Еpidemiological, Etiological and Clinical Aspects of Acute Infectious Conjunctives — at the Crossroads of Ophthalmology and Epidemiology (Clinical and Laboratory Study)

Abstract

The clinical and laboratory picture of acute infectious conjunctivitis has undergone significant changes in the last few years. This circumstance, apparently, is associated with the appearance of a large number of both eye and systemic forms of antibacterial, anti-inflammatory, immunocorrecting drugs and their widespread use, often without establishing an etiological factor of inflammation. The objective of our work was to propose a scheme of rational empirical therapy of acute infectious conjunctivitis, based on the potential of modern ophthalmopharmacology; and to study the etiological spectrum and features of the clinical picture of the above diseases, thereupon correcting the proposed scheme according to the obtained data. Material and methods. A retrospective analysis of over 20,000 outpatient charts of patients with acute inflammation of the conjunctiva and a prospective examination of 275 patients with acute infectious conjunctivitis was carried out. The method of polymerase chain reaction (quantitative and qualitative) was used to identify the genetic material of the pathogen in scrapings from the conjunctiva, the oropharynx and the nasopharynx. Results. The data of the retrospective analysis has shown that when the symptoms indicated acute infectious conjunctivitis, the actual diagnosis of an ophthalmologist was adenoviral conjunctivitis. There were no other nosological forms with the type of pathogen recorded in outpatient charts. The peak incidence was in the winter-spring period, with the highest number of cases in 2011 and 2013 (1509 and 1482 respectively). Results of the prospective study showed the leading role of adenoviruses (20 % of cases), hemophilic rod (18 % of cases) and pneumococcus (12 % of cases) in the development of acute inflammation of the mucous membrane of the eye. As a concomitant infection, the bacteria of the staphylococcus group were found most often. The spectrum of the revealed pathology confirmed the validity of the selected empirical therapy. Conclusion. The results of the study allow us to recommend the prescription of three groups of drugs (antibiotic, antiviral, non-steroidal anti-inflammatory drug) in the treatment of acute infectious conjunctivitis.

In Vitro Study of Picloxidine 0.05 % Antiviral Activity (on the Example of Adenovirus)

“…Необходимо подчеркнуть, что в условиях амбулаторного приема, как правило, отсутствует возможность лабораторной расшифровки конкретных причин воспаления глаз, и в данной ситуации практикующий врач должен руководствоваться принципами эмпирической (исходя из чувствительности предполагаемых патогенов) терапии при назначении препаратов. В нашей предыдущей публикации мы предложили схему местной эмпирической рациональной терапии различных форм острых конъюнктивитов, включающую, с учетом новых данных в отношении спектра возбудителей, три составляющих: антибиотик, противовирусное средство, противовоспалительный препарат [12]. При этом необходимо учитывать, что не всегда симптомы воспаления купируются в рамках сроков рекомендуемой терапии -в данном случае в пределах 10 дней, что диктует необходимость смены препаратов и пролонгации терапии до момента выздоровления.…”