RESUMEN
PURPOSE OF REVIEW: To highlight the clinical features of mpox with an emphasis on ocular manifestations and to review treatment options for this re-emerging infectious disease. RECENT FINDINGS: Ocular involvement of mpox varies by clade. The most recent 2022 outbreak appears to be associated with fewer conjunctivitis cases compared to previous outbreaks. However, the ocular findings occurring during this newly emerging clade can be visually threatening and include cases of keratitis, rapidly progressing scleritis, and necrotizing periorbital rashes. SUMMARY: Ocular mpox is an important clinical feature of systemic mpox virus (MPXV) infection. Heightened clinical suspicion allows for a timely diagnosis and the initiation of antiviral treatment, when appropriate. Randomized clinical trials for mpox systemic and ocular treatment efficacy are lacking. Prior clinical experience with smallpox and in-vitro mpox data support the use of systemic antivirals such as tecovirimat, cidofovir, brincidofovir and topical use of trifluridine in ocular mpox management, though treatment-resistant infection can occur and portend a poor prognosis.
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Antivirales , Infecciones Virales del Ojo , Humanos , Antivirales/uso terapéutico , Infecciones Virales del Ojo/diagnóstico , Infecciones Virales del Ojo/virología , Infecciones Virales del Ojo/tratamiento farmacológico , Orthopoxvirus , Escleritis/diagnóstico , Escleritis/tratamiento farmacológico , Escleritis/etiologíaRESUMEN
We report a case of a 53-year-old HIV-negative patient in San Francisco, California, USA, with no classic mpox prodromal symptoms or skin lesions who experienced fulminant, vision-threatening scleritis, keratitis, and uveitis. Deep sequence analysis identified monkeypox virus RNA in the aqueous humor. We confirmed the virus on the cornea and sclera by PCR.
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Mpox , Estados Unidos/epidemiología , Humanos , Persona de Mediana Edad , Cara , Reacción en Cadena de la Polimerasa , Síntomas Prodrómicos , ARN ViralRESUMEN
SIGNIFICANCE: Acute infectious conjunctivitis poses significant challenges to eye care providers. It can be highly transmissible, and because etiology is often presumed, correct treatment and management can be difficult. This study uses unbiased deep sequencing to identify causative pathogens of infectious conjunctivitis, potentially allowing for improved approaches to diagnosis and management. PURPOSES: This study aimed to identify associated pathogens of acute infectious conjunctivitis in a single ambulatory eye care center. CASE REPORTS: This study included patients who presented to the University of California Berkeley eye center with signs and symptoms suggestive of infectious conjunctivitis. From December 2021 to July 2021, samples were collected from seven subjects (ages ranging from 18 to 38). Deep sequencing identified associated pathogens in five of seven samples, including human adenovirus D, Haemophilus influenzae , Chlamydia trachomatis , and human coronavirus 229E. CONCLUSIONS: Unbiased deep sequencing identified some unexpected pathogens in subjects with acute infectious conjunctivitis. Human adenovirus D was recovered from only one patient in this series. Although all samples were obtained during the COVID-19 pandemic, only one case of human coronavirus 229E and no SARS-CoV-2 were identified.
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COVID-19 , Conjuntivitis , Humanos , Enfermedad Aguda , California/epidemiología , COVID-19/diagnóstico , COVID-19/epidemiología , Secuenciación de Nucleótidos de Alto Rendimiento , PandemiasRESUMEN
PURPOSE OF REVIEW: Given the impact that society as a whole, and medicine specifically, has experienced as a result of the COVID-19 pandemic, an examination of clinical care changes enacted in the field of ophthalmology is of interest to the specialty. RECENT FINDINGS: In order to adapt to the reality of the COVID-19 pandemic, measures, such as broadening telehealth capabilities, adopting universal masking, careful sanitation procedures, applying virtual teaching in academic environments, and deferring elective surgeries were put in place. These were aimed at reducing person-to-person spread of SARS-CoV-2. Though best efforts were made at triaging ophthalmic emergencies during these times, unfortunate delays in care were observed in some circumstances. Finally, a prospective study interrogating the risk of spread at slit lamp distances for short periods of time was encouraging, suggesting low risk of transmissibility, though limited by a small case-positive sample size. SUMMARY: Significant changes have been made in the design and delivery of ophthalmic care during the COVID-19 pandemic. Some of these, such as telemedicine, may provide value in a postpandemic world.
