Keratoconjunctivitis epidemica
| Classification according to ICD-10 | |
|---|---|
| B30.0 + | Adenovirus keratoconjunctivitis |
| ICD-10 online (WHO version 2019) | |
The epidemic keratoconjunctivitis (Short medical jargon Epidemica or KCE ) is a viral disease of the connective and cornea of the eye . Due to the strong contagiousness (transferability) and the limited treatment options, the disease is also popularly called eye flu .
Pathogen
Pathogens are generally pathogenic adenovirus , from the species Human Mastadenovirus D the serotypes 8, 19 (only the subtype 19a, 19p causes hemorrhagic cystitis) and 37. These are characterized by particular resistance and long-lasting infectivity outside of the host body from.
Route of infection
It is a highly infectious smear infection that can be transmitted via towels, door handles (especially in swimming pools), etc. Therefore, measures to prevent or prevent the spread of infection are in the foreground. Hygiene measures (such as hand disinfection) are important. Since the second eye is infectious up to the 14th day after the onset of the disease , it makes sense to isolate those affected by taking additional sick leave for about 14 days.
Course of disease
The incubation period of the disease is eight to nine days. Typical is a sudden one-sided onset of the disease with massive tearing, reddening of the conjunctiva , burning sensation, foreign body sensation, swelling of the upper eyelid and the nictitating skin ( plica semilunaris ) and sometimes painful swelling of a lymph node ( lymphadenopathy ) directly in front of the ear or on the lower jaw. As a rule, after a few days (milder) involvement of the second eye occurs.
Nummuli , characteristic corneal opacities that can impair vision in the long term, are the long-term consequences of 25% of sufferers . A failure of the stem cells of the limbus, which form corneal epithelium, and the occurrence of keratoconus are also correlated with a previous keratoconjunctivitis epidemica.
A process mediated by the immune system in which so-called CD4 T helper cells and the activation of immunoglobulin E play a role is responsible for the formation of this cloudiness . This also seems to explain the effectiveness of cyclosporine A eye drops, which have recently come into use after their effects were demonstrated in a large multicenter study.
diagnosis
The diagnosis is usually made by the ophthalmologist on the basis of the clinical picture. In the case of epidemic outbreaks, detection is provided by amplification and sequencing of the samples. Mainly the hexon and the fiber components are sequenced. In some cases it makes sense to sequence the entire genome .
therapy
The natural course of the disease is self-limiting. There is no causal therapy. Antiviral drugs show little success, symptomatically, tear substitutes as eye drops can be useful in the acute phase of the disease. In July 2017, the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) recommended the approval of ciclosporin for the treatment of keratoconjunctivitis.
One possible treatment method is the local application of povidone-iodine in drop or gel form. In a small clinical study, there was a slight reduction in the duration of the disease and a somewhat reduced frequency of numbers. Surgical removal of the opacities using an excimer laser ( phototherapeutic keratectomy , PTK) can also help.
Reporting requirement
Keratoconjunctivitis epidemica is one of the notifiable diseases in Germany . According to Section 7 of the Infection Protection Act, however, reporting is only required if the pathogen adenoviruses is directly detected in an eye swab for laboratories, etc. or if it occurs more frequently.
literature
- Birthe Meyer-Rüsenberg et al .: Keratoconjunctivitis epidemica. Infection situation and current information on prophylaxis and therapy. In: Deutsches Ärzteblatt. 108, No. 27, 2011, pp. 475-480. ( online ; PDF; 426 kB)
Web links
- Keratoconjunctivitis epidemica and other conjunctivitis caused by adenoviruses (PDF; 54 kB) - RKI.de ( HTML version ( Memento from March 3, 2013 in the Internet Archive ))
- Highly Contagious Viral Infection What is Eye Flu? , on: n-tv from February 8, 2020
- Images in Atlas of Ophthalmology
Individual evidence
- ↑ Singhal D et al: Vernal conjunctivitis . Ed .: Surv Ophthalmol. Elsevir, New York 2018.
- ↑ Meeting highlights from the Committee for Medicinal Products for Human Use (CHMP) 17-20 July 2017 , EMA PM of July 21, 2017, accessed on July 28, 2017
- ↑ H. Hutter: Keratoconjunctivitis epidemica: Therapy results during an epidemic (pdf, 95 kB); Clinical monthly sheets for ophthalmology No. 197 (1990)
