福岡県におけるコロナ禍後のアデノウイルス結膜炎の型別解析と臨床的特徴

Typing analysis and clinical characteristics of adenovirus conjunctivitis after the COVID-19 pandemic in Fukuoka

要約　目的：アデノウイルス（AdV）結膜炎には，眼科的臨床症状が重症のD種AdV8，37，53，54，56，64，85などによる流行性角結膜炎と，結膜炎症状はD種に比べて比較的軽症のB種AdV3などによる咽頭結膜熱（PCF）がある。両者ともにコロナ禍には激減した。今回，コロナ禍後に福岡県で流行したAdVの型と臨床症状について検討した。

対象と方法：2022年1月1日〜2024年3月31日に川原眼科および福岡大学病院でAdV結膜炎と診断し，AdV抗原検査キットの残渣検体からヘキソン部分PCR法でAdVが検出された72例72眼について後方視的に検討した。

結果：平均年齢27.6±16.9歳で，72例中4例がAdV抗原検査陰性であった。AdV抗原検査は発症後平均2.3±7.1日に施行され，7例は発症0日で施行されており，すべて陽性であった。ヘキソン部分のPCR検査で同定されたAdV型はAdV3が49例，AdV37が8例，AdV8，53，56が各4例，AdV64が2例，AdV54が1例であった。偽膜はAdV8の1例，角膜炎の合併はAdV3の3例，AdV8の2例，AdV54の1例，多発性角膜上皮下浸潤はAdV56の1例で認めた。家族の発熱を含む罹患前の家族歴は半数以上（37例）に認めた。

結論：検出された型はAdV3が多く，全国サーベイランスと一致していた。眼科的臨床症状は比較的軽症のPCFであったが，角膜炎を合併した症例もみられた。PCFを引き起こすAdV3の感染経路は飛沫・接触感染であるため，感染拡大防止策が特に重要である。

Abstract　Purpose：To investigate the type and clinical symptoms of Adenovirus（AdV） conjunctivitis that has been prevalent in a community after the COVID-19 outbreak in Fukuoka.

Methods：This retrospective study was made on 72 eyes of 72 cases diagnosed with AdV conjunctivitis at Kawahara Eye Clinic and Fukuoka University Hospital between January 1, 2022 and March 31, 2024, in which AdV was detected in AdV antigen test kit residue samples by hexon partial PCR.

Results：The mean age was 27.6±16.9 years, while 4 of the 72 cases had negative AdV antigen tests. AdV antigen tests were performed on average 2.3±7.1 days after onset, and all 7 patients who had been performed the test on day 0 of onset were positive. AdV types identified by PCR testing of the hexon were AdV3 in 49 cases, AdV37 in 8 cases, AdV8, 53, and 56 in 4 cases each, AdV64/85 in 2 cases, and AdV54 in 1 case. Conjunctival pseudomembrane was observed in 1 case of AdV8, and keratitis was observed in 3 cases of AdV3, 2 cases of AdV8, and 1 case of AdV54, respectively, but multiple corneal subepithelial infiltrates were observed in only 1 case of AdV56. A family history including fever before the onset was present in 37 cases, more than half of the cases.

Conclusion：The most common type detected in this study was AdV3 of species B, which was consistent with the detection results of the nationwide surveillance. The ophthalmological clinical symptoms of PCF were relatively milder than EKC, however, three cases were complicated with keratitis. Since AdV3, which causes PCF, is transmitted by droplets and contact, it is particularly important to take measures to prevent the spread of infection.