Acute Viral Conjunctivitis Research Articles

Prevalence of endemic acute viral conjunctivitis and its preventive and curative homeopathic management among the population of south Gujarat: A community based cross sectional study

Prevalence of endemic acute viral conjunctivitis and its preventive and curative homeopathic management among the population of south Gujarat: A community based cross sectional study

Role of Topical Steroids, Anti Virals in Treating Acute Viral Conjunctivitis in Initial Presentation

Role of Topical Steroids, Anti Virals in Treating Acute Viral Conjunctivitis in Initial Presentation

A ‘look’ into conjunctivitis

Conjunctivitis is a common condition characterised by inflammation of the conjunctiva and is the most likely diagnosis in a patient with a red eye and discharge. Acute conjunctivitis is usually a self-limiting condition or one that is easily treated with topical ophthalmic preparations in most cases. Viral conjunctivitis is the most common cause of conjunctivitis followed by bacterial conjunctivitis. Purulent discharge and adherence of the eyelids upon awakening are strong indicators of bacterial conjunctivitis, however other similarities in presentation of conjunctivitis often leads to misdiagnoses. Acute viral conjunctivitis is most commonly caused by adenoviruses and allergic conjunctivitis is usually caused by seasonal pollens. Acute viral conjunctivitis is treated symptomatically while the use of topical antibiotics are useful in limiting the duration of conjunctivitis with a bacterial aetiology. Allergic conjunctivitis is also treated symptomatically with topical antihistamine/mast cell stabiliser preparations. Conjunctivitis secondary to sexually transmitted diseases such as chlamydia or gonorrhoea require systemic antimicrobials in addition to topical treatment.

A randomized controlled trial of povidone-iodine/dexamethasone ophthalmic suspension for acute viral conjunctivitis.

PurposeTo evaluate the clinical safety and efficacy of povidone-iodine (PVP-I) 0.6%/dexamethasone (DEX) 0.1% ophthalmic suspension vs vehicle in patients with clinically suspected acute viral conjunctivitis.Patients and methodsThis was a randomized, double-masked, parallel-group, vehicle-controlled study. Adults with a clinical diagnosis of suspected acute viral conjunctivitis were randomized 1:1 to PVP-I/DEX ophthalmic suspension or vehicle bilaterally four times daily for 5 days (Days 1–5). Evaluation was on Days 1, 3 (+1-day window), and 6 (+1). Patients with signs of acute viral conjunctivitis at the Day 6 visit received open-label PVP-I/DEX for five additional days and were evaluated on Day 11–14. The primary efficacy endpoint was clinical resolution of acute viral conjunctivitis in the study eye at the Day 6 visit.ResultsOverall, 132 patients were randomized and received treatment (PVP-I/DEX, n=66; vehicle, n=66); 38 patients continued into the open-label portion of the study. Not enough patients with confirmed adenoviral conjunctivitis (n=32/132) were enrolled to assess the primary endpoint, although there were some efficacy trends in the PVP-I/DEX group for global clinical score (sum of watery conjunctival discharge and bulbar conjunctival redness). There were no serious treatment-emergent adverse events (TEAEs) and no patients discontinued due to a TEAE. In the masked phase, 56.1% of patients receiving PVP-I/DEX experienced at least one TEAE vs 43.9% in the vehicle group; 78.9% of patients in the open-label phase experienced at least one TEAE. Most TEAEs were mild in severity.ConclusionPVP-I/DEX ophthalmic suspension administered for ≤14 days had a favorable safety profile and was generally well tolerated.

Molecular Epidemiology of Circulating Human Adenovirus Types in Acute Conjunctivitis Cases in Chandigarh, North India

Human adenovirus (HAdV) is a major cause of viral conjunctivitis. The various serotypes implicated in the causation are 3, 4, 8, 19 and 37. The present study aimed to know the circulating types of HAdV causing acute conjunctivitis in North India. A total of 23 conjunctival swabs were collected from patients with clinically suspected acute viral conjunctivitis during 2014–2015. The HAdV was implicated in the etiology in 65.2% of cases. The sequencing of representative samples using hexon gene suggests the presence of serotype 8 and 4. The serotype eight sequences showed 99%–100% similarity with other Indian strains. The phylogenetic analysis showed that the current circulating serotypes, responsible for conjunctivitis, belonged to epidemic keratoconjunctivitis strains.

