Epidemic Haemorrhagic Conjunctivitis

First recognized in Ghana in 1969, epidemic acute haemorrhagic conjunctivitis has caused epidemics in a number of parts of the world, which have given their name to the disease (e.g. Nairobi eye).

Organism Enterovirus 70 is the most important aetiological agent and has been responsible for tens of millions of cases. Coxsackievirus A24 has also been responsible for large outbreaks.

Clinical features The infection starts suddenly, with pain and sub-conjunctival haemorrhages. There is often much swelling and discomfort in the eye; however, it is a self-limiting condition, terminating within 1-2 weeks. In a few cases, there are systemic effects involving the upper respiratory tract or central nervous system (CNS). CNS effects are identical to those of poliomyelitis and residual paralysis can occur.

Diagnosis is clinical once the first few cases of an epidemic have been identified. Laboratory confirmation can be made by isolating the virus from a conjunctival swab.

Transmission is from one person to another from the discharges of infected eyes. Where there are systemic infections, transmission may be by the respiratory route. As with trachoma, intra-familial transmission is common and in situations of poor hygiene and overcrowding, large epidemics can occur.

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