Subsequent development of Kawasaki disease following acute human adenovirus infection among siblings.

We report a middle-childhood girl presented with high-grade fever and headache for 4 days. Following this, the child developed mucocutaneous symptoms. She had a notable family history of autoimmune disease. Tests revealed increased inflammatory markers. On the sixth day of illness, a two-dimensonal echocardiogram showed an enlarged coronary artery, diagnosed as incomplete Kawasaki disease (KD) and treated with IVIG and aspirin.Within a week, her younger sibling, an early-childhood girl presented with features of viral prodrome, developed mucocutaneous lesions and subcutaneous oedema of limbs. Her investigations also showed elevated inflammatory markers and echocardiographic changes, diagnosed as incomplete KD.The subsequent development of KD in siblings, both showing initial viral symptoms and a family history of autoimmune disease, led to the suspicion of a potential viral trigger. This was confirmed through viral PCR studies for human adenovirus (type 3). These cases highlight an unusual occurrence of KD developing in siblings following acute adenoviral infection.

A fatal case of viral sepsis and encephalitis in a child caused by human adenovirus type 7 infection.

Adenoviruses are highly prevalent pathogens responsible for a wide range of clinical diseases, including respiratory tract infection, acute gastroenteritis, and conjunctivitis. However, adenovirus infection is rarely associated with central nervous system involvement. Here, we report a fatal viral sepsis and encephalitis in a child caused by a human adenovirus type 7 infection. We detected human adenovirus type 7 in the patient's nasopharyngeal swab, blood, and cerebrospinal fluid. Our findings indicate clinicians should be aware of the possible central nervous system involvement in adenovirus infection.

A Case Series of Children with Acute Hepatitis and Human Adenovirus Infection.

BACKGROUND: Human adenoviruses typically cause self-limited respiratory, gastrointestinal, and conjunctival infections in healthy children. In late 2021 and early 2022, several previously healthy children were identified with acute hepatitis and human adenovirus viremia. METHODS: We used International Classification of Diseases, 10th Revision, codes to identify all children (<18 years of age) with hepatitis who were admitted to Children's of Alabama hospital between October 1, 2021, and February 28, 2022; those with acute hepatitis who also tested positive for human adenovirus by whole-blood quantitative polymerase chain reaction (PCR) were included in our case series. Demographic, clinical, laboratory, and treatment data were obtained from medical records. Residual blood specimens were sent for diagnostic confirmation and human adenovirus typing. RESULTS: A total of 15 children were identified with acute hepatitis - 6 (40%) who had hepatitis with an identified cause and 9 (60%) who had hepatitis without a known cause. Eight (89%) of the patients with hepatitis of unknown cause tested positive for human adenovirus. These 8 patients plus 1 additional patient referred to this facility for follow-up were included in this case series (median age, 2 years 11 months; age range, 1 year 1 month to 6 years 5 months). Liver biopsies indicated mild-to-moderate active hepatitis in 6 children, some with and some without cholestasis, but did not show evidence of human adenovirus on immunohistochemical examination or electron microscopy. PCR testing of liver tissue for human adenovirus was positive in 3 children (50%). Sequencing of specimens from 5 children showed three distinct human adenovirus type 41 hexon variants. Two children underwent liver transplantation; all the others recovered with supportive care. CONCLUSIONS: Human adenovirus viremia was present in the majority of children with acute hepatitis of unknown cause admitted to Children's of Alabama from October 1, 2021, to February 28, 2022, but whether human adenovirus was causative remains unclear. Sequencing results suggest that if human adenovirus was causative, this was not an outbreak driven by a single strain. (Funded in part by the Centers for Disease Control and Prevention.).

Complications of Adenoviral Keratoconjunctivitis in Ophthalmologists and Orthoptists: Epidemiology and Risk Factor, A Retrospective Questionnaire Analysis.

