Epidemic keratoconjunctivitis.

Following a definition of epidemic keratoconjunctivitis (EKC) and the etiologic agent responsible, a brief history of the disorder dating back to 1889 is given. The clinical course, signs, symptoms, and corneal involvement of this disease, which sets it apart from other adenovirus conjunctivitis, are described. During the late summer of 1981, epidemics of viral conjunctivitis were reported in India and Miami, Florida. At this same time, in our office in Memphis Tennessee, we examined and treated 15 patients who had EKC of the adenovirus type 8 variety. A brief history, objective findings, and treatment of this condition are given along with findings, treatment, and follow-up of our series of patients; a probable cause of infection is offered. Good office hygiene can prevent the spread of EKC. Schiötz tonometry on a patient in the incubation period or during the later infection stage can spread the disease. Patients with EKC in whom a conjunctival pseudomembrane develops may have permanent scarring in the fornicies. Subepithelial corneal opacities of EKC may persist for months or longer, some more than three years. Use of topical steroids may cause remission of the subepithelial corneal opacities, but, when the drug is discontinued, reappearance of the lesions may result after months or a year or more.

[The cat as a possible infection source for Chlamydia psittaci keratoconjunctivitis in humans]. / Die Katze als mögliche Infektionsquelle für Chlamydia-psittaci-bedingte Keratokonjunktivitis beim Menschen.

Acute follicular keratoconjunctivitis in a 25-year-old female patient was diagnosed as an infection with Chlamydia psittaci supposedly originating from a household cat with similar symptoms. The diagnosis was based on clinical symptoms, the appearance of Chlamydia-psittaci-specific IgM in the patient and the cat, and excluded other pathogenic agents. Chlamydiae organisms could not be isolated, probably due to prior antibiotic treatment. Two weeks of continuous treatment led to complete recovery of the patient and the cat. Other zoonotic infections of conjunctivitis in cats and keratoconjunctivitis in man caused by Chlamydia psittaci are mentioned.

[Keratoconjunctivitis caused by Chlamydia psittaci]. / Keratokonjunktivitis durch Chlamydia psittaci.

A 25-year-old female patient suffering from acute follicular keratoconjunctivitis with epithelial and subepithelial corneal infiltrates was examined. Antibodies of the IgM class directed against C. psittaci were found. Infection due to C. trachomatis was ruled out by serology (ELISA) and negative isolation attempts. The patient's cat had rhinitis and conjunctivitis and a positive C. psittaci specific IgM antibody titer. Systemic application of tetracycline resulted in fast resolution of symptoms in both the patient and her cat.

Epidemic keratoconjunctivitis: report of an outbreak in an ophthalmology practice and recommendations for prevention.

In Fall 1981, an outbreak of acute infectious conjunctivitis with keratitis (EKC) occurred in patients who had visited a private ophthalmology clinic just prior to onset of illness. Among an estimated 2,200 patient visits to the office from August 10 to October 15, 1981 for problems unrelated to infectious conjunctivitis, 39 (1.8%) persons subsequently developed EKC. The median incubation period was 6.5 days (range, 1 to 14 days). A case-control study was done to identify risk factors associated with contracting EKC; patients with EKC were more likely than control patients to have been examined by one or the other of two of the four ophthalmologists at the clinic and to have undergone procedures such as tonometry or foreign body removal. Adenovirus was isolated from conjunctival swabs from four of five persons with conjunctivitis; three were type 8 and one was type 7. Recognition of the problem and improved handwashing practices were associated with terminating the outbreak. This outbreak illustrates the potential for transmission of adenovirus infection during the provision of eye care. Infection control practitioners should be familiar with measures for the prevention of such infections among ophthalmology patients.

Epidemic keratoconjunctivitis.

An outbreak of epidemic keratoconjunctivitis (EKC) in a rural area is described. It was characterised by its explosive outbreak, relatively short duration and high infectivity. The aetiology is discussed.

The role of face flies in an episode of infectious bovine keratoconjunctivitis.

