Acute Hemorrhagic Conjunctivitis Workup

Updated: Jan 02, 2019
  • Author: Jean Deschênes, MD, FRCSC; Chief Editor: Hampton Roy, Sr, MD  more...
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Approach Considerations

The rapid course and the benign outcome of acute hemorrhagic conjunctivitis (AHC), as well as the difficulty of performing rapid viral studies, make laboratory testing impractical in the clinical setting. More rapid diagnostic tests have been developed and continue to be improved. Neutralizing assays with standardized antisera have been used with good results. These are being supplanted by PCR assay methods, which reduce the time needed for viral typing. These methods involve amplification of the viral nucleotide sequences and their comparison with the sequences of the 66 known serotypes of human enterovirus.


Polymerase Chain Reaction

Park and colleagues reported on a rapid identification method to determine the causative agents of acute hemorrhagic conjunctivitis (AHC). [13] This method uses PCR analysis from conjunctival swab specimens obtained from patients with AHC.

The PCR assay is an in vitro test, which can be used to diagnose AHC by producing large amounts of specific deoxyribonucleic acid (DNA) or ribonucleic acid (RNA) from the infectious agent. [14, 15]


Other Tests

Molecular serotyping

While reliance on virus culture methods persists, rapid identification by molecular serotyping, directly using clinical specimens rather than cell cultures, was evaluated and found to be effective by Park and colleagues in an outbreak in South Korea. [13]

Culture and sensitivity assessment

Culture and sensitivity studies should be obtained in all cases of corneal superinfection and appropriate antibiotics given. [16] A sensitive real-time (RT) PCR test has been used to aid in the rapid clinical diagnosis in cases of this contagious epidemic. [17]

Histologic findings

The initial response to the viral infection in acute hemorrhagic conjunctivitis (AHC) is a mononuclear cell inflammatory response. A watery intercellular exudate is present, which is replaced by subconjunctival blood as the infection progresses. [18]