PURPOSE: The purpose of this study was to assess the medical history of adenoviral keratoconjunctivitis (AK) and subepithelial infiltrates (SEIs) among French ophthalmologists and orthoptists and the frequency of unreported occupational diseases. We also described short-term and long-term consequences of AK and evaluated associated factors. METHODS: The REDCap questionnaire was diffused online several times over 7 consecutive months, from October 2019 to May 2020, through mailing lists (French Society of Ophthalmology, residents, and hospital departments), social networks, and by word of mouth. RESULTS: Seven hundred ten participants were included with a response rate of 6.2% for ophthalmologists, 3.8% for orthoptists, and 28.3% for ophthalmology residents. The medical history of AK was found in 24.1% (95% confidence interval 21%-27.2%) of respondents and SEI in 43.9% (36.5%-51.3%) of the AK population. In total, 87.1% (82.1%-92.1%) of AK occupational diseases were not declared. In total, 57.7% of respondents took 9.4 ± 6.2 days of sick leave, mostly unofficial, and 95.7% stopped surgeries for 13.0 ± 6.6 days. Among the AK population, 39.8% had current sequelae, with 17.5% having persistent SEIs, 19.9% using current therapy, and 16.4% experiencing continuing discomfort. SEIs were associated with wearing contact lenses (odds ratio 3.31, 95% confidence interval 1.19-9.21) and smoking (4.07, 1.30-12.8). Corticosteroid therapy was associated with a greater number of sequelae (3.84, 1.51-9.75). CONCLUSIONS: AK and SEI affect a large proportion of ophthalmologists and orthoptists, possibly for years, with high morbidity leading to occupational discomfort. Few practitioners asked for either to be recognized as an occupational disease. Associated factors would require a dedicated study.

Epidemiological characteristics, clinical characteristics, and prognostic factors of children with atopy hospitalised with adenovirus pneumonia.

BACKGROUND: Atopy may be associated with disease severity and a poor prognosis of human adenovirus (HAdV) pneumonia in children. Our aim was to observe the clinical characteristics and pulmonary radiological changes in children with atopy and HAdV pneumonia in China. METHODS: Children hospitalised with HAdV pneumonia from June 2018 to December 2019 were analysed. All children were divided into atopic with HAdV, non-atopic with HAdV, and atopic without HAdV infection group. Each group was further divided into the mild and severe pneumonia groups according to disease severity. Standard treatment was initiated after admission, and regular follow-up evaluations were conducted at 1 month after discharge. Baseline and clinical characteristics and pulmonary radiological changes in children with and without atopy were evaluated. Risk factors associated with small airway lesions in patients with HAdV pneumonia were analysed. RESULTS: The eosinophil count in the atopic group was significantly higher than that in the non-atopic group (P < 0.05). Severe coughing, wheezing, and small airway lesions on chest high-resolution computed tomography (HRCT) upon admission, after discharge and 1 month after discharge were significantly higher in the atopic group (with or without HAdV infection) than in the non-atopic group (P < 0.05). There were significant differences in the number of patients with wheezing and small airway lesions during hospitalisation and after discharge among the three groups (P < 0.05). The risks of small airway lesions in children with a family or personal history of asthma, severe infection, atopy, and HAdV infection were 2.1-, 2.7-, 1.9-, 2.1-, and 1.4-times higher than those in children without these characteristics, respectively. CONCLUSIONS: Children with atopy and HAdV pneumonia may experience severe coughing in mild cases and wheezing in mild and severe cases. Children with atopy are more susceptible to the development of small airway lesions, recurrent wheezing after discharge and slower recovery of small airway lesions as observed on pulmonary imaging than non-atopic children after HAdV infection. A family or personal history of asthma, atopy, severe infection, and HAdV infection are independent risk factors associated with the development of small airway lesion as observed on chest HRCT.

Adenovirus Infection in Children with Down Syndrome.

