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Thread: Conjunctivitis, Adenoviral picture - Pediatric Atlas

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    Default Conjunctivitis, Adenoviral picture - Pediatric Atlas

    Discussion
    This patient presents with the classic signs and symptoms of conjunctivitis from Adenovirus. There are multiple serotypes of adenovirus, and viral infection has a variety of clinical effects throughout the body. Most commontly, adenovirus can cause a variety of respiratory infections from bronchitis, to croup, to pneumonia. In immunocompromised patients, the respiratory effects can be severe. During World War II, scores of soldiers in crowded environments and under stress developed acute respiratory disease (ARD), later found to be from adenovirus. Adenovirus infection is also responsible for diarrhea in children, acute hemorrhagic cystitis, rashes, and rarely meningoencephalitis. There are over 40 serotypes of adenovirus in subgroups A-F.

    In the eye, adenovirus most commonly manifests as a follicular conjunctivitis. Though symptoms may range in severity, a common constellation of signs and symptoms is frequently manifest. Red and irritated conjunctiva is typical of the infection. This is seen clinically as conjunctival injection with folliculitis, especially on the inferior palpepral conjunctiva. Occasionally, pinpoint subconjunctival hemorrhages may develop.

    Patients often complain of burning or gritty foreign body sensation. There is usually a watery, mucoid discharge—morning crusting is a common complaint. The lids may become red and edematous. Classically, preauricular lymphadenopathy can be palpated.

    Symptoms usually begin and predominate in one eye, and within a few days, have spread to the contralateral eye. A history of antecedent upper respiratory tract infection or close contact with someone with a "red eye" is common.

    When adenoviral eye infections further involve the cornea, the term epidemic keratoconjunctivitis (EKC) is used. While some argue that this is on a spectrum with simple follicular conjunctivitis, most clinicians use the term EKC when pseudomembranes are present, supeithelial corneal infiltrates develop, or corneal erosions are evident. Patients with EKC may have photophobia and reduced vision long after resolution of the acute infection.

    Pharyngoconjunctival fever describes adenoviral conjunctivitis with the additional systemic symptoms of fever, sore throat, and headache. Corneal infiltrates are very rare.

    Adenovirus infection is quite contagious, as the virus is transmitted readily in respiratory or ocular secretions, contaminated fomites (including eye droppers and mascara bottles), and even contaminated swimming pools. Frequent handwashing is recommended and care must be taken to avoid contamination to others through towels, make-up, instruments, or other fomites.

    Practice Essentials
    Viral conjunctivitis, or pinkeye (see the image below), is a common, self-limiting condition that is typically caused by adenovirus. Other viruses that can be responsible for conjunctival infection include herpes simplex virus (HSV), varicella-zoster virus (VZV), picornavirus (enterovirus 70, Coxsackie A24), poxvirus (molluscum contagiosum, vaccinia), and human immunodeficiency virus (HIV).

    Viral conjunctivitis is highly contagious, usually for 10-12 days from onset as long as the eyes are red. Patients should avoid touching their eyes, shaking hands, and sharing towels, among other activities. Transmission may occur through accidental inoculation of viral particles from the patient's hands or by contact with infected upper respiratory droplets, fomites, or contaminated swimming pools. The infection usually resolves spontaneously within 2-4 weeks.

    Diagnosis
    Generally, a diagnosis of viral conjunctivitis is made on the clinical features alone. Lab tests are typically not necessary, but they may be helpful in some cases. Specimens can be obtained by culture and smear if inflammation is severe, in chronic or recurrent infections, with atypical conjunctival reactions, and in patients who fail to respond to treatment. Giemsa staining of conjunctival scrapings may aid in characterizing the inflammatory response.

    Management
    Treatment of adenoviral conjunctivitis is supportive. Patients should be instructed to use cold compresses and lubricants, such as artificial tears, for comfort. Topical vasoconstrictors and antihistamines may be used for severe itching but generally are not indicated. For patients who may be susceptible, a topical astringent or antibiotic may be used to prevent bacterial superinfection.
    Conjunctivitis, Adenoviral picture Pediatric Atlas attachment.php?s=d74946946107e2281ea7aa5f445e1bd2&attachmentid=1751&d=1441139256

    Etiology
    Adenoviral conjunctivitis is the most common cause of viral conjunctivitis. Particular subtypes of adenoviral conjunctivitis include epidemic keratoconjunctivitis (pink eye) and pharyngoconjunctival fever.

    Viral conjunctivitis is highly contagious, usually for 10-12 days from onset as long as the eyes are red. Patients should avoid touching their eyes, shaking hands, and sharing towels, among other activities. Transmission may occur through accidental inoculation of viral particles from the patient's hands or by contact with infected upper respiratory droplets, fomites, or contaminated swimming pools.

    Primary ocular herpes simplex infection is common in children and usually is associated with a follicular conjunctivitis. Infection usually is caused by HSV type I, although HSV type II may be a cause, especially in neonates. Recurrent infection, typically seen in adults, usually is associated with corneal involvement.

    VZV can affect the conjunctiva during primary infection (chickenpox) or secondary infection (zoster). Infection can be caused by direct contact with VZV or zoster skin lesions or by inhalation of infectious respiratory secretions.

    Picornaviruses cause an acute hemorrhagic conjunctivitis that is clinically similar to adenoviral conjunctivitis but is more severe and hemorrhagic. Infection is highly contagious and occurs in epidemics.

    Molluscum contagiosum may produce a chronic follicular conjunctivitis that occurs secondary to shedding of viral particles into the conjunctival sac from an irritative eyelid lesion.

    Vaccinia virus has become a rare cause of conjunctivitis because, with the elimination of smallpox, the vaccination rarely is administered. Infection occurs through accidental inoculation of viral particles from the patient's hands.

    HIV is the etiologic agent of acquired immunodeficiency syndrome (AIDS). Ocular abnormalities in patients with AIDS primarily affect the posterior segment, but anterior segment findings have been reported. When conjunctivitis occurs in a patient with AIDS, it tends to follow a more severe and prolonged course than in patients without AIDS. In general, patients with AIDS may develop a transient, nonspecific conjunctivitis, characterized by irritation, hyperemia, and tearing, that requires no specific treatment. Microsporidia has been isolated from the cornea and conjunctiva of several patients with AIDS and keratoconjunctivitis. In these patients, symptoms included foreign body sensation, blurred vision, and photophobia; most cases resolved without antimicrobial therapy

    References:
    EyeRounds.org: Adenoviral Conjunctivitis
    http://emedicine.medscape.com/articl...70-overview#a4











    Last edited by Medical Photos; 09-01-2015 at 08:27 PM.

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