acute hemorrhagic conjunctivitis
Introduction
Introduction to acute hemorrhagic conjunctivitis Acute hemorrhagic conjunctivitis (AHC) is a newly discovered eye disease caused by enterovirus type 70. It has spread to all parts of the world and has become one of the most common eye diseases in humans. Strong and can be characterized by subconjunctival hemorrhage and corneal epithelial damage. The disease occurs mostly in summer and autumn, mainly through water or direct contact infection. Humans are generally susceptible to this disease, and there is no gender difference, which can occur at all ages. The disease occurs mostly in summer and autumn, mainly through water or direct contact infection. Humans are generally susceptible to this disease, and there is no gender difference. It can occur at all ages. Although the infection rate is high in children under 10 years old, the incidence rate is low. For recessive infections, adults, especially those aged 20 to 40, account for more than 80% of the incidence. After the disease, some immunity can be left, but repeated infections can still occur. basic knowledge The proportion of sickness: 0.2% - 0.5% Susceptible people: 20 to 40 years old Mode of infection: infection through water or direct contact Complications: conjunctivitis headache
Cause
Causes of acute hemorrhagic conjunctivitis
In the world, when the disease is endemic, a new type of microRNA virus is isolated. The virus is about 20-30 nanometers in diameter, spherical, RNA single-virus, acid-resistant, ether-resistant, resistant to iodine, sensitive to heat. It can be inactivated by heating to 50 ° C minutes, and can grow on Hela cells and human embryo lung cell culture medium. The virus is a neurotropic virus. Some strains can make monkeys when inoculated into monkeys by brain or spinal cord. Causes nerve damage, or lower limbs flaccid paralysis, as the pathogen of this disease is caused by enterovirus 70 in picornavirus, and recently found another enterovirus Coxsackie A24 can also cause the same clinical lesions .
The disease occurs mostly in summer and autumn, mainly through water or direct contact infection. Humans are generally susceptible to this disease, and there is no gender difference. It can occur at all ages. Although the infection rate is high in children under 10 years old, the incidence rate is low. For recessive infections, adults, especially those aged 20 to 40, account for more than 80% of the incidence. After the disease, some immunity can be left, but repeated infections can still occur.
Prevention
Acute hemorrhagic conjunctivitis prevention
During the epidemic, its main measures were:
1 Personal hygiene: Do not use dirty hands to blink, implement a separate towel.
2 Public Health: Strict management of swimming pools, bathrooms, hairdressers, and baths and washbasins in collective units.
3 Isolation of infectious sources: Isolation measures should be taken for patients to prevent transmission. During the epidemic, the quarantine work should be strengthened for stations and terminals, and patient outflows should be strictly prohibited.
4 Do not use preventive eye drops in the absence of a valid antiviral drug to cross-infect rabbits;
5 Strengthen disinfection work: Enterovirus is sensitive to heat and dryness. It can be inactivated by heating to 60 ° C minutes. Common disinfectants such as alcohol (50% 30 seconds, 70% 10 less, 90% 10 seconds), iodine ( 0.2% PA iodine 1 minute), carbolic acid (1% 5 minutes) and cresol (3% 15 minutes) have good inactivation, it is recommended to wash hands with 70% alcohol (90% irritating) Waiting for drying, as a disinfection measure, clinical experiments prove that the use of interferon eye can prevent the occurrence of this disease, due to the high economic value, there is no practical application value during the pandemic.
There is no effective method for the prevention of complications of the nervous system. During the period of AHC, avoiding fatigue and prohibiting intramuscular injection may have a certain effect on alleviating symptoms or reducing the occurrence of the complication.
Complication
Acute hemorrhagic conjunctivitis complications Complications conjunctivitis headache
In most cases, there may be swelling of the anterior submandibular lymph nodes and tenderness. This symptom disappears with the regression of conjunctivitis. In rare cases, iritis may still occur.
Neurological complications are rare in clinical practice. Currently, there are only 35 cases in India, 8 cases in Senegal, 33 cases in Taiwan, and 10 cases in Shanghai. The Shenye comprehensive literature reports that the complications have the following characteristics:
More than 1 occurs in adult males;
2 often occurs 2 to 3 weeks after conjunctivitis;
3 prodromal symptoms include fever, fatigue, headache and flu-like symptoms;
4 The initial manifestations of nerve root irritation and rapid muscle weakness, a few days after the performance of exercise paralysis;
5 is flaccid, mainly involving the lower limbs;
6 Emphasis can cause muscle atrophy, mild or moderate can return to normal, although the incidence of these neurological complications is very low, but more serious, and can leave permanent paralysis.
