Epidemiological Investigation and Risk Factor Analysis of Acute Hemorrhagic Conjunctivitis in Huangshi Port District, Huangshi City.

Objective: This study is aimed at investigating the epidemiology and risk factors of acute hemorrhagic conjunctivitis (pinkeye) in Huangshi Port District of Huangshi City. Methods: A total of 593 cases of acute hemorrhagic conjunctivitis from January 2019 to December 2021 were selected as the observation group. The epidemiological characteristics (age of onset, season, occupation, clinical manifestations, and etiological characteristics) were analyzed. A total of 425 healthy subjects (nonacute hemorrhagic conjunctivitis) were selected as the control group. The general data of the two groups were compared, and the risk factors affecting the occurrence of acute hemorrhagic conjunctivitis were analyzed by logistic regression. Results: The onset age of acute hemorrhagic conjunctivitis was mainly concentrated in 0-20-year-old and 60-year-old age groups, and the onset season was mainly concentrated in April to August, with the highest incidence in May. The proportions of middle school students and workers in patients with acute hemorrhagic conjunctivitis were higher than those of other occupations (both P < 0.05). Ocular conjunctival congestion, tingling, and foreign body sensation were the main clinical manifestations of patients with acute hemorrhagic conjunctivitis. Among the 593 conjunctival swab samples collected in this study, the positive rates of HEV70 and CVA24v were higher than those of adenovirus nucleic acid (both P < 0.05). The proportion of people aged ≤40 years old, male, working outdoors, using potable water equipment, contact history of patients with acute conjunctivitis, history of chemical substances entering eyes, combined with immune system diseases, and public toilet utilization rate ≥ 1 times/d in the observation group was higher than that in the control group (all P < 0.05), and the proportion of people washing hands before eating and after toilet was lower than that in the control group (P < 0.05). Multiple logistic regression analysis showed that working place outdoors, use of potable water equipment, contact history of patients with acute conjunctivitis (all P < 0.05), and use of public toilets ≥ once a day were risk factors for the occurrence of acute hemorrhagic conjunctivitis, and washing hands before eating and after toilet was a protective factor (P < 0.05). Conclusion: The onset age of acute hemorrhagic conjunctivitis was mainly concentrated in 0-20-year-old and 60-year-old age; the onset season was mainly concentrated in summer and autumn; adenovirus is the main pathogenic bacteria; ocular conjunctivitis congestion, tingling, and foreign body sensation were the main clinical manifestations; working place outdoors, use of potable water equipment, contact history of patients with acute conjunctivitis (all P < 0.05), and use of public toilets ≥ once a day were risk factors for the occurrence of acute hemorrhagic conjunctivitis, while washing hands before eating and after toilet was a protective factor.

A recent epidemic of acute hemorrhagic conjunctivitis.

The coxsackievirus A24 variant was implicated in four of six major acute hemorrhagic conjunctivitis outbreaks in Singapore since its discovery in 1970. Hela cell suspension in 24-well flat-bottom tissue culture plates was a satisfactory alternative to monolayer cells grown in test tubes for virus isolation. Respiratory illness occurred in 20 of 98 patients with acute hemorrhagic conjunctivitis. Apart from conjunctival secretions, respiratory and oral transmission of coxsackievirus A24 variant would explain the rapid and extensive spread of acute hemorrhagic conjunctivitis during an outbreak.

Isolation of enterovirus 70 (EV70) from patients with acute haemorrhagic conjunctivitis in two areas of Saudi Arabia.

This is the first epidemic of acute haemorrhagic conjunctivitis (AHC) reported from Saudi Arabia in which enterovirus 70 (EV70) was implicated as aetiological agent. EV70 was isolated from 5 of 29 conjunctival scrapings from patients with AHC. Two human diploid cell lines, human skin fibroblast (HSF) and human embryonic lung fibroblast (MRC-5), were quite sensitive for the isolation of this virus. The relatively high isolation rate could also be attributed to the timing of collection of specimens and perhaps to the fact that conjunctival scrapings contained more virus particles than did eye swabs.

A recent epidemic of Coxsackie virus type A24 acute haemorrhagic conjunctivitis in Singapore.

A recent epidemic of acute conjunctivitis in Singapore showed again the importance of Coxsackie virus type A24 variant as a causative agent of acute haemorrhagic conjunctivitis (AHC). Although the ocular manifestations appeared similar to those described for the 1970 and 1975 outbreaks, a markedly higher rate of respiratory involvements was noted. Not observed in previous epidemics were herpes-like vesicles in the conjunctiva and eyelids of one patient and vesicles in the buccal mucosa and lips of another from whom Coxsackie virus A24 was isolated. The most interesting finding in this study was the isolation of five wild (non-Sabin) poliovirus type 1 strains. Three strains were obtained from conjunctival and two from throat swabs of patients with mild to severe conjunctivitis. It is conceivable that the rare reports of polio-like paralysis or radiculomyelitis accompanying or following AHC in a few Asian countries could be attributed to concurrent infections with a poliovirus and either enterovirus type 70 or Coxsackie virus type A24.

