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PubMed1987

Etiology and diagnosis of neonatal conjunctivitis.

Chlamydia trachomatis was isolated from the most inflamed eye of 13 of 107 (12%) infants with neonatal purulent conjunctivitis and from none of 100 healthy infants (p less than 0.01). Staphylococcus aureus was recovered from 49 (46%) inflamed eyes and from 8 (8%) healthy eyes (p less than 0.01). Streptococcus pneumoniae, Haemophilus influenzae, Branhamella catarrhalis, Escherichia coli and Klebsiella pneumoniae were isolated from very few infants with conjunctivitis but not from controls. No organisms could be recovered from 23 (22%) infants with conjunctivitis and from 60 (60%) healthy infants (p less than 0.01). The incidence of neonatal purulent conjunctivitis was 107 (2%), of 5,924 births. Eyes infected with C. trachomatis were significantly more inflamed than eyes from which S. aureus or no organisms could be isolated. Furthermore, conjunctival "pseudomembranes" were associated with C. trachomatis. The age at onset of the chlamydial conjunctivitis was higher compared to the age at onset of conjunctivitis in which S. aureus or no organisms were isolated.

Bacteriological Techniques↗
PubMed2000

Antibiotics for acute bacterial conjunctivitis.

BACKGROUND: There are concerns regarding whether antibiotic therapy confers significant benefit in the treatment of acute bacterial conjunctivitis. OBJECTIVES: The aim of this review is to assess the benefit and harm of antibiotic therapy in the management of acute bacterial conjunctivitis. SEARCH STRATEGY: We searched the Cochrane Eyes and Vision Group specialised register, the Cochrane Controlled Trials Register - Central, MEDLINE and the reference lists of identified trial reports. We used the Science Citation Index to look for articles that cited the relevant studies, and we contacted investigators and pharmaceutical companies for information about additional trials. The most recent searches were carried out in September 1998. SELECTION CRITERIA: We included double masked randomised controlled trials in which any form of antibiotic treatment had been compared with placebo in the management of acute bacterial conjunctivitis. This included topical, systemic and combination (for example, antibiotics and steroids) antibiotic usage. DATA COLLECTION AND ANALYSIS: One reviewer extracted data and the accuracy was checked by a second reviewer. Relative risks were summarised. We tested for heterogeneity between studies. MAIN RESULTS: Six published trials were identified of which three fulfilled the eligibility criteria for inclusion in this review. One trial was single masked and therefore excluded. A second report, when translated, was found to have no placebo group and was therefore excluded. One trial is currently 'awaiting assessment'. This has been published in abstract form and has yet to be fully reported. All the trials thus far identified appear to have been conducted on a selected specialist care patient population. The trials were heterogeneous in terms of their inclusion and exclusion criteria, the nature of the intervention, and the outcome measures assessed. Meta-analysis indicates that acute bacterial conjunctivitis is frequently a self-limiting condition, as clinical remission (cure or significant improvement) occurred by days two to five in 64% (95% confidence interval (CI) 57% to 71%) of those treated with placebo. Treatment with antibiotics was, however, associated with significantly better rates of clinical remission (days two to five: relative risk (RR) 1.31 95% CI 1.11 to 1.55, NNT=5) with a suggestion that this benefit was maintained for late clinical remission (days six to 10: RR 1.27 95% CI 1.00 to 1.61, NNT=5). Antibiotic treatment was associated with rates of microbiological remission (pathogen eradication or reduction). No serious outcomes were reported in either the active or placebo arms of these trials, indicating that important sight-threatening complications are an infrequent occurrence. REVIEWER'S CONCLUSIONS: Acute bacterial conjunctivitis is frequently a self-limiting condition but the use of antibiotics is associated with significantly improved rates of early clinical remission and early and late microbiological remission. Since trials to-date have been conducted in selected specialist care patient populations these results may not necessarily be generalisable to a primary care based population. A trial based in primary care designed to assess the cost-effectiveness of commonly prescribed antibiotic(s) versus placebo in acute bacterial conjunctivitis is warranted.

Acute Disease↗
PubMed1988

The diagnosis and treatment of chlamydial conjunctivitis.

