Acute Hemorrhagic Conjunctivitis Clinical Presentation
- Author: George Plechaty, MD; Chief Editor: Hampton Roy, Sr, MD more...
Acute hemorrhagic conjunctivitis (AHC) is a rapidly progressive and contagious viral infection.[8, 9]
AHC begins with an initial period of catarrhal inflammation.[10, 11] The presentation becomes more dramatic with the rapid appearance of conjunctival petechiae. These conjunctival petechiae soon coalesce to form subconjunctival hemorrhages. These are associated with a painful, rapidly progressive follicular conjunctivitis. The lids often become swollen and indurated. The infection resolves within 5-7 days, during which the symptoms of pain and irritation are present.
Punctate corneal epithelial defects have been noted and subepithelial corneal opacities have been described.
The most common manifestation of enteroviral infection is a low-grade fever of unknown etiology in infants. While concerned mainly with conjunctivitis here, it should be noted that numerous organ systems can be involved. They range from the myocardium to the central nervous system and can also include the respiratory system and the skin.
The presentation of acute hemorrhagic conjunctivitis (AHC) can be dramatic. Findings include swollen lids, conjunctival follicles, chemosis, and, depending on the stage at which the patient is seen initially, subconjunctival hemorrhages, which can range from petechiae to large areas of conjunctival involvement. The cornea can exhibit superficial epithelial changes.
The symptoms also include are pain and irritation, and the lids and periocular tissues present with marked inflammation.
Khan A, Sharif S, Shaukat S, et al. An outbreak of acute hemorrhagic conjunctivitis (AHC) caused by coxsackievirus A24 variant in Pakistan. Virus Res. 2008 Oct. 137(1):150-2. [Medline].
Wu D, Ke CW, Mo YL, et al. Multiple outbreaks of acute hemorrhagic conjunctivitis due to a variant of coxsackievirus A24: Guangdong, China, 2007. J Med Virol. 2008 Oct. 80(10):1762-8. [Medline].
Cabrerizo M, Echevarria JE, Otero A, et al. Molecular characterization of a coxsackievirus A24 variant that caused an outbreak of acute haemorrhagic conjunctivitis in Spain, 2004. J Clin Virol. 2008 Nov. 43(3):323-7. [Medline].
Goh KT, Ooi PL, Miyamura K, et al. Acute haemorrhagic conjunctivitis: seroepidemiology of coxsackievirus A24 variant and enterovirus 70 in Singapore. J Med Virol. 1990 Jul. 31(3):245-7. [Medline].
Moura FE, Ribeiro DC, Gurgel N, et al. Acute haemorrhagic conjunctivitis outbreak in the city of Fortaleza, northeast Brazil. Br J Ophthalmol. 2006 Sep. 90(9):1091-3. [Medline].
Aoki K, Sawada H. Long-term observation of neutralization antibody after enterovirus 70 infection. Jpn J Ophthalmol. 1992. 36(4):465-8. [Medline].
Chen TM, Liu RC. [Study on the efficacy of quarantine during outbreaks of acute hemorrhagic conjunctivitis outbreaks at schools through the susceptive-infective-quarantine-removal model]. Zhonghua Liu Xing Bing Xue Za Zhi. 2013 Jan. 34(1):75-9. [Medline].
Wright PW, Strauss GH, Langford MP. Acute hemorrhagic conjunctivitis. Am Fam Physician. 1992 Jan. 45(1):173-8. [Medline].
Peter G, ed. Report on the committee of infectious diseases. Red Book. 24th ed. 1997. 198-199.
Rubenstein JB. Disorders of the conjunctiva and limbus. Yanoff MA, Duker JS, eds. Ophthalmology. Mosby; 1995. 5.1.5.
Spencer WH, Zimmerman LE. Conjunctiva. Spencer WH, ed. Ophthalmic Pathology. 1985. Vol 1: 130-131.
Moshirfar M, Fenzl CR, Li Z. What we know about ocular manifestations of Ebola. Clin Ophthalmol. 2014. 8:2355-7. [Medline].
Park SW, Lee CS, Jang HC, et al. Rapid identification of the coxsackievirus A24 variant by molecular serotyping in an outbreak of acute hemorrhagic conjunctivitis. J Clin Microbiol. 2005 Mar. 43(3):1069-71. [Medline].
Nigrovic LE, Chiang VW. Cost analysis of enteroviral polymerase chain reaction in infants with fever and cerebrospinal fluid pleocytosis. Arch Pediatr Adolesc Med. 2000 Aug. 154(8):817-21. [Medline].
Vajpayee RB, Sharma N, Chand M, et al. Corneal superinfection in acute hemorrhagic conjunctivitis. Cornea. 1998 Nov. 17(6):614-7. [Medline].
Xiao XL, Wu H, Li YJ, Li HF, He YQ, Chen G, et al. Simultaneous detection of enterovirus 70 and coxsackievirus A24 variant by multiplex real-time RT-PCR using an internal control. J Virol Methods. 2009 Jul. 159(1):23-8. [Medline].
Spencer WH, ed. Ophthalmic Pathology. 1985. Vol 1:128-131.
Jun EJ, Nam YR, Ahn J, et al. Antiviral potency of a siRNA targeting a conserved region of coxsackievirus A24. Biochem Biophys Res Commun. 2008 Nov 14. 376(2):389-94. [Medline].
Tan EL, Marcus KF, Poh CL. Development of RNA interference (RNAi) as potential antiviral strategy against enterovirus 70. J Med Virol. 2008 Jun. 80(6):1025-32. [Medline].
Jun EJ, Won MA, Ahn J, et al. An antiviral small-interfering RNA simultaneously effective against the most prevalent enteroviruses causing acute hemorrhagic conjunctivitis. Invest Ophthalmol Vis Sci. 2011 Jan. 52(1):58-63. [Medline].