Epidemic hemorrhagic keratoconjunctivitis

An outbreak of acute hemorrhagic conjunctivitis in central Minnesota

The only confirmed outbreak of acute hemorrhagic conjunctivitis in the continental United States during 1982 occurred in Brainerd, Minnesota. The disease first appeared in a 27-year-old woman during a trip to Tahiti. The patient's two daughters (8 months old and 3 years old) developed mild conjunctivitis two days later. Although the symptoms of all three had completely resolved before they arrived in Brainerd, illness compatible with acute hemorrhagic conjunctivitis developed in five other individuals who shared a house with them there. Symptoms appeared within two days in four of the five and within three days in the fifth. All five had high neutralizing antibody titers to enterovirus 70 (1:128, 1:32, 1:32, 1:128, and 1:256) and one had high antibody titers to coxsackievirus A24 which may cause similar symptoms (less than 1:4 in all cases). The symptoms resolved without sequelae in all five patients within five days. These cases demonstrated that a person who is no longer symptomatic can still infect others and that an infected person can transmit enterovirus 70 for at least eight days after the onset of symptoms.

Clinical findings and results of treatment in an outbreak of acute hemorrhagic conjunctivitis in southern Florida

An epidemic of acute hemorrhagic conjunctivitis in Miami, Florida, involved approximately 800 documented cases and more than 2,500 suspected cases. This epidemic was caused by an enterovirus 70 infection affecting primarily young black people residing within a high-risk area. Acute hemorrhagic conjunctivitis is characterized by the rapid onset of swollen eyelids, foreign-body sensation, burning, watery discharge, and, usually, bilateral ocular involvement. Signs include distinctive bulbar conjunctival hemorrhages and a follicular conjunctival reaction with only mild and infrequent corneal involvement. This infection is short in duration, self-limited, and free of significant ocular sequelae. Symptomatic treatment appears to be as effective as various topical medical regimens for relief of symptoms. Secondary bacterial infections (occurring in individuals who used urine as an eyewash) and one case of a transient acute Bell's palsy were the only complications associated with this acute hemorrhagic conjunctivitis epidemic.