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DOI: 10.1055/s-0029-1245338
© Georg Thieme Verlag KG Stuttgart · New York
Diagnostik und Therapie der Herpesvirus-assoziierten Uveitis
Diagnosic and Therapeutic Aspects of Herpes Virus Associated UveitisPublication History
Eingegangen: 30.11.2009
Angenommen: 3.3.2010
Publication Date:
20 May 2010 (online)
![](https://www.thieme-connect.de/media/klimo/201005/lookinside/thumbnails/10.1055-s-0029-1245338-1.jpg)
Zusammenfassung
Viren der Herpes-viridae-Familie können nach Angaben der WHO bei 60 – 95 % aller Menschen nachgewiesen werden. Sie stellen eine bedeutende Ursache infektassoziierter intraokularer Entzündung dar. Molekularbiologische Methoden haben die Diagnostik der Herpesvirus-assoziierten Erkrankungen deutlich erweitert und gleichzeitig neue Erkenntnisse generiert. Neben den klassischen Krankheitsbildern der durch HSV und VZV ausgelösten Keratitis und „anterioren Uveitis” konnten neue Erkenntnisse v. a. für CMV-Infektionen etabliert werden. Zwar stellen Keratitis und anteriore Uveitis die häufigsten Manifestationen herpetischer Erkrankungen dar, allerdings umfasst das Spektrum auch schwere Verläufe mit posteriorer Uveitis, Panuveitis oder Retinitis (akute retinale Nekrose). Da die Therapie dieser Erkrankungen erheblich differiert, ist ein rascher Erregernachweis anzustreben. Klinische Befunde können wertvolle Hinweise auf die differenzierte Ätiologie der Infektion bieten, allerdings ist ein konkreter Virusnachweis anzustreben. Serologische Untersuchungen sind aufgrund der hohen Durchseuchung wenig geeignet. Dagegen hat sich die Analyse von Kammerwasser- und Glaskörperproben bewährt. Die spezifische Antikörperanalyse und der Nachweis des Virusgenoms mittels PCR haben sich als exzellente diagnostische Hilfe mit hoher Sensitivität und Spezifität erwiesen. Mit diesem Beitrag sollen die diagnostischen Methoden sowie differenzialdiagnostischen Überlegungen zu Herpesvirus-assoziierter intraokularer Entzündungen dargestellt werden.
Abstract
According to the World Health Organization, 60– 95 % of the population worldwide is infected by viruses of the herpes viridae family. Excellent adaption of the organisms and host-related factors are probably predisposing for this global distribution. Herpes virus infections are probably the most common infectious cause of blindness in the Western world. Besides the well known manifestations of keratitis and anterior uveitis caused by HSV and VZV, new aspects have been discovered, in particular, in CMV-related disorders. Molecular biological methods have been instrumental to explore and discover herpes virus associated disorders and have provided new insights. Whereas keratitis and anterior uveitis are the most common clinical manifestations, more severe disorders such as posterior uveitis, panuveitis and acute retina necrosis syndrome have all been attributed to herpes virus infections. Since the therapeutic intervention greatly varies in these acute situations, identification of the causative agent is essential. Serology is rarly helpful, whereas analyses of aqueous humor or vitreous samples provide clues for the etiology. Aqueous humor antibody testing and PCR have demonstrated excellent diagnostic power with high sensitivity and high specificity. This review is intended to provide an overview on the diagnosis and differential diagnosis of this important disorder.
Schlüsselwörter
Infektiologie - intraokulare Entzündungen - Mikrobiologie - Retina
Key words
infectious diseases - intraocular inflammation - microbiology - retina
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Prof. Dr. Uwe Pleyer
Universitäts-Augenklinik, Charité Campus Virchow-Klinik
Augustenburger Platz 1
13353 Berlin
Phone: ++ 49/30/4 50 55 41 31
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Email: Uwe.pleyer@charite.de