Clinical and aetiological study of adenoviral conjunctivitis, with special reference to adenovirus types 4 and 19 infections

The clinical and aetiological findings are presented on 343 patients with clinical adenoviral conjunctivitis treated between July 1979 and July 1980 at 3 eye clinics in Sapporo. The age of the patients ranged from 12 days to 79 years, and the monthly incidence of the disease from 9 to 83, with clustering in the summer season. The aetiological diagnosis was established in 196 (57%) of 343 patients: adenovirus 3 in 24 cases; adenovirus 4 in 33 cases, including one case serologically diagnosed; adenovirus 8 in 124 cases; and adenovirus 19 in 15 cases. The different serotypes caused different clinical pictures. Adenovirus 19 conjunctivitis was more severe, with keratitis and preauricular lymphadenopathy more frequent than that of adenovirus 3 conjunctivitis. Adenovirus 4 conjunctivitis was generally similar to adenovirus 3 conjunctivitis. The clinical difference between the 2 groups adenoviruses 3 and 4, and adenoviruses 8 and 9, was statistically significant. Although in Japan adenovirus 8 was the most prevalent, adenoviruses 4 and 19 should be considered as causative agents of adenoviral conjunctivitis.

Experimental infection of rabbits with bovine herpesvirus-4: acute and persistent infection

A strain of bovine herpesvirus-4 (BHV-4) isolated from bovine cases of mammary pustular dermatitis was used for experimental infection of rabbits. The strain is serologically indistinguishable from the group prototype Movar 33/63 and from the American isolate DN599. Groups of rabbits were inoculated by various routes. Intravaginal and conjunctival inoculations resulted in vulvovaginitis and conjunctivitis, respectively, and in shedding of virus. The rabbits seroconverted for the virus, with high titers of antibodies (indirect fluorescent antibody test) that persisted throughout the experiment. Treatment with dexamethasone, beyond the acute infection, did not produce recrudescence of disease or shedding of the virus. Rabbits were killed at various times, from 3 to 6 months post-infection, and the virus was recovered from explant cultures of spleen and by cocultivation of spleen cells with bovine lung cells. These results demonstrate the usefulness of the rabbit as a model for studying the pathogenesis of BHV-4 infection in cattle.

An animal model of trachoma II. The importance of repeated reinfection

An animal model of chronic cicatrizing trachoma has been produced by repeated ocular inoculation with Chlamydia trachomatis serotype E, a genitally transmitted strain. We have now produced a chronic follicular conjunctivitis on cynomolgus monkeys by repeated inoculation with C. trachomatis serotype A, which has been isolated from an area of endemic trachoma. This disease was similar in all respects to that which followed infection with the serotype E strain. Cynomolgus monkeys inoculated with a single dose of serotype E of C. trachomatis strain developed an acute, self-limited follicular conjunctivitis, which was intense for 4 weeks and then slowly subsided. The organism could be reisolated only during the first 4 weeks after inoculation. On reinoculation at 15 and 30 weeks after the initial infections, these animals demonstrated only a mild and transitory clinical response, and the agent could be recovered for only up to 14 days after inoculation. In contrast, repeated weekly reinoculation with either serotype led to a chronic progressive clinical response in these animals, although after the first 6 weeks the agent was isolated only occasionally. This chronic disease was shown not to be due to hypersensitivity to the egg yolk components in which the organism was grown. These data suggest that the serotype of the chlamydial organism may not be as important in determining the clinical course of disease as is the frequency or persistence of exposure to the chlamydial agent. Although a single inoculum produced an acute follicular conjunctivitis, repeated inoculation is needed to produce the chronic disease characteristic of trachoma in this animal model.

Treatment of blepharitis and blepharoconjunctivitis: comparison of gentamicin-betamethasone, gentamicin alone and placebo

At two university centres 46 patients presenting with symptomatic infective blepharitis or blepharoconjunctivitis participated in a double-blind study of a new antibiotic-steroid ointment containing gentamicin and betamethasone. There was no significant difference in response to 2 weeks of therapy between the patients treated with this ointment and those treated with either an ointment containing gentamicin alone or a placebo ointment. There was also no significant correlation between the clinical response and the results of the bacterial cultures of swabs obtained at the beginning and the end of the study. However, the patients treated with the placebo had a much higher rate of recurrence of their symptoms over a 6-week follow-up period. The patients who before treatment had associated rosacea, dry eyes and a long duration of symptoms showed a poor response to therapy.