BACKGROUND: Adenovirus infections are prevalent in children. They usually cause a mild self-limited disease. However, this infection can be associated with considerable morbidity and mortality in specific populations, especially among immunocompromised children. Children with Down syndrome are susceptible to a higher frequency and increased severity of viral infections. Little is known about the severity and clinical course of adenovirus infections in children with Down syndrome. OBJECTIVES: To characterize hospitalized children diagnosed with Down syndrome and presenting with adenovirus infection. METHODS: We performed a retrospective review of children admitted with adenovirus from January 2005 to August 2014 from a single tertiary pediatric medical center in Israel. Data were compared between patients with and without Down syndrome. RESULTS: Among the 486 hospitalized children with adenoviral infection, 11 (2.28%) were diagnosed with Down syndrome. We found that children with Down syndrome were more likely to experience a higher incidence of complications (18.2% vs. 2.4%, P = 0.008), a higher rate of admissions to the intensive care unit (36.4% vs. 2.4%, P < 0.001), and more prolonged hospitalizations (17 ± 15.9 days compared to 4.46 ± 3.16, P = 0.025). CONCLUSIONS: Children with Down syndrome who were hospitalized with adenovirus infection represent a high-risk group and warrant close monitoring. If a vaccine for adenovirus becomes available, children with Down syndrome should be considered as candidates.

Cytokine/Chemokine Expression Is Closely Associated Disease Severity of Human Adenovirus Infections in Immunocompetent Adults and Predicts Disease Progression.

Increasing human Adenovirus (HAdV) infections complicated with acute respiratory distress syndrome (ARDS) even fatal outcome were reported in immunocompetent adolescent and adult patients. Here, we characterized the cytokine/chemokine expression profiles of immunocompetent patients complicated with ARDS during HAdV infection and identified biomarkers for disease severity/progression. Forty-eight cytokines/chemokines in the plasma samples from 19 HAdV-infected immunocompetent adolescent and adult patients (ten complicated with ARDS) were measured and analyzed in combination with clinical indices. Immunocompetent patients with ARDS caused by severe acute respiratory disease coronavirus (SARS-CoV)-2, 2009 pandemic H1N1 (panH1N1) or bacteria were included for comparative analyses. Similar indices of disease course/progression were found in immunocompetent patients with ARDS caused by HAdV, SARS-CoV-2 or panH1N infections, whereas the HAdV-infected group showed a higher prevalence of viremia, as well as increased levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and creatine kinase (CK). Expression levels of 33 cytokines/chemokines were increased significantly in HAdV-infected patients with ARDS compared with that in healthy controls, and many of them were also significantly higher than those in SARS-CoV-2-infected and panH1N1-infected patients. Expression of interferon (IFN)-γ, interleukin (IL)-1ß, hepatocyte growth factor (HGF), monokine induced by IFN-γ (MIG), IL-6, macrophage-colony stimulating factor (M-CSF), IL-10, IL-1α and IL-2Ra was significantly higher in HAdV-infected patients with ARDS than that in those without ARDS, and negatively associated with the ratio of the partial pressure of oxygen in arterial blood/fraction of inspired oxygen (PaO2/FiO2). Analyses of the receiver operating characteristic curve (ROC) showed that expression of IL-10, M-CSF, MIG, HGF, IL-1ß, IFN-γ and IL-2Ra could predict the progression of HAdV infection, with the highest area under the curve (AUC) of 0.944 obtained for IL-10. Of note, the AUC value for the combination of IL-10, IFN-γ, and M-CSF reached 1. In conclusion, the "cytokine storm" occurred during HAdV infection in immunocompetent patients, and expression of IL-10, M-CSF, MIG, HGF, IL-1ß, IFN-γ and IL-2Ra was closely associated with disease severity and could predict disease progression.

Hepatic Manifestations of Nonhepatotropic Infectious Agents Including Severe Acute Respiratory Syndrome Coronavirus-2, Adenovirus, Herpes Simplex Virus, and Coxiella burnetii.

Nonhepatotropic viruses such as adenovirus, herpes simplex virus, flaviviruses, filoviruses, and human herpes virus, and bacteria such as Coxiella burnetii, can cause liver injury mimicking acute hepatitis. Most of these organisms cause a self-limited infection. However, in immunocompromised patients, they can cause severe hepatitis or in some cases fulminant hepatic failure requiring an urgent liver transplant. Hepatic dysfunction is also commonly seen in patients with severe acute respiratory syndrome coronavirus-2 infection. Patients with preexisting liver diseases are likely at risk for severe coronavirus disease 2019 (COVID-19) and may be associated with poor outcomes.

Adenovirus-36 as one of the causes of obesity: the review of the pathophysiology.

