Pharyngoconjunctival Fever - Causes, Symptoms, Diagnosis, and Management

Introduction

Pharyngoconjuntival fever (PCF) is a chronic, extremely contagious fever affecting the pharynx and the eyes. It has a deleterious effect on the patient's quality of life. It is mainly characterized by fever, pharyngitis, lymphadenopathy, and acute follicular conjunctivitis (eye infection). It is commonly seen in children and is usually bilateral. The other eye shows symptoms one to three days after the first eye. However, the symptoms in the second eye are usually mild.

What Is the Main Cause of Pharyngoconjunctival Fever?

Adenovirus is a double-stranded deoxyribonucleic acid (DNA) virus analogous to upper respiratory tract infection. PCF is most commonly associated with type 3 and type 4 adenoviruses. Occasionally, other subtypes of the adenovirus may be involved with PCF.

How Is Pharyngoconjunctival Fever Transmitted From Infected Person to a Healthy Individual?

PCF is more infectious in the initial eight days of incubation. PCF infection is highly contagious. Following are the different routes of transmission for the virus-

• Air droplets from infected persons.

• Contaminated swimming pool.

• Contaminated inert objects like door handles, plates, etc.

Who Are Most Vulnerable to Pharyngoconjunctival Fever?

The population that is at an increased risk of contracting PCF are:

• Cohabitation with an infected person at home, college, or workplace.

• Children.

• Institutionalized people.

• Prisons inmates.

• Military officials.

What Are the Various Clinical Signs and Symptoms Associated With Pharyngoconjunctival Fever?

PCF presents with systemic and ocular manifestations within five days after the first exposure to the virus. PCF affects both eyes, one eye usually preceding the other eye.

• Systemic manifestations related to PCF include -

  • Sudden onset of high-grade fever (104° F) lasting for ten days.

  • Malaise and myalgia.

  • Pharyngitis (inflammation of the pharynx).

  • Gastrointestinal disturbances.

• Ocular signs and symptoms associated with PCF are -

  • Redness and swelling of the conjunctiva.

  • Irritation, itching, and burning sensation of the eyes.

  • Epiphora is defined as the increased production of tears caused by poor drainage or increased tear production.

  • Swelling and ecchymosis (discoloration of the skin due to bruising of the subepithelial tissue) of the eyelids.

  • Tender preauricular and non-tender cervical lymphadenopathy (inflammation of the lymph nodes).

  • Keratitis is inflammation of the cornea.

  • Photophobia is described as sensitivity to light.

How Is the Diagnosis of Pharyngoconjunctival Fever Articulated?

The diagnosis of PCF is mainly achieved by clinical examination.

• Clinical evaluation of the eye by slit-lamp technique initially reveals diffuse hyperemia of the eye in the fornix region. Membranes and pseudomembranes of the conjunctiva occasionally occur with other clinical manifestations.

Diagnostic tests are adjuncts to the clinical diagnosis and help to rule out other similar conditions. The numerous diagnostic tests employed for the diagnosis of PCF are:

• Culturing the virus is the gold-standard method for identifying the virus. It is done in the acute phase of the disease.

• Real-time polymerase chain reaction (RT-PCR) is the latest test used to detect the virus. It has a high sensitivity rate.

• Cytology of the conjunctival scrapings is stained with Giemsa stain for detecting intranuclear bodies.

• Serological tests like complement fixation tests, fluorescent antibody tests, and immune enzyme assays are all employed to assess antigen-antibody reactions.

What Are the Complications Linked to Pharyngoconjunctival Fever?

Prolonged PCF results in the following complications:

• Punctate keratitis is characterized by the death of cells on the superficial surface of the cornea. It often results in impaired vision.

• Subepithelial infiltrates are seen mainly in PCF. They represent the delayed type of immune response.

• Secondary bacterial infection.

• Chronic infection.

Diseases That Have Similar Findings With Pharyngoconjunctival Fever:

The diseases that mimic PCF include:

• Chlamydial conjunctivitis is a disease of the newborn, occurring within twelve days of birth. It is described by redness of the eye, swelling of the eyelids, and pus discharge. It is bacterial in origin.

• Allergic conjunctivitis is the inflammation of the conjunctiva due to numerous allergens like airborne allergens. It results in teary eyes, itching, roopy discharge, and swelling.

PCF is differentiated from other forms of conjunctivitis by obtaining a complete history and performing diagnostic tests.

What Are the Different Measures Adopted to Manage Pharyngoconjunctival Fever?

There is no definite cure for PCF perse. The main goal of treatment is to reduce the symptoms and prevent complications.

• Palliative management of PCF includes:

  • Administration of cold compress and artificial tears.

  • Topical anti-inflammatory drugs help, like NSAIDs (nonsteroidal anti-inflammatory drugs) and corticosteroids, reduce inflammation. Steroids are given in severe cases with subepithelial infiltrates. Tapering the dose and regular monitoring of patients under steroids is crucial. Long-term use of steroids may lead to increased viral shedding.

  • Topical antihistamines are prescribed to reduce the itching sensation.

  • Topical antimicrobials are given to reduce the microbial load.

  • Topical germicidal drugs like Povidone-iodine, along with steroids, help in decreasing the symptoms and viral titers.

• Surgical management of PCF is conducted in rare conditions. Patients suffering from cicatricial conjunctivitis (chronic conjunctivitis with fibrosis of the conjunctiva leading to vision loss) and symblepharon (a pathological condition of the eye defined by adhesion of bulbar and palpebral conjunctiva) are treated surgically. The various modes of surgical intervention encompass;

  • Excimer laser photo keratectomy.

  • Fornix reconstruction is the procedure of reconstructing the shallows fornix in the eye. Deep fornix helps in motility.

  • Entropion repair is a surgical procedure performed to correct the everted eyelid.

What Are the Various Steps Undertaken to Prevent the Spread of Virus in the Pharyngoconjunctival Fever?

Preventive measures employed by healthcare workers, patients, and their caregivers to prevent the spread of the virus include:

• Proper hand hygiene measures, including regular washing of hands and wearing disposable gloves.

• Patients with PCF should be isolated, and their articles should not be shared.

• Proper cleaning of instruments with sodium hypochlorite used to care for PCF patients.

• Avoid eye contact with the instruments used for PCF patients.

• A separate red-eye room is allocated for patients suffering from PCF.

Prognosis of Pharyngoconjunctival Fever:

PCF overall enjoys an excellent prognosis. The presence of infiltrates in the subepithelium is related to impaired vision. The condition is self-limiting in nature. It usually resolves within three weeks.

Conclusion

PCF is a benign, contagious condition of the eye. It affects people living in crowded regions with affected patients. It is easily diagnosed clinically and resolves by itself. Patient education will help in reducing the overall economic burden of the disease.