Acute bacterial conjunctivitis - antibiotic susceptibility and resistance to commercially available topical antibiotics in Nepal.

There is a shifting trend in susceptibility and resistance of the bacteria towards available antibiotics in the last decade. Therefore, periodic studies to monitor the emerging trends in antibiotic susceptibility and resistance are crucial in guiding antibiotic selection. The aim of this study was to determine the most common pathogens causing bacterial conjunctivitis, and to find the in vitro susceptibility and resistance of these pathogens to commercially available topical antibiotic eye drops in Nepal. Conjunctival smears and antibiotic sensitivity tests were performed for 308 patients presenting to the Eye Care Center, Padma Nursing Home, Pokhara, Nepal from 11th December 1012 to 4th October 2013 with clinical signs and symptoms of acute infective conjunctivitisin in a hospital based cross-sectional study. Antibiotic sensitivity tests were performed for thirteen commercially available topical antibiotics- Chloroamphenicol, Moxifloxacin, Ofloxacin, Ciprofloxacin, Gentamycin, Tobramycin, Neomycin, Bacitracin, Polymyxin-B, Methicillin, Cephazoline, Amikacin and Vancomycin. Acute infective conjunctivitis and viral conjunctivitis was more common in adults and in males. Bacterial conjunctivitis was present in about one third (32.47% to 36.04%) of the patients with acute infective conjunctivitis, and it was more common in children. Bacteria were highly sensitive (93-98%) to most commercially available antibiotics but significant resistance was found against three antibiotics-Bacitracin (9.0%), Neomycin (16.0%) and Polymyxin-B (24.0%). MRSA infection was found in 7.0% of the bacterial isolates. Rest of antibiotics, showed variable resistance (14.3% to 100.0%). All cases of Ophthalmia neonatorum were bacterial. The best commercially available antibiotic for bacterial conjunctivitis was Moxifloxacin.

Effect of "Pink Eye" Label on Parents' Intent to Use Antibiotics and Perceived Contagiousness.

Parents of children who presented for a pediatrics appointment responded to a clinical vignette that described a child with symptoms consistent with acute viral conjunctivitis. In a 2 × 2 randomized survey design, the physician in the vignette either used the term "pink eye" or "eye infection" to describe the symptoms, and either told parents that antibiotics are likely ineffective at treating the symptoms or did not discuss effectiveness. When the symptoms were referred to as "pink eye," parents remained interested in antibiotics, despite being informed about their ineffectiveness. By contrast, when the symptoms were referred to as an "eye infection," information about antibiotic ineffectiveness significantly reduced interest, Mdiff = 1.63, P < .001. Parents who received the "pink eye" label also thought that the symptoms were more contagious and were less likely to believe that their child could go to child care, compared with parents who received the "eye infection" label, Mdiff = 0.37, P = .38.

Artificial tears alone versus 0.45% ketorolac tromethamine with artificial tears for the treatment of acute viral conjunctivitis.

To evaluate the effects of preservative-free 0.45% ketorolac tromethamine and artificial tears (carboxymethylcellulose) compared with those of preservative-free artificial tears alone on the symptoms and signs of acute viral conjunctivitis. This was a randomized, double-masked clinical trial that included 50 patients who were diagnosed with acute viral conjunctivitis and distributed into two groups (Group 0: artificial tears and Group 1: 0.45% ketorolac tromethamine + carboxymethylcellulose). The patients were instructed to use the medication 4 times daily. Signs (conjunctival hyperemia, chemosis, follicles, and secretion) and symptoms (general ocular discomfort, itching, foreign body sensation, tearing, redness, and swelling of the eyelids) were scored at baseline and on the third and seventh days of treatment using a standardized questionnaire and slitlamp anterior segment examination. Both groups showed an improvement in the signs and symptoms of conjunctivitis in their follow-up visits. There was no significant difference in symptom and sign scores between Group 0 and Group 1 in the study visits (p>0.05). The frequency of side effects during treatment was similar between groups (p>0.05). Our findings indicate that 0.45% ketorolac tromethamine was not superior to the use of artificial tears in relieving the signs and symptoms of viral conjunctivitis.

