Coxsackievirus A24 and acute haemorrhagic conjunctivitis in Sri Lanka

Virological and epidemiological analysis of coxsackievirus A24 variant epidemic of acute hemorrhagic conjunctivitis in Okinawa, Japan, in 2011

BACKGROUND

Acute hemorrhagic conjunctivitis (AHC) is a highly contagious enterovirus infection of the conjunctiva and cornea. Coxsackievirus A24 variant (CA24v) is one of its etiological agents. We report a clinical, epidemiological, and virological analysis of a large epidemic of AHC that occurred from May to September, 2011, in Okinawa, Japan.

METHODS

Clinical and epidemic aspects were evaluated for 435 AHC patients (348 bilateral and 87 unilateral, 783 eyes). Virological studies were carried out on nine isolates from ten patients. Virus isolation and direct detection of the enterovirus genome by the reverse transcription polymerase chain reaction method and complete nucleotide sequencing of the VP1 gene and phylogeny-based classification using the VP4 sequences were carried out.

RESULTS

The 11-15-year age group comprised the highest (62.0%) proportion of cases among all age groups. Conjunctival hyperemia was present in all patients, and subconjunctival hemorrhage, superficial punctate keratitis, and preauricular lymphadenopathy were present in 25.4%, 10.3%, and 7.8% of eyes, respectively. CA24v was isolated from the epidemic strain, and phylogenetic analysis based on a fragment of the VP1 gene showed 96%-97% identity between the current strain and the recent China/GD01/2010 strain.

CONCLUSION

These findings demonstrate that the clinical and epidemiological features of AHC observed in this study were similar to those of the past epidemic in the same region. It should be noted that sequential outbreaks of AHC due to CA24v might occur in the same location after a considerable period of time, and public health precautions are necessary to control this explosive epidemic.

Chapter 4 Picornavirus infections

The oldest member of the Picornaviruses group is polio virus, which was recognized early by clinicians because of its characteristic paralytic disease. This chapter examines the polio virus in regard to its virology, disease, and prevention by vaccines and chemoprophylaxis. Polio has been well controlled in most developed countries using live or inactivated vaccines. Research work has intensified using genetic engineering techniques to produce live attenuated viruses with defined and stable mutations so as to prevent reversion to virulence, and also to produce immunogenic oligopeptides or proteins for a new generation of inactivated polio vaccines. Chemotherapy is therefore not required for polio infections. In contrast, neither vaccines have been developed against rhinovirus infections, nor are the vaccines thought to have a use, unless broadly reacting antigenic determinants can be located. Several interesting but only weakly effective antiviral compounds have been selected against rhinoviruses and this is a major research area at present. Studies continue also with interferon, but because of toxicity problems these look less interesting at present. Sequence and biochemical data is now available for several additional enterovirus strains and this could open new possibilities both with antivirals or vaccines (for example synthetic peptides) in the near future.

Molecular identification of coxsackievirus A24 variant, isolated from an outbreak of acute hemorrhagic conjunctivitis in Singapore in 2005

An outbreak of acute hemorrhagic conjunctivitis (AHC) was reported in Singapore military camps in the year 2005. A total of 103 conjunctival swab specimens were collected from military personnel diagnosed clinically with AHC. PCR testing on these conjunctival specimens revealed the presence of an enterovirus, and this was confirmed by virus isolation. Molecular typing using a partial VP1 gene confirmed a variant of coxsackievirus A24 (CA24v) as the most likely etiological agent for the outbreak. Full-length genome sequencing was carried out on 2 selected virus strains, DSO-26SIN05 and DSO-52SIN05. Sequence comparison and phylogenetic analyses of the VP4, VP1 and 3Cpro gene regions were performed, clustering the Singapore CA24v strains with viruses originating from Asia in the post-2000 era. In addition, we report evolution rates of 4.2 x 10(-3) and 1.0 x 10(-3) nucleotide/year, respectively, for the VP4 capsid and 3Cpro gene regions. Our result shows a focal evolutionary point around 1965-1966, suggesting that the CA24v virus has been evolving constantly since its emergence in Singapore, nearly 40 years ago.

Acute hemorrhagic conjunctivitis epidemic caused by coxsackievirus A24 variants in Korea during 2002-2003

A variant of coxsackievirus A24 (CA24v) is one of the agents causing acute hemorrhagic conjunctivitis. There was an epidemic of acute hemorrhagic conjunctivitis caused by CA24v in Korea from 2002 to 2003. Seventy-one strains of CA24v were isolated from 159 conjunctival specimens (45%). Most of the patients were school children under the age of 20. The epidemic began in the first week of August in 2002, and spread extensively, with a peak in the third week of September. CA24v strains were also isolated from conjunctival specimens in 2003. Reverse transcription polymerase chain reaction (RT-PCR) was performed and sequencing of the 340 bp fragment of the VP1 region of the viruses. Sequencing data were multiple-aligned using CLUSTAL W (version 1.81). Phylogenetic trees were plotted using TreeView (version 1.6.6). Homologies ranged from 97.7%-100%, depending on geographical regions: from 99.4%-100% in 2002 and 98.4%-100% in 2003. A phylogenetic tree based on the nucleotide sequence homologies formed clusters depending on years rather than on geographical regions. Identities (98%-100%) were found among the Korean CA24v strains, and there was 85%-90% homology between these and the prototype strain.

Coxsackievirus B3-associated panuveitis

A 29-year-old woman suffered from headaches, diarrhoea, and high grade fever followed by a unilateral retinal vasculitis, papillitis, and chorioretinitis. Abnormal electrocardiographic findings and antibody titre dynamics strongly suggested a coxsackievirus B3 infection. With respect to prior observations on coxsackievirus B group associated uveitis this viral infection may be considered in patients with well defined extraocular manifestations and uveitis.

A recent epidemic of Coxsackie virus type A24 acute haemorrhagic conjunctivitis in Singapore

A recent epidemic of acute conjunctivitis in Singapore showed again the importance of Coxsackie virus type A24 variant as a causative agent of acute haemorrhagic conjunctivitis (AHC). Although the ocular manifestations appeared similar to those described for the 1970 and 1975 outbreaks, a markedly higher rate of respiratory involvements was noted. Not observed in previous epidemics were herpes-like vesicles in the conjunctiva and eyelids of one patient and vesicles in the buccal mucosa and lips of another from whom Coxsackie virus A24 was isolated. The most interesting finding in this study was the isolation of five wild (non-Sabin) poliovirus type 1 strains. Three strains were obtained from conjunctival and two from throat swabs of patients with mild to severe conjunctivitis. It is conceivable that the rare reports of polio-like paralysis or radiculomyelitis accompanying or following AHC in a few Asian countries could be attributed to concurrent infections with a poliovirus and either enterovirus type 70 or Coxsackie virus type A24.

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.