Characterization of nontypable Streptococcus pneumoniae-like organisms isolated from outbreaks of conjunctivitis

From January through June 1980 seven colleges and universities in various parts of New York State (NYS) reported outbreaks of conjunctivitis affecting at least 1,500 students of both sexes. Of the 125 conjunctival swabs tested in our laboratory, organisms identified as nontypable Streptococcus pneumoniae were isolated in pure culture from 24% and in combination with other organisms from 22%. Although bile-soluble and susceptible to optochin, the isolates had a dry-colony appearance and no typable capsule with the Neufeld capsular-swelling test. Mouse passage of four representative NYS isolates did not stimulate production of a typable capsule. We subsequently chose to refer to these isolates as S. pneumoniae-like organisms. Of primary importance to our study, all NYS isolates tested were similar in biochemical and immunological reactions, antibiotic susceptibility, and virulence in mice. Of 18 strains referred to us from three other outbreaks (California, 1980; NYS, 1981; Illinois, 1981), four of the six tested biochemically gave the same biochemical reactions as the four NYS isolates, and 16 of the 18 tested immunologically reacted strongly with antisera produced against those four isolates, showing line(s) of identity with each other and with the NYS isolates.

An epidemic of acute hemorrhagic conjunctivitis due to coxsackievirus A24

An epidemic of acute hemorrhagic conjunctivitis in 416 (10.8%) of 3,830 staff and students of the Christian Medical College and Hospital in Vellore, India, during September-December 1979 was studied. Virus was isolated in cultures of HeLa cells from 171 of the 249 persons cultured. Most of the viral isolates were identified as an antigenic variant of coxsackievirus A24. Success in isolating the virus from conjunctival swabs was inversely proportional to the time elapsed between the onset of illness and the time the specimens were collected. In general, titers of antibody to coxsackievirus A24 were low or undetectable. Three persons had subconjunctival hemorrhage with no other symptoms, and virologic evidence of infection with coxsackievirus A24 was obtained in two of them.

Aetiology and treatment of acute bacterial infection of the external eye

The microbial flora of 738 patients with acute bacterial conjunctivitis, corneal ulceration, blepharitis, dacryocystitis, and discharging sockets has been investigated. Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae were the main pathogens isolated. Str. viridans was associated with conjunctivitis in patients aged under 1 year. moraxella sp. was isolated on only one occasion. Overall, 40% of specimens were associated with Staph. epidermidis or mixed skin flora, which also occurred with cultures of the normal eye. Clostridium welchii was isolated on 3 occasions but was not associated with bullae or gas gangrene. The least overall resistance, of 6%, was to chloramphenicol, but no one antibiotic was effective against all pathogens. Gentamicin remains the antibiotic of choice for Pseudomonas aeruginosa infection.

Conjunctivitis-otitis syndrome

Purulent conjunctivitis associated with otitis media was studied in 124 patients in a private practice over a period of one year. Of the 132 patients seen with purulent conjunctivitis, 96 (73%) concurrently had otitis media. In 29 (47%) of 60 families with more than one child, siblings of the index cases had either purulent conjunctivitis or otitis media, or both, simultaneously or within one month. During the study period, conjunctival cultures were obtained from 75 patients with purulent conjunctivitis-otitis media and patients with purulent conjunctivitis whose siblings had purulent conjunctivitis-otitis media or otitis media. Haemophilus influenzae was isolated from 55 (73%). Thirty-one of the patients had nasal cultures done simultaneously with conjunctival cultures. An identical pathogen was isolated from 27 (87%) patients.