Chlamydial conjunctivitis will usually go unrecognized and therefore untreated unless it is specifically considered. The possibility of chlamydial infection must be borne in mind in neonatal conjunctivitis, in acute conjunctivitis in sexually active adults, and in chronic follicular conjunctivitis. Chlamydial conjunctivitis is often indistinguishable from other forms of conjunctivitis on clinical grounds, and accurate diagnosis is based on laboratory tests. It seems that direct fluorescent antibody (DFA) cytology offers an attractive alternative to the more complicated and time-consuming tissue culture isolation method. Once diagnosed, chlamydial infection should be treated with the appropriate systemic antibiotics, and proper posttreatment follow-up is necessary to assess the efficacy of treatment.

Chlamydia Infections↗
PubMed1983

IgG specific antibodies to rye grass and ragweed pollen antigens in the tear secretions of patients with vernal conjunctivitis.

We studied the tears of 30 patients (25 males and five females, ranging in age from 8 to 34 years) with vernal conjunctivitis for pollen-specific IgG antibodies to rye grass and ragweed antigen E by an enzyme-linked immunosorbent assay (ELISA). Eighteen of 30 (60%) and 20 of 30 (67%) patients with vernal conjunctivitis had significant levels (more than 2 S.D. from the mean of control tears) of IgG antibodies in their tear secretions to rye grass (geometric mean = 68.7 ELISA units) and ragweed antigen E (geometric mean = 50 ELISA units), respectively. In contrast, the control groups (eight atopic individuals, four with seasonal rhinitis, and 12 with allergic conjunctivitis) had low amounts of specific IgG antibodies to these two pollen antigens in their tears. Total IgG and IgM were also increased in the tears of patients with vernal conjunctivitis. To evaluate whether these immunoglobulins and specific IgG antibodies were locally produced by the conjunctival tissues, we used transferrin as a marker for the leakage of plasma proteins into tears. We found that the specific IgG antibodies to rye grass or ragweed antigen E, or both, in the tears were locally produced by the conjunctival tissues. The local production ranged from 20% to 99.9%. Of 17 patients with vernal conjunctivitis and undetectable pollen-specific IgE antibodies in their tears, 14 (82.4%) had tear specific IgG antibodies to rye grass or ragweed antigen E or both, whereas of those with measurable tear IgE antibodies, only nine of 13 (69%) had tear IgG antibodies to rye grass or antigen E or both. These results suggested that both IgE- and IgG-mediated immune mechanisms may be important in the pathogenesis of vernal conjunctivitis.

Adolescent↗
PubMed1989

Investigation of an outbreak of Moraxella conjunctivitis at a Navajo boarding school.

In 1986, an outbreak of Moraxella follicular conjunctivitis occurred in girls attending a Navajo boarding school in New Mexico. We diagnosed 19 cases of culture-proven, and 21 of clinical conjunctivitis based on isolation of Moraxella from conjunctival cultures and the occurrence of symptoms significantly associated with positive culture. Sharing eye makeup was significantly associated with Moraxella-positive conjunctivitis (odds ratio [OR] = 7.2, P = .004) and showed a trend toward significance in those with clinical conjunctivitis (OR = 2.9, P = .09). Eyeliner and eye shadow were implicated (OR = 4.1, P less than .05). We cultured samples of 13 students' makeup; one third of the eyeliners were positive for Moraxella. Nasal carriage of Moraxella was found in 35 (44%) of the 79 female boarders and in 20 (21%) of 97 Navajo patients at two nearby clinics. In a prospective evaluation of the effect of patient education and rifampin therapy on the occurrence of conjunctivitis during an 11-month follow-up period, both types of intervention were successful in significantly reducing the rate of conjunctivitis when compared with that in a control group.

Adolescent↗
PubMedDate not supplied

Ligneous conjunctivitis.

Ligneous conjunctivitis (McKusick 217090) is a rare form of chronic conjunctivitis characterized by the development of firm fibrin-rich, woody-like pseudomembraneous lesions mainly on the tarsal conjunctivae. Less frequently, similar lesions may occur on other mucous membranes of the body indicating that these manifestations are part of a systemic disease. Histopathological findings from affected humans and (plasminogen-deficient) mice indicate that wound healing, mainly of injured mucosal tissue, is impaired due to markedly decreased (plasmin-mediated) extracellular fibrinolysis. Pseudomembraneous lesions of the eyes and other mucosal tissue mainly contain clotted fibrin(ogen). Actually, systemic plasminogen deficiency has been linked to ligneous conjunctivitis in humans and mice. In one case, ligneous conjunctivitis has been induced by antifibrinolytic treatment with tranexamic acid. Further rare associated disorders of ligneous conjunctivitis are congenital occlusive hydrocephalus and juvenile colloid milium. This review outlines the historical background, clinical characteristics of ligneous conjunctivitis and its associated complications, histological abnormalities of pseudomembraneous lesions, inheritance, hemostasiologic and molecular genetic findings in affected patients, current treatment approaches, and the plasminogen-deficient mouse as an animal model.

