Pharyngoconjunctival fever

Pharyngoconjunctival fever is an adenoviral keratoconjunctivitis syndrome primarily caused by human adenovirus types 3, 4, and 7 ^[4]. It presents as a systemic viral illness with ocular involvement, characterized by fever, pharyngitis, and bilateral follicular conjunctivitis with periauricular lymphadenopathy ^[2][4]. This syndrome represents the most common clinical manifestation of adenoviral ocular infection, distinct from the more severe epidemic keratoconjunctivitis caused by different serotypes ^[4].

The hallmark presentation includes abrupt onset of high fever, pharyngitis, bilateral conjunctivitis, and periauricular lymph node enlargement ^[2][4]. The conjunctivitis is typically follicular in nature, and the condition may present as part of a systemic infection affecting individuals of all ages ^[4]. The clinical accuracy in diagnosing viral conjunctivitis is reported to be less than 50%, highlighting the importance of clinical recognition of the characteristic symptom cluster ^[2].

Human adenovirus is the most common cause of infectious conjunctivitis worldwide, affecting people of all ages and demographics ^[4]. Pharyngoconjunctival fever outbreaks are specifically due to HAdV types 3, 4, and 7, while epidemic keratoconjunctivitis outbreaks are caused by types 8, 19, 37, and 54 ^[4]. Cases are reported more frequently during warmer months ^[1]. Outbreaks have occurred in various community settings including nursing homes and college campuses ^[3].

Adenoviruses are highly contagious pathogens with multiple transmission routes ^[2]. The primary modes include hand-to-eye contact, direct contact with ocular secretions, respiratory droplets, and contact with ophthalmic care providers and their medical instruments ^[2][3]. The virus can also spread via contaminated surfaces due to its extreme resistance to physical and chemical agents ^[1]. Transmission occurs through close contact including the fecal-oral route and small droplets ^[3].

Infection may be prevented through hand washing, avoiding touching eyes before washing hands, and avoiding contact with sick individuals ^[3]. Strict attention to infection-control practices is effective for stopping transmission in healthcare settings ^[3]. Maintaining adequate chlorination is necessary for preventing swimming pool-associated outbreaks ^[3]. A live adenovirus vaccine protecting against types 4 and 7 has been used in some military personnel ^[3].

1. 1González-López JJ et al. Adenoviral keratoconjunctivitis: an update. Arch Soc Esp Oftalmol. 2013 Mar. PMID: 23473088. doi: 10.1016/j.oftal.2012.07.007.PubMed: https://pubmed.ncbi.nlm.nih.gov/23473088/
2. 2Jhanji V et al. Adenoviral keratoconjunctivitis. Surv Ophthalmol. 2015 Sep-Oct. PMID: 26077630. doi: 10.1016/j.survophthal.2015.04.001.PubMed: https://pubmed.ncbi.nlm.nih.gov/26077630/
3. 3Wikipedia contributors. Adenovirus infection - Wikipedia [Internet]. Wikipedia. cited 2 Sept 2026.Available from: https://en.wikipedia.org/wiki/Adenovirus_infection
4. 4Chigbu DI et al. Pathogenesis and management of adenoviral keratoconjunctivitis. Infect Drug Resist. 2018. PMID: 30046247. doi: 10.2147/IDR.S162669.PubMed: https://pubmed.ncbi.nlm.nih.gov/30046247/