Description of adenovirus , structure, survival abd spread

1. Epidemic keratoconjunctivitis
(red eyes)
Department of Ophthalmology
Muhimbili University of Health and Allied Sciences

2. Epidemic keratoconjunctivitis (red eyes)

3. Outline:
• Introduction
• Etiology
• Pathogenesis
• Clinical presentation
• Investigations
• Treatment, Prevention and Control
• Take home message
April 18, 2024 7:37:49 AM 3

4. Introduction:
•

5. Introduction ctn…
• Conjunctivitis is
characterized by:
– Dilation of the
conjunctival vessels
– Hyperemia/eye redness
– Edema of the
conjunctiva
– Eye discharge.
• It is commonly known as a
“red” or “pink eye”

6. Who is at risk?

7. What is the situation like in Dar
es Salaam?
• Around 800-900 attended cases in 1 week
in Dar-es-salaam (MOH)

8. What causes conjunctivitis?
Acute Conjunctivitis
VIRUSES
Adenoviruses >75%
Others:
Rubella, measles, .
Herpesviruses,
Picornaviruses
(coxsackievirus and
enterovirus)
BACTERIA
C.trachomatis
Staphylococcus
spp
S. pneumoniae
ALLERGIC
pollen, grass
and other
airborne
80%
13.6%
6.4%

9. What is the etiology of EKC?

10. Cont…
About 19 serotypes known to cause epidemic
keratoconjunctivitis (EKC).
The most commonly associated serotypes
include adenovirus 8, 19, 37 and 54.
Less frequently, serotypes 2-5, 7, 9, 10, 11, 14,
16, 21, and 29.

11. Cont.
• Adenoviruses are able to survive outside of
the body for a prolonged period of time (up to
30 days).

12. PATHOGENESIS
The incubation period is 2-14 days.
Most people will have symptoms in 5-6 days
after infection.
Viral shedding may occur among asymptomatic
individual.
 Infected person may remain infectious for 10-14
days after symptoms develop

13. PATHOGENESIS
4/18/2024 13

14. Disease
transmission
INDIRECT CONTACT
Contaminated surfaces
such as:
• Door handles
• Medical instruments
• Towels etc.
DIRECT CONTACT:
• Ocular secretions
• Respiratory
secretions

15. How is red eye transmitted?

16. Clinical Presentation:
• The diagnosis of Keratoconjunctivitis is
basically clinical.
History
Ocular Examination

17. Symptoms
May range from non specific to specific
Non specific are flu-like symptoms
Fever
General body malaise

18. Symptoms ctn…
• Specific symptoms includes:
 Eye redness
 Foreign body sensation
 Excessive tearing
 Photophobia
 Eyelid swelling

19. Symptoms

20. Symptoms ctn...
The symptoms usually starts in one eye
and the fellow eye will involve after a few
days.

21. General examination:
• Lymphadenopathy is common: tender
preauricular and submandibular Lymph
nodes

22. Ocular Examination:
• Visual Acuity is usually normal
– It may be slightly reduced incase of corneal
involvement
• Eyelid oedema ranges from mild to severe.
• Conjunctival hyperaemia
• Conjunctival follicles

23. Ocular Examination ctn…
• Eyelid edema
• Matted eyelashes
With whitish discharge
• Diffuse conjunctival
Hyperemia
• Subconjunctival
hemorrhage

24. Signs ctn…
A: conjunctival
Follicles
B: Conjunctival
Pseudomembrane
C: Conjunctical
scarring
D:Subepithelial
corneal infiltrates

25. Slit lamp exam
Subepithelial infiltrates (SEI)
with superficial punctate
keratitis (SPK) caused by
adenovirus.

26. LABORATORY DIAGNOSIS
 Diagnosis relays on clinical presentation, in case of
failure to treatment lab investigation may be necessary.
METHODS SENSITIVITY SPECIFICITY
Viral Culture 92% - 95% 95% -97%
NAAT 94%-97% 95%-98%
ELISA 94%- 96% 94%- 97%
Adenoplus (RPS) 91%-95% 85%-88%

27. Adenovirus Swab Test

28. Treatment:
• Treatment is Non-specific
• It mainly is supportive

29. Supportive treatment
• Aim: to relieve
symptoms
1. Spontaneous
resolution: 2-3 weeks
2. Artificial tears
(preferably
preservative free) QID
2-4 weeks
3. Topical antihistamine
and vasoconstrictors
4. Discontinuation of
contact lens wear

30. 6. Removal of membranes
or pseudomembranes
7. Cold compresses
8. Topical steroids: in
specific cases by
ophthalmologist only
9. Topical antibiotics-in
presence of bacterial
superinfection.

31. Prevention:
• Aim: reduction of transmission risk
• Meticulous hand hygiene.
• Avoid eye rubbing and towel sharing.
• Disinfection of instruments and clinical
surfaces after examining a patient.

34. Complications:

35. Don’ts:
• Avoid:

36. Don’ts ctn…

37. Don’ts ctn…

38. THANK YOU
Karibu kliniki ya macho!!