The dramatic increase of people affected by obesity worldwide seems to be influenced by external factors independent of eating habits, physical exercise, or genetic characteristics. There may be a number of such factors, but one hypothesis is that there is person-to-person transmission, causing an epidemic effect, as occurs with infectious diseases. In animal models, experimental infection with human adenovirus-36 (Adv36) causes obesity. Humans cannot be experimentally infected, but a number of studies found a correlation of positive serology for Adv36 with overweight/obesity in humans. In vitro studies have shown that Adv36 accelerates the differentiation and proliferation of preadipocytes into adipocytes and increases their lipid concentration. Another viral mechanism involved is the activation of a noninsulin-dependent process that increases glucose uptake, mainly in adipose tissue and muscle. The increased glucose, coupled with increased lipogenesis due to increased fatty acid synthase and the action of peroxisome proliferator-activated receptor gamma (PPAR-gamma) in stimulating adipocyte differentiation from adult stem cells enhances fat accumulation within the adipocytes. In studies conducted to date, the Adv36 E4 open reading frame 1 gene (E4orf1), which activates the glucose transporter protein isoform 4 (GLUT4) and glucose transporter protein isoform 1 (GLUT1) glucose transporters, appears to play a major role in the virus adipogenesis. The aim of this study was to review the pathophysiology of obesity and the role of Adv36.

An outbreak of adenovirus D8 keratoconjunctivitis in Leicester, United Kingdom, from March to August 2019.

We report a large epidemic (n = 126) of keratoconjunctivitis predominantly with two lineages of adenovirus (AdV) type D8 in patients seen in eye casualty between march and August 2019. Other AdV species identified by viral sequencing included B, C, and E. Despite various features of more severe eye disease being present, these were not significantly different between the different AdV species, with similar rates of pseudomembrane formation and keratitis observed in patients with AdV species B as for those with AdV species D.

Adenoviral cytopathic changes in pleural fluid: A unique cytological presentation mimicking malignancy.

Adenoviruses are emerging as important viral pathogens in immunocompromised patients due to immunodeficiency diseases and recently hematopoietic stem cell and solid organ transplant recipients, impacting morbidity and even mortality. Immunocompromised children are prone to respiratory infection, due to alterations in their immune system. When confronted with diseases involving the pleural effusions, such as viral infections, the diagnostic problem becomes more complex and special effort is needed to recognize and characterize them accurately and to differentiate them from other pathologies such as malignancies. However, cytology of adenoviral infection in pleural effusions has not been reported before. We report a case of an adenovirus infection of the pleural effusion which included lymphocytosis associated with background atypical cells showing a cytopathic effect (cytoplasmic viral particles). The differential diagnosis included lymphoma and infections. Immunohistochemical stain for adenovirus was positive and confirmed by molecular studies. Usually in viral infections there are cytopathic changes due to viral particles affecting epithelial cells but this case is unique as the viral particles were identified in macrophages. We discuss the significance of such infection in comparison with other viral changes indigenous to the pleural effusions, which could also occur in such specimens.

[Outbreak of epidemic keratoconjunctivitis caused by human adenovirus serotype 8 in a nursing home.] / Brote de queratoconjuntivitis epidémica por adenovirus humano serotipo 8 en una residencia de mayores.

OBJECTIVE: Ocular infections caused by human adenovirus are highly contagious and can cause outbreaks, especially in nursing homes. In this work, we describe the epidemiological and analytical research as well as the control measures carried out for a conjunctivitis outbreak. METHODS: Descriptive epidemiological study. Cases with a symptom onset date prior to oficial communication were analyzed retrospectively. The rest was analyzed prospectively. Conjunctival smears were collected for microbiological study. Virological analysis was performed by detecting adenovirus by PCR and genotyping. A data questionnaire that collected clinical and epidemiological information was designed. Possible risk factors associated with infection were studied by calculating the Odds Ratio. RESULTS: On June 11, 2019, the Epidemiological Surveillance Section of the Provincial Health Department of Albacete was notified of the existence of a large number of cases of conjunctivitis in a geriatric center. 54 cases were declared: 43 internal residents, 3 day center assistants and 8 workers. Attack rates were 35.8%, 12.5% and 8.4% respectively. Three risk factors were associated with the disease: patient´s lack of autonomy, being a resident at the nursing home and having their room assigned on the first floor. Human adenovirus serotype 8 was detected in the patients' samples. CONCLUSIONS: A high attack rate was observed in internal residents and the disease was associated with patient´s lack of autonomy and having their room assigned on the first floor of the nursing home. The outbreak was caused by human adenovirus serotype 8.