Animals↗
PubMed2002

Changes in tear function and the ocular surface after topical olopatadine treatment for allergic conjunctivitis: an open-label study.

BACKGROUND: Olopatadine hydrochloride 0.1% eye drops represent a new class of anti-allergic agent with combined antihistaminic and mast cell-stabilizing properties. OBJECTIVE: The purpose of this study was to describe alterations in tear function and the ocular surface in patients with allergic conjunctivitis and to analyze the effect of topical olopatadine treatment on corneal sensitivity, tear function, and impression cytology variables. METHODS: This was a single-center, 3-visit, prospective, open-label study conducted in patients with allergic conjunctivitis. Patients received 1 drop of topical olopatadine hydrochloride 0.1% BID for 3 weeks. At each visit, patients and healthy control subjects underwent routine ophthalmic examinations and measurements of corneal sensitivity and tear function (Schirmer test of tear quantity, tear film break-up time [BUT], fluorescein staining of the cornea). All control subjects and a subgroup of patients also underwent conjunctival impression cytology for assessment of squamous metaplasia and goblet cell density. The outcomes of interest were changes in corneal sensitivity, tear function, and impression cytology variables after 3 weeks of treatment with olopatadine eye drops, both in patients with allergic conjunctivitis and between patients and controls. RESULTS: At enrollment, the study included 46 eyes of 23 patients (9 men, 14 women; age range, 20-42 years) with allergic conjunctivitis; results were calculated based on the 21 patients who completed the study. The control group consisted of 70 eyes of 35 healthy subjects (13 men, 22 women; age range, 22-39 years). Before treatment, 64.3% of the eyes of patients with allergic conjunctivitis had a fluorescein staining score of >1 point, whereas after treatment, 14.3% had a score of >1 point (P < 0.001). Patients' mean (+/- SD) corneal sensitivity improved to 55.0 +/- 2.5 mm from the pretreatment value of 42.5 +/- 2.5 mm (P < 0.001). Mean BUT values before and after treatment were 8.1 +/- 3.5 and 14.0 +/- 7.0 seconds, respectively (P < 0.001). Before treatment, patients' mean squamous metaplasia grade was 2.5 +/- 0.5; at the end of treatment, it had decreased to 1.0 +/- 0.5 (P < 0.001). The mean pretreatment goblet cell density of 545 +/- 85 cells/mm2 improved to 1,090 +/- 100 cells/mm2 after treatment (P < 0.001). CONCLUSION: In the patient population studied, the disorder of tear function, squamous metaplasia, and loss of ocular surface goblet cells associated with allergic conjunctivitis improved with topical olopatadine treatment.

Adult↗
PubMed1986

Epidemiology of neonatal conjunctivitis.

Chlamydial conjunctivitis was diagnosed in 46 of 100 infants less than two months old presenting with conjunctivitis. Streptococcus, Staphylococcus, and Hemophilus species were most frequently identified in the remainder. All infants with chlamydial conjunctivitis were black and were born by vaginal delivery (P less than 0.001). Average age at presentation was 13 days for chlamydial and 21 days for other causes of bacterial conjunctivitis (P less than 0.001) with symptoms present an average of five to six days prior to presentation. There was no statistically significant difference in sex, birthweight, APGAR scores, bilaterality, fever, or prophylactic drops administered. Mothers of infants with chlamydial conjunctivitis averaged 19.5 years old versus 23.0 for the bacterial group (P less than 0.001). There was no statistically significant difference in past obstetrical or sexually transmitted disease history. Persistent chlamydial conjunctivitis following a two-week course of oral erythromycin as recommended by Centers for Disease Control was documented in 19% of patients with chlamydial infection.

Anti-Bacterial Agents↗
PubMed2000

Allergic conjunctivitis and contact lenses: experience with olopatadine hydrochloride 0.1% therapy.

