title: Hemorrhagic viral keratoconjunctivitis in Taiwan caused by adenovirus types 19 and 37: applicability of polymerase chain reaction-restriction fragment length polymorphism in detecting adenovirus genotypes.
abstract: OBJECTIVE
  Acute keratoconjunctivitis with prominent subconjunctival hemorrhage (SCH) is usually perceived by a clinician as acute hemorrhagic conjunctivitis (AHC) associated with enteroviruses; however, SCH can also be an adenoviruses infection. A rapid and sensitive laboratory diagnosis is helpful for differential diagnosis. Therefore, the sensitivity and applicability of polymerase chain reaction (PCR) and reverse transcription (RT)-PCR diagnoses were evaluated for keratoconjunctivitis associated with viral infection.
  
  
  METHODS
  Conjunctival swabs from patients with acute conjunctivitis were tested using a PCR-restriction fragment length polymorphism (PCR-RFLP) for adenovirus detection and RT-PCR for enterovirus detection. The results were compared with those using the culture isolation and neutralization test; also, the clinical findings of the patients were analyzed with special attention to SCH patterns.
  
  
  RESULTS
  Neither coxsackievirus A type 24 variant (CA24v) nor enterovirus type 70 (EV70) was detected in 113 patients with acute conjunctivitis. The positive results of adenovirus (Ad) were 39.9% by the PCR method and 37.1% by culture isolation. For the patients with adenoviral conjunctivitis, 68.1% was owing to Ad37 and 19.2% was owing to Ad19. SCH was present in 51.5% of the positive cases, and 44.7% of the Ad-positive patients had secondary illnesses.
  
  
  CONCLUSIONS
  SCH can be a predominant presentation of Ad19 and Ad37 keratoconjunctivitis and may herald a new stage in the evolution of adenoviruses. PCR and PCR-RFLP are rapid and reliable methods for Ad detection and typing; however, if the amplified genes and restriction enzymes are not properly selected, they may not be able to detect new genotypes of adenoviruses or the evolution of these viruses.
authors.affiliation: Department of Ophthalmology, Kaohsiung Medical University, Taiwan.
authors.forename: C H
authors.initials: CH
authors.lastname: Chang
authors.forename: M M
authors.initials: MM
authors.lastname: Sheu
authors.forename: K H
authors.initials: KH
authors.lastname: Lin
authors.forename: C W
authors.initials: CW
authors.lastname: Chen
mesh_terms: D000258:Adenovirus Infections, Human / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology*; D000260:Adenoviruses, Human / Q000235:genetics* / Q000254:growth & development / Q000302:isolation & purification; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003228:Conjunctiva / Q000821:virology; D003232:Conjunctivitis, Acute Hemorrhagic / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology*; D017931:DNA Primers / Q000737:chemistry; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012150:Polymorphism, Restriction Fragment Length; D011446:Prospective Studies; D013624:Taiwan / Q000453:epidemiology; D014776:Virus Cultivation
chemical_list: D017931:DNA Primers; D004279:DNA, Viral