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Pharyngoconjunctival Fever

Fever Pharyngo Conjunctival

Pharyngoconjunctival fever (PCF) is a clinical syndrome caused by adenoviruses. PCF may occur in unrelated incidents, or as an epidemic. The main features are conjunctivitis, pharyngitis, and fever. It is highly contagious.


Presentation

Most cases of conjunctivitis are caused by viruses, of which the most common microorganism is adenovirus [1] [2]. Viral conjunctivitis is often misdiagnosed as having a bacterial etiology, as viral conjunctivitis presents similarly to other types of conjunctivitis [3].

Pharyngoconjunctival fever (PCF) is a specific syndrome commonly caused by certain serotypes of the human adenovirus [4]. PCF can either occur sporadically or as an outbreak, however, it is more common in warm weather. Populations most susceptible to outbreaks are children in institutions such as schools, and people sharing living quarters. Most outbreaks originate from contaminated water bodies such as public swimming pools [5].

PCF and epidemic keratoconjunctivitis (EKC) are the more frequent syndromic manifestations of adenoviral infection of the eye. PCF is typically less severe than EKC [6]. The incubation period ranges from 5 days to almost 2 weeks, after which patients experience fever that usually resolves over the period of 10 days. There may be a history of exposure to individuals with conjunctivitis or pharyngitis, as infected individuals are highly contagious in the first few days of symptomatic infection. The infection is acute, self-limiting, and is more severe in patients with low immunity. Superimposed bacterial infection is possible.

PCF initially affects one eye, becoming bilateral as the infection progresses. Ocular manifestations include pronounced conjunctivitis. Common complaints are redness, burning, tearing, itching, and photophobia. In addition, there may be a watery discharge, edema, bruising, and tenderness of the eyelids.The appearance of the eye may resemble that of traumatic injury. The virus may occasionally cause the formation of a pseudomembrane (an even rarer occurrence in other types of conjunctivitis) which may be accompanied by a mucopurulent discharge, mostly consisting of mononuclear white blood cells. Subepithelial infiltrates (SEIs), white lesions on the cornea, are a consequence of the disease and may remain for months after the infection has cleared. This leads to possible visual disturbances, including decreased visual acuity.

The respiratory features of PCF are mainly pharyngitis and rhinitis, which vary in severity. Oropharyngeal erythema may be visualized.

Systemic symptoms include high-grade fever and tender or non-tender lymphadenopathy (approximately half of known cases), particularly in the cervical and preauricular regions [3]. Other non-specific features include general malaise and muscle pain.

