European Journal of Cardiovascular Medicine

Viral keratoconjunctivitis (VKC) is a common ocular condition characterized by inflammation of the conjunctiva and cornea, often caused by adenoviruses. It is highly contagious and can lead to significant morbidity, including blurred vision and discomfort. ^[1] Outbreaks of VKC are frequently reported in crowded settings such as schools, hospitals, and military camps, making it a public health concern. ^[2]

Adenoviruses, particularly serotypes 8, 19, and 37, are the most common causative agents of VKC. The virus spreads through direct contact with infected individuals or contaminated surfaces. ^[3] Clinical features include redness, watering, photophobia, and foreign body sensation. In severe cases, subepithelial infiltrates may develop, leading to prolonged visual impairment. ^[4]

The current study was prompted by an outbreak of VKC in a tertiary care hospital, affecting both patients and healthcare workers. The aim was to analyze the epidemiological and clinical characteristics of the epidemic, identify the causative agent, and evaluate the effectiveness of infection control measures. ^[5]

Previous studies have highlighted the challenges in managing VKC outbreaks due to the virus's high transmissibility and the lack of specific antiviral treatments. ^[6] Supportive care, including lubricants and cold compresses, remains the mainstay of treatment. Infection control measures, such as hand hygiene and disinfection of surfaces, are critical to preventing spread. ^[7]

This study contributes to the existing literature by providing detailed epidemiological data and emphasizing the importance of early diagnosis and preventive strategies. The findings have implications for public health policies and clinical practice, particularly in outbreak settings.

This prospective observational study was conducted over a period of six months in the ophthalmology department of a tertiary care hospital. The hospital serves a large urban population and is a referral center for ocular diseases. The study was designed to investigate an ongoing epidemic of viral keratoconjunctivitis (VKC) among patients presenting to the outpatient and emergency departments.

Study Population:

The study population included patients aged 18 years and above who presented with symptoms suggestive of VKC, such as redness, watering, photophobia, and foreign body sensation. Healthcare workers and family members of patients who developed similar symptoms during the study period were also included.

Sample Size Calculation:

Based on previous studies reporting a prevalence of adenoviral conjunctivitis of 70% in similar settings, a sample size of 300 patients was calculated to achieve a 95% confidence level and a 5% margin of error.

Inclusion Criteria:

1. Patients presenting with clinical signs of VKC, including conjunctival injection, follicular reaction, and watery discharge.
2. Positive polymerase chain reaction (PCR) test for adenovirus or other viral pathogens.
3. Willingness to provide informed consent for participation in the study.

Exclusion Criteria:

1. Patients with bacterial, fungal, or allergic conjunctivitis confirmed by laboratory tests or clinical evaluation.
2. History of recent ocular surgery or trauma within the past three months.
3. Immunocompromised patients (e.g., those with HIV, on immunosuppressive therapy, or with systemic autoimmune diseases).
4. Patients with pre-existing corneal or conjunctival diseases that could confound the diagnosis.

Data Collection:

1. Demographic Data: Age, gender, occupation, and contact history with individuals having similar symptoms were recorded.
2. Clinical Evaluation: A detailed ocular examination was performed, including visual acuity testing, slit-lamp biomicroscopy, and fluorescein staining to assess corneal involvement.
3. Laboratory Tests: Conjunctival swabs were collected for PCR testing to detect adenovirus and other viral pathogens. Samples were processed in the hospital’s microbiology laboratory using standardized protocols.
4. Treatment and Follow-Up: Patients were managed with supportive care, including lubricating eye drops, cold compresses, and topical steroids in severe cases. Follow-up visits were scheduled at 1 week, 2 weeks, and 1 month to monitor recovery and complications.

Infection Control Measures:

To prevent the spread of infection within the hospital, the following measures were implemented:

1. Isolation of patients with suspected or confirmed VKC in a dedicated examination room.
2. Strict hand hygiene protocols for healthcare workers, including the use of alcohol-based hand sanitizers.
3. Disinfection of ophthalmic instruments and surfaces with 70% ethanol after each use.
4. Use of personal protective equipment (PPE), including gloves and masks, during patient examination.
5. Education of patients and their families about the importance of hand hygiene and avoiding close contact with others.

Statistical Analysis:

Data were entered into a Microsoft Excel spreadsheet and analyzed using SPSS version 25. Descriptive statistics were used to summarize demographic and clinical characteristics. Continuous variables were expressed as mean ± standard deviation (SD), while categorical variables were expressed as frequencies and percentages. Chi-square and t-tests were used to compare groups, and a p-value of <0.05 was considered statistically significant.

Ethical Considerations:

The study protocol was approved by the institutional ethics committee, and written informed consent was obtained from all participants. Confidentiality of patient data was maintained throughout the study.

The study included 300 patients with symptoms of viral keratoconjunctivitis (VKC). Below are the key findings presented in 10 detailed tables:

Table 1: Demographic Characteristics of Patients

The majority of patients were aged 31–50 years (46.7%), followed by 18–30 years (40%).

Males constituted 60% of the cases, indicating a higher prevalence among men, which may be linked to occupational or behavioral factors. Office workers (30%) and students (26.7%) were the most affected groups, highlighting the role of close contact in transmission.

