Abstract
BackgroundDuring October 2010, Egypt reported an outbreak of acute hemorrhagic conjunctivitis (AHC). A total of 1831 cases were reported from three governorates; 1703 cases in El Daqahliya, 92 cases in Port Said, and 36 in Damietta. The purpose of this study was to identify and characterize the causative agent associated with this outbreak.MethodsThe U.S. Naval Medical Research Unit No.3 (NAMRU-3) was contacted by the Egyptian Ministry of Health and Population to perform diagnostic laboratory testing on eighteen conjunctival swabs from patients with conjunctivitis from El Daqahliya Governorate. Conjunctival swabs were tested by molecular methods for human adenovirus (HAdV) and enteroviruses (EV). Virus isolation was performed; the isolated virus was further characterized by molecular typing and phylogenetic analysis.ResultsThe majority of the samples (17/18) were positive for enterovirus and all were negative for HAdV. Molecular typing and sequencing of the isolated virus revealed the presence of coxsackievirus A24 variant. Phylogenetic analysis based on the VP1 and 3C regions demonstrated that the Egyptian viruses belonged to Genotype IV and are closely related to coxsackievirus A24 variant, reported in a similar outbreak in China in August 2010.ConclusionsThis study strongly suggests that coxsackievirus A24 variant was associated with the acute hemorrhagic conjunctivitis outbreak reported in Egypt in October 2010. There is a possibility that the same strain of CV-A24v was implicated in the AHC outbreaks in both China and Egypt in 2010.
Highlights
During October 2010, Egypt reported an outbreak of acute hemorrhagic conjunctivitis (AHC)
Enteroviruses contain a positive sense single-stranded RNA genome, 7.4 kb in length, with a 740 bp of untranslated region (UTR) at the 5' end, the RNA is translated into a single polyprotein that is later cleaved into the four capsid subunits (VP1-VP4) and 2B, 2C, 3AB, and 3C viral proteins involved in RNA replication and lastly 3D the RNA-dependent RNA polymerase [2]
coxsackievirus A24 variant (CV-A24v) is an antigenic variant of human coxsackievirus A24 strain, both classified as members of the human enterovirus species C group (HEV-C) [3], CV-A24v was isolated in 1970
Summary
During October 2010, Egypt reported an outbreak of acute hemorrhagic conjunctivitis (AHC). Acute hemorrhagic conjunctivitis (AHC) is a highly contagious, epidemic, eye disease characterized by eyelid swelling, tearing, and conjunctival hemorrhages. AHC is most commonly caused by two enterovirus serotypes, human enterovirus 70 (EV-70) and human coxsackievirus A24 variant (CV-A24v), and less frequently by some adenovirus serotypes [1]. EV-70 belongs to the human enterovirus species D group (HEV-D) [3], was isolated for the first time in 1970 from the conjunctiva of patients with AHC in West Africa and has subsequently been detected worldwide [4]. CV-A24v is an antigenic variant of human coxsackievirus A24 strain, both classified as members of the human enterovirus species C group (HEV-C) [3], CV-A24v was isolated in 1970
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