Coxsackie virus A 24 variant as the etiological agent of the acute haemorrhagic conjunctivitis epidemic at Vellore, in 1986.

Coxsackie virus A 24 variant (CA24v) was found to be the etiological agent of an epidemic of acute haemorrhagic conjunctivitis (AHC) in Vellore during the months of October and November in 1986. CA24v was isolated in 21 of 25 acutely ill patients. In addition, seroconversion was seen in 11 of the 16 patients from whom paired sera were collected.

An epidemic of acute hemorrhagic conjunctivitis in the city of Sao Paulo.

This is a clinical and laboratory report on 98 patients with acute viral conjunctivitis who were referred to the Eye Clinic of the Escola Paulista de Medicina of Sao Paulo, Brazil, from February 1983 to February 1984. It was planned with the objective of confirming the importance of adenovirus and enterovirus 70 as etiological agents of viral conjunctivitis. The occurrence of an outbreak of acute hemorrhagic conjunctivitis during the summer of 1984 permitted a better study of enterovirus 70. In addition, we could demonstrate that sporadic cases, from March to July 1983, were caused by the same virus. This fact confirmed the idea that the spread of the disease was not related to the recent arrival of the virus in the community, but to weather conditions of heat and high humidity.

Epidemic acute haemorrhagic conjunctivitis due to Coxsackie virus A24 variant in Ghana.

An outbreak of acute haemorrhagic conjunctivitis (AHC) occurred in Accra, Ghana, reaching a peak in July 1987. Individuals ranging from infants to adults over 50 years were infected, with those between 20 and 30 years being the most affected group. There was a female preponderance. Clinical features included conjunctivitis, subconjunctival haemorrhage and ocular pain. Some patients reported of blurred vision due to mild keratitis. Isolation of virus from clinical specimens of AHC patients was successful only in cells of human origin such as HeLa and FL. Coxsackie virus A24 variant (CA 24v) was identified as the aetiologic agent. This is the first report to associate CA 24v with an epidemic of AHC in Africa, south of the Sahara, which is outside the endemic area of Southeast Asia and the Caribbeans. This finding suggests that earlier outbreaks of AHC in Ghana and Africa may have been due to CA 24v but went undetected. The results of various tests performed during this study suggest that, at least, two antigenically different viruses of CA 24v circulated during the course of this epidemic.

Platelet functions in patients with meningococcal meningitis at the Kenyatta National Hospital, Nairobi.

OBJECTIVE: To determine platelet abnormalities in patients with menigococcal meningitis. DESIGN: Case control study. SUBJECTS: Fifty seven cases of mennigococcal meningitis based on a cerebrospinal fluid gram stain for gram negative diplococcus or positive culture were recruited. Fifty-seven controls matched for age and sex were also recruited. The following platelet functions tests were performed; platelet counts, platelet adhesiveness, platelet aggregation and clot retraction. RESULTS: Fifty seven patients (41 males and 16 females) with meningococcal meningitis were studied. Their mean age was 25.5 +/- 8.32 years with a range of 15 to 45 years. Five patients had purpura, four peripheral gangrene, eight conjunctival haemorrhages and one was in shock. There was a statistical significant difference in the platelet aggregation and clot retraction between the patients and controls at p-values of 0.0001 and 0.0002 respectively. There was no significant difference in the platelet count and adhesiveness between the patients and the controls at a p-value of 0.203 and 0.22 respectively. No association was found between the platelet functions and the clinical presentations. CONCLUSION: Patients with meningococcal meningitis have abnormalities in the platelet functions mainly in aggregation and adhesiveness.

[Rapid diagnosis of enterovirus 70 infection by detection of IgM antibodies with a biotin-avidin ELISA].

A biotin-avidin immunoassay was developed to detect IgM antibodies to enterovirus 70 (EV70) in sera from patients with acute hemorrhagic conjunctivitis. Biotinylated monoclonal antibody to EV70 and horseradish peroxidase-streptavidin were used in an indirect IgM capture ELISA. 40 acute- and convalescent-phase serum pairs were tested and 34 sera (85.0%) in the convalescent phase were positive for IgM antibodies. The positive rate of the method was much higher than that of the non-biotin-avidin system for EV70 (55%). Two sera in the acute phase, which were negative for neutralizing antibodies, had IgM antibodies. Two serum specimens which had been collected a third time from 2 patients during the seventh week after onset were positive for IgM, showing that EV70 IgM lasts at least for one month and a half. The biotin-avidin ELISA is sensitive and can be performed in 2 days instead of 3 days for the non-biotin-avidin method, and is useful for rapid diagnosis of EV70 infection.