OBJETIVO: Las infecciones oculares causadas por adenovirus humanos son altamente contagiosas y pueden causar brotes, especialmente en residencias de ancianos. El objetivo de este trabajo fue exponer las investigaciones epidemiológicas y analíticas realizadas para el estudio del brote de queratoconjuntivitis epidémica y las medidas establecidas para su control. METODOS: Se realizó un estudio epidemiológico descriptivo. Se analizaron de forma retrospectiva los casos con fecha de inicio de síntomas anterior a la comunicación oficial, y de forma prospectiva el resto. Se recogieron frotis conjuntivales para estudio microbiológico. El análisis virológico fue realizado mediante la detección de adenovirus por PCR y genotipado. Se diseñó un cuestionario de datos que recogía información clínica y epidemiológica. Se estudiaron posibles factores de riesgo asociados a la infección mediante el cálculo de la Odds Ratio. RESULTADOS: El 11 de junio de 2019 se notificó a la Sección de Vigilancia Epidemiológica de la Dirección Provincial de Sanidad de Albacete la existencia de un número elevado de casos de conjuntivitis en un centro geriátrico. Se declararon 54 casos: 43 entre residentes internos, 3 entre asistentes del centro de día y 8 entre personal laboral. Las tasas de ataque fueron del 35,8%, 12,5% y 8,4%, respectivamente. La falta de autonomía, el ser residente interno y estar ubicado en la primera planta fueron factores asociados a la enfermedad. Se detectó adenovirus humano serotipo 8 en las muestras correspondientes a enfermos. CONCLUSIONES: Se observó una elevada tasa de ataque en residentes internos y la enfermedad se asoció con la falta de autonomía y la localización en la primera planta. El brote fue causado por adenovirus humano serotipo 8.

Severe adenovirus pneumonia with hemophagocytic syndrome and respiratory failure.

We report the case of an 18-month-old infant with severe serotype 3 adenovirus pneumonia, exceptionally associated with hemophagocytic syndrome. Treatment included cidofovir and mechanical ventilation for 13 days. The child developed chronic respiratory insufficiency due to bronchiectasis and bronchiolitis obliterans.

Obesity and Diabetes in an Arab population: Role of Adenovirus 36 Infection.

Prior infection with adenovirus 36 (Adv36) has been associated with increased adiposity, improved insulin sensitivity, and a lower prevalence of diabetes. This study investigated the prevalence of Adv36 seropositivity and its association with obesity and diabetes among adults attending a diabetes centre in the UAE.Participants (N = 973) with different weight and glucose tolerance categories were recruited. Adv36 seropositivity (Adv36 + ) was assessed using ELISA. Differences among groups were analyzed using statistical tests as appropriate to the data. Prevalence of Adv36+ in the study population was 47%, with no significant difference in obese and non-obese subgroups (42.5% vs 49.6% respectively; p=non-significant). Females were more likely to be Adv36+ compared to males (odds ratio 1.78; 95% CI 1.36-2.32, p < 0.001). We found no significant association between Adv36 seropositivity and different BMI categories, or glucose tolerance status. In our population, the effect of Adv36 infection on lipid profile varied between healthy individuals and individuals with obesity. Adv36 infection is more prevalent in the UAE than in other countries but has no association with obesity. Our study found that females were more likely to be Adv36 positive regardless of weight or diabetes status.

Epidemiology of Adenovirus Infections and Outcomes of Cidofovir Treatment in Severely Ill Children.

