An outbreak of acute hemorrhagic conjunctivitis due to Coxsackievirus A24 in a residential school, Naharlagun, Arunachal Pradesh: July 2023

Pallavi Boro; Tojum Gongo; Kimo Ori; Yompe Kamki; Nyai Ete; Moji Jini; Lobsang Jampa; Saurav Jyoti Patgiri; Neelanjana Sarmah; Aktarul Islam Siddique; Chandra Kanta Bhattacharjee; Nargis K Bali; Biswajyoti Borkakoty

doi:10.1016/j.ijmmb.2024.100549

An outbreak of acute hemorrhagic conjunctivitis due to Coxsackievirus A24 in a residential school, Naharlagun, Arunachal Pradesh: July 2023

Indian J Med Microbiol. 2024 Mar 5:48:100549. doi: 10.1016/j.ijmmb.2024.100549. Online ahead of print.

Authors

Affiliations

¹ Department of Community Medicine, Tomo Riba Institute of Health and Medical Sciences (TRIHMS), Naharlagun, Arunachal Pradesh, India. Electronic address: boropallavi@gmail.com.
² Department of Ophthalmology, Tomo Riba Institute of Health and Medical Sciences (TRIHMS), Naharlagun, Arunachal Pradesh, India. Electronic address: tommy111great@gmail.com.
³ Department of Community Medicine, Tomo Riba Institute of Health and Medical Sciences (TRIHMS), Naharlagun, Arunachal Pradesh, India. Electronic address: orikimo007@gmail.com.
⁴ Department of Microbiology, Tomo Riba Institute of Health and Medical Sciences (TRIHMS), Naharlagun, Arunachal Pradesh, India. Electronic address: dryompe@gmail.com.
⁵ Department of Ophthalmology, Tomo Riba Institute of Health and Medical Sciences (TRIHMS), Naharlagun, Arunachal Pradesh, India. Electronic address: nyai1994@gmail.com.
⁶ Tomo Riba Institute of Health and Medical Sciences (TRIHMS), Naharlagun, Arunachal Pradesh, India. Electronic address: mojijini@gmail.com.
⁷ State-IDSP, Naharlagun, Arunachal Pradesh, India. Electronic address: ljampa2013@gmail.com.
⁸ Indian Council of Medical Research-Regional Medical Research Centre for NE region (ICMR-RMRC NE), Dibrugarh, 786010, Assam, India. Electronic address: saurav.patgiri@gmail.com.
⁹ Regional VRDL, Indian Council of Medical Research-Regional Medical Research Centre for NE region (ICMR-RMRC NE), Dibrugarh, 786010, Assam, India. Electronic address: sarmahneelanjana@gmail.com.
¹⁰ Regional VRDL, Indian Council of Medical Research-Regional Medical Research Centre for NE region (ICMR-RMRC NE), Dibrugarh, 786010, Assam, India. Electronic address: aktaruls@gmail.com.
¹¹ Regional VRDL, Indian Council of Medical Research-Regional Medical Research Centre for NE region (ICMR-RMRC NE), Dibrugarh, 786010, Assam, India. Electronic address: chandrabhattacharya111@gmail.com.
¹² Department of Clinical Microbiology, Sher-I Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu & Kashmir, India. Electronic address: nargisbali@gmail.com.
¹³ Regional VRDL, Indian Council of Medical Research-Regional Medical Research Centre for NE region (ICMR-RMRC NE), Dibrugarh, 786010, Assam, India. Electronic address: biswaborkakoty@gmail.com.

PMID: 38395257
DOI: 10.1016/j.ijmmb.2024.100549

Abstract

Purpose: An acute conjunctivitis outbreak was investigated at a residential school in Naharlagun, Arunachal Pradesh, Northeast India, in July 2023. We aimed to identify the etiological agent and assess any complications in follow-up cases.

Methods: We used a structured questionnaire to record clinical findings and followed up with cases one-month post-conjunctivitis. Sixty-one cases were examined and eight conjunctival and oropharyngeal swab samples were collected after obtaining informed consent from guardians/school authorities. We screened for 33 viral and bacterial pathogens using an IVD-approved Real-time PCR assay. Further, the samples were subjected to nucleic acid sequencing.

Results: Among 465 screened students and staff, 80 individuals (approximately 17.2%) showed acute hemorrhagic conjunctivitis symptoms among which 61 cases were available for clinical examination. We identified the Enterovirus responsible by targeted sequencing using next-generation sequencing. The etiological agent was found to be Coxsackievirus A24, a member of Enterovirus C, in seven out of eight samples subjected to sequencing. Common symptoms included conjunctival hyperemia and foreign body sensation (100%), bilateral eye involvement (73.8%), eye pain (70%), watery discharge (49.2%), and eyelid swelling (38%). Only 6.5% had purulent discharge. Most cases resolved within 5-6 days, with only 9.8% reporting abdominal symptoms post-conjunctivitis. No serious complications occurred within one month. Throat swabs aided in diagnosing enterovirus infections alongside eye swabs.

Conclusions: The outbreak of acute conjunctivitis was caused by Coxsackievirus A24, a member of Enterovirus C. Cases resolved spontaneously within 6-7 days, with no severe complications. Collecting oropharyngeal swabs alongside conjunctival swabs could improve enteroviral conjunctivitis diagnosis.

Keywords: AHC; Acutehemorrhagic conjunctivitis; Arunachal Pradesh; CA24v,Conjunctivitis; Coxsackievirus A24; Enterovirus; Outbreak; School children.