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COVID-19 , Telemedicina , Humanos , Pandemias , Estudios Prospectivos , SARS-CoV-2RESUMEN
PURPOSE OF REVIEW: To revisit ocular rosacea as an underappreciated condition which can cause permanent blindness if inadequately treated, and to review data supporting improved diagnostic and treatment strategies. RECENT FINDINGS: Ocular rosacea has an underrecognized prevalence in children and individuals with darker skin tone. Rosacea has several associations with other significant systemic diseases. Variations in local and systemic microbiome, including demodex infestation, may play a role in pathogenesis, severity, and in explaining the different phenotypes of rosacea. The National Rosacea Society Expert Committee established an updated classification system of rosacea in 2017. New treatment algorithms based on these clinical subtypes are suggested. SUMMARY: With continued advancements in the understanding of the epidemiology and pathogenesis of rosacea, randomized controlled trials specific for ocular rosacea remain lacking. There is overall consensus that rosacea and ocular rosacea require chronic maintenance treatment strategies involving combination topical and systemic therapies.
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Rosácea , Ceguera , Humanos , Prevalencia , Rosácea/diagnóstico , Rosácea/terapiaRESUMEN
PURPOSE: The etiology of conjunctivitis is often misdiagnosed. An ideal diagnostic test would identify all possible infectious causes. In this study, we apply unbiased metagenomic RNA deep sequencing (MDS) to identify pathogens causing conjunctivitis. DESIGN: Molecular study of prospectively collected conjunctival swabs from patients with presumed infectious conjunctivitis. PARTICIPANTS: Patients with presumed acute infectious conjunctivitis. METHODS: Conjunctival swabs were collected from patients presenting with acute conjunctivitis. Swabs were processed for MDS. Pathogens were identified using a rapid computational pipeline to analyze the nonhost sequences obtained from MDS. Differential gene expression analysis was performed to evaluate for host transcriptome signatures for infectious types. Clinical samples were deidentified, and laboratory personnel handling the samples and interpreting the data were masked. MAIN OUTCOME MEASURES: Pathogens and differential transcripts identified by MDS. RESULTS: Metagenomic RNA deep sequencing detected pathogens in 86% (12/14) of the patients tested. Swabs from 10 of 14 patients were positive for human adenovirus (HAdV) while swabs from 2 of 14 patients were positive for Vittaforma corneae (a parasitic fungal species of the microsporidia group). Samples positive for HAdV by RNA-seq were independently verified in a CLIA-certified laboratory. Pathogen-directed polymerase chain reaction confirmed the presence of V. corneae genome in the samples positive by RNA-seq. Local host transcriptome analysis identified 12 differentially expressed genes that provided distinct expression signatures for patients infected with HAdV compared with V. corneae. CONCLUSIONS: Metagenomic RNA deep sequencing can reliably detect and quantify common and rare pathogens causing conjunctivitis, and identify strains. The unbiased nature of metagenomic RNA deep sequencing allowed an expanded scope of pathogen detection, including fungal species not commonly associated with acute conjunctivitis. In addition, the identification of infection type-specific local host transcriptome signatures may allow for pathogen detection even when the pathogen load is too low for direct identification.
