Recombinant type Human mastadenovirus D85 associated with epidemic keratoconjunctivitis since 2015 in Japan.

The aim of this study was to report the emergence of a recombinant human mastadenovirus (HAdV) type 85 (HAdV-85) and to describe its genomic and clinical characteristics. The strains were detected and identified in Japan in cases of adenoviral conjunctivitis including epidemic keratoconjunctivitis (EKC). The type was designated as HAdV-85 based on the novel combination of penton base (P = HAdV-37), hexon (H = HAdV-19), and fiber (F = HAdV-8). The whole genome sequence determined for HAdV-85 was compared against sequences of other types in the same species. The results of the phylogenetic analysis suggested a recombinant origin between HAdV-53 and HAdV-64, which have been two major causes of adenoviral EKC in Japan over the past decade. During the period between 2008 and 2016 in Kumamoto city, southwest of Japan, 311 cases diagnosed with conjunctivitis were diagnosed as being the consequence of adenoviral infections. Among them, 11 cases were determined to have been caused by HAdV-85 since 2015. Thus, HAdV-85 could be an emerging causative agent of adenoviral conjunctivitis.

[What about tropical endemic vernal keratoconjunctivitis? Which relationship with intestinal parasites?] / Que savons-nous de la limboconjonctivite endémique des tropiques ? Et quel rapport avec les parasites intestinaux ?

Given the causative parasite hypothesis for tropical endemic limbo-conjunctivitis (TELC), we conducted an analytical case-control study of all children with tropical endemic limbo-conjunctivitis seen in the ophthalmology department of Laquintinie hospital in Douala during the period from January 2nd to April 30, 2015. RESULTS: We identified 64 cases of tropical endemic limbo-conjunctivitis out of 550 children seen; a hospital prevalence of 11.6%; thirteen cases (eight boys and five girls) did not meet inclusion criteria, and 51 cases were included, 31 boys (60.8%) and 20 girls (39.2%) with a male/female (M/F) sex-ratio of 1.41. For controls, we included 28 males (54.9%) and 23 girls (45.1%) for a M/F sex-ratio of 1.22. The prevalence of tropical endemic limbo-conjunctivitis in boys was 12.1%, and for girls it was 7.1% in the case group. Stage II was the most frequent at 29 cases (56.9%), as well as the mixed form at 31 cases (60.8%). The frequency of intestinal parasites was 14 cases (27.5%) in the group of tropical endemic limbo-conjunctivitis patients and 6 cases (11.8%) in the control group (P=0.08). Entamoeba histolytica in its cystic form was the most intestinal parasite found in both groups, 10 cases for tropical endemic limbo-conjunctivitis (19.6%) and 6 cases in the control groups (11.8%). The mean serum IgE among cases was 81.2 IU/ml, while in the controls it was 15.6 IU/ml (P=0.001) CONCLUSION: There is no relationship between intestinal parasitic infection and the occurrence of tropical endemic limbo-conjunctivitis.

Adenovirus-related epidemic keratoconjunctivitis outbreak at a hospital-affiliated ophthalmology clinic.

Adenovirus-associated epidemic keratoconjunctivitis (A-EKC) is a cause of large and prolonged outbreaks in ophthalmology clinics and can result in substantial morbidity. A-EKC outbreaks are often the result of contaminated ophthalmologic equipment, surfaces, or hands. Contaminated multidose eye drops are also a likely culprit, but few prior studies provide clear epidemiologic evidence that adenovirus transmission resulted from contamination of eye drops. We describe an A-EKC outbreak at a large, hospital-affiliated eye clinic that affected 44 patients. The unique epidemiology of the outbreak provides strong evidence that contaminated multidose dilating eye drops resulted in adenovirus transmission. Removal of multidose eye medication from the clinic, combined with case finding, enhanced infection control and enhanced environmental cleaning, led to rapid control of the outbreak.

Lacrimal Duct Occlusion Is Associated with Infectious Keratitis.