Fever
  • Pharyngoconjunctival fever (PCF) is a clinical syndrome caused by adenoviruses. PCF may occur in unrelated incidents, or as an epidemic. The main features are conjunctivitis, pharyngitis, and fever. It is highly contagious.[symptoma.com]
  • fever caused by adenovirus type 3. ( 11280197 ) Harley D....DICK A. 2001 8 Outbreak of pharyngoconjunctival fever at a summer camp--North Carolina, 1991. ( 1579128 ) 1992 9 Outbreak of pharyngoconjunctival fever at a summer camp--North Carolina, 1991[malacards.org]
  • Manifestations of the illness included pharyngitis, cough, fever to 104 F (40 C), headache, myalgia, malaise, and conjunctivitis. On August 2, the DEHNR was notified of a similar outbreak during a second 4-week session at the camp.[ncbi.nlm.nih.gov]
  • […] pharyngoconjunctivitis (disorder), Pharyngoconjunctival Fever, Adenoviral pharyngoconjunctivitis, pharyngo-conjunctival fever, Pharyngoconjunctival fever, pharyngoconjunctival fever, Adenovirus Infections, Human Term info database cross reference MSH[ebi.ac.uk]
Fatigue
  • General Symptoms People who have PCF often complain of fatigue and upset stomach. Some may also have a pharyngitis. A pharyngitis is an inflammation of the throat that appears reddened and is covered with bumps called follicles.[verywell.com]
  • Symptoms Prodromal symptoms are typical: fatigue, malaise and low-grade fever for up to one week. Eye pain, redness, watering and photophobia may occur. Facial pain may precede other symptoms and is typically confined to one dermatome.[patient.info]
Ecchymosis
  • . - Ecchymosis (non-raised reddish or bluish discolouration) of lids. - Cervical lymphadenopathy. - Painful pre-auricular lymphadenopathy.[nhp.gov.in]
Disability
  • SIGNS AND SYMPTOMS Most viral infections produce a mild, self-limiting conjunctivitis, but some have the potential to produce severe, disabling visual difficulties.[medicalstudy.blogspot.com]
Preauricular Adenopathy
  • Nontender cervical lymphadenopathy and tender, enlarged preauricular adenopathy may be present.[odlarmed.com]
  • Background Pharyngoconjunctival fever (PCF) is an acute and highly infectious illness characterized by fever, pharyngitis, acute follicular conjunctivitis, and regional lymphoid hyperplasia with tender, enlarged preauricular adenopathy.[emedicine.medscape.com]
  • Preauricular adenopathy may develop. Chemosis, pain, and punctate corneal lesions that are visible with fluorescein staining may be present. Systemic symptoms and signs are mild or absent.[merckmanuals.com]
  • EKC’s Pediatric Cousin Pharyngoconjunctival fever (PCF) is an acute and highly infectious illness characterized by fever, pharyngitis, acute follicular conjunctivitis and regional lymphoid hyperplasia with tender, enlarged preauricular adenopathy.[reviewofoptometry.com]
Splenomegaly
  • Cardiovascular examination was normal in all, and none had hepato- or splenomegaly. None had a rash. The joints of one 9-year-old child (F, 9y; Table 2) who complained of arthralgia were examined, but no objective signs of arthritis were found.[health.gov.au]
Nasal Discharge
  • Common additional symptoms and signs include nasal complaints related to adenoidal infection and hypertrophy (coryza, stuffiness, epistaxis), posterior nasal discharge causing cough, systemic complaints (headache, malaise, achiness, anorexia), tender[musculoskeletalkey.com]
Coarse Rales
  • There was evidence of respiratory infection in 69% of patients, with wheezing and coarse rales frequently present, contrary to the general belief that bronchitis is rare.[medigoo.com]
Rales
  • There was evidence of respiratory infection in 69% of patients, with wheezing and coarse rales frequently present, contrary to the general belief that bronchitis is rare.[medigoo.com]
Abdominal Cramps
  • Other symptoms include headache, fever, and abdominal cramps 其它症状包括头痛、发烧及腹痛 Therefore, although yellow fever has never been reported from Asia, this region is at risk because the appropriate mosquitos and primates are present.[hujiang.com]
Tachycardia
  • Physical findings are not shown, but when these were measured the children had fever and tachycardia.[health.gov.au]
Heart Disease
  • disease, diabetes, adverse pregnancy outcomes and nosocomial pneumonia Contains a brand new section on oral immunology – prepared by guest authors – as relevant to dentistry Contains a new section on the microbiology of perimplantitis Presents a fully[books.google.com]
Neck Swelling
  • Septic thrombophlebitis of the internal jugular vein causes pain, dysphagia, and neck swelling and stiffness. Sepsis occurs 3-10 days after the sore throat starts. Infection can spread to the lungs and other distant sites.[atsu.edu]
Epistaxis
  • Common additional symptoms and signs include nasal complaints related to adenoidal infection and hypertrophy (coryza, stuffiness, epistaxis), posterior nasal discharge causing cough, systemic complaints (headache, malaise, achiness, anorexia), tender[musculoskeletalkey.com]
Headache
  • Manifestations of the illness included pharyngitis, cough, fever to 104 F (40 C), headache, myalgia, malaise, and conjunctivitis. On August 2, the DEHNR was notified of a similar outbreak during a second 4-week session at the camp.[ncbi.nlm.nih.gov]
  • Adenovirus 3 detected F, 12y 17 Itchy, red eyes, fever, headache, nausea - - Left eye swab.[health.gov.au]
  • The infection has_symptom fever, has_symptom lymphadenopathy of the neck, and has_symptom headache. [ ] A condition characterized by fever, conjunctivitis, and pharyngitis resulting from infection by adenovirus. [ NCIT : C34924 ] Synonyms: Adenoviral[ebi.ac.uk]
  • […] term you might hear if your child has a symptom complex of (you guessed it) high fever that lasts 4-5 days pharyngitis (sore throat) conjunctivitis (inflammed eyes, usually without pus formation) enlargement of the lymph nodes ("glands") of the neck headache[drhull.com]
Agitation
  • The virus containing particles may become resuspended when the water is agitated by swimmers (6,7). Natural bodies of water may have inherent virucidal properties possibly related to certain species of bacteria (6,8).[cdc.gov]
Stroke
  • Take advantage of a wealth of images that capture the clinical manifestations and findings associated with Kawasaki disease, lupus, lymphoma, stroke, and many other disorders seen in children.[books.google.com]