Homeopathy and Epidemic Viral Conjunctivitis

A single blind clinical trial including 92 patients was done to demonstrate a time-effective homeopathic approach involving Euphrasia eye drops for acute viral conjunctivitis.

Sensitivity and Specificity of the AdenoPlus Test for Diagnosing Adenoviral Conjunctivitis

To compare the clinical sensitivity and specificity of the AdenoPlus test with those of both viral cell culture (CC) with confirmatory immunofluorescence assay (IFA) and polymerase chain reaction (PCR) at detecting the presence of adenovirus in tear fluid. A prospective, sequential, masked, multicenter clinical trial enrolled 128 patients presenting with a clinical diagnosis of acute viral conjunctivitis from a combination of 8 private ophthalmology practices and academic centers. Patients were tested with AdenoPlus, CC-IFA, and PCR to detect the presence of adenovirus. The sensitivity and specificity of AdenoPlus were assessed for identifying cases of adenoviral conjunctivitis. Of the 128 patients enrolled, 36 patients' results were found to be positive by either CC-IFA or PCR and 29 patients' results were found to be positive by both CC-IFA and PCR. When compared only with CC-IFA, AdenoPlus showed a sensitivity of 90% (28/31) and specificity of 96% (93/97). When compared only with PCR, AdenoPlus showed a sensitivity of 85% (29/34) and specificity of 98% (89/91). When compared with both CC-IFA and PCR, AdenoPlus showed a sensitivity of 93% (27/29) and specificity of 98% (88/90). When compared with PCR, CC-IFA showed a sensitivity of 85% (29/34) and specificity of 99% (90/91). AdenoPlus is sensitive and specific at detecting adenoviral conjunctivitis. An accurate and rapid in-office test can prevent the misdiagnosis of adenoviral conjunctivitis that leads to the spread of disease, unnecessary antibiotic use, and increased health care costs. Additionally, AdenoPlus may help a clinician make a more informed treatment decision regarding the use of novel therapeutics. clinicaltrials.gov Identifier: NCT00921895.

Detection of adenovirus and herpes simplex virus in the tears of chronic conjunctivitis

To analyze the tears of outpatients who had chronic conjunctivitis infected adenovirus (AdV) and (or) herpes simplex virus (HSV). It was an experimental study. 81 patients with chronic conjunctivitis (adult 66 cases, children 15 cases), 9 cases with acute viral conjunctivitis and 30 healthy control cases. To collect their tears, use polymerase chain reaction (PCR) to detect herpes simplex virus and adenovirus, and analyze the results of PCR, clinical symptoms and signs. In patients with chronic conjunctivitis, adenovirus-positive rate was 32.1% (26/81) and herpes simplex virus-positive rate was 30.9% (25/81). In children patients with chronic conjunctivitis, the adenovirus-positive rate was 33.3% (5/15) and herpes simplex virus-positive rate was 13.3% (2/15). In adult group, the adenovirus-positive rate was 31.8% (21/66) and herpes simplex virus-positive rate was 34.8% (23/66). In patients who underwent acute conjunctivitis, the adenovirus-positive rate was 61.5% (16/26). It has statistical differences (chi2=16.884, P<0.01) with no acute conjunctivitis patients. The herpes simplex virus-positive rate was 42.3% (11/26). It has statistical differences (chi2=5.351, P=0.021) with no acute conjunctivitis patients. The positive rate of virus detection was 0% (0/30) in the normal negative control group. The adenovirus-positive rate was 100.0% (9/9) in the positive control group-patients with acute viral conjunctivitis. 37 patients were adenovirus-positive and (or) herpes simplex virus-positive. The rate of redness with itching was 32.4% (12/37) in virus positive patient. The rate of redness was 64.9% (24/37). The rate of itching was 56.8% (21/37). The rate of lower eyelid follicles was 73.0% (27/37) in virus positive patients. The rate of adenovirus and herpes simplex virus positive expression is considerable in the patients with chronic conjunctivitis. The positive rate of patients with the history of virus infection is rather higher than no infection history.