Background: To explore the prevalence of lacrimal duct obstruction in patients with infectious keratitis, and the necessity of lacrimal duct dredge in the treatment of human infectious keratitis. Methodology/Principle Findings: The design is prospective, non-control case series. Thirty-one eyes from twenty-eight continuous patients with infectious keratitis were included in this study. The presence/absence of lacrimal duct obstruction was determined by the lacrimal duct irrigation test. The diagnosis of infectious keratitis was made based on clinical manifestations, cornea scraping microscopic examination and bacterial/fungus culture. Diagnosis of viral keratitis was set up based on the recurrent history, deep neovascularization and typical outlook of the cornea scar. The treatment of keratitis included drugs, eye drops or surgery, while treatment of chronic dacryocystitis was lacrimal duct dredging with supporting tube implantation surgery. In the thirty-one eyes with infectious keratitis, fifteen suffered from fungal keratitis (48%), two bacterial keratitis (6%), and fourteen viral keratitis (45%). Eleven eyes (35%) from ten patients with infectious keratitis also suffered from lacrimal duct obstruction. In those cases, six eyes also suffered from lower canalicular obstruction, three nasolacrimal duct obstruction and chronic dacryocystitis, one a combination of upper and lower canalicular obstruction, one upper canalicular obstruction. After local and systemic applications of anti-bacterial, anti-viral, anti-fungal and anti-inflammatory drugs, twenty-eight eyes (90%) recovered within three weeks, while the ulceration of three patients required the lacrimal duct dredging and supporting tube implantation surgery for the healing. Conclusions: Herein, we first report that the prevalence of infectious keratitis is closely correlated to the occurrence of lacrimal duct obstruction. When both confirmed, simultaneous treatment of keratitis and lacrimal duct obstruction promptly is required. Further evaluation of mechanism, prevention and control of the diseases are warranted.

Clinical and corneal microbial profile of infectious keratitis in a high HIV prevalence setting in rural South Africa.

The purpose of this investigation was to determine the clinical and corneal microbial profile of infectious keratitis in a high human immunodeficiency virus (HIV) prevalence setting in rural South Africa. Data in this cross-sectional study were collected from patients presenting with symptoms of infectious keratitis (n = 46) at the ophthalmology outpatient department of three hospitals in rural South Africa. Corneal swabs were tested for herpes simplex virus type 1 (HSV-1) and 2 (HSV-2), varicella zoster virus (VZV) and adenovirus DNA by real-time polymerase chain reaction (PCR) and for bacteria and fungi by culture. Based on clinical history, disease characteristics and laboratory results, 29 (63 %) patients were diagnosed as viral keratitis, including 14 (48 %) viral keratitis cases complicated by bacterial superinfection, and 17 (37 %) as bacterial keratitis. VZV and HSV-1 DNA was detected in 11 (24 %) and 5 (11 %) corneal swabs, respectively. Among clinically defined viral keratitis cases, a negative viral swab was predominantly (93 %) observed in cases with subepithelial inflammation and was significantly associated with an increased duration of symptoms (p = 0.003). The majority of bacteria cultured were Gram-positive (24/35), including Staphylococcus epidermidis and S. aureus. Viral aetiology was significantly associated with a history of herpes zoster ophthalmicus (p < 0.001) and a trend was observed between viral aetiology and HIV infection (p = 0.06). Twenty-one (47 %) keratitis cases were complicated by anterior uveitis, of which 18 (86 %) were HIV-infected cases with viral keratitis. The data implicate a high prevalence of herpetic keratitis, in part complicated by bacterial superinfection and/or uveitis, in HIV-infected individuals presenting with infectious keratitis in rural South Africa.

Human adenovirus type 8: the major agent of epidemic keratoconjunctivitis (EKC).

Human adenovirus type 8 (HAdV-8) is the most common causative agent of a highly contagious eye disease known as epidemic keratoconjunctivitis (EKC). HAdV-8 strains have been classified into genome types HAdV-8A to 8K and HAdV/D1 to D12 according to restriction endonuclease analysis. This review focuses on the significance of HAdV-8 as an agent of EKC. Molecular analysis of HAdV-8 genome types HAdV-53 and HAdV-54 was performed to reveal potential genetic variation in the hexon and fiber, which might affect the antigenicity and tropism of the virus, respectively. On the basis of the published data, three patterns of HAdV-8 genome type distribution were observed worldwide: (1) genome types restricted to a microenvironment, (2) genome types distributed within a country, and (3) globally dispersed genome types. Simplot and zPicture showed that the HAdV-8 genome types were nearly identical to each other. HAdV-54 is very close to the HAdV-8P, B and E genomes, except in the hexon. In a restriction map, HAdV-8P, B, and E share a very high percentage of restriction sites with each other. Hypervariable regions (HVRs) of the hexon were conserved and were 100% identical among the genome types. The fiber knob of HAdV-8P, A, E, J and HAdV-53 were 100% identical. In phylogeny, HVRs of the hexon and fiber knob of the HAdV-8 genome types segregated into monophyletic clusters. Neutralizing antibodies against one genome type will provide protection against other genome types, and the selection of future vaccine strains would be simple due to the stable HVRs. Molecular analysis of whole genomes, particularly of the capsid proteins of the remaining genome types, would be useful to substantiate our observations.

