Acute follicular conjunctivitis caused by adenovirus type 34

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Abstract

PURPOSE:

Adenovirus type 34 belongs to adenovirus subgenus B. The prototype virus of adenovirus 34 was isolated from a renal transplant recipient. However, no case of acute conjunctivitis caused by adenovirus 34 has been reported. Recently, we encountered two cases of acute follicular conjunctivitis in which adenovirus 34 was isolated.

METHODS:

The clinical isolates were identified by the standard neutralization test. The sequences of seven hypervariable regions in the hexon protein of these cases were compared with those of several prototype strains of adenovirus subgenus B.

RESULTS:

The cases were middle-aged, 34 and 41 years old, and male, and they exhibited moderate conjunctivitis with upper respiratory tract symptoms. Isolates from cell culture were identified as adenovirus 34 by NT. The mean homology rate (percentage of total number of coincident amino acids in the total length of amino acids in seven hypervariable regions) between clinical isolates and the adenovirus 34 prototype was 96.5%; in contrast, those between clinical isolates and the prototypes of adenovirus 11, adenovirus 14, and adenovirus 35 were 55.6%, 66.7%, and 57.9%, respectively. The results of conventional serotyping by neutralization test were confirmed by these values.

CONCLUSIONS:

These results indicate that adenovirus 34 may induce acute conjunctivitis in immunocompetent subjects and that special attention should be paid to adenovirus 34 as a causative agent for adenoviral conjunctivitis.

Section snippets

Case 1

: In September 1997, a healthy 34-year-old unmarried man with no significant medical history presented with an acute onset of redness, irritation, and discharge of the left eye. He had had a sore throat for 2 weeks. Examination showed moderate acute follicular conjunctivitis (Figure 1) without left preauricular lymph node enlargement. The cornea showed no epithelial keratitis. No abnormality was observed in the uveal tract or fundus of this eye. The right eye was normal. Visual acuity was 20/20

Results

Conjunctival scrapings taken in the early stage of conjunctivitis showed a predominance of mononuclear cells in 75% of the specimens. A mixed mononuclear and polymorphonuclear cell response was seen in the remaining 25% of the specimens.

The virus was in both cases identified as adenovirus 34 by conventional neutralization and hemagglutination inhibition techniques, using 20 antibody units of antisera to prototypes 1 to 41. Only antiserum to type 34 neutralized the isolates. The clinical strains

Discussion

The human adenoviruses currently number 49 serotypes.11, 12 To date, adenovirus 34 has been isolated from renal transplant recipients5, 6 and from patients with AIDS.7 It is reported that an intermediate strain between adenovirus 34 and adenovirus 35, which was neutralized by both adenovirus 34 and adenovirus 35 antisera, was isolated from patients with acute conjunctivitis.13 However, that strain showed identical restriction patterns to adenovirus 35 prototype strain (Holden) with SmaI, BamHI,

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