OBJECTIVE: The efficacy of Patanol, a topically applied anti-allergic agent, was evaluated in a group of patients with allergic conjunctivitis due to contact lens wear (GROUP I) and a group comprised of seasonal allergic conjunctivitis patients, vernal conjunctivitis patients and atopic keratoconjunctivitis patients (GROUP II). METHODS: One drop of Patanol was administered to each eye twice daily. Signs and symptoms were assessed 7, 14, and 28 days after initiation of drug therapy. RESULTS: Itching/burning, tearing, hyperemia and papillary reaction were reduced to scores of 0/1 (absent/mild) in 85%, 90%, 81% and 62%, respectively, of GROUP I patients at Day 28. The allergic conditions in GROUP II patients also improved with Patanol treatment. Itching/burning, tearing, hyperemia and papillary reactions were absent/mild in 60%, 76%, 96% and 90%, respectively, of these patients at Day 28. CONCLUSION: Patanol treatment effectively and rapidly alleviated the signs and symptoms of allergic conjunctivitis due to contact lens wear as well as vernal conjunctivitis, atopic keratoconjunctivitis and the common seasonal allergic conjunctivitis. Patanol allowed allergic patients to be more comfortable while permitting them to continue using contact lenses.

Acute Disease↗
PubMed1999

Bacteremia, meningitis, and brain abscesses in a hospitalized infant: complications of Pseudomonas aeruginosa conjunctivitis.

This report describes a preterm infant hospitalized in a neonatal intensive care unit who developed Pseudomonas aeruginosa conjunctivitis associated with bacteremia, meningitis, and multiple brain abscesses. P. aeruginosa conjunctivitis can rapidly progress to an invasive eye infection, such as corneal ulceration or endophthalmitis, leading to poor vision or blindness. Progression of this infection may lead to systemic disease. However, as illustrated in this report, P. aeruginosa conjunctivitis may be associated with the development of systemic complications such as bacteremia and meningitis in the absence of invasive eye disease. P. aeruginosa is a relatively common cause of conjunctivitis in hospitalized preterm and low birth weight infants. Given the severity of the ocular and systemic complications of Pseudomonas conjunctivitis, clinicians are reminded that prompt detection and treatment of neonatal conjunctivitis is critical.

Bacteremia↗
PubMed2002

Respiratory syncytial virus may be a pathogen in allergic conjunctivitis.

PURPOSE: The host response to allergens appears to be regulated by T helper type 2 cell patterns of local cytokine production. We hypothesized that respiratory syncytial virus (RSV) infects the normal conjunctival epithelium and produces interleukin (IL)-4, causing a local allergic reaction. METHODS: Giemsa staining, immunocytochemical study, flow cytometric analysis, and reverse-transcriptase polymerase chain reaction (RT-PCR) were performed on tear and cytology samples from individuals with allergic and postoperative conjunctivitis. Histamine was assayed by radioimmunoassay, and IL-4 by enzyme-linked immunosorbent assay. RESULTS: The total number of cells collected by brush cytology did not differ between allergic and postoperative conjunctivitis. The levels of IL-4 and histamine in the specimens and mean IL-4 tear level were significantly increased in patients with allergic conjunctivitis. Cytocentrifuge preparations contained conjunctival epithelial cells with lymphocytes (a few CD3- and CD4-bearing cells), mast cells, eosinophils, and higher human leukocyte antigen (HLA)-DR expression in allergic patients. RT-PCR analysis showed that samples from allergic conjunctivitis expressed increased transcripts of IL-4 and IL-13. A higher percentage of RSV sequences were detected in allergic patient samples. Immunocytochemical study and RT-PCR showed that epithelial cells were infected with RSV. Average concentrations of IL-4 in culture supernatants were higher than levels in uninfected cells. CONCLUSIONS: These results suggest that the clinical features of human allergic conjunctivitis are associated with T helper type 2 cytokine expression. RSV in conjunctival epithelial cells may be an environmental pathogen in allergic conjunctivitis.

Adolescent↗
PubMed1998

Complications of conjunctivitis caused by Pseudomonas aeruginosa in a newborn intensive care unit.