Lepra Conyugal / Conjugal leprosy

OBJETIVOS: Determinar la ocurrencia de lepra entre cónyuges y precisar las características de la enfermedad en el caso índice y en el secundario. MÉTODOS: Estudiamos sus características en una zona de la Costa Caribe colombiana (Departamento del Atlántico), durante 1980-2000, a través de la revisión de las historias clínicas del Programa Control de Lepra, del examen clínico y de entrevistas con los afectados. RESULTADOS: Encontramos 26 parejas con lepra conyugal, que representan el 5,4 % de los casos diagnosticados durante el periodo, con edades entre 20 y 89 años. El 65,4 % de los casos índices fueron hombres y 22 (84,6 %) lepromatosos; dos tenían lepra indeterminada y dos tuberculoide. Los casos secundarios fueron tuberculoides en su mayoría (42,3 %) y, en conjunto, 61 % paucibacilares. Ningún caso índice paucibacilar se asoció con lepra multibacilar en el cónyuge. Sólo dos parejas tenían consanguinidad. Ninguno de los cónyuges llegó enfermo al matrimonio y su convivencia entre la aparición de la enfermedad en el caso índice y el secundario, varió entre 5 y 40 años. La convivencia de los cónyuges varió entre 5 y 44 años. Las discapacidades se presentaron con mayor frecuencia en los pies y fueron más graves en los casos índices lepromatosos, con enfermedad de larga evolución, que en los secundarios, porque éstos fueron paucibacilares con mayor frecuencia y se detectaron cuando su enfermedad tenía menor tiempo de evolución. CONCLUSIONES: La lepra conyugal es poco frecuente, requiere varios años de convivencia para presentarse en el segundo cónyuge y es más común cuando el caso primario es lepromatoso. Cuando un cónyuge es paucibacilar su pareja no desarrollara lepra multibacilar.

The change of etiological agents and clinical signs of epidemic viral conjunctivitis over an 18-year period in southern Taiwan.

BACKGROUND: Epidemic viral conjunctivitis is a highly contagious eye disease that occurs worldwide and is caused mainly by adenoviruses and enteroviruses. An 18-year analysis of the changes of pathogens and clinical signs in a subtropical and densely populated island presents certain special features. METHODS: We retrospectively analyzed the clinical information and laboratory records of the conjunctivitis patients with positive conjunctival swabs from 1980 to 1997. RESULTS: The positive rate of laboratory diagnosis of epidemic conjunctivitis was 50.0% (1,233/2,467). From 1980 to 1994, the predominant causative agent of adenoviral keratoconjunctivitis was adenovirus type 8 (Ad8), with six genotypes being evolved. Three of the new Ad8 genotypes each caused a new epidemic. After 1995 the predominant adenoviral pathogens shifted to Ad37 and Ad19, and no more Ad8 was isolated. Enterovirus type 70 (EV70) was isolated from four outbreaks of acute hemorrhagic conjunctivitis (AHC) from 1980 to 1984, but rarely in later years. Coxsackievirus A type 24 variant (CA24v), which first appeared in 1985, appeared later as the causes of four major epidemics of AHC from 1985 to 1994. The overall clinical symptoms of viral conjunctivitis were more severe in the 1990s than in the 1980s. CONCLUSION: In southern Taiwan, outbreaks of adenoviral keratoconjunctivitis caused by new genomic variants could be associated with the long-term endemic co-circulation of Ad8, Ad19, and Ad37, while epidemics of CA24v AHC were caused mainly by introduction of new viral strains from neighboring countries. The aggravation of host symptoms in the 1990s needs further investigation and close follow-up.

Adenovirus detected by polymerase chain reaction in multidose eyedrop bottles used by patients with adenoviral keratoconjunctivitis.

PURPOSE: We investigated the potential of a multidose eyedrop bottle used by patients with adenoviral keratoconjunctivitis as a source for spreading infection. DESIGN: Prospective consecutive case series. METHODS: The contents of multidose eyedrop bottles given to patients with adenoviral conjunctivitis and in use for 1 week were analyzed by polymerase chain reaction for adenovirus after as long as 9 weeks of preservation at room temperature. RESULTS: Of 26 patients with adenoviral keratoconjunctivitis, the eyedrop bottles of 19 patients (73%) were positive for adenovirus. The maximum detection interval was 9 weeks. Significantly higher prevalences of intrafamilial infection (P =.0098) and of corneal subepithelial opacity (P =.046) were observed among cases with adenoviral contamination than among cases without contamination. CONCLUSIONS: Multidose bottles used by patients with adenoviral keratoconjunctivitis are a possible vector for viral transmission for as long as 9 weeks.

No sequence variation in part of the hexon and the fibre genes of adenovirus 8 isolated from patients with conjunctivitis or epidemic keratoconjunctivitis (EKC) in Norway during 1989 to 1996.