Symptom
Acute hemorrhagic conjunctivitis symptoms Common symptoms Scleral bleeding eyesight increased eye pain nerve root stimulation muscle atrophy conjunctival congestion conjunctival edema and corneal ulcers tears nasal congestion paralysis
1. Incubation period
The incubation period is short, generally about 24 hours, and the longest is no more than 3 days. The laboratory can inoculate the eye in the wrong way, and the virus can be isolated from the eye within 18 to 36 hours.
2, sleeping symptoms
The onset is urgent. It can be either binocular or monocular at the beginning, but it quickly affects both eyes. After the onset, there is a strong foreign body sensation, eye pain and fear of light tears. The secretion begins to be serous and later becomes mucus. Cellulose, general virginity develops at the apex of 1 to 2 days, gradually decreases after 3 to 4 days, returns to normal after 7 to 10 days, and a few cases have headache, fever, nasal congestion, sore throat and other symptoms.
3, symptoms
Including swelling of the eyelids, subconjunctival hemorrhage, multiple corneal epithelial exfoliation, punctate subepithelial infiltration, conjunctival hyperemia, edema, conjunctival follicles and swollen lymph nodes.
(1) eyelid swelling
Different in weight, all patients can occur, its swelling is edematous, without red pain, usually disappears in a few days.
(2) Conjunctival performance
1) subconjunctival hemorrhage: the incidence rate is as high as 70% or more, so there is "acute hemorrhagic conjunctivitis", the predilection site is above the iliac crest, the bleeding is mostly spots or flakes, the color is bright red, and the entire conjunctiva can be affected in severe cases. There are bleeding underneath, which is very similar to traumatic subconjunctival hemorrhage. Hemorrhage occurs within 1~2 days. Light is absorbed by one week or so, and severe one takes 1 month to absorb. Clinically, it is divided into two according to whether there is bleeding under the subconjunctiva. Type: Hemorrhagic type is more common in young patients; edema type is found in elderly patients.
2) Follicular formation: less than EKC, early due to edema of the conjunctiva edema is not obvious, after 3 to 4 days to wait for edema to subside, in order to find more small follicular formation in the conjunctiva.
(3) corneal performance
1) Multiple multi-membrane epithelial exfoliation: the incidence is high. After three hours of onset, the corneal epithelium can have multiple epithelial exfoliation of the needle size, which is scattered or arranged in strips and distributed in a sheet shape, causing eye pain and foreign body sensation. The main reason is that after 3 to 4 days, it can disappear on its own, and a few last for more than 2 weeks.
2) punctate subepithelial infiltration: 30% of patients with conjunctivitis subsided after punctate epithelial infiltration, usually only a few infiltration points, mostly in the center of the cornea, must be found through the slit lamp, most in 1 ~ After 4 weeks, it disappears on its own, and generally does not cause visual impairment. The cortisol is in the eye and disappears within a few days.
(4) Other symptoms
In most cases, there may be swelling of the anterior submandibular lymph nodes and tenderness. This symptom disappears with the regression of conjunctivitis. In rare cases, iritis may still occur.
(5) Neurological complications
It is rare in clinical practice. At present, there are only 35 cases in India, 8 cases in Senegal, 33 cases in Taiwan, and 10 cases in Shanghai. The Shenye comprehensive literature reports that the complications have the following characteristics: 1 occurs in adult males. 2 often occurs 2 to 3 weeks after conjunctivitis. 3 prodromal symptoms include fever, burnout, headache and flu-like symptoms. 4 Initial manifestations of nerve root irritation and rapid muscle weakness, a few days after the performance of exercise paralysis. 5 is flaccid, mainly involving the lower limbs. 6 Emphasis can cause muscle atrophy, mild or moderate can return to normal, although the incidence of these neurological complications is very low, but more serious, and can leave permanent paralysis, it is worthy of caution.
Examine
Examination of acute hemorrhagic conjunctivitis
(1) Virus isolation: The virus was isolated from the conjunctival sac of the patient, and the positive rate was the highest on the first day after the disease, and began to decrease after 3 days, and was negative after 5 days.
(2) Serological examination: serological examination can also be used in patients with negative conjunctival virus isolation. The recovery period (about 2 weeks) neutralizing antibody titer is more than 4 times higher than the acute phase to determine the diagnosis.
Diagnosis
Diagnosis and differentiation of acute hemorrhagic conjunctivitis
diagnosis
It is not difficult to diagnose the disease during the pandemic, but it is at the beginning of the epidemic or sporadic cases.
Differential diagnosis
If not noticed, it can be confused with conjunctivitis caused by bacteria or other viruses.