BACKGROUND: In infancy Pseudomonas aeruginosa conjunctivitis may lead to a rapidly progressive invasive eye infection. In some cases this destructive eye disease is associated with or followed by infection at other sites. We observed seven hospitalized infants with P. aeruginosa conjunctivitis who developed systemic complications of P. aeruginosa infection without evidence of invasive eye disease, prompting us to examine the characteristics of this infection and its associated systemic complications in hospitalized infants. METHODS: We reviewed retrospectively the course, treatment and outcome of infants with nonepidemic P. aeruginosa conjunctivitis in the Newborn Special Care Unit at Yale-New Haven Hospital during a 10-year period from November 1, 1986, to October 31, 1996. RESULTS: Eighteen infants with P. aeruginosa conjunctivitis had mean birth weights and gestational ages of 29.3 weeks and 1380 g, respectively. The average postnatal age at onset of P. aeruginosa conjunctivitis was 17 days. No infant had invasive eye disease. Systemic complications occurred in seven (39%) infants and included bacteremia, meningitis, brain abscess and death. Infants who developed systemic complications had lower mean birth weights (850 g vs. 1716 g, P = 0.04) and lower mean gestational ages (26.4 vs. 31.2 weeks, P = 0.02) than infants who did not. Six of seven infants weighing < 1000 g developed systemic complications; two of these infants died. CONCLUSIONS: In hospitalized infants P. aeruginosa conjunctivitis may be associated with systemic complications with or without invasive eye infection, emphasizing the need for early detection and treatment of this infection in this population.

Conjunctivitis↗
PubMed2006

Obliterative microangiopathy presenting as chronic conjunctivitis in a patient with relapsing polychondritis.

PURPOSE: To report histopathologic findings and treatment of obliterative microangiopathy in a patient with chronic conjunctivitis due to relapsing polychondritis (RP). METHODS: This interventional case report describes a 50-year-old woman with relapsing polychondritis was referred to the Ocular Immunology and Uveitis Service for bilateral tearing due to refractory chronic conjunctivitis. Ocular examination revealed the presence of bilateral follicular conjunctivitis. Conjunctival biopsy of the inferior palpebral conjunctiva was performed, and the histopathologic findings guided the therapeutic intervention. RESULTS: The pathology of the conjunctival biopsy included granulomatous obliterative microangiopathy with numerous eosinophils, plasma cells, lymphocytes, and epithelioid cells in the substantia propia. The chronic conjunctivitis resolved with systemic methotrexate therapy. CONCLUSIONS: Microangiopathy may cause chronic conjunctivitis in patients with RP and may be a harbinger of evolving nonocular problems as a consequence of incomplete control of this autoimmune disorder. Immunomodulatory therapy should be considered in such cases to prevent possible cardiovascular, renal, respiratory, and neurologic complications of vasculitis. Although methotrexate has been used in treatment of RP-related necrotizing scleritis with poor results, it can be sufficient for the conjunctivitis with microangiopathy associated with RP.

Chronic Disease↗
PubMed2005

Clinical and bacterial characteristics of acute bacterial conjunctivitis in children in the antibiotic resistance era.

BACKGROUND: Acute conjunctivitis is the most common eye disorder in young children. Bacteria are responsible for 54-73% of all cases. The goals of the study were to identify the rates of Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis in cases of bacterial conjunctivitis in children and to define antibiotic resistance rates. METHODS: During a 2-year study period, conjunctival swabs of children 2-36 months old were collected prospectively. Nontypable H. influenzae, S. pneumoniae and M. catarrhalis were defined as the study pathogens. Analyzed variables included demography, clinical presentation, bacteriologic results and susceptibility patterns. RESULTS: There were 428 patients enrolled. Of all cultures, 55% (237 of 428) yielded at least 1 of the study pathogens. H. influenzae and S. pneumoniae were isolated from 29 and 20% of cultures, respectively. beta-Lactamase production was found in 29% of H. influenzae isolates, and penicillin nonsusceptibility was observed in 60% of S. pneumoniae isolates. The most common S. pneumoniae serotypes were: 19F (14%); 6A and 14 (11% each). Nontypable S. pneumoniae was found in 12%. The 7-valent pneumococcal conjugate vaccine (PCV-7) could potentially cover 44% of all isolates. Conjunctivitis-otitis syndrome was found in 32% of patients, of whom 82% of cultures yielded H. influenzae. CONCLUSIONS: Antibiotic resistance rates are alarmingly high. Conjunctivitis-otitis syndrome, predominantly caused by H. influenzae, is quite common. The potential coverage of the PCV-7 in conjunctivitis is relatively lower than that reported in other pneumococcal infections. Our findings should alert physicians on the choice of appropriate antibiotic treatment, on the frequent copresence of acute otitis media and on the potential role of conjunctivitis in the spread of antibiotic-resistant pathogens.

Acute Disease↗
PubMedDate not supplied

Prevalence of Chlamydophila felis and feline herpesvirus 1 in cats with conjunctivitis in northern Italy.