BACKGROUND/AIMS: Several local epidemics of keratoconjunctivitis/conjunctivitis caused by adenovirus type 8 (Ad8) occurred in Norway from August 1995 to May 1996. A smaller epidemic occurred in 1992. The Ad8 hexon forms the surface of the virion and contains the hypervariable regions loop I(1) and loop I(2). The fibre mediates the primary contact with cells. Sequence variation in hexon and fibre genes might play an important role in the pathogenicity of adenoviruses. The aim of this study was to investigate the genetic variability at the hexon and fibre genes in 26 strains of Ad8 isolated from 1989 to 1996. METHODS: The genetic variability of 26 strains of Ad8 isolated from 1989 to 1996 was studied by sequencing part of the hexon and fibre genes. The Ad8 sequences were compared with each other and with two Ad8 strains from the EMBL database. In addition, 14 of the 26 isolates were subjected to restriction endonuclease analysis. RESULTS: No significant sequence variation was seen during the six year period. CONCLUSION: The Ad8 strains causing epidemics of keratoconjunctivitis/conjunctivitis in Norway are genetically stable.

[Clinical features of epidemic nosocomial keratoconjunctivitis in 41 patients].

PURPOSE: To evaluate the clinical features of nosocomial epidemic keratoconjunctivitis (EKC) occurring in the ophthalmology ward of Tokyo Medical University Hospital. MATERIALS AND METHODS: We studied the symptoms and clinical course of 41 patients who had EKC caused by nosocomial infections in our hospital. We attempted to detect adenovirus antigen and viral DNA from conjunctival swabs and also to isolate the virus. RESULTS: The clinical symptoms of EKC, including postoperative cases, were not severe. In some cases, patients' complaints, for example, increase of lacrimation or appearance of a foreign body sensation, were contributory to diagnosis. Among the 41 patients, 31 out of 34 (91.2%) EKC patients who had undergone ophthalmic surgery had EKC in the operated eye. In cases receiving bilateral operations, EKC occurred first in the initially operated eye. The sensitivity of Adeno-check was 76.9%. Adenovirus type 19 was isolated from conjunctival swabs in 26 cases. CONCLUSIONS: The early diagnosis of EKC is extremely important to prevent the spread of nosocomial infections. Careful observation of operated eyes and close attention to patient complaints may aid in the early detection of EKC.

[Nosocomial and community outbreak of epidemic keratoconjunctivitis in Navarra in 1996]. / Brote nosocomial y communitario de queratoconjuntivitis epidémica en Navarra en el año 1996.

BACKGROUND: Epidemic keratoconjunctivitis is an acute, generally bilateral infection, that appears sporadically or in outbreaks from a source of common infection which may be a visit to the ophthalmologist or a swimming pool. Keratitis may evolve to form sub-epithelial injuries in the cornea lasting as much as several months. METHODS: Description of an outbreak of epidemic keratoconjunctivitis that took place in Navarra (Spain) between April and August 1996 and which affected at least 266 people. RESULTS: The epidemiological research highlights the existence of two ophthalmologist consulting rooms as the transmission mechanism for the infection in 46 of the 116 patients researched. The spread of the infection in the environment of the patients was recorded in 119 cases, 62 of which are considered secondary cases. The aetiological diagnosis of the outbreak was carried out 11 days after the start of the microbiological research, isolating adenovirus in conjunctival samples of 8 of the 19 patients researched. CONCLUSIONS: The preventive measures taken to control the outbreak and their effectiveness was highlighted by the gradual reduction in cases.

Causes of conjunctivitis and keratoconjunctivitis in Karachi, Pakistan.

The causes of conjunctivitis and keratoconjunctivitis in 388 patients who attended eye casualty departments in Karachi, Pakistan, during a 5 month period were investigated. Most of these infections were diagnosed as adenovirus (291, 75%) or bacterial (71, 18.3%). Of the remainder, 9 cases (2.3%) were caused by herpes simplex virus and 7 (1.8%) by Chalmydia trachomatis. There was no evidence of typical active trachoma in this urban population. Bacteria or Candida albicans were also grown from 44 of the adenovirus cases (15%). Many of the bacteria grown from eyes in this study were resistant to antibiotics, probably because of inadequate and/or inappropriate self-medication with antibiotics in this community.

[An outbreak of keratoconjunctivitis in a dairy farm]. / Een uitbraak van kerato-conjuctivitis op een melkveebedrijf.

An outbreak of infectious kerato-conjunctivitis is described in a dairy herd during the (winter)stable period. Moraxella was isolated from lacrimation fluid from three animals. The development of the infection was possibly precipitated by a vaccination with modified live IBR virus, adenovirus type 3 and parainfluenza virus type 3. Presumably, climatological-stable conditions play an important role in the clinical manifestation of the infection.