Workup

The diagnosis of pharyngoconjunctival fever is clinical [7]. Possible studies carried out entail viral culture, adenovirus-specific antibody titers, polymerase chain reaction (PCR), enzyme-linked immunosorbent assay (ELISA), and immunochromatography. Viral cultures may only be beneficial within the first 10 days of infection. Antibodies against the virus are gauged via complement fixation, where blood samples are drawn soon after symptoms appear, and then after 2 to 3 weeks later. An increase in antibodies in the second sample of at least four times the original sample is indicative of recent adenoviral infection. Typically, laboratory tests take about a week to yield results. Electron microscopy may also be utilized.

Treatment

  • As a result, doctors know that people with PCF will eventually feel better so treatment is designed to help manage symptoms. The ultimate goal of treatment is to make the patient feel better.[verywell.com]
  • Treatment: Because pharyngoconjunctival fever is contagious and self-limiting, the primary treatment once again is patient education. Instruct patients to stay home from work or school until there is absolutely no discharge.[medigoo.com]
  • Taper this treatment slowly to avoid recurrence of corneal opacities.[nhp.gov.in]
  • Treatment is of course supportive care while the virus "runs its course."[drhull.com]
  • Treatment Medical Care Because PCF usually is a self-limited disease, treatment is mainly symptomatic, as follows: Cold compresses several times per day for 1-2 weeks Artificial tears 4-8 times per day for 1-3 weeks Drug therapy Drug therapy may be used[emedicine.medscape.com]

Prognosis

  • Prognosis: Most cases of PCF are acute, benign and self-limiting. Infection usually resolves spontaneously within 2-3 weeks. Sub-epithelial infiltrates may last for months together and may decrease vision if visual axis is involved.[nhp.gov.in]
  • […] conditions pharyngitis coryza pneumonia infectious conjunctivitis Prevention vaccinations live, oral, enteric-coated vaccines military recruits 17-50 years of age infection control procedures contact and droplet precaution chlorination of swimming pools Prognosis[medbullets.com]
  • Prognosis [ 11 ] Eyelid and conjunctival lesions tend to resolve over 1-2 weeks. Epithelial keratitis resolves over two weeks and has a good prognosis. Stromal keratitis is more likely to result in corneal scarring.[patient.info]
  • Deaths are exceedingly rare but have been reported. [11] Prognosis [ edit ] Adenovirus can cause severe necrotizing pneumonia in which all or part of a lung has increased translucency radiographically, which is called Swyer-James Syndrome. [12] Severe[en.wikipedia.org]

Etiology

  • Here we explored the epidemiology and etiology of two adenovirus serotype 3 outbreaks in Hangzhou in 2011. One acute respiratory outbreak was found in Chun'an County, where a total of 371 cases were confirmed in 5 of 23 towns from 4 to 31 May 2011.[ncbi.nlm.nih.gov]
  • […] fever. ( 13474843 ) FUKUMI H....Fujita C. 1957 28 Epidemiology of pharyngoconjunctival fever. ( 13411125 ) BELL J.A. 1957 29 Adenoviruses associated with pharyngoconjunctival fever; isolation of adenovirus type 7 & serological studies suggesting its etiological[malacards.org]
  • Viral conjunctivitis is often misdiagnosed as having a bacterial etiology, as viral conjunctivitis presents similarly to other types of conjunctivitis.[symptoma.com]
  • PCF most frequently is caused by adenovirus serotypes 3 and 7, but serotypes 2, 4, and 14 also have been documented as etiologic agents. In addition, sporadic outbreaks caused by serotypes 1, 5, 6, 8, 11, and 19 have been reported.[odlarmed.com]
  • PCF most frequently is caused by adenovirus serotypes 3 and 7, but serotypes 2, 4, and 14 also have been documented as etiologic agents.[emedicine.medscape.com]

