Pharyngoconjunctival Fever (PCF)

Pharyngoconjunctival Fever (PCF)

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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.

Adenoviruses are the most common cause of acute viral infections of the conjunctiva, 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.

The adenoviruses consist of a group of 35 morphologically similar but antigenically distinct DNA viruses that share a common complement-fixing antigen. 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. [1, 2, 3, 4]

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).

United States

Because PCF occurs epidemically and sporadically, the frequency is not known.

Many cases of PCF are self-limited and mild, although chronic infections have been reported. Long-term ocular sequelae are rare.

PCF occurs equally in men and in women.

Disease is seen predominantly in children and institutionalized individuals, with epidemics occurring within families, schools, prisons, ships, and military organizations.

Melendez CP, Florentino MM, Martinez IL, Lopez HM. Outbreak of epidemic keratoconjunctivitis caused by adenovirus in medical residents. Mol Vis. 2009. 15:557-62. [Medline].

Dosso AA, Rungger-Brändle E. Clinical course of epidemic keratoconjunctivitis: evaluation by in vivo confocal microscopy. Cornea. 2008 Apr. 27(3):263-8. [Medline].

Ishiko H, Aoki K. Spread of epidemic keratoconjunctivitis due to a novel serotype of human adenovirus in Japan. J Clin Microbiol. 2009 May 6. [Medline].

Artieda J, Pineiro L, Gonzalez M, Munoz M, Basterrechea M, Iturzaeta A, et al. A swimming pool-related outbreak of pharyngoconjunctival fever in children due to adenovirus type 4, Gipuzkoa, Spain, 2008. Euro Surveill. 2009 Feb 26. 14(8):[Medline].

Monnerat N, Bossart W, Thiel MA. [Povidone-iodine for treatment of adenoviral conjunctivitis: an in vitro study]. Klin Monatsbl Augenheilkd. 2006 May. 223(5):349-52. [Medline].

Donnenfeld E, Pflugfelder SC. Topical ophthalmic cyclosporine: pharmacology and clinical uses. Surv Ophthalmol. 2009 May-Jun. 54(3):321-38. [Medline].

Chang CH, Lin KH, Sheu MM, et al. The change of etiological agents and clinical signs of epidemic viral conjunctivitis over an 18-year period in southern Taiwan. Graefes Arch Clin Exp Ophthalmol. 2003 Jul. 241(7):554-60. [Medline].

D’Angelo LJ, Hierholzer JC, Keenlyside RA, et al. Pharyngoconjunctival fever caused by adenovirus type 4: report of a swimming pool-related outbreak with recovery of virus from pool water. J Infect Dis. 1979 Jul. 140(1):42-7. [Medline].

Dawson CR, Sheppard JD. Follicular conjunctivitis In: Duane TA and Jaeger EW, eds. Duane’s Clinical Ophthalmology. Vol. 4. 1989.

Diamante GG, Leibowitz HM. Superficial punctate keratopathy. In: Leibowitz HM and Waring GO, eds. Corneal Disorders: Diagnosis and Management. 2nd ed. 1998:432-479.

Liesegang TJ. Conjunctiva. In: Wright KW, ed. Textbook of Ophthalmology. 1997. 665-690.

McMillan NS, Martin SA, Sobsey MD, et al. Outbreak of pharyngoconjunctival fever at a summer camp — North Carolina, 1991. JAMA. 1992. 267:2867-2868.

Nakayama M, Miyazaki C, Ueda K, et al. Pharyngoconjunctival fever caused by adenovirus type 11. Pediatr Infect Dis J. 1992 Jan. 11(1):6-9. [Medline].

Pavan-Langston D. Viral diseases of the cornea and external eye. In: Albert DM, Jakobiec FA, eds. Principles and Practices of Ophthalmology. Vol. 1. 1994:117-161.

Reed DB. Viral and bacterial conjunctivitis. Prevention of disastrous results. Postgrad Med. 1989 Sep 15. 86(4):103-4, 107-9, 113-4. [Medline].

Rietveld RP, van Weert HC, ter Riet G, Bindels PJ. Diagnostic impact of signs and symptoms in acute infectious conjunctivitis: systematic literature search. BMJ. 2003 Oct 4. 327(7418):789. [Medline].

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van Bijsterveld OP, de Jong JC, Muzerie CJ, Wermenbol AG. Pharyngoconjunctival fever caused by adenovirus type 19. Ophthalmologica. 1978. 177(3):134-9. [Medline].

Enomoto M, Okafuji T, Okafuji T, Chikahira M, Konagaya M, Hanaoka N, et al. Isolation of an intertypic recombinant human adenovirus (candidate type 56) from the pharyngeal swab of a patient with pharyngoconjunctival fever. Jpn J Infect Dis. 2012. 65 (5):457-9. [Medline].

Xie L, Yu XF, Sun Z, Yang XH, Huang RJ, Wang J, et al. Two adenovirus serotype 3 outbreaks associated with febrile respiratory disease and pharyngoconjunctival fever in children under 15 years of age in Hangzhou, China, during 2011. J Clin Microbiol. 2012 Jun. 50 (6):1879-88. [Medline].

Ingrid U Scott, MD, MPH Jack and Nancy Turner Professor of Ophthalmology, Professor of Public Health Sciences, Penn State Eye Center, Pennsylvania State University College of Medicine

Ingrid U Scott, MD, MPH is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Macula Society, Phi Beta Kappa, Retina Society

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Sidney Kimmel Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Hospital

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Ophthalmological Society, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cornea Society, AAO, OMIC, Allergan; Avedro; Bio-Tissue; GSK, Novartis; Shire; Sun Ophthalmics; TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Avedro; Bio-Tissue; Shire.

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

John D Sheppard, Jr, MD, MMSc Professor of Ophthalmology, Microbiology and Molecular Biology, Clinical Director, Thomas R Lee Center for Ocular Pharmacology, Ophthalmology Residency Research Program Director, Eastern Virginia Medical School; President, Virginia Eye Consultants

John D Sheppard, Jr, MD, MMSc is a member of the following medical societies: American Academy of Ophthalmology, American Society for Microbiology, American Society of Cataract and Refractive Surgery, American Uveitis Society, Association for Research in Vision and Ophthalmology

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: 1-800-DOCTORS; AbbVie; Alcon; Aldeyra; Allergan; Alphaeon; ArcScan; Baush+Lomb; Bio-Tissue; Clearside; EyeGate; Hovione; Mededicus; NovaBay; Omeros; Pentavision; Portage; Santen; Science Based Health; Senju; Shire; Sun Pharma; TearLab;TearScience;Topivert<br/>Serve(d) as a speaker or a member of a speakers bureau for: AbbVie; Alcon; Allergan; Bausch+Lomb; Bio-tissue; EyeGate;Hovione;LayerBio; NovaBay;Omeros;Portage; Santen; Shire; Stemnion; Sun Pharma;TearLab;TearScience; Topivert <br/>Received research grant from: Alcon; Aldeyra; allergan; Baush+ Lomb; EyeGate; Hovione; Kala; Ocular Therapeutix;Pfizer; RPS; Santen;Senju;Shire;Topcon; Xoma.

Pharyngoconjunctival Fever (PCF)

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