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Conjuntivitis/diagnóstico , Secuenciación de Nucleótidos de Alto Rendimiento/métodos , Metagenómica/métodos , Adulto , Anciano , Conjuntivitis/microbiología , ADN Bacteriano/análisis , ADN de Hongos/análisis , ADN Viral/análisis , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenAsunto(s)
Úlcera de la Córnea/diagnóstico , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/diagnóstico , Área Bajo la Curva , Bacterias/clasificación , Córnea , Úlcera de la Córnea/microbiología , Diagnóstico Diferencial , Técnicas de Diagnóstico Oftalmológico , Sistemas Especialistas , Infecciones Bacterianas del Ojo/microbiología , Infecciones Fúngicas del Ojo/microbiología , Hongos/clasificación , Humanos , Curva ROC , EspecializaciónAsunto(s)
Perforación Corneal/etiología , Endoftalmitis/complicaciones , Infecciones Bacterianas del Ojo/complicaciones , Infecciones Neumocócicas/complicaciones , Anciano de 80 o más Años , Biopsia , Perforación Corneal/diagnóstico , Endoftalmitis/diagnóstico , Endoftalmitis/microbiología , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/microbiología , Humanos , Masculino , Infecciones Neumocócicas/diagnóstico , Infecciones Neumocócicas/microbiología , Rotura Espontánea , Streptococcus pneumoniae/aislamiento & purificación , Tomografía Computarizada por Rayos X , UltrasonografíaAsunto(s)
Úlcera de la Córnea/diagnóstico , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/diagnóstico , Metagenómica , Infecciones Estafilocócicas/diagnóstico , Infecciones Estreptocócicas/diagnóstico , Úlcera de la Córnea/microbiología , ADN Bacteriano/genética , Pruebas Diagnósticas de Rutina , Infecciones Bacterianas del Ojo/microbiología , Infecciones Fúngicas del Ojo/microbiología , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Metagenoma , ARN Bacteriano/genética , Infecciones Estafilocócicas/microbiología , Staphylococcus/genética , Staphylococcus/aislamiento & purificación , Infecciones Estreptocócicas/microbiología , Streptococcus/genética , Streptococcus/aislamiento & purificaciónAsunto(s)
Infecciones por Coronavirus , Coronavirus , Pandemias , Neumonía Viral , Betacoronavirus , COVID-19 , Humanos , SARS-CoV-2 , Lágrimas , Esparcimiento de VirusAsunto(s)
Investigación Biomédica/tendencias , Síndromes de Ojo Seco/tratamiento farmacológico , Síndromes de Ojo Seco/diagnóstico , Ácidos Grasos Omega-3/administración & dosificación , Humanos , Evaluación de Resultado en la Atención de Salud , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del TratamientoAsunto(s)
Infecciones Fúngicas del Ojo/microbiología , Micosis/microbiología , Scedosporium/aislamiento & purificación , Enfermedades de la Esclerótica/microbiología , Anciano de 80 o más Años , Antifúngicos/uso terapéutico , Terapia Combinada , Infecciones Fúngicas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/terapia , Humanos , Masculino , Micosis/diagnóstico , Micosis/terapia , Procedimientos Quirúrgicos Oftalmológicos , Enfermedades de la Esclerótica/diagnóstico , Enfermedades de la Esclerótica/terapiaAsunto(s)
Enfermedades de la Conjuntiva/diagnóstico , Enfermedades de la Córnea/diagnóstico , Infecciones del Ojo/diagnóstico , Secuenciación de Nucleótidos de Alto Rendimiento , Metagenoma , Enfermedades de la Esclerótica/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Animales , Bacterias/genética , Enfermedades de la Conjuntiva/microbiología , Enfermedades de la Conjuntiva/parasitología , Enfermedades de la Córnea/microbiología , Enfermedades de la Córnea/parasitología , Infecciones del Ojo/microbiología , Infecciones del Ojo/parasitología , Femenino , Hongos/genética , Humanos , Masculino , Persona de Mediana Edad , Parásitos/genética , Reacción en Cadena de la Polimerasa , Estudios Retrospectivos , Enfermedades de la Esclerótica/microbiología , Enfermedades de la Esclerótica/parasitologíaAsunto(s)
Infecciones Bacterianas/complicaciones , Úlcera de la Córnea/etiología , Salud Global , Enfermedades Desatendidas/epidemiología , Antibacterianos/uso terapéutico , Úlcera de la Córnea/tratamiento farmacológico , Úlcera de la Córnea/prevención & control , Países en Desarrollo , Promoción de la Salud/organización & administración , Humanos , Lepra/complicaciones , Oncocercosis Ocular/complicaciones , Tracoma/complicacionesRESUMEN