Epidemiology

  • The epidemiologic investigation, initiated by the DEHNR on August 7, identified the cause as pharyngoconjunctival fever (PCF) associated with infection with adenovirus type 3. This report summarizes findings from the investigation.[ncbi.nlm.nih.gov]
  • Jawetz E. 1957 26 An intrafamilial epidemic of pharyngoconjunctival fever. ( 13393836 ) Anderson G.R....VAN HORNE R.G. 1957 27 Studies on the adenovirus as an etiological agent of pharyngoconjunctival fever. ( 13474843 ) FUKUMI H....Fujita C. 1957 28 Epidemiology[malacards.org]
  • Respiratory and Enterovirus Br, National Center for Infectious Diseases; Div of Field Epidemiology, Epidemiology Program Office, CDC.[cdc.gov]
Sex distribution
Age distribution

Pathophysiology

  • PATHOPHYSIOLOGY The route of inoculation of adenoviruses causing pharyngoconjunctival fever determines the pathophysiologic sequence.[musculoskeletalkey.com]
  • Pathophysiology The adenoviruses consist of a group of 35 morphologically similar but antigenically distinct DNA viruses that share a common complement-fixing antigen.[odlarmed.com]
  • PATHOPHYSIOLOGY Viral conjunctival infections are thought to be caused by airborne respiratory droplets or direct transfer from one’s fingers to the conjunctival surface of the eyelids.[medicalstudy.blogspot.com]
  • Many adenovirus infections are subclinical or asymptomatic. 15–70% of conjunctivitis worldwide Etiology and Pathophysiology DNA virus 60 to 90 nm in size, 6 species (A through F) with 50 known serotypes Adenovirus can remain dormant in lymphoreticular[unboundmedicine.com]

Prevention

  • Author information 1 Department of Infectious Diseases, Hangzhou Center for Disease Control and Prevention, Jianqiao Town, Hangzhou, Zhejiang Province, China.[ncbi.nlm.nih.gov]
  • Goals of pharmacotherapy (treatment with medicines) are to reduce morbidity and to prevent any complications. Antiviral eye drops were tried in some patients, but there was no definite benefit of these.[nhp.gov.in]
  • Elsevier Health Sciences, ٠٨‏/٠٩‏/٢٠١٤ - 161 من الصفحات As the authors describe in this volume dedicated to vision in children, great strides have been made in recent years in preventing and identifying any loss of visual acuity, and, when identified,[books.google.com]
  • What they ... [ Read Full Story ] May 10, 2019 If your provider is ordering nebulizers and the drugs used in them for their patients, here are things in the documentation that will help prevent a resubmission to Medicare and ease medical codi... [ Read[coder.aapc.com]

References

Article

  1. Uchio E, Takeuchi S, Itoh N, Matsuura N, Ohno S, Aoki K. Clinical and epidemiological features of acute follicular conjunctivitis with special reference to that caused by herpes simplex virus type 1. Br J Ophthalmol. 2000;84(9):968–972.
  2. Epling J. Bacterial conjunctivitis. BMJ Clin Evid. 2010;2010:0704.
  3. O’Brien TP, Jeng BH, McDonald M, Raizman MB. Acute conjunctivitis: truth and misconceptions. Curr Med Res Opin. 2009;25(8):1953–1961.
  4. Kuo SC, Shen SC, Chang SW, Huang SC, Hsiao CH. Corneal superinfection in acute viral conjunctivitis in young children. J Pediatr Ophthalmol Strabismus. 2008;45(6):374–376.
  5. González-López JJ, Morcillo-Laiz R, Muñoz-Negrete FJ. Adenoviral keratoconjunctivitis: an update. Arch Soc Esp Oftalmol. 2013;88(3):108–115.
  6. Mahmood AR, Narang AT. Diagnosis and management of the acute red eye. Emerg Med Clin North Am. 2008;26(1):35–55.
  7. Ghebremedhin B. Human adenovirus: Viral pathogen with increasing importance. Eur J Microbiol Immunol (Bp). 2014;4(1):26–33.

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Last updated: 2019-07-11 20:27