Background
Pharyngoconjunctival fever (PCF) is an acute and highly infectious illness characterized by fever, pharyngitis, acute follicular conjunctivitis, and regional lymphoid hyperplasia with tender, enlarged preauricular adenopathy. [1]
Adenoviruses are the most common cause of acute viral infections of the conjunctiva, [1] occurring epidemically or sporadically throughout all seasons. Clinically, 4 syndromes of adenoviral ocular infection have been recognized, as follows: epidemic keratoconjunctivitis, pharyngoconjunctival fever (PCF), nonspecific sporadic follicular conjunctivitis, and chronic papillary conjunctivitis.
Pathophysiology
The adenoviruses consist of a group of 35 morphologically similar but antigenically distinct DNA viruses that share a common complement-fixing antigen. [2] Ubiquitous throughout the world, these extremely stable, ether-resistant organisms cause infections of the upper respiratory tract and the eye. PCF most frequently is caused by adenovirus serotypes 3 and 7, but serotypes 2, 4, and 14 also have been documented as etiologic agents. In addition, sporadic outbreaks caused by serotypes 1, 5, 6, 8, 11, and 19 have been reported. [3, 4, 5, 6]
Transmission occurs through contact with infected upper respiratory droplets or fomites, or through swimming pools, in which fecal excretion of the virus is believed to be responsible. Communicability ranges from 100% during the first few days to 0% by 10-15 days after the onset of symptoms. The incubation period after exposure is 5-12 days (average, 8 d).
Epidemiology
Frequency
United States
Because PCF occurs epidemically and sporadically, the frequency is not known.
Mortality/Morbidity
Many cases of PCF are self-limited and mild, although chronic infections have been reported. Long-term ocular sequelae are rare.
Sex
PCF occurs equally in men and in women.
Age
Disease is seen predominantly in children and institutionalized individuals, with epidemics occurring within families, schools, prisons, ships, and military organizations.
Prognosis
Most cases of PCF are self-limited and mild, although chronic cases have been reported. Long-term ocular sequelae are rare.
Patient Education
Patients should be counselled about the extremely contagious nature of this infection. [2] Fomites, including napkins, towels, pillowcases, and clothing, should not be shared, and the importance of frequent hand-washing should be emphasized since hand-washing is essential to avoid transmission. Health care workers may be precluded from patient contact for up to 2 weeks because of this infection, particularly if they work regularly with individuals who are immunocompromised. In general, workers with significant contact with people should not work until the weeping stops, which typically takes 1-2 weeks.