A combination povidone-iodine 0.4%/dexamethasone 0.1% ophthalmic suspension in the treatment of adenoviral conjunctivitis

The objective of this pilot study was to determine the preliminary efficacy of a novel ophthalmic suspension containing povidone-iodine 0.4% and dexamethasone 0.1% in the treatment of adenoviral conjunctivitis. A prospective, open-label, single-armed, phase II clinical trial in humans. Eligible patients with the clinical signs and symptoms of acute conjunctivitis who tested positive for adenoviral antigen by Rapid Pathogen Screening (RPS) Adeno Detector were enrolled in a single treatment arm consisting of a combination povidone-iodine 0.4%/dexamethasone 0.1% sterile ophthalmic suspension given four times daily for a minimum of 5 days. RPS Adeno Detector testing was performed at baseline and at each follow-up visit along with ocular fluid sampling by conjunctival swabs. Subsequent analysis performed on all swabs included both adenoviral titer by quantitative polymerase chain reaction (qPCR) and cell culture with confirmatory immunofluorescence (CC-IFA). The primary endpoint was clinical resolution of conjunctival injection and discharge. Secondary measures included reduction of qPCR titers and eradication of infectious virus as determined by CC-IFA. A total of nine eyes of six patients with clinical signs and symptoms of acute viral conjunctivitis and a positive RPS Adeno Detector test result were enrolled in the study. In eight/nine eyes enrolled in the study, clinical resolution was observed by day 3 or day 4. In six/six eyes with detectable adenovirus by qPCR, significant reduction in viral titer was seen by day 3, day 4, or day 5. In five/six eyes with infectious virus confirmed by CC-IFA at enrollment, elimination of infectivity was achieved by day 4 or day 5. One patient was lost to followup. An ophthalmic suspension containing povidone-iodine 0.4% and dexamethasone 0.1% may be a useful agent in the treatment of acute RPS Adeno Detector-positive conjunctivitis. A further placebo-controlled study with a larger number of patients is warranted.

Epidemiology of Acute Viral Conjunctivitis at a Junior High School - October 2007

Background: Acute conjunctivitis is a highly contagious disease that can quickly spread through the community. In October 2007, a junior high school reported an outbreak of acute conjunctivitis among its students and staff. We describe the epidemiology of the outbreak at this school. Methods: A questionnaire was designed to identify persons who became ill with conjunctivitis. The questionnaire was distributed to all students and staff at the school on October 17, 2007. A case was defined as a person who had red eyes or physician diagnosed acute, non-allergic conjunctivitis lasting for at least one day. A secondary case was defined as a family member who became ill one to seven days after a student became ill. Conjunctival swabs were taken for viral culture. Results: Of the 681 questionnaires distributed, the response rate was 93.2%. During September 1 and October 17, 2007, there were 246 cases of conjunctivitis (attack rate = 35.2%). Of these, 234 (95.1%) had red eyes, 184 (74.8%) had pain, 172 (70.0%) had increased tearing, and 48 (19.5%) had photophobia. Constitutional symptoms, mainly fever, were present in 32 (13.7%) cases. Of the 988 family members, 167 secondary cases were identified (secondary attack rate = 16.9%). The odds of a case being a first- or second-year student was higher than being a third-year student (odds ratio [OR] = 1.7; 95% confidence interval [CI]: 1.1–2.6 and OR = 2.5; 95% CI: 1.7–3.7, respectively). Virus was isolated from one of three conjunctival swabs taken, which yielded coxsackie A24 virus. Conclusions: Coxsackie A24 virus caused acute conjunctivitis affecting 35.2% of the population at this school. The outbreak was controlled after instituting increased awareness of the epidemic, enhanced hand hygiene practices, and strengthened disinfection measures of shared equipments. Younger students were at increased risk of disease possibly as the result of socio-behavioral differences.

