Adenoviral conjunctivitis – the sharp infectious damage of a mucous membrane of eyes caused by adenoviruses. Adenoviral conjunctivitis proceeds with temperature increase, the phenomena of a nazofaringit, local symptoms (puffiness a century, hyperaemia mucous, dacryagogue, burning, pain, the itch separated from eyes). Diagnosis of adenoviral conjunctivitis is carried out by the ophthalmologist taking into account data of a bacteriological research of dab from a conjunctiva and PTsR-scrape. Treatment of adenoviral conjunctivitis includes instillations of medicines of anti-virus and antibacterial action, a mortgaging of eye ointments.
Adenoviral conjunctivitis (faringo-conjunctival fever) is the high-contagious infection caused by adenoviruses and proceeding with inflammatory defeat of a conjunctiva mucous the top airways (pharyngitis), temperature increase of a body. In ophthalmology the epidemic outbreaks of adenoviral conjunctivitis usually are registered during the autumn and spring period, mainly in organized children's collectives.
Reasons of adenoviral conjunctivitis
As causative agents of adenoviral conjunctivitis during epidemic flashes adenoviruses of serotypes 3, 7a, 11 act; at sporadic cases – adenoviruses 4, 6, 7, 10 types. Ways of transfer of adenoviral conjunctivitis - airborne or contact. Hit of adenovirus on a mucous membrane of eyes happens during the sneezing, cough or direct entering of an infection from the polluted hands. From the infection moment before emergence of clinical symptoms there pass from 3 to 10 days (on average 5-7 days).
Factors of the increased risk are: contact with sick adenoviral conjunctivitis, overcooling, eye injuries, hygiene violation, bathing in the polluted reservoirs and pools, non-compliance with rules of carrying and care of contact lenses, a SARS, surgical treatment of pathology of a cornea, stresses.
At a cytologic research of dab at patients with adenoviral conjunctivitis the destruction of epitelialny cages which is characterized by a vakuolization, chromatin disintegration, a hypertrophy of kernels, formation of a nuclear cover comes to light. In a tsitogramma cages of mononuclear type prevail.
On features of a clinical current allocate a catarrhal, follicular and filmy form of adenoviral conjunctivitis. Catarrhal and follicular adenoviral conjunctivitis can arise at different age, filmy develops mainly at children.
Symptoms of adenoviral conjunctivitis
The clinic of adenoviral conjunctivitis demonstrates in 5-8 days from the moment of infection. In the beginning diseases temperature increase of a body with the expressed phenomena of pharyngitis and rhinitis, a headache, dispepsichesky frustration is noted; submaxillary lymphadenitis develops.
On the second wave of fever there are symptoms of conjunctivitis at first in one eye, and in 2-3 days – on other eye. Local symptoms at adenoviral conjunctivitis are characterized by puffiness and reddening a century, not plentiful mucous or mucopurulent separated, the feeling of a foreign matter, an itch and burning, dacryagogue, a photophobia moderate blefarospazmy. Hyperaemia is expressed in all departments of a conjunctiva, extends to plaintive meat, a semi-lunar and lower transitional fold.
The catarrhal form of adenoviral conjunctivitis proceeds with the insignificant phenomena of a local inflammation: small reddening mucous eyes, moderate quantity of separated. The course of catarrhal adenoviral conjunctivitis a lung, disease duration – about one week. Usually complications from a cornea are not observed.
The follicular form of adenoviral conjunctivitis is characterized by existence of vesiculate rashes (follicles) on a mucous membrane of an eye. Follicles can be small, dot or large, translucent and jellylike; to settle down in corners a century or to cover all infiltrirovanny and loosened mucous, especially in the field of a transitional fold. Follicular reaction resembles an initial stage of trachoma superficially, however diagnostic mistakes usually do not happen as at trachoma there are no phenomena of a nazofaringit, fever, and rashes are localized in the field of a conjunctiva of an upper eyelid.
The filmy form of adenoviral conjunctivitis meets in a quarter of cases. Proceeds with formation of the thin films of grayish-white color covering a mucous membrane of an eye. Usually films gentle, easily are removed a wadded tampon; but the dense fibrinozny imposings soldered to a conjunctiva which hardly are removed from the inflamed mucous can sometimes be formed. After removal of films naked mucous can bleed. Sometimes dot subconjunctival hemorrhages and infiltrates which completely resolve after recovery come to light. An outcome of filmy adenoviral conjunctivitis quite often is scarring mucous. At filmy adenoviral conjunctivitis the general state suffers: high fever (to 38 °C-39 of °C) which can keep from 3rd to 10 days develops. The filmy form of adenoviral conjunctivitis can be mistakenly taken for diphtheria.
Diagnosis of adenoviral conjunctivitis
At suspicion of adenoviral conjunctivitis the ophthalmologist finds out existence in the anamnesis of contact with the patient with faringo-conjunctival fever. At survey conjunctivitis symptoms in combination with catarrhal changes of the top airways and a regionarny limfadenopatiya come to light.
For allocation of adenovirus use laboratory serological, cytologic, virologic methods. Early diagnosis of adenoviral conjunctivitis is carried out by the immunofluorescent method allowing to reveal specific virus anti-genes in dab from a mucous membrane of an eye.
The polymerase chain reaction (PCR) finding adenovirus DNA in conjunctival scrape is informative. Antibodies to adenoviruses in serum of blood reveal by means of the reaction of binding of a complement (RBC), the imuunofermentny analysis (IFA). As diagnostic criterion of adenoviral conjunctivitis serves increase of a caption of antibodies in 4 and more times. For the purpose of allocation and identification of adenovirus on culture of cages the bacteriological research of dab from a conjunctiva is conducted.
Treatment of adenoviral conjunctivitis
Treatment of adenoviral conjunctivitis is carried out on an outpatient basis, using antiviral means. Locally appoint instillations of interferon and a deoxyribonuclease in drops of 6-8 times a day on the first week of a disease and 2-3 times a day – within the second week. As antiviral therapy also use a mortgaging of ointments for eyelids (tebrofenovy, florenalovy, bonaftonovy, riodoksolovy, adimalevy).
For prevention of accession of a secondary infection application of antibacterial eye drops and ointments is expedient. Before absolute clinical recovery at adenoviral conjunctivitis reception of antihistaminic medicines is shown. For the purpose of the prevention of development of a kseroftalmiya apply artificial substitutes of a tear (for example, a karbomer).
Forecast and prevention of adenoviral conjunctivitis
Forecast of adenoviral conjunctivitis favorable: usually the disease comes to an end with absolute clinical recovery in 2-4 weeks. At development of a syndrome of a dry eye prolonged use of slezozamestitel is required.
Prevention of outbreaks of adenoviral conjunctivitis in collectives consists in timely isolation of the diseased, airing and damp cleaning of rooms, respect for personal hygiene. In an office of the ophthalmologist it is necessary to carry out careful disinfection and sterilization of tools (pipettes, eye sticks), cleaning with use of dezsredstvo, quartz treatment. In pools control of the mode of chlorination of water according to existing rules is necessary.