PURPOSE: The purpose of this study was to identify conjunctival transcriptome differences in patients with Acanthamoeba keratitis compared with keratitis with no known associated pathogen. METHODS: The host conjunctival transcriptome of 9 patients with Acanthamoeba keratitis (AK) is compared with the host conjunctival transcriptome of 13 patients with pathogen-free keratitis. Culture and/or confocal confirmed Acanthamoeba in 8 of 9 participants with AK who underwent metagenomic RNA sequencing as the likely pathogen. Cultures were negative in all 13 cases where metagenomic RNA sequencing did not identify a pathogen. RESULTS: Transcriptome analysis identified 36 genes differently expressed between patients with AK and patients with presumed sterile, or pathogen-free, keratitis. Gene enrichment analysis revealed that some of these genes participate in several biologic pathways important for cellular signaling, ion transport and homeostasis, glucose transport, and mitochondrial metabolism. Notable relatively differentially expressed genes with potential relevance to Acanthamoeba infection included CPS1, SLC35B4, STEAP2, ATP2B2, NMNAT3, and AKAP12. CONCLUSIONS: This research suggests that the local transcriptome in Acanthamoeba keratitis may be sufficiently robust to be detected in the conjunctiva and that corneas infected with Acanthamoeba may be distinguished from the inflamed cornea where no pathogen was identified. Given the low sensitivity for corneal cultures, identification of differentially expressed genes may serve as a suggestive transcriptional signature allowing for a complementary diagnostic technique to identify this blinding parasite. Knowledge of differentially expressed genes may also direct investigation of disease pathophysiology and suggest novel pathways for therapeutic targets.
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Purpose of Review: This study is to highlight the incidence of corneal pseudomicrocysts in FDA-approved antibody-drug conjugates (ADCs), and success of preventive therapies for pseudomicrocysts and related ocular surface adverse events (AEs). Recent Findings: ADCs are an emerging class of selective cancer therapies that consist of a potent cytotoxin connected to a monoclonal antibody (mAb) that targets antigens expressed on malignant cells. Currently, there are 11 FDA-approved ADCs with over 164 in clinical trials. Various AEs have been attributed to ADCs, including ocular surface AEs (keratitis/keratopathy, dry eye, conjunctivitis, blurred vision, corneal pseudomicrocysts). While the severity and prevalence of ADC-induced ocular surface AEs are well reported, the reporting of corneal pseudomicrocysts is limited, complicating the development of therapies to prevent or treat ADC-related ocular surface toxicity. Summary: Three of 11 FDA-approved ADCs have been implicated with corneal pseudomicrocysts, with incidence ranging from 41 to 100% of patients. Of the six ADCs that reported ocular surface AEs, only three had ocular substudies to investigate the benefit of preventive therapies including topical steroids, vasoconstrictors, and preservative-free lubricants. Current preventive therapies demonstrate limited efficacy at mitigating pseudomicrocysts and other ocular surface AEs.
RESUMEN
Infectious keratitis is a leading cause of corneal blindness worldwide with little information known about causative etiologies in Malawi, Africa. This area is resource-limited with ophthalmologist and microbiology services. The Department of Ophthalmology at the Kamuzu College of Health Sciences in Blantyre, Malawi, is a participating site of an international corneal ulcer consortium, capriCORN (Comprehensive Analysis of Pathogens, Resistomes, and Inflammatory-markers in the CORNea). In this study, 50 patients with corneal ulcers were swabbed for pathogen identification using RNA-sequencing. Corneal trauma was reported in 41% and 19% of the patients worked in agriculture. A pathogen was identified in 58% of the cases. Fungal pathogens predominated, followed by viruses and bacteria. Aspergillus, Fusarium, HSV-1, and Gardnerella were the most common pathogens detected. 50% of patients reported treatment with an antibiotic before presentation. Pathogens unusual for infectious keratitis, such as Subramaniula asteroids, Aureobasidium pullulans, and Gardnerella vaginalis, were also detected.