Evaluation of therapeutic interventions for vaccinia virus keratitis.

Brandt Lab // Publications // Mar 01 2011

PubMed ID: 21278209

Author(s): Altmann S, Brandt CR, Murphy CJ, Patnaikuni R, Takla T, Toomey M, Nesbit B, McIntyre K, Covert J, Dubielzig R, Leatherberry G, Adkins E, Kodihalli S. Evaluation of therapeutic interventions for vaccinia virus keratitis. J Infect Dis. 2011 Mar 1;203(5):683-90. doi: 10.1093/infdis/jiq103. Epub 2011 Jan 28. PMID 21278209

Journal: The Journal Of Infectious Diseases, Volume 203, Issue 5, Mar 2011

BACKGROUND Vaccinia virus keratitis (VACVK) is a complication of smallpox vaccination that can result in blindness. There are no Food and Drug Administration-approved treatments for VACVK, and vaccinia immunoglobulin (VIG) is contraindicated in isolated VACVK. We used a rabbit model of infection to compare several therapeutic options for VACVK.

METHODS Rabbit eyes were infected with 10(5) plaque-forming units of the Dryvax strain of vaccinia virus and scored daily for 28 days using a modified MacDonald-Shadduck scoring system. Animals were treated for 10 days after the onset of keratitis with albumin, VIG, prednisolone acetate, trifluridine, or combinations thereof. Ocular viral titers and vaccinia-specific antibody titers were determined by plaque assay and enzyme-linked immunosorbent assay, respectively.

RESULTS Treatment with intravenous VIG neither exacerbated nor ameliorated VACVK. Topical prednisolone acetate interfered with viral clearance, and ocular disease rebounded in prednisolone-treated groups. The most effective treatment was topical trifluridine alone.

CONCLUSIONS We conclude that (1) VIG did not negatively affect the treatment of isolated keratitis, (2) topical corticosteroids should not be used for treating VACVK, and (3) treatment with topical trifluridine, with or without intravenous VIG, is the preferred therapeutic regimen for treating VACVK.