye complicates no more than 1 in 300 chlamydial infections of the genital tract in adults.
An unusually large outbreak of conjunctivitis caused by adenovirus type 4 involved 113 proved cases during a 7-month period. Though the disease was less severe than is commonly seen in epidemic keratoconjunctivitis caused by other serotypes, the cornea was affected in 23% of cases and symptoms persisted for at least 5 weeks in 6 patients. A concurrent increase in nonocular adenovirus type 4 infections in the Bristol area was not observed. Nine of the cases could have arisen as a result of hospital cross-infection.
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The pattern of adenovirus infection of the eye in the Bristol area has been considered over a period of 9 years. During this time three outbreaks of keratoconjunctivitis, caused in turn by serotypes 8, 10/19, and 4, were observed. When adenoviruses are subdivided into three groups, based on their haemagglutination properties, it is evident that those serotypes responsible for epidemic keratoconjunctivitis belong to Group II. Ocular infection by serotypes in Groups I and III usually results in a follicular conjunctivitis, with or without upper respiratory tract infection, and with markedly less corneal involvement.
Nineteen cases of keratoconjunctivitis caused by an adenovirus serologically related to types 10 and 19 are described. Seventeen of the patients presented over a period of 7 weeks and included 4 who were involved in a minor outbreak at a factory. The presentation and clinical features closely resembled those caused by adenoviruses types 8 and 19. Mild to severe follicular conjunctivitis, superficial punctate keratitis, discrete subepithelial opacities, membrane formation, and conjunctival scarring were all observed.
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