Cattle partially protected from face flies (Musca autumnalis) had much less infectious bovine keratoconjunctivitis and yielded fewer isolated of hemolytic Moraxella bovis than did similar cattle that received no face fly protection. The number of new isolated of M bovis from the unprotected cattle was highly correlated with the number of face files observed on the cattle. Close physical proximity to cattle infected with M bovis was important in the spread of the bacteria to previously uninfected cattle; however, it did not require physical contact among the cattle to spread from herd to herd. Moraxella bovis first began to spread from herd to herd after face fly populations exceeded 10/animal for 1 month. Keratoconjunctivitis was not observed in 53% of the cattle from which M bovis was isolated. Moraxella bovis was isolated from 4 of 45 pools of face files collected from animals in the untreated herds.

The role of Hydrotaea armipes Fall. (Diptera, Muscidae) in the transmission of infectious bovine keratoconjunctivitis.

The tests to isolate the IBK causative agent Moraxella bovis from the flies Hydrotaea armipes Fall., captured while feeding on tears in the eye region of infected calves, have failed. Many successful isolations of Branhamella catarrhalis from the digestive tract of the flies and the smears taken from the eyes of the infected calves indicate that this agent is acquired by the flies while sucking tears from the eyes of the sick animals. A similar transmission is presumed by the authors with Moraxella bovis. In experiment this bacterium survives on the body surface of Hydrotaea armipes for 14 hours, in the digestive tract for 15 hours and even longer.

Epidemic keratoconjunctivitis caused by adenovirus type 8: epidemiologic and laboratory aspects of a large outbreak.

During late 1977 and early 1978, 192 cases of epidemic keratoconjunctivitis occurred in a community in central Georgia. In 86 of these cases, the patient had been exposed to a single ophthalmologist's office (physician A) 3-22 days before onset of illness. Patients considered as cases were more likely to have had invasive ophthalmologic procedures than non-cases (p < 0.001), and a linear relationship existed between the number of procedures performed and the attack rate (r = 0.91, p < 0.05). Adenovirus type 8 (AV8) was identified as the responsible pathogen by culture and/or antibody determination for 20 of these patients. Group-specific AV hexon antigen and type specific dodecon antigen were identified in four of seven ophthalmic solutions obtained from physician A's office. The outbreak stopped after proper control techniques were initiated.

The epidemiological and economic importance of fly infestation of meat and milk producing animals in Europe.

The importance of fly infestation in the transmission of disease and in the loss of production through "fly worry" to meat and milk producing animals is reviewed. As well as being confirmed disseminators of certain enteric diseases of man, eg, cholera, salmonellosis and colienteritis, flies have also been implicated in the transmission of mastitis and certain ophthalmic infections, principally keratoconjunctivitis in cattle. "Fly worry, particularly from biting flies such as Stomoxys calcitrans and Haematobia irritans, has been shown to have an adverse effect on meat and milk production since fly control greatly increases yields.

The aetiology of a keratoconjunctivitis occurring in goats in the Sudan.

An infectious keratoconjunctivitis occurring in goats in the Sudan is described. Experimental transmission using infective ocular discharges resulted in a conjunctivitis in young kids and a severe keratoconjunctivitis in an adult goat. A pleomorphic organism which resembled Rickettsia spp was found in conjunctival smears from naturally and experimentally infected animals. Neither Mycoplasma nor Chlamydia spp were isolated in microbiological cultures.

Epidemic keratoconjunctivitis at a Vietnamese refugee camp in Florida.

During the summer of 1975 an ongoing outbreak of conjunctivitis occurred among Vietnamese refugees temporarily housed at a U.S. mainland camp. Twenty-two per cent of surveyed refugees gave a history of the disease and 10% were documented as having clinical conjunctivitis at the time of the survey. Fifty-six per cent of documented cases were in children less than 10 years of age. The attack rate among American camp personnel was 4%. Comprehensive microbiologic analysis revealed multiple potential pathogens in most cases, but the recovery of adenovirus 8 (AV8) in 81% of cases cultured within two weeks of onset implicated AV8 as the principal cause of the epidemic.