Clinical Presentation, Investigation and Control of an Outbreak of Adenoviral Conjunctivitis in a Neonatal Unit at a Tertiary Hospital.

BACKGROUND: Nosocomial spread of adenovirus infection has been reported in neonatal, pediatric and adult medical units. This nonenveloped and hardy virus is resistant to numerous disinfectants thus posing a challenge for control and prevention of adenovirus infections in health care settings. METHODS: An epidemiologic outbreak investigation revealed an adenoviral outbreak in the neonatal nursery as well as in the neonatal screening outpatient department for Retinopathy of Prematurity (ROP). All suspected cases (94 neonates) underwent adenoviral conventional polymerase chain reaction (PCR) and representative samples underwent sequencing by Sanger's method. The clinical features and disease course were studied. Infected babies were started on tobramycin eye drops. Topical steroid eye drops were added for those who developed pseudomembranes. RESULTS: We found 58 cases of laboratory-confirmed neonatal adenovirus conjunctivitis (between July 10 and October 24, 2019). Redness (96%) was the most common presentation followed by discharge (68.9%) and lid edema (51.7%). Pseudomembrane were seen in 77.5% of the infected neonates. Prior ROP examination was carried out in 38 (65.5%) neonates. Respiratory symptoms were present in 7 (12.06%) neonates. Sequencing revealed serotype 8 as the cause of the outbreak. Control measures were strictly implemented. Standard Operating Procedures (SOPs) for ROP screening were revisited, revised and reinforced to prevent future outbreaks. CONCLUSIONS: We observed ROP screening as a risk factor for the development of adenoviral conjunctivitis in neonatal care units. Neonates present with different clinical manifestations as compared with adults. Prompt control measures were implemented to control the adenoviral outbreak.

Multiplex PCR testing requires a robust multi-disciplinary strategy to effectively manage identified cases of chlamydial conjunctivitis.

INTRODUCTION: Implementation of an in-house polymerase chain reaction (PCR) multiplex assay by West of Scotland Specialist Virology Centre to improve sample processing means all viral eye swabs are now routinely tested for Adenovirus, Herpes simplex, Varicella and Chlamydia. Concern was raised regarding subsequent management and sexual health attendance for Chlamydia-positive patients identified in eye casualty. METHODS: A retrospective review of virology results identified 76 Chlamydia-positive patients from 1914 eye swabs (4%) from May 2007 to April 2008. Of these results, 12 originated from Glasgow eye casualty and available clinical notes were cross-referenced with the sexual health network (Sandyford). RESULTS: Identified issues included no documentation of implications of testing, poor communication of positive results and poor referral pathways to sexual health for assessment; all leading to inadequate management. A shared care network was created to address these issues. A designated sexual health advisor was identified to improve sexual health referral, specialist assessment, standardised management and contact tracing. Re-audit showed more consistent follow-up. CONCLUSION: New PCR technology has resulted in a shared care approach to address corresponding implications of testing. Effective communication with a structured protocol and a central point of contact has improved follow-up and ensures appropriate best practice management of chlamydial conjunctivitis.

Collect, boil and amplify--a simple approach for the detection of three common viruses associated with epidemic keratoconjunctivitis, conjunctivitis and dendritic ulcers.

During 2011' an outbreak of epidemic keratoconjunctivitis led to increased clinical requests for molecular screening of viruses from conjunctival swabs. To maximise throughput with minimal cost, a simple boil extraction on dry swabs followed by amplification and real-time detection using 'in-house' assays for herpes simplex viruses (HSV) and adenoviruses with RNaseP as an internal control was validated and introduced. Data from 541 patients who were tested for one or more viral targets was analysed. Adenovirus was most frequently detected accounting for 30% of all cases including the community outbreak. Genotyping of the hexon gene identified the cause as an adenovirus type 8. HSV was detected in 7% of the samples tested, predominantly HSV-1 with a single case of HSV-2. Invalid results due to poor RNaseP signals were reported in 10.5% of samples but for the HSV-1 assay 23% of the samples were invalid due to interference of the fluorescein dye used by ophthalmologists resulting in repeat sampling to obtain a valid result. Despite this, when compared to conventional techniques such as direct immunofluorescence, collect, boil and amplify increased significantly the detection of DNA viruses in conjunctival samples ensuring improved diagnosis, patient management and infection control measures at a modest cost.