Isolation of a variant human adenovirus identified based on phylogenetic analysis during an outbreak of acute keratoconjunctivitis in Chennai.

Background & objectives: Though several viruses are responsible for conjunctivitis, but human adenovirus (HAdV) is by far the most common cause. Epidemic conjunctivitis causes morbidity and early detection of aetiological agent is essential in preventing spread of disease as some of serotypes of adenoviruses cause a severe form of conjunctivitis. This study was undertaken to identify the causative agent of conjunctivitis outbreak in Chennai in 2010. Methods: Conjunctival samples collected from 17 patients with conjunctivitis were subjected to virological investigations. Culture and PCR for detection of adenovirus and enterovirus were carried out. PCR positive products were further subjected for DNA sequencing. The nucleotide sequences of the hexons of isolates were analyzed by comparison with all 51 human adenovirus strains. Phylogenetic tree was constructed using DAMBE software. Results: Among 17 patients, seven were positive for adenovirus by PCR on the direct specimen, none was positive for enterovirus. Eleven of 30 conjunctival swabs showed cytopathic effect in HEp-2 cell line and were confirmed as HAdV by PCR. The DNA sequence data of the 11 isolates had equal percentage of homology with HAdV 6 and 2 on blast analysis. On phylogenetic analysis with GeneBank data of 51 adenovirus strains, 11 isolates from patients during the outbreak of conjunctivitis formed a separate clade indicating a new variant strain. Interpretation & conclusions: Based on phylogenetic analysis it was concluded that the recent conjunctivitis outbreak that occurred in Chennai was caused by a variant adenovirus strain.

Brote de queratoconjuntivitis epidémica en un Servicio de Oftalmología / A nosocomial outbreak of epidemic keratoconjunctivitis

We describe a nosocomial outbreak of keratoconjunctivitis at the Ophthalmology Clinic in Hospital Carlos Van Buren, that affected 150 patients, during August and September of 2006. This outbreak was concomitant with a community outbreak produced by the same agent in the city of Valparaiso that affected 681 other patients. Although adenovirus was not isolated in the nosocomial cases, positive cultures were obtained from community cases, so the diagnosis was based on clinical and epidemiological criteria. The infection rate within the Clinic patients was 5.2 percent considering the population that attended the Clinic in this period. The evaluation of patient care practices showed that common risk factors among affected cases were measurement of ocular tension with a tonometer in the Ophthalmology Clinic (without disinfection of the tonometer between patients), contamination of work surfaces (equipment, furniture), and poor compliance of hand hygiene. Control measures adopted were cleaning, disinfection of tonometer, equipment and work surfaces, and reinforcement of hand hygiene measures. With these measures, it was possible to control the nosocomial outbreak, despite the continued outpatient care of community-acquired cases.

Se describe un brote nosocomial de queratoconjun-tivitis epidémica en la Policlínica de Oftalmología del Hospital Carlos Van Burén, que afectó a 150 pacientes, durante los meses de agosto y septiembre de 2006. Este brote se presentó en el contexto de un brote en la ciudad de Valparaíso que afectó a otros 681 pacientes. Aun cuando no se logró aislar adenovirus (ADV) en los casos nosocomiales, se aisló ADV en pacientes del brote comunitario, por lo que el diagnóstico de los casos nosocomiales se basó en criterios clínicos y epidemiológicos. La tasa de ataque del brote nosocomial fue de 5,2 por ciento considerando la población consultante del período. La evaluación de prácticas de atención directa mostró que los factores de riesgo de los casos serían la medición de la tensión ocular mediante tonómetro en la Policlínica de Oftalmología (sin desinfección del tonómetro entre paciente y paciente), contaminación de superficies de trabajo (equipos, mobiliario) y bajo cumplimiento de la higienización de manos. Las medidas de control fueron limpieza, desinfección del tonómetro, equipos y superficies de trabajo, junto a reforzamiento de lavado de manos. Con estas medidas se logró controlar el brote intrahospitalario a pesar de mantenerse las consultas provenientes del brote en la comunidad.

Queratoconjuntivitis por adenovirus generadas a partir de una consulta oftalmológica / Adenovirus keratoconjunctivitis acquired in an ophtalmology clinic

Introduction: Eye infection is a common cause of ophtalmologic consultation. Adenovirus keratoconjunctivitis outbreaks are common worldwide but its impact and clinical characteristic in Chilean population is unkown. Objective: To describe a series of adenovirus keratoconjunctivitis cases. Patients and Method: The Índex case and contacts received medical care in the Hospital Clínico Universidad de Chile between April and August 2006. A complete ophthalmologic exam and microbiologic evaluation was performed. Results: Nine patients presented a pattern of characteristic epidemic keratoconjunctivitis. In x cases sub-corneal epithelial infiltrates were observed for a period of more than six months. Three affected patients were ophtalmologists, staff at the Hospital. In seven patients ADV was isolated all bellonging to type D genus. Conclusions: Adenovirus type D caused epidemic keratoconjunctivitis in a series of Chilean individuals. Ophthalmologist may have transmitted the virus to patients.

