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Acute Hemorrhagic Conjunctivitis

Acute Hemorrhagic Conjunctivitides

Acute hemorrhagic conjunctivitis is a brief viral infection presenting with the sudden onset of ocular signs and symptoms which progress and resolve rapidly. It is typically caused by an enterovirus and was first reported in Ghana. Subsequently, cases have been reported from countries with overcrowding and unhygienic conditions as it is transmitted by the feco-oral route.


Presentation

Acute hemorrhagic conjunctivitis (AHC) is a contagious and rapidly progressive viral infection reported from poor regions with unhygienic living conditions [1] [2]. It is caused mainly by enterovirus 70, although coxsackievirus A24 variant, adenoviruses [3] [4] [5] and Epstein-Barr virus [6] [7] have also been reported to cause it. Enteroviruses spread easily via the feco-oral route, contaminated hands/ personal items [8] [9] and vertically between mother and child.

AHC has an incubation period ranging from 12 hours to 2 days and the self-limiting disease can last for up to two week [9] [10]. Patients present with an acute onset of ocular pain, redness of the eye, photophobia, ocular irritation with excessive lacrimation, and chemosis [8] [10]. The clinical manifestations depend on the stage of the infection. In the initial stage, the patient has paranasal sinus mucosal inflammation [11] [12] followed by the appearance of petechia on the conjunctiva. Subsequently, these may form subconjunctival hemorrhages and are accompanied by follicular conjunctivitis, eyelid edema, and induration. In the early part of the AHC infection, the inflammatory response is monocellular and watery and changes to a blood stained response with the progression of the infection [12]. The corneal signs include epithelial keratitis and subepithelial opacities. Occasionally, enterovirus infection has been reported to cause acute lower limb flaccid paralysis, cranial nerve palsies and radiculomyelitis [13] along with conjunctivitis. Infectious mononucleosis has also been associated with AHC [6] [7]. AHC symptoms usually resolve in 2 weeks and sequelae are rare.

Enteroviral infection in infants can present as low-grade fever of unspecified etiology and can involve other organs like the myocardium, lungs, central nervous system and the skin.

