Adenoviral Keratoconjunctivitis: Diagnosis, Management, and Prevention

Abstract

Purpose of Review This review will provide an updated overview of the diagnosis, management, and prevention of adenoviral keratoconjunctivitis. Recent Findings Human adenovirus (HAdV) is undergoing nomenclature changes because of whole genome sequencing. Recombination has led to newly identified ocular pathogens like HAdV-D53, HAdV-D54, and HAdV-D56. No quick, highly sensitive and specific diagnostic test is available for ocular adenoviral infections. PCR takes a few hours but is not widely available. Results of using PCR in employees at one medical center support the view of endemic HAdV in the community. Summary Infection control is highly important as no treatment for ocular HAdV infections exists, ocular sequelae can be significant, and HAdV is endemic. Diagnosis of HAdVocular infections can be challenging; ophthalmologists are best positioned to diagnose the condition and provide antibiotic stewardship. Development of an accurate diagnostic test with quick turnaround would lead to major benefits in terms of less antibiotic use and fewer work furloughs. Outbreaks occur when infection control becomes lax.

Conjunctivitis: A Systematic Review

“…[28] Recent advances in genome sequencing of human adenoviruses (HAdV) have identified over 72 unique HAdV genotypes classified into seven different species (HAdV-A through HAdV-G), with HAdV-D species having the most members and the strongest association with viral conjunctivitis. [29,30] Perhaps the most common form of infection by the adenoviruses in children is pharyngoconjunctival fever (PCF) caused by HAdV types 3, 4, and 7. [31][32][33] This condition is usually characterized by the presence of fever, pharyngitis, periauricular lymphadenopathy, and acute follicular conjunctivitis.…”

“…Classically, serotypes 8, 19, 37, and less frequently serotype 4 were believed to be associated with EKC, but more recently, HAdV-D53 and HAdV-D54 have been identified in several outbreaks and are thought to be responsible for the majority of EKC cases. [30] Pseudomembranes, which are sheets of fibrinrich exudates without blood or lymphatic vessels, may be encountered in the tarsal conjunctiva of the EKC patients. [35] Depending on the intensity of inflammation, true conjunctival membranes may also form in EKC.…”

“…Use of 1 and 2% cyclosporine-A (CsA) eye drops have been advocated for the treatment of SEIs, and it has been demonstrated to be effective in improving patient symptoms and reducing the amounts of infiltrates. [30,56] However, Jeng et al suggested that it might be difficult to wean patients completely off CsA once they have started it; in their study, when CsA was stopped, SEIs returned, necessitating reinstitution of the CsA eye drops. [57] This finding is in contrast with the Reinhard's pilot study, where no recurrence was observed after discontinuation of the CsA drops.…”

Precaution and prevention of coronavirus disease 2019 infection in the eye

“…They are resistant to typical disinfection, such as 70% alcohol. 15 On the other hand, enveloped viruses such as coronavirus are more sensitive to simple disinfection, heat, dryness, or extreme pH.…”

An outbreak of adenovirus D8 keratoconjunctivitis in Leicester, United Kingdom, from March to August 2019

“…4 If these were hospital-acquired infections, then it is possible that improved handwashing (rather than the use of alcohol gels), fomite, and equipment cleaning could have prevented some of these cases. 14 F I G U R E 3 Maximum-likelihood tree using hexon partial gene sequences of 993 bp. The Leicester adenovirus D8 sequences (blue font) are most closely related to either virus sequences from outbreaks of epidemic keratoconjunctivitis in Germany/Tibet or from Japan/Europe…”