アデノウイルス結膜炎の迅速診断法の臨床的意義

Clinical implication of rapid diagnostic tests in adenoviral conjunctivitis

　臨床的にウイルス性結膜炎を疑われた患者49例を対象とし，polymerase chain reaction （PCR）法とrestriction fragment length polymorphism analysis （RFLP）法を組み合わせたPCR-RFLP法，分離培養法および酵素抗体法を行い，アデノウイルス（Ad）結膜炎診断における有用性を比較検討した。さらにPCR法陽性例をAd結膜炎とし，非Ad結膜炎と臨床症状を比較した。その結果，PCR法では63％，分離培養法では59％，酵素抗体法では33％が陽性であった。分離培養法陽性例および酵素抗体法陽性例はいずれもPCR法陽性であった。また，Ad結膜炎は非Ad結膜炎より重症であった。今回の成績からPCR-RFLP法は偽陰性がなく，Ad結膜炎の正確な診断法と考えられる。

We evaluated the value of rapid diagnostic tests in 49 patients suspected of viral conjunctivitis. The tests included culture isolation, enzyme-linked immunosorbent assay (ELISA) and PCR-RFLP which is a combination of polymerase chain reaction (PCR) and restriction fragment length polymorphism analysis (RFLP). Each of the three tests was evaluated as to sensitivity and specificity. We defined PCR-positive cases as adenoviral conjunctivitis. Their clinical features were compared with those of nonadenoviral conjunctivitis. Out of the 49 patients, 63% were positive for PCR, 59% were positive for culture isolation, and 33% were positive for ELISA. Incidence of severe conjunctivitis, corneal complications, lymphadenopathies and pseudomembranes were significantly higher in patients with adenoviral conjunctivitis than in nonadenoviral one. There was no false negative case for PCR-RFLP in the present series. PCR-RFLP analysis, therefore, seems to be an accurate method in the diagnosis of adenoviral conjunctivitis.