Epidemic hemorrhagic conjunctivitis

Introduction to epidemic hemorrhagic conjunctivitis Epidemic hemorrhagic conjunctivitis, also known as acute hemorrhagic conjunctivitis (commonly known as pink eye disease), is a new type of acute viral eye disease that has been prevalent in the world for nearly 30 years. It is an acute infectious disease caused by enterovirus type 70. It has many subconjunctival hemorrhages, often complicated by keratitis, and may have neurological complications. The main reason is a highly contagious and rapidly occurring viral conjunctivitis caused by adenovirus type 8, 19, 29, 37 adenovirus (human adenovirus D subtype). basic knowledge The proportion of the disease: the probability of the population is 2.1% Susceptible people: no special people Mode of transmission: contact and iatrogenic transmission Complications: medullary paralysis respiratory failure

Cause of epidemic hemorrhagic conjunctivitis

Virus infection (90%):

In 1971, the disease was discovered in China, and enterovirus type 70 has been isolated. The prototype of type 70 was isolated from the combination membrane swab of acute conjunctivitis, which is related to the pathogenesis of this disease.

Pathogenesis

The virus is present in the eye secretions of the patient. The virus passes through the eye-hand-eye, the handkerchief, the towel, the basin, the bath, the swimming pool, the beauty equipment, which directly and indirectly invade from the eye or the oropharynx, the conjunctiva, and the mucous membrane. Propagation in local or pharyngeal epithelial lymph nodes quickly causes a series of clinical symptoms of the conjunctiva.

Epidemic hemorrhagic conjunctivitis prevention

1. Isolation and treatment of all patients. All patients are required to be treated at home or at a fixed point, and all isolation should be resolved after all symptoms have disappeared (usually 7-10 days).

2. The outbreak unit will do a morning check, find suspected cases in time, and isolate the treatment in time.

3. Carry out disinfection work. Patients should wash their faces with separate towels and washbasins, and regularly disinfect the towels and washbasins. Use 75% alcohol or chlorine disinfectant to wipe or boil the items that have been touched by the patient. For collective units that have an outbreak, disinfection should be carried out on daily necessities, production utensils, toys, utensils or public places that may be contaminated.

4, the patient should be isolated until the symptoms disappear, the patient used towels, handkerchiefs to be boiled and disinfected, contact with the patient's hands should be washed with soap and running water, strengthen ophthalmic device disinfection, prevent iatrogenic transmission, should be avoided during the epidemic Go to the public bath and swimming pool.

Complications of epidemic hemorrhagic conjunctivitis Complications, medullary paralysis, respiratory failure

Eye complications are mainly bacterial infections, mainly in the nervous system similar to polio, mostly occurring 2 to 4 weeks after onset (5 days to 6 weeks), in India, Thailand, Taiwan and Senegal There are 200 cases reported, but compared with millions of cases, it is very rare. The clinical manifestations are fever and systemic symptoms of 1 to 3 days, followed by radiculopathy and acute soft palate, showing asymmetry. One to more limb paralysis, muscle atrophy in the second to third weeks, can cause sequelae, half of the cases may have medullary paralysis, and occasionally respiratory failure.

Epidemic hemorrhagic conjunctivitis symptoms Common symptoms Keratitis Conjunctival hyperemia Corneal erosion Conjunctiva appears grayish white membrane Ear lymph nodes enlargement Tears periorbital edema

The incubation period is generally 24h, the longest can reach 6 days, the onset is rapid, rapid eyelid edema, conjunctival congestion, tearing and eyeball pain usually occur in one eye first, and then spread to another eye in a few hours, about 20% of cases appear Symptoms such as fever, headache, general malaise, etc., about 70% to 90% of cases after the onset of 2 to 3 days after the onset of characteristic performance - subconjunctival hemorrhage, ranging from small bleeding points to the entire subconjunctival hemorrhage, Visible epithelial keratitis with short and no sequelae, corneal epithelial flaking in the early stage, healed after about 1 week, lymph node enlargement in the ear is common, children can recover in 2 to 3 days, and adults recover completely within a week or two. Occasionally, corneal epithelial exfoliation occurs repeatedly for several years. Conjunctival edema is common in elderly cases, while in young cases, the amount of bleeding is large. About 30% of cases after 3 to 5 days after onset, small follicles appear on the sacral conjunctiva. Spleen staining with fluorescein in most cases can be seen in corneal erosion or punctate epithelial keratitis, the first 24h eye secretion is serous or serous mucus, and contains a large number of polymorphonuclear leukocytes.

In the event of an outbreak, a diagnosis can be made based on epidemiological and clinical manifestations, and the diagnosis depends on the isolation of the virus.

Examination of epidemic hemorrhagic conjunctivitis

In the 3 days after the onset of the disease, enterovirus type 70 can be detected from the patient's conjunctival swab or scraping, and the increase in antibody titer can be detected from the patient's double serum, and the virus can be detected by polymerase chain reaction. RNA is a fast and sensitive method.

In the majority of cases with fluorescein staining under slit lamp, corneal erosion or punctate epithelial keratitis can be seen. The secretion of the eye in the first 24 hours is serous or serous mucus and contains a large number of polymorphonuclear leukocytes.

Diagnosis and differentiation of epidemic hemorrhagic conjunctivitis

Differential diagnosis

1. Epidemic keratoconjunctivitis (EKC): Small-scale epidemic or sporadic cases of acute epidemic hemorrhagic conjunctivitis (AHC) should be differentiated from adenovirus-induced epidemic keratoconjunctivitis (EKC), and the latency of 1EKC is higher. Long, usually 5 to 7 days, and AHC is 1 day. After 2AHC onset, conjunctivitis reaches a peak for several hours, and the course of disease does not exceed 1 week. The condition of EKC reaches a peak several days after onset, and maintains 2~ 3 weeks, 3 in the early AHC sub-conjunctival hemorrhage is a characteristic manifestation, but rare in EKC, 4 follicular-like deposition on the conjunctiva is common in EKC, after the conjunctivitis subsides often left behind the corneal epithelial ecchymosis, can appear in AHC Sexual keratitis, no sequelae.

2. Acute catarrhal conjunctivitis: acute catarrhal conjunctivitis is characterized by obvious conjunctival hyperemia, with the iliac crest and sacral conjunctiva as the weight, conjunctival secretions, early serous, and then become mucopurulent, often The upper and lower eyelids are affixed to the bundle, and the smear or culture can detect bacteria, and the antibacterial treatment is effective.

3. Swimming pool conjunctivitis (including body conjunctivitis): caused by a strain of Chlamydia trachomatis, the patient has a history of swimming in the public swimming pool, the conjunctiva is highly congested, there is significant nipple hypertrophy and follicular hyperplasia, especially in the follicular area below the follicle Significantly, there were more secretions in the early stage, which may have systemic symptoms, fever, fatigue and upper respiratory tract inflammation. Inclusions were found in the conjunctival scraping.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.