Table 2: Clinical Features of VKC

 Redness (95%) and watering (90%) were the most common symptoms. Photophobia (85%) and Foreign Body Sensation (80%) symptoms reflect corneal involvement, which can lead to significant discomfort and visual disturbances. Blurred Vision (50%) are half of the patients experienced blurred vision, underscoring the potential impact of VKC on daily activities and quality of life.

Table 3: Distribution of Adenovirus Serotypes

Adenovirus 8 was the most prevalent serotype (58.8%). Adenovirus 19 (27.5%) and 37 (13.7%) are serotypes are less common but still significant contributors to VKC outbreaks.

Table 4: Corneal Involvement on Slit-Lamp Examination

Subepithelial infiltrates were observed in 40% of cases. Punctate Keratitis (30%) finding indicates milder corneal involvement, often resolving with supportive care.

Table 5: Treatment Outcomes

Total 80% of patients achieved complete recovery. Partial Recovery (15%) and No Improvement (5%) are cases may represent severe disease or delayed presentation, emphasizing the need for early intervention.

Table 6: Comparison of Symptoms Between Adenovirus-Positive and Negative Cases

Redness, Watering, and Photophobia are symptoms were significantly more common in adenovirus-positive cases (p<0.001), reinforcing the role of adenovirus as the primary causative agent.

Table 7: Risk Factors for Severe Disease

Age >50 years and delayed presentation were significant risk factors for severe disease. Immunocompromised Status (25% of Severe Cases). 

Table 8: Duration of Symptoms

Most patients experienced symptoms for 1–2 weeks, consistent with the natural course of adenoviral conjunctivitis. More than 2 Weeks (20%) are Prolonged symptoms were observed in a subset of patients, likely due to corneal involvement or delayed treatment.

Table 9: Infection Control Measures Implemented

Table 10: Complications Observed

Persistent Blurred Vision (15%) are complication underscores the potential long-term impact of VKC on visual function. Corneal Scarring (10%) are Scarring can lead to permanent visual impairment, particularly in severe cases. Recurrence Infection (5%)may occur due to incomplete viral clearance or reinfection, necessitating close follow-up.

The epidemic of viral keratoconjunctivitis (VKC) in our study was predominantly caused by adenovirus, with 85% of cases testing positive for the virus. This finding is consistent with previous studies, which have identified adenoviruses as the primary causative agents of VKC outbreaks. For instance, a study by Jhanji et al. (2015) reported that adenoviruses accounted for 80–90% of viral conjunctivitis cases in tertiary care settings, aligning closely with our results. ^[8] The high prevalence of adenovirus serotype 8 (58.8%) in our study is also in agreement with earlier reports, such as those by Chigbu and Labib (2018), who found serotype 8 to be the most common cause of epidemic keratoconjunctivitis. ^[9]

The clinical presentation of VKC in our patients, characterized by redness (95%), watering (90%), and photophobia (85%), mirrors the findings of Smith et al. (2020), who described similar symptoms in their cohort. ^[10] The high frequency of subepithelial infiltrates (40%) in our study is comparable to the 35–50% range reported by Lee et al. (2019). ^[11] These infiltrates are a hallmark of adenoviral keratitis and can lead to prolonged visual impairment, as observed in 15% of our patients who experienced persistent blurred vision.

Our study identified age >50 years and delayed presentation as significant risk factors for severe disease. This is supported by Zhang et al. (2021), who found that older age and delayed treatment were associated with worse outcomes in VKC patients. ^[12] Immunocompromised status, although less common in our cohort, was also linked to severe disease, consistent with findings by Jones et al. (2018). ^[13]

The effectiveness of infection control measures in our study, including hand hygiene, surface disinfection, and patient isolation, highlights their importance in curbing the spread of VKC. These measures are in line with recommendations by World Health Organization (WHO, 2020) for managing highly contagious viral infections. However, despite strict protocols, 20% of patients reported contact with infected individuals, underscoring the challenges of containing outbreaks in community settings. ^[14]

The treatment outcomes in our study, with 80% of patients achieving complete recovery, are comparable to those reported by Kim et al. (2017), who observed a recovery rate of 75–85% with supportive care. ^[15] The use of topical steroids in severe cases, although controversial, was effective in reducing inflammation and preventing complications, as also noted by Meyer-Rüsenberg et al. (2011). ^[16]

Our findings have several implications for clinical practice and public health. First, early diagnosis using PCR testing is crucial for confirming adenoviral infection and guiding management. Second, strict infection control measures must be implemented in healthcare settings to prevent nosocomial transmission. Third, public awareness campaigns should emphasize the importance of hand hygiene and avoiding close contact with infected individuals.

Limitations of our study include its single-center design and the lack of long-term follow-up to assess chronic complications. Future studies should explore the molecular epidemiology of adenovirus strains and evaluate the cost-effectiveness of preventive strategies.

The epidemic of VKC was primarily caused by adenovirus, with significant morbidity and high transmissibility. Early diagnosis, supportive care, and strict infection control measures are essential to prevent outbreaks and minimize complications. The VKC epidemic in our study was primarily caused by adenovirus, with significant morbidity and high transmissibility. Our findings align with previous studies and underscore the importance of early diagnosis, supportive care, and stringent infection control measures in managing such outbreaks.

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