Introducción: La patología ocular infecciosa es frecuente en la consulta oftalmológica, especialmente la conjuntivitis y queratoconjuntivitis epidémica (QCE). Brotes de esta patología son causados por adenovirus (ADV) en el extranjero; en Chile se desconoce su impacto y características. Objetivos: Describir una serie de casos de queratonconjuntivitis epidémica por adenovirus. Material y Pacientes: Al caso índice y los contactos de una serie de casos de QCE por ADV que consultaron en el Hospital Clínico de la Universidad de Chile, entre abril y agosto de 2006, se les realizó examen oftalmológico completo y estudio de ADV por aislamiento viral, detección de antígenos y de genoma viral. Se estableció el género de ADV mediante reacción de polimerasa en cadena. Resultados: Los 9 pacientes infectados presentaron QCE característica. En algunos casos se observaron infiltrados sub-epiteliales corneales que se extendieron por más de seis meses. Tres pacientes eran médicos oftalmólogos. En 7 de los 9 pacientes examinados se aisló ADV; todos del género D. Conclusiones: En Chile, la QCE puede ser causada por el subgénero tipo D. El médico oftalmólogo es un potencial vector en la transmisión de ADV en un brote de QCE, por lo que es fundamental que sea considerado en las estrategias de prevención de esta patología.

Dermatoceratoconjuntivite atópica em pacientes do Ambulatório de Dermatologia Infanto-Juvenil em centro de referência / Atopic keratoconjunctivitis in patients of the pediatric dermatology ambulatory in a reference center

OBJETIVO: Avaliar a frequência de dermatoceratoconjuntivite atópica, seus sintomas e alterações em pacientes do Ambulatório de Dermatologia Infanto-Juvenil da Irmandade da Santa Casa de Misericórdia de São Paulo com diagnóstico prévio de dermatite atópica. MÉTODOS: Foram avaliados 52 portadores de dermatite atópica do Ambulatório de Dermatologia Infanto-Juvenil, menores de 16 anos (média de idade 8,9 ± 4,1 entre 2 e 16 anos) por meio de um protocolo de questões de sintomas e avaliação oftalmológica dos sinais. Os sinais e sintomas foram graduados de 0 (ausente) a 4 (maior intensidade), e em alguns casos apenas como presentes ou não. A análise foi descritiva e estatística, com nível de significância de 5 por cento. RESULTADOS: A frequência da dermatoceratoconjuntivite atópica foi de 76,9 por cento entre os 52 pacientes com dermatite atópica, dos quais 26,7 por cento com conjuntivite atópica e 50,2 por cento com blefarite atópica. No grupo de dermatite atópica encontramos maior número de pacientes do sexo feminino e no grupo conjuntivite atópica maior número de pacientes do sexo masculino. A idade foi praticamente igual nos grupos estudados. Os sintomas mais frequentes foram olho vermelho e prurido, principalmente no grupo de conjuntivite atópica. Este último foi o sintoma com escore mais intenso e presentes em todos os pacientes do grupo conjuntivite atópica. Papilas e blefarite foram os sinais mais encontrados. O tempo de ruptura do filme lacrimal encontrava-se alterado na maioria dos pacientes. CONCLUSÕES: A frequência de dermatoceratoconjuntivite atópica foi de 76,9 por cento nos pacientes com dermatite atópica. O prurido foi o sintoma mais frequente, seguido por olhos vermelhos, mais relacionados ao grupo de conjuntivite atópica. A blefarite e as papilas foram os sinais mais encontrados, também no grupo de conjuntivite atópica. Devido ao crescimento da prevalência da dermatite atópica na população infantil, seria prudente realizar...

