Determinants of Outcomes of Adenoviral Keratoconjunctivitis

In this study, Dr. Cecilia Lee, Dr. Aaron Lee, and their coauthors performed a retrospective analysis of 500 patients with keratoconjunctivitis to identify the specific pathogens and host factors that were associated with worse outcomes. Conjunctivitis is a very common condition, most often caused by adenovirus D species. In the most severe cases patients can develop subepithelial infiltrates which can lead to vision loss.

Figure 1. Graphs showing the score and viral load reductions on days 1, 3, 6, 11, and 18 by adenoviral (AdV) species. A, Mean composite scores of symptoms in adenoviral keratoconjunctivitis. B, Mean composite scores of signs. C, Mean adenoviral load (copy numbers per milliliter in log₁₀). Participants with AdV D infection are significantly slower in improving signs and symptoms compared with patients infected with one of the remaining AdV species or the AdV-negative group. No significant difference in viral load exists among AdV species on day 1. The viral load of AdV D remains elevated on days 11 and 18 compared with other species. Colors represent different adenoviral species and the adenoviral-negative group. Bars represent 95% confidence intervals. *P < 0.05 indicates a significant difference in scores between different AdV species by analysis of variance (panel C includes adenovirus-positive species only).

There were several interesting findings. The authors identified a much wider variety of pathogens than expected, but also found that in many cases (22%) there was no detectible adenovirus, suggesting that other pathogens may be involved. They found that patients infected with adenovirus D had more severe symptoms and a longer disease course than those infected with other adenoviruses. Around 20% of the patients experienced some vision loss. In addition, patients' country of origin had an effect the evolution of clinical symptoms, development of subepithelial infiltrates, and clearance of viral load, an effect that did not depend on the type of adenovirus involved.

Taken together, the results from this study indicate that there it may be useful to routinely test and identify the adenovirus species in conjunctivitis cases to better predict outcomes and manage outbreaks. Host factors also play a role in determining the course of the disease.

Lee CS, Lee AY, Akileswaran L, Stroman D, Najafi-Tagol K, Kleiboeker S, Chodosh J, Magaret A, Wald A, Van Gelder RN. Determinants of Outcomes of Adenoviral Keratoconjunctivitis. Ophthalmology. 2018 Sep;125(9):1344-1353. doi: 10.1016/ j.ophtha.2018.02.016. Epub 2018 Mar 27. PubMed PMID: 29602567; PubMed Central PMCID: PMC6109430.