Camping
  • During July-September 1980, an epidemic of acute hemorrhagic conjunctivitis (AHC) occurred in several refugee camps and transit centers in Southeast Asia.[ncbi.nlm.nih.gov]
  • An outbreak of acute hemorrhagic conjunctivitis (AHC) was reported in Singapore military camps in the year 2005. A total of 103 conjunctival swab specimens were collected from military personnel diagnosed clinically with AHC.[ncbi.nlm.nih.gov]
  • Abstract Abstract During July–September 1980, an epidemic of acute hemorrhagic conjunctivitis (AHC) occurred in several refugee camps and transit centers in Southeast Asia.[ajtmh.org]
  • […] this Guideline) Enterovirus 70 (EV70) and Coxsackievirus A24 (CA24v) acute haemorrhagic conjunctivitis (rare epidemics) Predisposing factors Recent cold or other upper respiratory tract infection Low standards of hygiene Crowded conditions (schools, camps[college-optometrists.org]
Red Eye
  • This article aims at increasing public awareness by elaborating two diseases (Acute Hemorrhagic Conjunctivitis and Paederus spp keratoconjuctivitis, periorbital oedema-"Nairobi red eyes") confused by many as being associated with recurrent epidemics of[ncbi.nlm.nih.gov]
  • Acute hemorrhagic conjunctivitis (AHC) is an epidemic form of highly contagious conjunctivitis and is characterized by sudden onset of painful, swollen, red eyes, with conjunctival hemorrhaging and excessive tearing.[ncbi.nlm.nih.gov]
  • When infected with AHC, patients will experience painful, red eyes, swelling of the conjunctival tissue, and frequent mucus discharge from the eyes accompanied by excessive tearing and subconjunctival hemorrhaging.[en.wikipedia.org]
  • The differential diagnosis for red eye is broad because many ophthalmic conditions masquerade as conjunctivitis (Table). View this table: In this window In a new window Table.[pedsinreview.aappublications.org]
Excessive Tearing
  • Acute hemorrhagic conjunctivitis (AHC) is an epidemic form of highly contagious conjunctivitis and is characterized by sudden onset of painful, swollen, red eyes, with conjunctival hemorrhaging and excessive tearing.[ncbi.nlm.nih.gov]
  • When infected with AHC, patients will experience painful, red eyes, swelling of the conjunctival tissue, and frequent mucus discharge from the eyes accompanied by excessive tearing and subconjunctival hemorrhaging.[en.wikipedia.org]
  • The most common reported symptom was excessive tearing of the eye or epiphora (92.9%) followed by conjunctival hyperemia (65.8%), photophobia (54.1%), subconjunctival hemorrhage (48.1%), eye pain (47.5%), and palpebral chemosis (36.4%).[scholarworks.gsu.edu]
  • Most infected persons will complain of painful red eyes and frequent mucus discharge from the eyes accompanied by excessive tearing. Some also experience blurry vision and fever in addition to the common symptoms.[ghanaweb.com]
Blepharitis
  • Mild itching can also be a feature of blepharitis, dry eyes and, occasionally, bacterial or viral conjunctivitis.[aafp.org]
  • Other signs, such as dermatitis of the lid skin, inflammation of the lid margin (blepharitis), conjunctival scarring, and involvement of the cornea occur only in certain of the most severe disorders.[eyewiki.aao.org]
  • For example, smallpox vaccinations, though currently uncommon due to the disease's eradication, result in ocular vaccinia in about one per 40,000 vaccinations. 14 Aside from occurring in those with compromised immune systems, blepharitis, conjunctivitis[reviewofophthalmology.com]
  • Adenovirus conjunctivitis diagnosed by rapid, 10-min office test (AdenpPlus) DDx subconjunctival hemorrhage, blepharitis , eyelid disorders, scleritis, episcleritis, keratitis , pterygium, acute anterior uveitis, acute angle closure glaucoma.[hopkinsguides.com]
Conjunctival Disease
  • Cefpodoxime or cefixime not primarily recommended but may be alternative oral treatment instead of ceftriaxone for uncomplicated GC infection, but no proof of effectiveness for conjunctival disease.[hopkinsguides.com]

Workup

The clinical course of AHC is very rapid and resolves spontaneously, often without treatment. Hence the workup and laboratory tests have to be performed fast. Clinical suspicion, history and, a detailed ophthalmic examination remain the mainstay of diagnosis.

Studies for rapid viral detection are necessary to identify the causative organism and they are still being improved. Polymerase chain reaction (PCR) assays are supplanting standardized neutralizing antisera assays. Specimens from conjunctival swabs are used to identify the etiology of AHC [14] [15] [16]. Molecular serotyping with clinical samples has been found to be useful for rapid diagnosis, especially, during epidemics [14]. A real-time (RT) PCR has also provided an early diagnosis in epidemics [17]. In the case of bacterial superinfection of the cornea, microbiological culture and antibiotic sensitivity testing are performed [18].

Treatment

  • (September 2017) Treatment [ edit ] There is no treatment currently available. The virus generally resolves itself within a five to seven day period.[en.wikipedia.org]
  • Treatment of cultures with combinations of arildone and IFN resulted in an additive inhibition of acute hemorrhagic conjunctivitis virus production.[ncbi.nlm.nih.gov]
  • There is no known specific treatment for this disease, and containment includes increased attention to hygiene.[ncbi.nlm.nih.gov]
  • Symptomatic treatment appears to be as effective as various topical medical regimens for relief of symptoms.[ncbi.nlm.nih.gov]
  • Treatment Treatment of acute hemorrhagic conjunctivitis Departments: Ophthalmic Cornea Eye Science Treatment: drug treatment supportive treatment Treatment cycle: 3-5 weeks Cure rate: 98% Commonly used drugs: cetirizine hydrochloride erythromycin enteric-coated[healthfrom.com]