[Etiology of 1988 epidemic of acute hemorrhagic conjunctivitis in Beijing].

An epidemic of acute hemorrhagic conjunctivitis (AHC) occurred in Beijing during August-September in 1988. Conjunctival swabs were collected from 50 AHC patients at the Eye Clinic of the Peking Union Medical College Hospital. 25 strains of viruses were isolated with Hela cell cultures. All the viral isolates were identified as Coxsackievirus A 24 variant (CA 24 v) with antiserum from the Center for Disease Control, U. S. A. Paired serum samples from 30 AHC patients were examined for neutralizing against a representative strain of the viral isolates. 24 of them (80%) showed a fourfold or greater rise in neutralizing antibody titers. The results indicate that CA 24 v was the etiologic agent responsible for the 1988 epidemic of AHC. This is the first time an epidemic of AHC caused by CA 24 v is reported in the mainland of China.

[An etiology study on the 1986 epidemic of acute hemorrhagic conjunctivitis in China].

An epidemic of Acute Hemorrhagic Conjunctivitis (AHC) broke out in Shanghai, Henan and Fujian provinces of China in 1986. Twenty four strains of etiologically suspected virus were then isolated but not correctly identified. In 1990 9 out of 24 strains from these three places were re-examined by us in our laboratory, and found feasible to be neutralized by CA 24V antiserum, but not by antiserum to EV 70 as once reported by Henan. It was also found that these viruses (one strain from each of these three places) produced pathogenic changes in suckling mice, showed definite immuno-fluorescence with Mcabs, and were neutralized by McAbs against CA 24V which was isolated from Beijing by our laboratory in 1988. It is evident that all the isolates isolated from Shanghai, Henan and Fujian provinces in 1986 were Coxsackie-virus A 24 variant (CA 24V).

[An etiological study of acute hemorrhagic conjunctivitis in Beijing area in 1984].

Acute hemorrhagic conjunctivitis (AHC) has been widespread in China since 1971. An etiological survey of the sporadic outbreak in Beijing was done in 1984. Conjunctival swabs and sera were collected at the Eye Clinic of Peking Union Medical College Hospital and 10 strains of virus were isolated from 46 cases by culture on the HeLa cell line. 8 strains were identified as Enterovirus 70 by homologous antiserum J 670/71 obtained from the California State Laboratory of Viral and Rickettsial Diseases. 2 other strains defied neutralization by this antiserum and were eventually identified as Adenovirus type 3 and type 7. 30 paired sera were examined for neutralization antibodies to EV 70 (J 670/71). Among these, 23 (77%) showed fourfold or higher rise in titer. Furthermore, neutralization antibodies to EV70 (J 670/71) and the EV70 isolated from 7 patients with AHC by paired sera also showed a fourfold or higher rise in antibody titer, indicating that EV70 was the etiologic agent responsible for the 1984 outbreak in Beijing.

An outbreak of acute haemorrhagic conjunctivitis caused by enterovirus 70 in Jeddah during 1985.

Seventy-five cases of acute haemorrhagic conjunctivitis (A.H.C.) were subjected to full ophthalmic, bacteriological, virological, serological as well as cytological examinations. The majority of cases presented with bilateral conjunctivitis (70 out of 75). Although follicular reaction was the earliest sign, yet subconjunctival haemorrhages were the most constant findings in all the cases. Enterovirus 70 was isolated in 57 cases from conjunctival swabs and in 43 cases from serum samples. Complement flaxation test was positive for enterovirus 70 in 42 cases but negative for coxsackie and adenoviruses. No primary role has been found for bacteria in the pathogenesis of A.H.C. in this outbreak. Cytological examination of conjunctival scrappings showed the characteristics cytopathic effect (CPE) of enteroviruses.

Early and rapid diagnosis of acute haemorrhagic conjunctivitis with tear specimens.

Picornavirus particles and serotype-specific neutralizing antibody were demonstrated in tears collected during early onset of acute haemorrhagic conjunctivitis. Virus particles deposited from tears by airfuge ultracentrifugation and stained with potassium phosphotungstate were easily recognized by electron microscopy. Tear neutralizing antibody in the ultracentrifuged supernatant was detected by the neutralization test in monolayer HeLa cells grown in microtitration plates. The presence of virus particles and specific neutralizing antibody in tear specimens correlated with the serological findings.