Adenovirus Type 8-Associated Keratoconjunctivitis: Hospital Infections and Secondary Spread in Stockholm, 1967

Abstract

Epidemic keratoconjunctivitis (EKC) occurred in Stockholm during the first months of 1967. At the Karolinska Hospital, Stockholm, virological examinations were performed in almost all patients with keratoconjunctivitis or non-purulent conjunctivitis seen during this period, altogether 133 persons. By virus isolation or serological evidence adenovirus type 8 infection was confirmed in 20 out of the 27 patients presenting a typical clinical picture of EKC. In 24 patients EKC was initially suspected but the development of the disease and the absence of known exposure spoke against this diagnosis. No adenovirus type 8 was isolated and serological conversion was demonstrated in only one person of this group. No evidence of adenovirus type 8 infection was found in specimens from the remaining 82 patients in whom the diagnosis of EKC was only vaguely suspected, conjunctivitis often being the only symptom. No significant difference was demonstrated between the results of the two alternative procedures used for inoculation of specimens into tissue cultures. However, the direct inoculation procedure, modified according to the experiences obtained, might be the more efficient of the two methods. The virus content of the samples was shown often to be only just above the level of demonstrability by the technique used.

The probable source of infection was traced for most of the 27 typical EKC cases. Eight patients, all of whom had some minor traumatic lesions to the eye, might have been infected at the hospital, probably by contaminated ointments or solutions used for instillation into the eye. Tonometry had not been carried out in any of these patients. In at least 13 cases the disease seems to have been transmitted as secondary spread outside the hospital. Two months after onset of the disease only 2 adult patients had visual impairment. Corneal opacities persisted, however, for more than 6 months in several patients.