Prognosis

  • AHC almost always resolves without sequelae, having a good visual prognosis. However, corneal microbial superinfection has been reported after treatment with topical steroids and requires appropriate antimicrobial therapy. (See Treatment.)[emedicine.medscape.com]
  • Treatment is symptomatic having satisfactory prognosis. Causes Of Acute Hemorrhagic Conjunctivitis Acute hemorrhagic conjunctivitis is an infectious disease affecting eyes. It is caused by coxsackie virus A 24 and enterovirus 70.[tandurust.com]
  • […] habitats The local healthcare providers and local public health authorities have to ensure that the residents of a region are generally well-informed and made aware of basic preventive measures and precautions to be taken during an AHC outbreak What is the Prognosis[dovemed.com]

Etiology

  • This report describes that AHC epidemic and its etiologic agent.[ncbi.nlm.nih.gov]
  • Enteroviral infection in infants can present as low-grade fever of unspecified etiology and can involve other organs like the myocardium, lungs, central nervous system and the skin.[symptoma.com]
  • Coxsackievirus A24v (CA24v) was identified as the etiologic agent, and partial sequences from the VP1 gene show that the isolates are closely related to CA24v viruses that previously caused AHC epidemics in South Korea and French Guiana.[ncbi.nlm.nih.gov]
  • The etiologic agent was confirmed as enterovirus type 70 by a modified centrifugation-enhanced culture method followed by immunofluorescence and neutralization tests.[ncbi.nlm.nih.gov]
  • The etiological agent was confirmed as coxsackievirus A24 variant (CA24v) by virus isolation and sequencing of a part of the VP1/VP3 gene.[ncbi.nlm.nih.gov]

Epidemiology

  • A total of 1 067 981 conjunctivitis cases were reported to the surveillance system for 2011; there was an increase in the number of cases in epidemiologic weeks 6-26 (summer season) versus previous years.[ncbi.nlm.nih.gov]
  • VP1 is more informative than 3C(Pro) for describing molecular epidemiology and we hypothesize that accumulative mutations may have promoted the outbreak.[ncbi.nlm.nih.gov]
  • A recent epidemic of acute conjunctivitis in Dar es Salaam showed again the importance of developing a strong infectious diseases epidemiological surveillance network which is effective in minimising disease outbreaks.[ncbi.nlm.nih.gov]
  • This report describes the initial findings of an ongoing clinical, epidemiologic, and laboratory investigation of this outbreak.[ncbi.nlm.nih.gov]
  • The disease had a distinctive clinical picture and an unusual geographic epidemiology. Between 1969 and 1975 AHC has occurred almost exclusively in crowded coastal areas of tropical countries during hot, rainy seasons.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • Terminology Also known as Apollo disease Epidemiology First described in Ghana in 1969 Most common in developing countries, may affect 50% of local population Pathophysiology Epidemic form is rapidly progressive and highly contagious Clinical features[pathologyoutlines.com]
  • The American Academy of Ophthalmology's Pathology Atlas contains virtual microscopy images of tissue samples with the following types of conjunctivitis: Chronic Follicular Conjunctivitis Granulomatous Conjunctivitis Papillary Conjunctivitis Pathophysiology[eyewiki.aao.org]

Prevention

  • To control outbreaks of AHC, prevention methods (e.g., frequent hand washing and avoidance of sharing towels and bedding) should be targeted to groups at highest risk, and information should be disseminated after the first report of AHC in the area.[ncbi.nlm.nih.gov]
  • Yet methods to prevent or cure AHC are not available. Recent evidence has shown that small-interfering RNAs (siRNAs), mediators of posttranscriptional gene knockdown, can act as effective antiviral agents.[ncbi.nlm.nih.gov]
  • A total of 31,659 cases were reported to center for disease control and prevention of Guangdong, it was estimated that the number of actual AHC was 200 thousands.[ncbi.nlm.nih.gov]
  • Prevention Prevention of acute hemorrhagic conjunctivitis During the epidemic, the main measures are: personal hygiene: do not dirty hands Rouyan, the implementation of the towel sub-basin. public health: to the swimming pool, bathroom, barber shop and[healthfrom.com]