PURPOSE: To evaluate the frequency of atopic keratoconjunctivitis, its symptoms and changes in patients of Pediatric Dermatology Service of "Santa Casa de Misericordia de São Paulo" Hospital with a previous diagnosis of atopic dermatitis. METHODS: Fifty-two patients with atopic dermatitis under 16 years old (mean age 8.9 ± 4.1 between 2 and 16 years old) were evaluated through a protocol of questions and assessment of signs and symptoms. The signs and symptoms were graded from 0 (absent) to 4 (highest intensity), and in some cases only as present or not. The analysis was descriptive and statistical, with a 5 percent significance level. RESULTS: The frequency of atopic keratoconjunctivitis was 76.9 percent among the 52 patients with atopic dermatitis, including atopic conjunctivitis (26.7 percent) and atopic blepharitis (50.2 percent). Atopic dermatitis is more frequent in female patients and atopic conjunctivitis in male. Age was practically the same in both groups. The most frequent symptoms were red eye and itching, especially in the atopic conjunctivitis group. Itching was the most intense symptom and was present in all patients of the atopic conjunctivitis group. Blepharitis and papillae were the most common signs. Other signs were less frequent. The tear break-up time was changed in most patients. CONCLUSIONS: The prevalence of atopic keratoconjunctivitis was 76.9 percent in patients with atopic dermatitis. Itching was the most frequent symptom, followed by red eye, in patients with atopic conjunctivitis. Blepharitis and papillae were the most frequent signs in patients with atopic conjunctivitis. Due to the increasing prevalence of atopic dermatitis in children, it would be prudent to perform a routine ophthalmologic evaluation of these patients. From the patients evaluated in this study, none had been previously monitored with ophthalmological exams.

Acute viral Kerato-conjunctivitis: an epidemic in July-August 2007

To clinically analyze an outbreak of acute conjunctivitis which occurred at a Military Training School in Zarga and to characterize the etiology of the disease on the clinical basis at Prince Hashem Military Hospital [PHMH] in July-August 2007. A total of 59 trainees were interviewed and referred to the ophthalmologic clinic at Prince Hashem Military Hospital [PHMH] during the epidemic of the disease July-August 2007. All cases are males with age range from 18-24 years [mean age 21 years], maximum number of cases seen at two days of onset of symptoms. All 59 had red eye, 89.8% had pain, 86.3%had foreign body sensation and 87.5% had discharge. Bilateral involvement was seen in 73.5% and unilateral involvement in 26.5%, 43% of the total cases had corneal involvement and 20% of the cases had associated fever and periauricular lymphadenopathy. The epidemic of Kerato-conjunctivitis observed at the time of study was viral in origin based on clinical analysis and literature review. Adequate personal hygiene, hand cleanliness and avoiding overcrowding in barracks can minimize the epidemic spread

Laboratory results in ocular viral diseases: implications in clinical-laboratory correlation

PURPOSE: To document etiology and predictive value of clinical diagnosis in laboratory confirmed viral diseases. METHODS: Reports of culture-positive cases of samples collected from patients presenting from January 1987 - December 2001 were evaluated. RESULTS: One thousand nine hundred and sixty-four (1964) cultures were submitted during 1987-2001. Twenty-six percent were positive (514). Human herpesvirus 1 was the most frequent agent isolated from all positive culture (56 percent). Adenovirus was the most common virus isolated from conjunctiva (66 percent), human herpesvirus 1 from lid and cornea (76 percent, 88 percent) and cytomegalovirus from vitreous (27 percent). Some unusual pathogens were recovered from conjunctiva as cytomegalovirus and from cornea as adenovirus, enterovirus and cytomegalovirus. Recognition of common viral syndromes was human herpesvirus 1 (88 percent), epidemic keratoconjunctivitis (88 percent), acute hemorrhagic conjunctivitis (70 percent) and varicella zoster virus (100 percent). However, some misdiagnosed cases were observed. Thirteen percent of conjunctivitis thought to be caused by herpes were due to adenovirus, 3.2 percent to Enterovirus, 3.2 percent to varicella zoster virus and 3.2 percent to human cytomegalovirus. Also, 5 percent of cases with a clinical diagnosis of herpes keratitis were caused by adenovirus and 2.7 percent by enterovirus. Finally, 4.8 percent of cases thought to be adenovirus conjunctivitis were herpes conjunctivitis. CONCLUSIONS: Human herpesvirus 1 remains the most frequently isolated virus from ocular sites in general (56 percent). Nonherpetic corneal isolates were in decreasing order: adenovirus, enterovirus and cytomegalovirus. Clinical and laboratory correlation was less than 90 percent. The most misdiagnosed cases were herpes conjunctivitis and keratitis, some cases of adenovirus conjunctivitis some cases of acute hemorrhagic conjunctivitis. It is essential that a rapid and...

