Pharyngoconjunctival fever

Pharyngoconjunctival fever is one of two recognized adenoviral keratoconjunctivitis syndromes, produced by different adenovirus serotypes than epidemic keratoconjunctivitis ^[1]. It manifests as an ocular adenoviral infection with systemic involvement, distinguished by fever, pharyngeal inflammation, and follicular conjunctivitis ^[2][3]. Outbreak-associated cases are specifically attributable to human adenovirus types 3, 4, and 7 ^[3].

The syndrome presents with sudden onset of high fever, pharyngitis, bilateral conjunctivitis, and enlargement of periauricular lymph nodes ^[2]. Conjunctival involvement shows features similar to other conjunctival infections, with follicular conjunctivitis and occasionally pseudomembranes ^[1][2]. It is a self-limited ocular adenoviral manifestation that may occur with or without corneal involvement ^[2][3].

The exact incidence of adenoviral conjunctivitis remains unknown, though cases occur more frequently in warmer months ^[1]. Pharyngoconjunctival fever outbreaks are caused by human adenovirus types 3, 4, and 7, affecting populations of all ages and demographics ^[3]. Adenovirus is the most common infectious conjunctivitis worldwide ^[3].

Contagion occurs through direct contact or fomites, with the virus showing high resistance to physical and chemical agents ^[1]. Main routes include hand-to-eye contact, ocular secretions, respiratory droplets, and contact with ophthalmic care providers or instruments ^[2]. Adenoviruses also spread by fecal–oral and occasionally waterborne routes, as well as via contaminated surfaces ^[4].

Infection is preventable by hand washing, avoiding touching the eyes, mouth, and nose before hand hygiene, and avoiding close contact with sick individuals ^[4]. Strict infection-control practices effectively halt transmission in healthcare settings ^[4]. Adequate pool chlorination is required to prevent swimming pool–associated conjunctivitis outbreaks ^[4]. A live vaccine against adenovirus types 4 and 7 has been used in some military personnel to reduce disease rates ^[4].

1. 1 González-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. 2 Jhanji 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. 3 Chigbu 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/
4. 4 Wikipedia contributors. Adenovirus infection - Wikipedia [Internet]. Wikipedia. cited 23 Oct 2026. Available from: https://en.wikipedia.org/wiki/Adenovirus_infection