|Year : 1983 | Volume
| Issue : 5 | Page : 700-702
Ocular manifestations of kyasanur forest disease (A clinical study)
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
a a. Ocular manifestations of kyasanur forest disease (A clinical study). Indian J Ophthalmol 1983;31:700-2
Kyasanur forest disease is a tick borne haemorrhagic fever, belongs to the group B Arbor virus, transmitted by ticks of the genus Haemophysalis, the natural hosts being monkeys, several species of rats, birds, cattle etc. Man acquires the infection from bites of infected ticks during his contact with the forest. This disease was first discovered in 1957 in hilly forest area of Soraba and Sagar taluks of Shimoga district in Karnataka. The virus infection has been named Kyasanur Forest Disease (K.F.D.), in reference to the locality where the virus was first recovered from monkeys and where human cases have also occured. This disease is found in epidemic form mostly in summer.
The onset of disease is abrupt with high fever, severe headache, pain in the extremities and back with severe weakness and redness in the eyes which last for 8-10 days with a tendency for bleeding from nose, gums, stomach and intestines. Some cases may develop meningitis and encephalitis with a fatality rate of 5 percent. This disease is related to Russian Tick-born or Spring summer encephalitis.
Several observations were made in the past on this disease and there seems to be no study of ocular manifestations of this disease by the ophthalmologists as investigations have to be carried out in out of way hospitals in the forest area of Maland. In this study an attempt is made to study the ocular manifestations of K.F.D. in new acute cases during an epidemic in a rural hospital.
| Materials and Methods|| |
In this study 98 new acute serologically positive (rise in titre of specific antibodies) cases of K.F.D. which were seen in the first 2 weeks of disease were taken. Preliminary recording of age, sex, ocupation, history including recent visit to forest or any contact with similar illness, symptoms and signs. Routine ophthalmic examination was done including vision and ophthalmoscopy, extra ocular movements, cases were studied with corneal loupe and staining of cornea was done with fluorescein dye to rule out any corneal lesions. Examinations with slit-lamp and other sophisticated instruments could not be done as this study was done in a rural area.
| Observations|| |
[Table - 1] shows the distribution of cases according to age and sex.
[Table - 2] summarises the various ocular symptoms.
[Table - 3] shows results of clinical examination.
[Table - 4] records vision test. Visual acuity could not be assesed properly. Since most of the patients were very ill. Therefore a rough estimation of visual acuity was done.
[Table - 5] summarises important general manifestations of the disease apart from high fever, sevre headache, muscular and back pain which were seen almost in all cases.
Most of the cases were in the age group of 20-39 and more common in males  .
All 98 cases had generalised conjunctival congestion which is most noticeable in the bulbar conjunctiva, especially near the fornices and in palpabral conjunctiva. Serous discharge was present in 67 cases.
Out of 13 intra ocular haemorrhages (retinal and vitreous), 7 cases had other evidence of bleeding disorder like bleeding from nose, gums, haematemesis etc.
Papilloedema in 1 case was secondary to encephalitis.
| Discussion|| |
Though in the past several studies were made to study clinical features of Kyasanur forest disease. ,, no attempt was made to study the ocular manifestation of the disease in detail by the ophthalmologists, Work et all  Narasimha Murthy D.P.  have done detailed epidemiological study of this disease. Work T.H.  isolated virus from the human patients suffering from this disease.
Essentially K.F.D. is a febrile disease with a haemorrhagic tendency due to involvement of vascular system. As suggested by Rao R.L.  thrombocytopenia and leucopenia which are important features of the disease, possibly indicate the depression of haemopoeitic tissue resulting in haemorrhagic condition. The other cause of bleeding in haemorrhagic fever caused by group B Arbor virus to which K.F.D. belongs to, is considered to be some sort of hypersensitive allergic immunological reaction. Antigen antibody complexes damage the capillaries and adversely affect the haemopitic cells causing leucopenia and thrombocytopenia. 
Work and Trapido  Work T.H.  Rao R.L.  in their study have noted infection of conjunctiva in almost all the cases in the first few days of the disease. Out of 34 cases studied by Rao R.L.  5 patients had haemorrhagic signs, such as bleeding from gums and nose, haemtemesis etc. In our series all 98 cases had intense conjunctival congestion and 17 cases had haemorrhagic signs such as bleeding from nose and gums, haemetmesis and haemoptysis.
Conjunctival congestion, sub-conjunctival haemorrhage, superficial punctate keratitis, mild iritis, retinal and vitreous haemorrhages are also seen in related Arbor virus haemorrhagic fevers such as yellow fever, Dengue fever, Sand fly fever etc. 
Visual acuity less than 6160 in 22 cases was due to superficial punctate keratitis, photophobia, lenticular opacity, retinal and vitreous opacity.
| Summary|| |
Ocular manifestations of Kyasanur Forest Disease are described.
| Acknowledgement|| |
We sincerely thank, Medical Officers of primary health centre Hosanagar and Govt. J.C. Hospital Thirthahalli for permitting us to conduct this study.
| References|| |
Park, J.E. and K. Park, Text book of preventive and Social Medicine VIII Edition 410-411, Messrs. Banarsides Bhanot, Jabalpur, 1980.
Work and Trapido, Indian Journal of Medical Science, 11, 341, 1957.
Rao R.L., Journal of Indian Medical Association, Vol. 31, No. 3, 113-116, 1958.
Gupta K.K. and Yash Pal, Journal of India. Medical Association, Vol. 64, No. 9, 236-237, 1975.
Work T.H., Roderiquez, F.R., Bhatt, P.N., American Journal of Public Health, 49: 869, 1959.
Narasimha Murthy D.P., I.I.M.A., 31, 125-127.
Work T.H. J.I.M.A., 31, 111, 1958.
British Medical Journal, 3; 404, 1969.
Duke-Elder, System of Ophthalmology, Vol. VIII, Part I, 372-373, and Vol. IX, 353, Henry .
Kimpton London, 1966.
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]