Pharyngoconjunctival fever


Pharyngoconjunctival fever

Description, Causes and Risk Factors:

A highly infectious illness characterized by red eyes and a severe sore throat, and sometimes accompanied by fever, rhinitis, and swollen lymph nodes. Fever is sudden or gradual, ranging from 100 to 104 degrees and lasting up to 10 days. Initial symptoms of the eyes are itching, burning and tearing, and possibly swelling of the eyelids. Mild discharge and crusting of the eyelids may also occur in severe cases.

Pharyngoconjunctival fever is often seen in small outbreaks among school-age children. It occurs when a virus known as adenovirus affects the lining of the eye as well as the respiratory tract. Pharyngoconjunctival fever usually affects both eyes, with one eye generally affected more severely. This condition is extremely contagious.

Pharyngoconjunctival fever caused by type 3 virus is thought to occur most often in older children and to be associated with contaminated swimming pools. The disease has been reported, however, in infants and toddlers, and respiratory shedding can be important to its spread. Conjunctivitis has been observed in 30 to 70% of patients with the disease making the incidence of 88% reported here unusually high. There was evidence of respiratory infection in 69% of patients, with wheezing and coarse rales frequently present, contrary to the general belief that bronchitis is rare.

Transmission occurs through contact with infected upper respiratory droplets or fomites, or through swimming pools, in which fecal excretion of the virus is believed to be responsible. Communicability ranges from 100% during the first few days to 0% by 10-15 days after the onset of symptoms. The incubation period after exposure is 5-12 days.

Edema of the eyelids has been described in pharyngoconjunctival fever but migratory erythema, which was seen in 50% of patients, has not. In some instances the entire upper lid was red and swollen, in others the erythema was noticed first at the medial half of the lid, extending towards the bridge of the nose and mimicking the findings in ethmoiditis. In a few patients the erythema migrated to the inner part of the lower lid, as in dacryocystitis, or to the outer portion of the upper lid, as in dacryoadenitis.

Symptoms:

Pharyngoconjunctival fever can be observed in schools and can cause mild outbreaks among students. The symptoms include red eyes along with a very sore throat. Other symptoms can include a fever, runny nose, and swollen lymph nodes. The respiratory tract is also affected with this infection and so multiple symptoms can be observed.

Signs of disease include epiphora, conjunctival hyperemia and chemosis, subconjunctival hemorrhage, follicular or mild papillary conjunctival reaction, and eyelid edema.

Diagnosis:

Diagnosis of pharyngoconjunctival fevergenerally is made based on clinical presentation alone. Virus may be cultured during the acute epithelial stage only, because the stromal infiltrates that occur later in the disease are thought to be immune complexes against residual viral antigen.

Without positive viral cultures taken during the first 8-10 days, proof of diagnosis beyond clinical impression may be obtained from paired blood specimens; one specimen drawn 1 week after the onset of symptoms and the second specimen drawn 2-3 weeks later. A 4-fold or greater increase in humoral antibody to adenovirus, measured by complement fixation, indicates recent adenoviral infection.

Other diagnostic tests include electron microscopy, immunofluorescence, immunoperoxidase, polymerase chain reaction (PCR), and enzyme-linked immunosorbent assay (ELISA) testing. Several commercially available tests may provide a diagnosis, although laboratory processing time may be several days to over a week.

Treatment:

Because pharyngoconjunctival fever is contagious and self-limiting, the primary treatment once again is patient education. Instruct patients to stay home from work or school until there is absolutely no discharge. Also instruct them not to share utensils, glasses, linens or wash cloths with others. Apart from this:

    Cold compresses several times per day for 1-2 weeks.

  • Artificial tears 4-8 times per day for 1-3 weeks.

Medical management can range from cold compresses and artificial tears to topical vasoconstrictors (e.g., naphazoline) and steroids (Vexol, Flarex, Pred Forte) two to four times daily. If a membrane is present, peel it off with a wet, cotton-tipped applicator or forceps. After removal, prescribe a topical antibiotic-steroid combination such as TobraDex or Maxitrol q.i.d. (four times a day).

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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