RESUMO
PURPOSE: To determine the association between systemic vitamin D (VD) and immunoglobulin E (IgE) levels with severity and ocular surface inflammatory profile in patients with epidemic keratoconjunctivitis (EKC). METHODS: 210 eyes of 105 patients who were clinically diagnosed with EKC were included in the study. The levels of serum VD and serum IgE were measured. Schirmer's strip-based tear fluid (TF) was used to determine levels of IL-1ß, IL-6, IL-10, IL-17A, TNFα, MMP9, sICAM1, and VEGF-A in a subset of patients. RESULTS: Levels of VD were significantly ( P < 0.05) lower and levels of IgE were significantly higher in patients with severe forms of conjunctivitis compared to those with nonsevere forms. Majority of the patients with severe forms of the disease exhibited VD deficiency and/or abnormally high IgE. A negative correlation (r = -0.682; P < 0.0001) was observed between VD and IgE levels. TF levels of IL-1ß, IL-6, TNFα, and sICAM1 were significantly higher in eyes with severe forms of conjunctivitis compared to those with nonsevere forms and controls. These factors showed a positive correlation ( P < 0.05) with IgE levels and a negative correlation ( P < 0.05) with VD levels. CONCLUSION: Patients with severe forms of EKC exhibited VD deficiency and higher levels of IgE. Increased TF inflammatory factors demonstrated a disease causal relationship with VD and IgE. Hence, restoring the altered levels of VD and IgE to normal range would be pivotal in the prevention and management of severe conjunctivitis.
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Citocinas , Lágrimas , Vitamina D , Humanos , Lágrimas/metabolismo , Masculino , Feminino , Citocinas/metabolismo , Citocinas/sangue , Adulto , Vitamina D/sangue , Conjuntivite Viral/diagnóstico , Biomarcadores/metabolismo , Biomarcadores/sangue , Pessoa de Meia-Idade , Adulto Jovem , COVID-19/diagnóstico , Adolescente , SARS-CoV-2 , Imunoglobulina E/sangueRESUMO
PURPOSE: To report the clinical signs, symptoms, and viral clearance in individuals in the United States with adenoviral conjunctivitis (Ad-Cs). METHODS: Individuals ≥ 18 years presenting within 4 days of symptoms of Ad-Cs who met eligibility criteria and tested positive with both point-of-care immunoassay antigen and quantitative polymerase chain reaction (qPCR) testing were enrolled. Patient-reported symptoms, clinician-graded signs, and qPCR viral titers were collected at baseline, days 1-2, 4 (days 3-5), 7 (days 6-10), 14 (days 11-17) and 21 (days 18-21). RESULTS: There was no detectable viral titers by the day 14 visit in 6/8 patients. By day 21, there was no detectable viral titers in the 7 participants who completed the visit; however, signs and symptoms persisted including: blurry vision (5/7), discomfort (2/7) or redness (1/7). Masked clinicians also noted conjunctival redness (4/7), follicular conjunctivitis (4/7) and bulbar edema (3/7). CONCLUSION: Many patient-reported symptoms and clinical signs persist after viral titers are no longer detectable by qPCR. Using clinical signs and symptoms to determine quarantine duration may result in patients being furloughed longer than the time that the patient is infectious.