BACKGROUND: An increase in human adenovirus (HAdV) infections among hospitalized children in Singapore was observed since 2013. Young age (<2 years) and significant comorbidities have been associated with severe HAdV infections which can result in significant morbidity and mortality. Cidofovir (CDV) has been used to treat severe HAdV infections despite limited data and efficacy. METHODS: This is a retrospective, observational review of infants and children 1 month to 17 years of age with laboratory-confirmed severe HAdV infection, admitted to a pediatric tertiary care hospital in Singapore between January 2013 and September 2017. Severe infection was defined as requiring intensive care unit or high dependency care at any point during hospital admission. Clinical characteristics, potential risk factors for mortality, as well as the outcome of cases treated with CDV were examined. RESULTS: A total of 1167 children were admitted for HAdV infection, of which 85 (7.3%) were severe. For severe infections, the median age was 1.5 years (interquartile range: 0.72-3.2 years). The majority had comorbidities (69.4%) and presented with pneumonia (32.9%). Genotypes HAdV-7 (29.4%) and HAdV-3 (27.0%) were the most common HAdV genotypes identified. Thirteen (15.3%) patients died. Patients who died had a higher proportion of existing neurologic comorbidity (46.2% vs. 13.9%; P = 0.014) and presentation with pneumonia (69.2% vs. 26.4%; P = 0.008) compared with survivors. Patients who presented with pneumonia had a higher risk of 30-day mortality (odds ratio 4.3, 95% confidence interval: 1.0-28.6; P < 0.05). CDV was administered to 17 (20%) children for mainly viremia (47.1%) and/or pneumonia (41.2%). Mortality rate was 41.2% for severe HAdV cases treated with CDV. A significant proportion of patients who died when compared with recovered patients presented with pneumonia (6 of 7, 85.7% vs 1 of 10, 10%; P = 0.004). All 8 patients who had viremia received CDV and survived. CONCLUSIONS: Mortality can be high in pediatric patients with severe HAdV infections. HAdV-7 and HAdV-3 were the most common genotypes identified in our cohort with severe HAdV infection. Pneumonia is a potential risk factor for mortality in severe HAdV infections in our cohort. Early CDV administration may be considered in patients with severe HAdV infection and existing comorbidities but more studies are required.

MANAGEMENT OF ACUTE RESPIRATORY DISTRESS SYNDROME IN A CHILD WITH ADENOVIRUS PNEUMONIA: CASE REPORT AND LITERATURE REVIEW.

OBJECTIVE: To report the case of a child who developed acute respiratory distress syndrome (ARDS) from a pulmonary infection by adenovirus. CASE DESCRIPTION: A female patient aged 2 years and 6 months, weighting 10,295 grams developed fever, productive cough and vomiting, later on progressing to ARDS despite initial therapy in accordance with the institutional protocol for ARDS treatment. The child evolved to refractory hypoxemia and hypercapnia, requiring high parameters of mechanical pulmonary ventilation and use of vasoactive agents. In the treatment escalation, the patient received steroids, inhaled nitric oxide (iNO), was submitted to the prone position, started oscillatory high-frequency ventilation (HFOV) and extracorporeal membrane oxygenation (ECMO) was indicated due to severe refractory hypoxemia. During this time, the patient's clinical response was favorable to HFOV, improving oxygenation index and hypercapnia, allowing the reduction of vasoactive medications and mechanical ventilation parameters, and then the indication of ECMO was suspended. The patient was discharged after 26 days of hospital stay without respiratory or neurological sequelae. COMMENTS: Adenovirus infections occur mainly in infants and children under 5 years of age and represent 2 to 5% of respiratory diseases among pediatric patients. Although most children with adenovirus develop a mild upper respiratory tract disease, more severe cases can occur. ARDS is a serious pulmonary inflammatory process with alveolar damage and hypoxemic respiratory failure; Adenovirus pneumonia in children may manifest as severe pulmonary morbidity and respiratory failure that may require prolonged mechanical ventilation. Exclusive pulmonary recruitment and HFOV are advantageous therapeutic options.

Transepithelial Surface Ablation With Mitomycin C for the Treatment of Chronic Central Corneal Scars Following Adenoviral Keratoconjunctivitis.