References

Article

  1. Medina NH, Haro-Munoz E, Pellini AC, et al. Acute hemorrhagic conjunctivitis epidemic in Sao Paulo state, Brazil, 2011. Rev Panam Salud Publica. 2016 Feb; 39(2): 137-141
  2. Wu B, Qi X, Xu K, et al. Genetic characteristics of the coxsackievirus A24 variant causing outbreaks of acute hemorrhagic conjunctivitis in Jiangsu, China, 2010. PLoS One. 2014 Jan 24; 9(1):e86883
  3. Babalola OE, Amoni SS, Samaila E, et al. An outbreak of acute haemorrhagic conjunctivitis in Kaduna, Nigeria. Br J Ophthalmol. 1990; 74: 89–92
  4. Mirkovic RR, Schmidt NJ, Yin-Murphy M, Melnick JL. Enterovirus etiology of the 1970 Singapore epidemic of acute conjunctivitis. Intervirology. 1974; 4: 119–127
  5. Chang CH, Sheu MM, Lin KH, Chen CW. Hemorrhagic viral keratoconjunctivitis in Taiwan caused by adenovirus types 19 and 37: applicability of polymerase chain reaction-restriction fragment length polymorphism in detecting adenovirus genotypes. Cornea 2001; 20: 295–300
  6. Kanafani ZA, Bashur Z, Kanj SS. Acute Epstein-Barr virus infection causing bilateral conjunctival hemorrhages. South Med J. 2005;98:390-391.
  7. Heiligenhaus A, Dohrmann J, Koch J, et al. Severe bilateral panuveitis in a patient with asymptomatic Epstein-Barr virus infection. Eye 2001;15:792-793.
  8. Tavares FN, Campos RdM, Burlandy FM, et al. Molecular characterization and phylogenetic study of coxsackievirus A24v causing outbreaks of acute hemorrhagic conjunctivitis (AHC) in Brazil. PLoS One. 2011;6(8):e23206.
  9. Oh MD, Park S, Choi Y, et al. Acute hemorrhagic conjunctivitis caused by coxsackievirus A24 variant, South Korea, 2002. Emerg Infect Dis. 2003;9(8):1010–2.
  10. Ghazali O, Chua KB, Ng KP, et al. An outbreak of acute haemorrhagic conjunctivitis in Melaka, Malaysia. Singapore Med J. 2003;44(10):511–6.
  11. Rubenstein JB. Disorders of the conjunctiva and limbus. Yanoff MA, Duker JS, eds. Ophthalmology. Mosby; 1995. 5.1.5.
  12. Spencer WH, Zimmerman LE. Conjunctiva. Spencer WH, ed. Ophthalmic Pathology. 1985; 1: 130-131.
  13. Nilsson EC, Jamshidi F, Johansson SM, et al. Sialic acid is a cellular receptor for coxsackievirus A24 variant, an emerging virus with pandemic potential. J Virol. 2008;82(6):3061–8.
  14. Park SW, Lee CS, Jang HC, et al. Rapid identification of the coxsackievirus A24 variant by molecular serotyping in an outbreak of acute hemorrhagic conjunctivitis. J Clin Microbiol. 2005 Mar; 43(3):1069-71.
  15. Oberste MS, Maher K, Kilpatrick DR, et al. Typing of human enteroviruses by partial sequencing of VP1. J Clin Microbiol. 1999 May; 37(5):1288-93.
  16. Nigrovic LE, Chiang VW. Cost analysis of enteroviral polymerase chain reaction in infants with fever and cerebrospinal fluid pleocytosis. Arch Pediatr Adolesc Med. 2000 Aug; 154(8):817-21.
  17. Xiao XL, Wu H, Li YJ, et al. Simultaneous detection of enterovirus 70 and coxsackievirus A24 variant by multiplex real-time RT-PCR using an internal control. J Virol Methods. 2009 Jul; 159(1):23-8.
  18. Vajpayee RB, Sharma N, Chand M, et al. Corneal superinfection in acute hemorrhagic conjunctivitis. Cornea. 1998 Nov; 17(6):614-7.

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Last updated: 2018-06-21 18:13