Virological and Serological Studies of Neurological Complications of Acute Hemorrhagic Conjunctivitis in Thailand

Abstract

An extensive outbreak of acute hemorrhagic conjunctivitis (AHC) occurred from September to December 1974 in Thailand. At least 29 patients with polio-like motor paralysis that complicated AHC were hospitalized in Bangkok. Paired or triplicate samples of serum from 16 patients were tested for neutralizing antibody to enterovirus type 70 (EV70). A significant rise in titer of antibody was found for two patients, and the other 14 had neutralizing antibody titers ranging from 1:8 to 1:512 without an increasf larger than or equal to 1:16, a level which is considered to be diagnostically significant. Neutralizing antibody to EV70 was detected in 19S fractions of nine sera examined, but neutralizing antibody to three types of poliovirus was confined to 7S fractions. EV70 was isolated from one of seven stool specimens collected on day 37 after the onset of AHC and none of 10 samples of cerebrospinal fluid. These results and additional clinical and epidemiologic findings gave further support to the hypothesis that EV70 infection can cause polio-like motor paralysis as a complication of AHC.

Enteroviral conjunctivitis and its neurological complications

“…This was later confirmed with reports of paralytic complications of AHC from Senegal (29), Thailand (30) and Taiwan (20). Commonly two to three weeks after the onset of conjunctivitis, but at any time up to eight weeks, these patients developed a prodromal illness of fever and malaise that was quickly followed by root pains and paraesthesia which gave rise to the original diagnosis of radiculomyelitis.…”

“…These symptoms were in turn supplanted by an asymmetrical, flaccid paralysis in which the lower limbs were more commonly affected than the upper and the proximal portion of the limb more severely than the distal. The whole clinical picture closely resembled poliomyelitis (20,29,30,31,47,58). Although some recovered with no or minimal residual weakness over half had a permanent disability a proportion even remaining paraplegic (19).…”

“…Enterovirus 70 is seldom found in the faeces of patients with ocular or neurological symptoms (30,40,58) but virus is commonly found in the throat (70) and faeces during Coxsaekievirus A 24 infections and may persist for at least three weeks (35). It is possible, therefore, that an alternative method for infection exists with the latter virus by the faeeal-conjunctival route.…”

Koksaki A24 etkenli Akut Hemorajik Konjonktivitli Hastalarda Preoküler Gözyaşı Film Testleri

“…5 Rare cases of neurological complications including radiculomyelitis, palatal paresis, and Bell's palsy accompanying or following AHC especially caused by enterovirus 70 were reported in the literature. 6,15 But, in our study, we did not encounter any of these complications.…”

An epidemic of acute haemorrhagic conjunctivitis caused by enterovirus 70 in Okinawa, Japan, in 1994

“…During the short follow-up in our patients, we did not see any neurological manifestation. Neurological complications, such as poliolike motor paralysis, have been reported during epidemics of AHC, particularly in India and Thailand [8,14]. Changes in clinical features of AHC, such as a low incidence of subconjunctival haemorrhage and corneal complications or disappearance of neurological complica- tions, might be due to biological transformation of EV70.…”