PURPOSE: To assess visual and refractive outcomes and recurrence rates of subepithelial infiltrates after corneal surface ablation with mitomycin C (MMC) 0.02% for the treatment of chronic corneal scars following epidemic keratoconjunctivitis and to compare these results with a control group receiving only medical treatment. METHODS: This was a retrospective case series enrolling patients with central corneal scars following epidemic keratoconjunctivitis. Patients were divided into two groups: (1) control with clinical follow-up and refractive correction with glasses or rigid gas-permeable contact lenses when necessary and (2) transepithelial phototherapeutic keratectomy (PTK) with MMC 0.02%, combined with photorefractive keratectomy (PRK) in selected cases (treatment group). Signs and symptoms, corrected distance visual acuity (CDVA) in logMAR units, manifest and cycloplegic refraction, and depth of the corneal opacities were assessed. RESULTS: Thirty-five eyes of 27 patients (11 men [40.7%] and 16 women [59.3%]) were enrolled, with a mean follow-up of 54.4 ± 19.7 and 27.5 ± 22.8 months in the control and treatment groups, respectively. Mean improvement in CDVA was 0.13 ± 0.17 logMAR (P = .007) in the control group and 0.29 ± 0.24 logMAR (P = .001) in the treatment group. Intergroup comparison showed a greater improvement in the treatment group (P = .041). Mean hyperopic shift induced in the treatment group was +0.46 ± 1.20 diopters. The recurrence rate of subepithelial infiltrates was 77.7% in the control group and 11.7% in the treatment group throughout the follow-up (54.4 ± 19.7 and 27.5 ± 22.8 months, respectively). CONCLUSIONS: Corneal surface ablation with MMC 0.02% was efficient in treating corneal scars following adenoviral epidemic keratoconjunctivitis, with greater visual improvement in comparison to clinical treatment and a decreased rate of infiltrate recurrence. [J Refract Surg. 2020;36(1):55-61.].

Two cases of epidemic keratoconjunctivitis-associated dacryocystitis.

This report presents two cases of epidemic keratoconjunctivitis (EKC)-associated dacryocystitis. Both patients presented with preseptal edema. Orbital computed tomography (CT) scans were performed out of concern for orbital cellulitis and revealed soft tissue edema involving the preseptal aspect of the eyelids and also the lacrimal sac. Both patients were initially diagnosed with bacterial preseptal cellulitis with dacryocystitis and admitted for treatment with intravenous antibiotics. After no improvement on antibiotics, both patients were noted to have exam findings consistent with viral conjunctivitis, and one patient had a positive conjunctival swab for adenovirus. Both patients were subsequently treated with topical steroids, and symptoms improved. EKC has previously been identified as a cause of acquired nasolacrimal duct obstruction and canalicular stenosis, and acute inflammation of the lacrimal apparatus may explain this link. Dacryocystitis may also be contributory to the copious tearing seen in patients with epidemic keratoconjunctivitis.

Correlation between corneal involvement and anterior chamber flare in epidemic keratoconjunctivitis.

PURPOSE: To investigate the correlation between corneal involvement and anterior chamber flare using a laser flare meter in eyes with epidemic keratoconjunctivitis. METHODS: A total of 82 eyes of 50 (32 female and 18 male) consecutive patients with epidemic keratoconjuctivitis were evaluated. Besides complete opthalmic examination, anterior chamber flare measurements with laser flare meter (FM 600, Kowa, Kowa Company Ltd., Nagoya, Japan) were performed. The relationship between corneal involvement, subepithelial deposits, and anterior chamber flare was assessed. RESULTS: The mean age of the patients was 36.32 ± 18.77 (range 4-75) years and the mean duration of complaints was 5.28 ± 2.65 (range 1-12) days. The biomicroscopic findings were conjunctival hyperemia in 82 (100%), follicular reaction in 66 (80.5%), eyelid edema in 56 (68.3%), punctate epitheliopathy in 38 (46.3%), and subepithelial deposits in 36 (43.9%) eyes. The mean flare value was 17.35 ± 12.62 (range 2.0-45.0) photons/ms. Flare measurements were significantly higher in eyes with subepithelial deposits (p < 0.001). CONCLUSIONS: Subepithelial deposits seem to occur in eyes with higher anterior chamber inflammation in epidemic keratoconjunctivitis. The laser flare meter might be a useful tool to predict subepithelial deposit development in these patients.