Epidemic keratoconjunctivitis

Epidemic keratoconjunctivitis is a hospital infection, more than 70% of patients are infected in medical institutions. The source of infection is a patient with keratoconjunctivitis. The infection is spread by contact, less often - by airborne droplets.

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The factors of transmission of the pathogen are infected hands of medical personnel, reusable eye drops, instruments, devices, ocular prostheses, contact lenses.

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Adenoviruses of serotypes 8, 11, 19, 29 are the main causative agents of epidemic keratoconjunctivitis.

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Symptoms of epidemic keratoconjunctivitis begin with acute follicular conjunctivitis (often with film formation), which is accompanied by enlargement and soreness of the corresponding lymph nodes, severe headache and fever. After 7-10 days, corneal lesions join in (from 10 to 99% of cases), numerous superficial point opacities appear, accompanied by epithelial erosions. Sometimes infiltrates in the cornea appear under Bowman's membrane, and then the epithelium often remains intact.

The incubation period of the disease is 3-14, more often 4-7 days. The onset of the disease is acute, usually both eyes are affected: first one, after 1-5 days - the second. Patients complain of stinging, a sensation of a foreign body in the eye, lacrimation. The eyelids are swollen, the conjunctiva of the eyelids is moderately or significantly hyperemic, the lower transitional fold is infiltrated, folded, in most cases small follicles and pinpoint hemorrhages are detected. After 7-8 days, the symptoms of acute conjunctivitis subside, a period of apparent improvement begins (2-4 days), after which a repeated exacerbation of conjunctivitis is observed, accompanied by the appearance of pinpoint infiltrates on the cornea. The corneas of both eyes are affected, but in the second diseased eye - to a milder degree. Typically, small, punctate, subepithelial infiltrates appear, located under the Bowman's membrane, not stained with fluorescein. Their number increases over 2-5 days, affecting both the peripheral and central parts of the cornea. In some cases, in addition to typical subepithelial, superficial small epithelial infiltrates stained with fluorescein are found. In the following weeks, the infiltrates undergo slow reverse development. This period is accompanied by an increase in visual acuity, which decreased during the period of abundant corneal rashes. Sometimes, punctate opacities of the cornea regress very slowly, 1-3 years.

Adenoviral conjunctivitis is highly contagious. Outbreaks of infection are observed at different times of the year, mainly among adults in organized groups, but more often in eye hospitals or among people who have visited eye medical institutions. This is due to the peculiarities of the spread of the disease, transmitted mainly by airborne droplets in adenoviral conjunctivitis and by contact - in epidemic keratoconjunctivitis.

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There are three stages:

• I - acute conjunctival manifestations;
• II - corneal damage;
• III - recovery.

Diagnosis of epidemic keratoconjunctivitis

For the diagnosis of adenoviral eye diseases, the most important are immunofluorescent detection of adenoviral antigen in scrapings from the conjunctiva of the eyeball and serological testing of paired sera, which allows retrospective confirmation of the etiology by increasing titers of antibodies to the adenoviral antigen.

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Treatment of epidemic keratoconjunctivitis

Sulfonamides and antibiotics are prescribed to prevent secondary infection. Instillations of DNAase and Poludan are used. When adhesions begin (membranous form of epidemic keratoconjunctivitis), they are separated with a glass rod and 0.5% thiamycin ointment is applied.

Immunocorrective therapy with taktivin (6 injections in small doses - 25 mcg) or levamisole 75 mg once a week is indicated.

Treatment is difficult, since there are no drugs with selective action on adenoviruses. They use drugs with a broad antiviral effect: interferons (lokferon, oftalmoferon, etc.) or interferon inducers, instillations are carried out 6-8 times a day, and in the second week their number is reduced to 3-4 times a day. In the acute period, the antiallergic drug allergoftal or persallerg is additionally instilled 2-3 times a day and antihistamines are taken orally for 5-10 days. In cases of subacute course, alomid or lecrolin drops are used 2 times a day. In the case of formed films and the period of corneal rashes, corticosteroids are prescribed (dexapos, maxidex or oftan-dexamethasone) 2 times a day. For corneal lesions, typhon, korpozin, vitasik or coperegel are used 2 times a day. In cases of insufficient tear fluid over a long period of time, tear substitutes are used: natural tears 3-4 times a day, oftagel or vidisik-gel 2 times a day.

In case of recurrent epidemic keratoconjunctivitis, immunocorrective therapy with taktivin (25 mcg per course of 6 injections in small doses) or levamisole 75 mg once a week is indicated. For a long time after the epidemic keratoconjunctivitis, lacrimation is reduced, apparently due to damage to the lacrimal glands. The discomfort is relieved by the installation of polyglucin or liquifilm.

Prevention

Treatment of patients with adenoviral eye diseases should be accompanied by preventive measures, such as:

• examination of the eyes of each patient on the day of hospitalization to prevent the introduction of infection into the hospital;
• early detection of cases of disease development in hospital;
• isolation of patients in isolated cases of disease and quarantine in case of outbreaks, anti-epidemic measures;
• medical procedures (installation of drops, application of ointment) should be carried out with an individual sterile pipette and glass rod; eye drops should be changed daily;
• metal instruments, pipettes, and solutions of medicinal substances must be disinfected by boiling for 45 minutes;
• tonometers, instruments and devices that cannot withstand heat treatment must be disinfected with a 1% chloramine solution; after chemical disinfection, it is necessary to rinse the specified items with water or wipe them with a cotton swab soaked in 80% ethyl alcohol to remove any remaining disinfectants from their surface;
• in order to prevent the transmission of infection by the hands of medical personnel, it is necessary to wash your hands with soap and warm running water after each examination or treatment procedure, since treating your hands with alcohol is not enough;
• to disinfect the premises, wet cleaning should be carried out with a 1% chloramine solution and the air should be irradiated with ultraviolet rays;
• During an outbreak of the disease, it is necessary to avoid injury to the conjunctiva and cornea, for which such manipulations as eyelid massage, tonometry, subconjunctival injections, physiotherapy procedures, operations on the mucous membrane and eyeball are excluded;
• health education work.