Corneal Superinfection in Acute Viral Conjunctivitis in Young Children

Two children suffered from corneal superinfection following acute viral keratoconjunctivitis. Group A beta-hemolytic streptococci were isolated in one child and cultures were negative in the other child. The corneal ulcers resolved with prompt antibiotic therapy, but both patients developed amblyopia. Visual outcome following corneal superinfection in acute viral conjunctivitis may be poor when it occurs in young children.

Microbiota aeróbia conjuntival nas conjuntivites adenovirais

Objetivos: Estudar a microbiota aeróbica conjuntival em pacientes com quadro clínico de conjuntivite viral aguda. Método: Trinta pacientes entre 18 e 40 anos portadores de conjuntivite adenoviral e 30 pacientes sem a doença foram submetidos à colheita de material da conjuntiva para cultura. Os portadores de conjuntivite adenoviral foram submetidos ao exame até 3 dias após o início dos sintomas. As culturas foram realizadas utilizando-se os meios de ágar-sangue e ágar-chocolate. Pacientes em uso de medicação tópica ou sistêmica, usuários de lentes de contato e aqueles com doença ocular prévia ou doença sistêmica foram excluídos. Resultados: Houve positividade significantemente maior das culturas de conjuntiva nos pacientes com conjuntivite adenoviral (33,3%, sendo Haemophylus influenzae em 50% e Streptococcus pneumoniae em 50%) quando comparados ao grupo controle (6,6% - Staphylococcus coagulase negativo). O grupo de pacientes com conjuntivite e que apresentaram culturas positivas, não diferiu em nenhum dos critérios clínicos analisados do grupo com culturas negativas. Conclusão: Pacientes com conjuntivite adenoviral apresentaram maior freqüência de exames de cultura de amostra de conjuntiva positivas quando comparados aos controles normais. Os pacientes com conjuntivite adenoviral com cultura positiva apresentaram evolução clínica semelhante aos pacientes com cultura negativa. Os agentes isolados na microbiota conjuntival no grupo com conjuntivite foram diferentes do observado no grupo normal. Porém o resultado das culturas não apresentou correlação com a evolução clínica.

Genome Analysis of Adenovirus Type 7 and Adenovirus Type 11

Purpose: To study the epidemiology of adenovirus type 7 (Ad 7) conjunctivitis and adenovirus type 11 (Ad 11) conjunctivitis in the Japanese population by determining the genome type and sub-genome type. Methods: For Ad 7, we used 12 strains from patients with acute viral conjunctivitis and one strain from a patient with pneumonia. For Ad 11, we used 17 strains from patients with acute viral conjunctivitis and 3 strains from patients with cystitis. For Ad 7 genome typing, we used 11 DNA restriction endonucleases (REs) recognizing 6-or 7-base pair sequences, and for Ad 11 genome typing, we used 7 REs. For Ad 7 and Ad 11 sub-genome typing, we used Taq I and Hinf I that recognize 4- or 5-base pair sequences. Results: The 13 Ad 7 strains all belonged to the same genome type and sub-genome type (Ad 7dH1T1). Adenovirus type 11 strains showed six genome types, with Ad 11p being the most frequent strain. Fifteen Ad 11p strains showed three sub-genome types, but none was the same as the prototype. Conclusions: Adenovirus type 7 seemed quite stable and an epidemic may occur again. On the other hand, Ad 11 showed several different types. This finding suggests that Ad 11 did not cause an epidemic in Japan during the first half of the 1990s.

