Zusammenfassung
Hintergrund: Infektionen mit Viren aus der Herpesfamilie gehören zu den häufigsten Virusinfektionen der Menschheit. Der wichtigste Vertreter dieser Gruppe ist das Herpes-simplex-Virus (HSV), dessen Typ 1 Erkrankungen vorwiegend oberhalb der Gürtellinie verursacht, während der Typ 2 häufiger Affektionen im Bereich des Urogenitaltraktes verursacht. Bei immunkompetentem Wirt ist die Vermehrung des Virus durch das rasche Einsetzen unspezifischer Abwehrmechanismen auf Haut und Schleimhäute beschränkt. Nach relativ kurzer Zeit werden diese durch eine spezifische, erworbene Immunantwort ergänzt. Mit dem Einsetzen der spezifischen Immunantwort geht die Erkrankung von einer aktivreplikativen Form in eine latente Form über. In einem bestimmten Prozentsatz der Fälle kommt es jedoch periodisch zur Reaktivierung der Infektion. Patienten: Bei okulärer Beteiligung nimmt mit der Anzahl der Rezidive die Wahrscheinlichkeit für eine Progredienz von einer epithelialen zu einer stromalen Keratitis (HSK) zu. Im Gegensatz zur epithelialen wird die stromale Keratitis im Wesentlichen als eine immunpathologische Erkrankung aufgefasst. Die HSK stellt eine der häufigsten Erblindungsursachen in der westlichen Welt dar. Ergebnisse: Die Mechanismen, die zur Entwicklung der HSK und zur Etablierung der viralen Latenz beim Menschen führen, sind größtenteils unbekannt. Aus Tiermodellen, insbesondere der Maus, und klinischen Studien gibt es Hinweise für eine zellvermittelte Immunantwort als wesentliche Ursache der Gewebsschädigung. Schlussfolgerung: Der Kenntnisstand über die verschiedenen Aspekte der Pathogenese der herpetischen Keratitis ist noch lückenhaft. Die aktuellen pathophysiologischen Vorstellungen, wie z. B. die einer virusinduzierten Autoimmunerkrankung, bilden die theoretische Grundlage für die modernen therapeutischen Strategien.
Abstract
Background: Viral infections of Herpes origin are the most commonly encountered ones in man. The most important member of this family is the Herpes simplex virus (HSV), two varieties of which are known to exist: HSV-1 affects predominantly the upper half of the body, whereas HSV-2 is associated mainly with diseases of the urogenital tract. In the immunocompetent host, viral replication is usually confined to cutaneous and mucocutaneous sites, invasion of subcutaneous tissues being impeded by an early onset of non-specific defence mechanisms. These are rapidly complemented by the specific, mainly cellular, immune response. Patients: Epithelial dendritic keratitis is the first symptomatic clinical finding, and after several recurrences, the corneal stroma may become involved. This condition of herpetic stromal keratitis (HSK), which, in contrast to the epithelial one, is believed to be directed by a predominantly immunopathological process, is one of the leading causes of infectious blindness in developed countries. Results: The mechanisms underlying HSK, and the establishment of viral latency and reactivation are poorly understood. But on the basis of studies with mice as well as clinical immunohistological observations, evidence is now accumulating in support of a cell-mediated mechanism being responsible for corneal destruction. Conclusion: Our present knowledge of the pathogenesis of herpetic keratitis is incomplete. The different pathophysiological aspects reflecting our current understanding, such as that of a virally induced autoimmune disease, form the basis of accepted clinical treatment concepts.
Schlüsselwörter
Herpes-Keratitis - HSK - Latenz - okuläre Virusinfektion - Immunpathogenese - Autoimmunerkrankung - ACAID
Key words
Herpetic keratitis - HSV-1 - recurrence - viral latency - ocular viral infection - immunopathogenesis - autoimmune disease - ACAID
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Justus G. Garweg
Universitäts-Augenklinik · Inselspital
3010 Bern · Schweiz
Email: justus.garweg@insel.ch