The prevalence of Chlamydophila felis and feline herpesvirus 1 (FHV-1) infection in cats with conjunctivitis in northern Italy was investigated by conventional polymerase chain reaction (PCR) testing. In cats with conjunctivitis, C felis and FHV-1 were detected in 14 of 70 (20%) and in 23 of 70 (33%) animals, respectively. None of the 35 control cats were positive for C felis, whereas 7 (20%) of these cats were positive for FHV-1. Mixed infections were present in 5 of 70 cats (7%). Cats positive for C felis were significantly younger than control animals (P = .02), whereas no significant age differences were observed between FHV-1-positive cats and control cats (P = .41) or between FHV-1-positive animals and C felis-positive animals (P = .16). Cats sampled during acute-phase conjunctivitis were also investigated for the presence of C felis by conjunctival scrapings. In this acute phase, substantial agreement was found when comparing the results of the 2 methods (K = .80). The association between PCR results and conjunctivitis was evaluated for the 2 pathogens. The presence of C felis was significantly associated with conjunctivitis (P = .004), whereas the detection of FHV-1 did not significantly correlate with the clinical sign (P = .25), suggesting that, by itself. PCR is not suitable for the diagnosis of FHV-1-related conjunctivitis.

Animals↗
PubMed2000

Increasing bacterial resistance in pediatric acute conjunctivitis (1997-1998).

We sought to determine the current level of resistance in Haemophilus influenzae and Streptococcus pneumoniae, the primary pathogens of pediatric conjunctivitis. Between January 1997 and March 1998, we prospectively cultured acute conjunctivitis in 250 ambulatory pediatric patients from rural Kentucky whose average age was 24.3 months. In those 250 cases, 106 H. influenzae (42% of the total) and 75 S. pneumoniae (30% of the total) pathogens were isolated, with no growth or no pathogen resulting in 79 cases (32% of the total). Beta-lactamase was detected in 60 (69%) of 87 tested strains of H. influenzae. Among 65 isolates of S. pneumoniae tested for penicillin susceptibility, 44 (68%) were susceptible, 17 (26%) were resistant, and 4 (6%) were intermediate. Conjunctivitis with acute otitis media was observed in 97 patients (39%), and H. influenzae was recovered in 57% of these 97 cases. As for in vitro activity, ciprofloxacin, ofloxacin, and tetracycline were the most active; and gentamicin, tobramycin, polymyxin B-trimethoprim, and polymyxin B-neomycin were intermediately active. Sulfamethoxazole possessed no activity against either pathogen. Beta-lactamase production was detected in 69% of H. influenzae strains, which still remains the primary causative pathogen of both conjunctivitis and conjunctivitis-otitis syndrome. Penicillin-nonsusceptible S. pneumoniae was observed in 32% of 65 patients with S. pneumoniae conjunctivitis, with most strains being penicillin resistant.

Anti-Bacterial Agents↗
PubMed1982

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.

Adenoviridae Infections↗
PubMed2006

Clinical features of bacterial conjunctivitis in children.

OBJECTIVES: Conjunctivitis is a common cause of primary care and emergency department (ED) visits. There is a paucity of data in recent literature on the prevalence of pediatric bacterial conjunctivitis, and there are no evidence-based clinical guidelines for empirical treatment. The study objective was to describe clinical features most predictive of bacterial conjunctivitis. METHODS: This was a prospective study in a children's hospital ED. Conjunctival swabs for bacterial culture were obtained from patients aged 1 month to 18 years presenting with red or pink eye and/or the diagnosis of conjunctivitis. RESULTS: A total of 111 patients were enrolled over one year. Patients had a mean (+/-SD) age of 33.2 (+/-37.5) months, and 55% were male. Eighty-seven patients (78%) had positive bacterial cultures. Nontypeable Haemophilus influenzae accounted for 82% (71/87), Streptococcus pneumoniae for 16% (14/87), and Staphylococcus aureus for 2.2% (2/87). Five clinical variables were significantly associated with a positive bacterial culture. Regression analysis revealed that the combination of a history of gluey or sticky eyelids and the physical finding of mucoid or purulent discharge had a posttest probability of 96% (95% confidence interval = 90% to 99%). Subjective scoring by physicians for a positive culture was 50.6%. CONCLUSIONS: Conjunctivitis in children is predominantly bacterial, with nontypeable H. influenzae being the most common organism. A history of gluey or sticky eyelids and physical findings of mucoid or purulent discharge are highly predictive of bacterial infection. Based on the above data, empirical ophthalmic antibiotic therapy may be appropriate in children presenting with conjunctivitis.

Adolescent↗