Genome Analysis with Restriction Endonucleases Recognizing 4- or 5-Base Pair Sequences of Adenovirus Type

Purpose: To detect the genetic changes in adenovirus type 4 (Ad4) by DNA restriction endonuclease analysis during 1993–1995, when no epidemic outbreak of conjunctivitis occurred. Methods: We evaluated 16 Ad4 strains from patients with acute viral conjunctivitis at four eye clinics in Sapporo, northern Japan. Seven strains were obtained during the period from December 1993 through March 1994 (first period). Nine strains were obtained during the period from March through May 1995 (second period). These strains were analyzed using DNA restriction endonucleases, TaqI and HinfI. Results: The seven strains obtained during the first period showed identical DNA digestion patterns. The nine strains obtained during the second period showed two DNA digestion patterns using TaqI: five strains showed the same digestion pattern as that seen in the strains obtained during the first period, and four showed a different pattern. The genetic changes in Ad4 during 1993–1995 were less frequent than those reported previously during 1985–1989. Conclusion: It is suggested that the decrease in the incidence of infection in 1993–1995 was related to the decrease in the incidence of mutation in the Ad4 DNA.

Genome Analysis of Adenovirus Type 7 and Adenovirus Type 11

Purpose: To study the epidemiology of adenovirus type 7 (Ad 7) conjunctivitis and adenovirus type 11 (Ad 11) conjunctivitis by determining genome types and subgenomic types. Materials and Methods: For Ad 7 I used twelve strains from patients with acute viral conjunctivitis and one strain from a patient with pneumonia. For Ad 11 I used seventeen strains from patients with cystitis. For Ad 7 genome typing, I used eleven DNA restriction endonucleases (REs) recognizing 6- or 7-base pair sequences and for Ad 11 genome typing, I used seven. For Ad 7 and for Ad 11 subgenome typing, I used Taq 1 and Hinf I which recognize 4- or 5-base pair sequences. Results: The thirteen Ad 7 strains all belonged to the same genome type and subgenome type. Ad 11 strains showed six genome types. Ad 11 p was the most frequent strain. Fifteen Ad 11 p strains showed three subgenome types, but none of them was the same as the prototype. Conclusions: Ad 7 seems quite stable and the Ad 7 epidemic may recur again. On the other hand Ad 11 showed several different types. Ad 11 was probably not epidemic in the first half of the 1990s.

Genome Analysis With Restriction Endonucleases Recognizing 4- or 5-Base Pair Sequences of Adenovirus Type 4

Purpose: To ascertain the chronological change of subgenome types of adenovirus type 4 (Ad 4) through DNA analysis. Materials and Methods: We evaluated sixteen Ad 4 strains from patients with acute viral conjunctivitis at four eye clinics in Sapporo, Northern Japan. Seven strains were obtained from December 1993 through March 1994 (first period). Nine strains were obtained from March through May 1995 (second period). These strains were analyzed using DNA restriction endonucleases recognizing 4 or 5-base pair sequences, Taq I and Hin I. Results: The genome type of 16 strains was Ad 4a. Seven strains in the first period showed the same subgenome type. Nine strains in the second period showed two subgenome types: five strains showing the same subgenome type as in the first period, and four showing a different subgenome type. The two subgenome types were similar in DNA pattern, suggesting that both were derivatives of a common subgenome type. All the sixteen strains were a new subgenome type which was different from those previously isolated during 1985–1989. Conclusion: The subgenome types of Ad 4 in 1993–1995 have changed from those in 1985–1989. (J Jpn Ophthalmol Soc 103:386–391, 1999)

Genome analysis of adenovirus type 4 strains isolated from acute conjunctivitis in Japan

Strains of adenovirus type 4 (Ad4) isolated from patients with acute conjunctivitis were studied by DNA restriction analysis. The strains were isolated between July and December 1990 in Japan. All 63 isolates of Ad4 were identified as the genome type Ad4a. This study showed that the same Ado genome type, Ad4a, caused acute viral conjunctivitis, even in different areas of Japan.