Acute hemorrhagic conjunctivitis in Southeast Asian refugees arriving in the United States--isolation of enterovirus 70

During July-September 1980, an epidemic of acute hemorrhagic conjunctivitis (AHC) occurred in several refugee camps and transit centers in Southeast Asia. Of 2,356 refugees examined in Bangkok, 200 (8.5%) had conjunctivitis, including 116 (58%) with hemorrhagic signs. Because increasing numbers of refugees were arriving in the United States with conjunctivitis, a program of surveillance and control was implemented. Enterovirus 70, not previously reported from patients in the Western Hemisphere, was cultured from four arriving refugees. A fourfold rise in titer to enterovirus 70 was found in 10 others, either in the United States or Thailand. After control measures were instituted, the prevalence of the United States or Thailand. After control measures were instituted, the prevalence of conjunctivitis in arriving refugees declined from 49.8 per 1,000 to 3.8 per 1,000. Follow-up of cases after arrival in the United States revealed only one possible secondary case. Extensive epidemics of AHC in the Western Hemisphere are most likely to occur following importation into the humid, coastal areas of Central and South America.

[Occurrence and diagnosis of Chlamydia trachomatis infections in newborns and young infants (author's transl)]

Chlamydia trachomatis was assayed using McCoy cell culture on vaginal swabs from pregnant women and on conjunctival and nasopharyngeal swabs from newborns. C. trachomatis was found in 23 of 168 pregnant women (8%) and in 15 of 298 newborns (5%). Six newborns developed a typical inclusion conjunctivitis, whereas three infants developed pneumonia caused by C. trachomatis. Of a total of 50 children with conjunctivitis, C. trachomatis was found in six of 22 newborns, in four of 22 infants (2-3 months old) and in none of the older infants and children. Specific antibodies in serum could be demonstrated in most patients by the microimmunofluorescence technique, whereas antibodies against C. trachomatis were only found in a small percentage of the healthy children of various ages. Recommendations are given for the diagnosis of infections caused by C. trachomatis in newborns and infants.

An epidemic of acute conjunctivitis caused by enterovirus-70 in Singapore in 1980

The clinical, epidemiological and virological findings of the 1980 epidemic of acute conjunctivitis were described. Enterovirus 70 was isolated from 7 (35%) of 20 eye swabs submitted for virus isolation, and the paired sera of eight patients showed a four-fold or greater rise in neutralising antibody titre to Enterovirus 70. The disease mainly affected children and young adults of all ethnic groups. Most of the cases contracted the infection at home. The mean secondary attack rate was 72.6% and the mean incubation period, four days. The clinical features were similar to the 1970 and 1975 epidemics caused by Coxsackievirus A24. Subconjunctival haemorrhage was observed in 10% of the cases. Most of the cases recovered spontaneously within a week. Transmission of infection within the home was either indirect, probably through fomites contaminated with eye or respiratory discharges of cases, or direct, through intimate person-to-person contact. During outbreaks, health education on simple personal hygiene should be highlighted.

Isolation of Chlamydia psittaci from cats with conjunctivitis

Chlamydia psittaci was repeatedly demonstrated in stained smears of conjunctival scrapings from a group of cats in a single household and in 5 instances the organism was isolated by yolk sac inoculation of 6-day-old pathogen free, embryonated hen eggs. Thirteen of 15 cats in the cattery developed conjunctivitis at various times over a 9-month period. The outstanding features of the disease were its severity, chronicity and refractoriness to treatment. Prolonged (2 week) treatment with tetracycline was required to effect clinical recovery. Nine of 14 cats in the household developed significant complement-fixing (CF) antibody titres (greater than 128) to the chlamydia group antigen. A single serum from the owner had a titre of 32 although no associated illness was recognized. Of 134 serums collected from random source cats aged 1 month to 16 years, 17 (12.7%) also contained CF antibody to chlamydia group antigen. This is the first report of the isolation of chlamydia from cats with conjunctivitis outside North America and the first report to indicate general incidence figures for chlamydia infection of cats where vaccination is not used.

An animal model for cicatrizing trachoma

An animal model of cicatrizing trachoma was developed in cynomolgus monkeys. This model is consistent with our hypothesis that repeated ocular inoculation of Chlamydia trachomatis, BOUR strain, mimics the repeated reinfection that occurs naturally in endemic human trachoma. A chronic follicular conjunctivitis developed, and scarring later appeared in the superior tarsal conjunctiva. The organism was reisolated after the infection and was also demonstrated cytologically. Specific antichlamydial antibodies of both the IgM and IgG types appeared in the sera of the monkeys. Histopathologic examination of conjunctiva showed a marked lymphocytic response and the presence of germinal centers; areas of conjunctival scar tissue were also examined. Efforts to produce a similar model in rhesus monkeys were less successful.