Adenovirus conjunctivitis is an acute infectious lesion of the mucous membrane of the eyes caused by adenoviruses. Adenovirus conjunctivitis occurs with fever, nasopharyngitis, local symptoms (swelling of the eyelids, mucosal hyperemia, lacrimation, burning, pain, itching, discharge from the eyes). Diagnosis of adenovirus conjunctivitis is carried out by an ophthalmologist taking into account the data of bacteriological examination of a smear from the conjunctiva and PCR scraping. Treatment includes instillation of antiviral and antibacterial drugs, laying eye ointments.
ICD 10
B30.1 Conjunctivitis caused by adenovirus
General information
Adenovirus conjunctivitis (pharyngoconjunctival fever) is a highly contagious infection caused by adenoviruses and occurring with inflammatory lesions of the conjunctiva, upper respiratory tract mucosa (pharyngitis), increased body temperature. In ophthalmology, epidemic outbreaks of adenovirus conjunctivitis are usually registered in the autumn-spring period, mainly in organized children’s groups.
Causes
The causative agents of adenovirus conjunctivitis during epidemic outbreaks are adenoviruses of serotypes 3, 7a, 11; in sporadic cases, adenoviruses of types 4, 6, 7, 10. The ways of transmission of adenovirus conjunctivitis are airborne or contact. The adenovirus enters the mucous membrane of the eyes when sneezing, coughing or directly introducing infection from contaminated hands. From the moment of infection to the appearance of clinical symptoms, it takes from 3 to 10 days (on average 5-7 days). The increased risk factors are:
- contact with a patient with adenovirus conjunctivitis;
- hypothermia, acute respiratory viral infections;
- violation of hygiene;
- bathing in polluted reservoirs and pools;
- eye injuries;
- non-compliance with the rules of wearing and caring for contact lenses;
- surgical treatment of corneal pathology;
- stress.
Pathological anatomy
Cytological examination of a smear in patients reveals destruction of epithelial cells characterized by vacuolization, chromatin decay, nucleolar hypertrophy, and nuclear envelope formation. The cytogram is dominated by mononuclear cells.
Symptoms
According to the peculiarities of the clinical course, catarrhal, follicular and filmy forms of adenovirus conjunctivitis are distinguished. Catarrhal and follicular can occur at different ages, filmy develops mainly in children. The clinic manifests in 5-8 days from the moment of infection. At the beginning of the disease, there is an increase in body temperature with pronounced pharyngitis and rhinitis, headache, dyspeptic disorders; submandibular lymphadenitis develops.
On the second wave of fever, signs of conjunctivitis appear first in the area of one eye, and after 2-3 days – in the other eye. Local symptoms are characterized by swelling and redness of the eyelids, excessive mucous or mucopurulent discharge, foreign body sensation, itching and burning, lacrimation, photophobia, moderate blepharospasm. Hyperemia is expressed in all parts of the conjunctiva, extends to the lacrimal muscle, semilunar and lower transitional fold.
Catarrhal form
It proceeds with minor phenomena of local inflammation: a slight redness of the mucous membrane of the eye, a moderate amount of discharge. The course of catarrhal adenovirus conjunctivitis is mild, the duration of the disease is about one week. Usually there are no complications from the cornea.
Follicular shape
It is characterized by the presence of vesicular rashes (follicles) on the mucous membrane of the eye. Follicles can be small, dotted or large, translucent-gelatinous; located in the corners of the eyelids or cover the entire infiltrated and loosened mucosa, especially in the area of the transitional fold. The follicular reaction looks like the initial stage of trachoma, but there are usually no diagnostic errors, since there are no nasopharyngitis, fever, and rashes localized in the conjunctiva of the upper eyelid during trachoma.
Film form
It occurs in a quarter of cases. It proceeds with the formation of thin films of grayish-white color covering the mucous membrane of the eye. Usually the films are tender, easily removed with a cotton swab; but sometimes dense fibrinous overlays can form, soldered to the conjunctiva, which are hardly removed from the inflamed mucosa. After removing the films, the exposed mucosa may bleed. Sometimes pinpoint subconjunctival hemorrhages and infiltrates are detected, which completely resolve after recovery.
