Management of Adenoviral Keratoconjunctivitis: Challenges and Solutions

Labib, Bisant A; Minhas, Bhawanjot K; Chigbu, DeGaulle I

infection can also occur. 3, 11 Kosulin et al suggested that latent HAdV infection of the gut lymphoid cell could serve as a source of release of HAdV particles in the community. 18 Garnett et al demonstrated the asymptomatic persistence of group C adenovirus in human mucosal T lymphocytes or lymphoid tissue following primary adenoviral infection. 17 The stimulation of these adenovirus containing mucosal T-lymphocytes results in reactivation of latent HAdV with consequential leakage of reactivated viruses into intestinal epithelial cells, where adenoviruses undergo replication and subsequent shedding in stool. 11, 17, [19] [20] [21] This is indicative of persistent subclinical HAdV infection of the gut-associated lymphoid tissue. 20 Immunocompetent individuals are likely to shed less HAdV into their stool, in contrast to those who are immunocompromised, where significant amounts of HAdV are released. Immunocompromised individuals are also more likely to have reactivation of HAdV with productive infection of intestinal epithelial cells and consequential extensive viral dissemination in the community. As such, in the immunocompromised state, reactivation of persistent latent HAdV is an essential cause of HAdV dissemination. 18 These resultant, latent adenoviral infections are considered a significant challenge in managing and containing the virus within the community due to persistent adenoviral shedding and its high propensity of spread via hand-to-eye contact by those contaminated with fecal matter. 18 Another significant challenge in managing adenoviral infections, particularly in Group D HAdV, is the propensity for this group to cause oculogenital infection. Several published cases have demonstrated that Group D HAdV can be associated with concurrent urethritis and conjunctivitis. [22] [23] [24] [25] [26] HAdV 19 and 37 specifically have been sequestered from genital tracts of young adults with EKC, indicating the possibility of sexual transmission. 25, 26 Group D HAdV type 37, for example, has been isolated from sexually active men with adenoviral urethritis. 24 Additionally, Liddle et al discussed eight cases of individuals presenting with concurrent conjunctivitis and adenoviral urethritis. 23 Avolio et al also presented a case of two male patients with HAdV D37 associated urethritis and conjunctivitis, in which one of the spouses contracted adenoviral conjunctivitis via oculogenital contact. These cases highlight the importance of testing for the presence of adenovirus in clinical specimens collected from both urethral and conjunctival swab in men presenting with conjunctivitis, dysuria, and scant urethral discharge. 22