A 5-year evaluation of the adenoclone test for the rapid diagnosis of adenovirus from conjunctival swabs.

The rapid diagnosis of adenoviral ocular infections affords the opportunity to limit the transmission of virus within the community and avoid expensive, unnecessary, and ineffective therapy. This study evaluated the results of a 5-year experience with the Adenoclone test (Cambridge Biotech, Worcester, MA), an enzyme immunoassay, applied directly to conjunctival swabs obtained from infected eyes. The sensitivity of this test was determined on 372 consecutive adenovirus culture-positive ocular specimens. A subset of 106 specimens was evaluated, including a retrospective chart review to determine the relationship between the Adenoclone result and the time to viral cytopathic effect (CPE) in A549 cell culture, ocular titers (90% tissue culture infectious dose; TCID90), serotype, and associated clinical parameters. Overall, the sensitivity for Adenoclone was 38% (142 of 372), which improved to 65% (129 of 199) for samples positive in culture during the first week. A positive Adenoclone test result was associated with a shorter time to CPE in cell culture (p = 0.0001). The mean ocular titers (log TCID90) associated with a positive test result were found to be at a significantly higher dilution than a negative result (-1.70 +/- 0.93 vs. -0.88 +/- 1.00, p < 0.0001). A positive Adenoclone outcome was independent of the serotype but directly associated with a recent visit to an ophthalmologist's office, follicular conjunctivitis, and conjunctival chemosis. For the rapid diagnosis of adenoviral ocular infections, the Adenoclone test remains useful, but a more sensitive test based on nonradioactive amplification is eagerly anticipated.

The effects of corticosteroids of adenoviral replication.

OBJECTIVE: To evaluate the effects of Pred Forte (prednisolone acetate; Allergan Pharmaceutical, Irvine, Calif) on the replication of different adenoviral serotypes in vitro and in the adenovirus type 5/New Zealand rabbit ocular model. METHODS: The 50% inhibitory doses of Pred Forte and its components were determined for common ocular serotypes. The effects of continuous topical treatment with Pred Forte for 18 days were evaluated (eg, conjunctivitis, subepithelial immune infiltrates, and serial ocular viral titers) in the adenovirus 5/New Zealand rabbit ocular model. RESULTS: Pred Forte and prednisolone acetate inhibited adenoviruses 1, 5, 8, and 19 in vitro. In vivo, 1% Pred Forte significantly reduced conjunctivitis (P = .04) and subepithelial infiltrates (P = .02), but enhanced viral replication (P = .01) on days 9 to 21 and increased the duration of viral shedding (P < .001). CONCLUSIONS: Despite demonstrated anti-inflammatory and anti-immune effects, prolonged treatment of acute adenoviral infections with topical Pred Forte is not recommended because of the enhanced risks of viral transmission and community epidemics.

Adenoviral ocular isolates demonstrate serotype-dependent differences in in vitro infectivity titers and clinical course.

The purpose of this study was to evaluate clinical ocular adenoviral isolates for differences among and within serotypes with respect to in vitro infectivity titers and clinical course. The study design included a retrospective chart review and the determination of in vitro infectivity titers (TCID90s) of 90 clinical ocular isolates of various adenoviral serotypes. Adenovirus serotype 8 (AD8) was recovered in significantly greater numbers of patients in the second week of infection compared to all other serotypes (p < 0.002). AD3 and AD4 presented with the highest infectivity titers during the first week of acute infection. Up to 4 logs of variation was demonstrated in TCID90s among isolates of the same serotype. Among the clinical parameters studied, eyelid edema was significantly more common among AD8-infected patients as compared to all other serotypes (p < 0.04). For the first time, specific, but limited serotype differences with respect to infectivity titers and clinical course were demonstrated for adenoviral ocular isolates. Important variations in isolate virulence within a given serotype were also observed.