Pharyngoconjunctival Fever
Pharyngoconjunctival Fever
Introduction
Background
Adenoviruses are the most common cause of acute viral infections of the conjunctiva, occurring epidemically or sporadically throughout all seasons. Clinically, 4 syndromes of adenoviral ocular infection have been recognized, as follows: epidemic keratoconjunctivitis, pharyngoconjunctival fever (PCF), nonspecific sporadic follicular conjunctivitis, and chronic papillary conjunctivitis.
This article focuses on PCF, an acute and highly infectious illness characterized by fever, pharyngitis, acute follicular conjunctivitis, and regional lymphoid hyperplasia with tender, enlarged preauricular adenopathy.
Pathophysiology
The adenoviruses consist of a group of 35 morphologically similar but antigenically distinct DNA viruses that share a common complement-fixing antigen. Ubiquitous throughout the world, these extremely stable, ether-resistant organisms cause infections of the upper respiratory tract and the eye. PCF most frequently is caused by adenovirus serotypes 3 and 7, but serotypes 2, 4, and 14 also have been documented as etiologic agents. In addition, sporadic outbreaks caused by serotypes 1, 5, 6, 8, 11, and 19 have been reported.
Transmission occurs through contact with infected upper respiratory droplets or fomites, or through swimming pools, in which fecal excretion of the virus is believed to be responsible. Communicability ranges from 100% during the first few days to 0% by 10-15 days after the onset of symptoms. The incubation period after exposure is 5-12 days (average, 8 d).
Frequency
United States
Because PCF occurs epidemically and sporadically, the frequency is not known.
Mortality/Morbidity
Many cases are self-limited and mild, although chronic infections have been reported. Long-term ocular sequelae are rare.
Sex
PCF occurs equally in men and in women.
Age
Disease is seen predominantly in children and institutionalized individuals, with epidemics occurring within families, schools, prisons, ships, and military organizations.
Clinical
History
Patients may give a history of recent exposure to an individual with red eye at home, school, or work, or they may have a history of recent symptoms of an upper respiratory tract infection.
PCF is characterized by its associated systemic manifestations. Patients experience a sudden or gradual onset of fever ranging from 100-104°F, lasting up to 10 days. Myalgia, malaise, and GI disturbances frequently are associated with the fever. The pharyngitis may be mild or quite painful.
Initial symptoms of conjunctivitis range from slight itching and burning to marked irritation and tearing, but little photophobia. Swelling of the lids may occur within 48 hours.
Signs of disease include epiphora, conjunctival hyperemia and chemosis, subconjunctival hemorrhage, follicular or mild papillary conjunctival reaction, and eyelid edema.
Mild crusting of the lids and discharge may occur; if present, it usually is serous.
PCF most frequently is bilateral, with one eye typically having onset 1-3 days prior to the second eye. With bilateral disease, the first eye generally is affected more severely.
Physical
On general examination, look for a reddened posterior oropharynx covered with glassy follicles. Nontender cervical lymphadenopathy and tender, enlarged preauricular adenopathy may be present.
On ophthalmic examination, the conjunctivitis presents initially as a diffuse hyperemia that is generally more pronounced in the lower fornix but extends throughout the palpebral mucosa and onto the bulbar conjunctiva. It may be sufficiently boggy to give a slightly gelatinous appearance to the tissue.
The lower lid may be tender to palpation and ecchymotic, giving the appearance of recent ocular trauma. Conjunctival membranes and pseudomembranes are infrequent but may be present.
Causes
Adenoviruses are the most common cause of acute viral infections.