The outcome of filmy adenovirus conjunctivitis is often mucosal scarring. When the filmy form the general condition suffers: a high fever develops (up to 38 ° C-39 ° C), which can last from 3 to 10 days. The filmy form of adenovirus conjunctivitis may be mistaken for diphtheria.
Complications
Complications of adenovirus conjunctivitis can be bacterial or toxic-allergic conjunctivitis, dry eye syndrome, keratitis, otitis media, adenoiditis, tonsillitis.
Diagnostics
If adenovirus conjunctivitis is suspected, the ophthalmologist finds out whether there is a history of contact with a patient with pharyngoconjunctival fever. Examination reveals symptoms of conjunctivitis in combination with catarrhal changes in the upper respiratory tract and regional lymphadenopathy.
Laboratory serological, cytological, and virological methods are used to isolate adenovirus. Early diagnosis is carried out by the immunofluorescence method, which allows to identify specific viral antigens in a smear from the mucous membrane of the eye.
Polymerase chain reaction (PCR) is informative, detecting adenovirus DNA in conjunctival scraping. Antibodies to adenoviruses in the blood serum are detected using the complement binding reaction (RSC), enzyme immunoassay (ELISA). The diagnostic criterion for adenovirus conjunctivitis is an increase in the titer of antibodies by 4 or more times. In order to isolate and identify adenovirus on cell culture, a bacteriological examination of a smear from the conjunctiva is carried out.
Treatment
Treatment of adenovirus conjunctivitis is carried out on an outpatient basis using antiviral agents. Locally, interferon and deoxyribonuclease instillations are prescribed in drops 6-8 times a day during the first week of the disease and 2-3 times a day during the second week. As antiviral therapy, the laying of ointments for the eyelids (tebrofen, florenal, bonafton, riodoxol, adimalevoy) is also used.
To prevent the addition of secondary infection, it is advisable to use antibacterial eye drops and ointments. Until complete clinical recovery with adenovirus conjunctivitis, antihistamines are indicated. In order to prevent the development of xerophthalmia, artificial tear substitutes (for example, carbomer) are used.
Prognosis and prevention
The prognosis of adenovirus conjunctivitis is favorable: usually the disease ends with a complete clinical recovery in 2-4 weeks. With the development of dry eye syndrome, long-term use of tear substitutes is required.
Prevention of outbreaks of adenovirus conjunctivitis in collectives consists in timely isolation of patients, ventilation and wet cleaning of premises, personal hygiene. In the ophthalmologist’s office, it is necessary to carry out thorough disinfection and sterilization of instruments (pipettes, eye sticks), cleaning with the use of disinfectants, quartz treatment. In swimming pools, it is necessary to monitor the water chlorination regime in accordance with current regulations.
Literature
- Aoki K., Kaneko H., Kitaichi N. et al. Clinical features of adenoviral conjunctivitis at the early stage of infection // Jpn J Ophthalmol. — 2011. — № 1. — Р. 11–15. link
- Hoffman J. Adenovirus: ocular manifestations // Community Eye Health. — 2020. — № 108. — Р. 73–75.
- Bialasiewicz A. Adenoviral keratoconjunctivitis // Sultan Qaboos Univ Med J. — 2007. — № 1. — Р. 15–23.
- Meyer-Rüsenberg B., Loderstädt U., Richard G. et al. Epidemic keratoconjunctivitis: the current situation and recommendations for prevention and treatment // Dtsch Arztebl Int. — 2011. — № 27. — Р. 475–480.
- Yeu E., Hauswirth S. A. Review of the Differential Diagnosis of Acute Infectious Conjunctivitis: Implications for Treatment and Management // Clin Ophthalmol. — 2020. — № 14. — Р. 805–813.
- Jonas R. A., Ung L., Rajaiya J., Chodosh J. Mystery Eye: Human Adenovirus and the Enigma of Epidemic Keratoconjunctivitis // Prog Retin Eye Res. — 2020. — № 76.
- Macgregor Price R. H., Graham C., Ramalingam S. Association between viral seasonality and meteorological factors // Sci Rep. — 2019. — № 9. link