OBJETIVOS: Documentar a etiologia e prever a importância do diagnóstico clínico em doenças virais oculares confirmadas em laboratório. MÉTODOS: Todos os relatórios de pacientes com cultura viral positiva durante o período de janeiro 1987 - dezembro 2001 foram analisados. RESULTADOS: Quinhentos e quatorze (514) casos foram encontrados. Em geral, herpesvírus 1 humano foi o agente mais freqüentemente isolado. Adenovírus foi o vírus mais comumente isolado da conjuntiva (66 por cento), herpesvírus 1 humano das pálpebras e córnea (76 por cento, 88 por cento respectivamente) e citomegalovírus do vítreo (27 por cento). Alguns agentes não usuais foram isolados da conjuntiva como citomegalovírus e da córnea como adenovírus, enterovírus e citomegalovírus. Reconhecimento das síndromes virais comuns foi: herpervírus 1 humano (88 por cento), ceratoconjuntivite epidêmica (88 por cento), conjuntivite aguda hemorrágica (70 por cento). Porém, alguns casos com diagnóstico incorreto foram observados. Treze por cento das conjuntivites com diagnóstico de herpes foram causadas por adenovírus, 3,2 por cento por enterovírus, 3,2 por cento por varicella zoster vírus e 3,2 por cento por citomegalovírus. Também, 5 por cento dos casos com diagnóstico clínico de ceratite herpética eram adenovírus e 2,7 por cento enterovírus. Além disso, 4,8 por cento dos casos em que se pensaram em conjuntivite por adenovírus, eram conjuntivite por herpes. Finalmente, 30 por cento dos casos em que se diagnosticaram conjuntive hemorrágica aguda, o agente etiológico era adenovírus. CONCLUSÃO: Em geral herpesvírus humano 1 continua a ser o vírus mais comum encontrado nas infecções oculares (56 por cento). Agentes não herpéticos isolados da córnea foram em ordem decrescente: adenovírus, enterovírus e citomegalovírus. A correlação entre o diagnóstico clínico e laboratorial foi menor do que 90 por cento. Um diagnóstico rápido e específico é essencial em casos de apresentações virais atípicas...

Aspectos clínicos e epidemiológicos da conjuntivite alérgica em serviço de referência / Epidemiological and clinical features of allergic conjunctivitis in a reference center

OBJETIVO: Avaliar aspectos demográficos e clínicos de pacientes com conjuntivite alérgica atendidos em centro de referência. MÉTODOS: Estudo prospectivo no qual sinais e sintomas foram graduados com fichas padronizadas e diagnóstico diferencial feito pelo quadro clínico. RESULTADOS: Foram avaliados 207 pacientes, 131 (63,28 por cento) do sexo masculino e com idade variando de 1 a 45 anos. Destes, 38,65 por cento foram diagnosticados como ceratoconjuntivite primaveril; 38,65 por cento como ceratoconjuntivite atópica; 12,56 por cento como conjuntivite alérgica perene e em 10,14 por cento dos pacientes não houve diagnóstico definido. A presença de alergia extra-ocular foi maior em pacientes com conjuntivite atópica (91,25 por cento) e menor em pacientes com primaveril (32,5 por cento) e a história de alergia na família foi maior naqueles sem diagnóstico definido (59,1 por cento) e menor no grupo de conjuntivite primaveril (28,75 por cento). Os sintomas mais intensos foram prurido e lacrimejamento em pacientes com ceratoconjuntivites e houve correlação positiva entre a intensidade dos sintomas e dos sinais clínicos. CONCLUSÕES: Houve predomínio de formas crônicas e graves da alergia ocular com ameaça potencial à função visual.

BACKGROUND: To evaluate demographic and clinical features of patients with allergic conjunctivitis in a reference center. METHODS: Prospective study using sings and symptoms graduated by standardized charts for clinical diagnosis. RESULTS: We evaluated 207 patients, age ranging form 1 to 45 years and of whom 131 (63.28 percent) were males. Of the patients, 38.65 percent presented vernal keratoconjunctivitis; 38.65 percent, atopic keratoconjunctivitis; 12.56 percent, perennial allergic conjunctivitis and in 10.14 percent patients the diagnosis was not defined. Extraocular allergy was more frequent in patients with atopic keratoconjunctivitis (91.25 percent) and less frequent in patients with vernal keratoconjunctivitis (32.5 percent). Family history of allergy was more frequent in patients without defined diagnosis (59.1 percent) and less frequent in the vernal group (28.75 percent). The most itense symptoms were itching and tearing in patients with keratoconjunctivitis. There was a positive correlation between symptom intensity and signs severity. CONCLUSION: Chronic and severe types of ocular allergy, with potential threat to visual function, predominated in the studed group.

Ceratoconjuntivite epidêmica: utilidade da Terapêutica Homeopática / Epidemic keratoconjunctivitis: usefulness of homeopathic therapy

Os autores apresentam resultados interessantes utilizando a terapêutica homeopática em casos de ceratoconjuntivite epidêmica