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Conjuntivite Viral , Conjuntivite , Humanos , Estados Unidos/epidemiologia , Conjuntivite Viral/diagnóstico , Conjuntivite Viral/epidemiologia , Carga Viral , Conjuntivite/diagnóstico , Conjuntivite/epidemiologiaRESUMO
Viral conjunctivitis is one of the most common acute eye diseases. The fall and winter months are known to be the main season for viral infections which is also reflected in the ophthalmological outpatient clinics. Viral conjunctivitis is often accompanied by symptoms of the upper and lower respiratory tract, fever, chills, arthralgia or skin lesions. The spectrum of pathogens comprises DNA viruses such as Adeno-, Herpes simplex and Molluscum contagiosum as well as RNA viruses. Symptoms caused by pandemic pathogens such as SARS-CoV-2 and mpox viruses can also cause ocular manifestation. Viral conjunctivitis is often self-limiting leaving no residual symptoms, however an ophthalmologist should be consulted if there are inflammatory symptoms of the anterior eye accompanied by visual disturbance. It is particularly important to recognize the affection of corneal or even intraocular structures early to initiate an adequate and effective therapy. Affection of the cornea, vitreus or retina can result in temporary or permanent impairment of the field of vision and visual acuity. The diagnosis is usually made without further tests on the basis of the typical clinical presentation. Rapid tests or PCR diagnostics are also available for confirmation. In most patients the treatment is symptomatically with artificial tears and antibiotic eye drops in cases accompanied by secondary bacterial infections, not prophylactically. If the cornea or other ocular structures are affected by certain viruses, local as well as systemic virostatic therapy is initiated. The most important prophylactic measure is meticulous and consistent hygiene.
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Conjuntivite Viral , Conjuntivite , Humanos , Conjuntivite Viral/diagnóstico , Conjuntivite Viral/tratamento farmacológico , Conjuntivite Viral/prevenção & controle , Córnea , Lubrificantes Oftálmicos/uso terapêuticoRESUMO
Viruses account for 80% of all cases of acute conjunctivitis and adenovirus; enterovirus and herpes virus are the common causative agents. In general, viral conjunctivitis spreads easily. Therefore, to control the spread, it is crucial to quickly diagnose illnesses, strictly implement hand washing laws, and sanitize surfaces. Swelling of the lid margin and ciliary injection are subjective symptoms, and eye discharge is frequently serofibrinous. Preauricular lymph node swelling can occasionally occur. Approximately 80% of cases of viral conjunctivitis are caused by adenoviruses. Adenoviral conjunctivitis may become a big global concern and may cause a pandemic. Diagnosis of herpes simplex viral conjunctivitis is crucial for using corticosteroid eye solution as a treatment for adenovirus conjunctivitis. Although specific treatments are not always accessible, early diagnosis of viral conjunctivitis may help to alleviate short-term symptoms and avoid long-term consequences.
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Infecções por Adenoviridae , Infecções por Adenovirus Humanos , Adenovírus Humanos , Conjuntivite Viral , Conjuntivite , Ceratite Herpética , Humanos , Conjuntivite Viral/diagnóstico , Adenoviridae , Simplexvirus , Infecções por Adenovirus Humanos/diagnóstico , Infecções por Adenovirus Humanos/epidemiologiaRESUMO
ABSTRACT: Ligneous conjunctivitis is a rare cause of chronic conjunctivitis that may be triggered by ocular insults such as trauma or infections. We present an interesting case of ligneous conjunctivitis caused by a viral infection that responded well to conservative management. Topical cyclosporine and heparin are a good treatment regimen that caused resolution of lesions and prevented recurrences.
Assuntos
Conjuntivite Viral , Conjuntivite , Dermatopatias Genéticas , Humanos , Conjuntivite/diagnóstico , Conjuntivite/tratamento farmacológico , Conjuntivite/etiologia , Conjuntivite Viral/diagnóstico , Conjuntivite Viral/tratamento farmacológico , OlhoRESUMO
PURPOSE: To evaluate the frequency of Human adenovirus (HAdV) and its serotypes in keratoconjunctivitis patients who attended the outpatient clinics of Mansoura Ophthalmic Center, Egypt. METHODS: Conjunctival secretions and corneal scrapings were collected from patients complaining of clinically diagnosed viral keratoconjunctivitis. The molecular method for HAdV detection was performed by polymerase chain reaction (PCR) followed by restriction enzymes (REA) determination of serotypes for hexone gene. RESULTS: HAdV infection was detected in 38% of samples. There were 4 serotypes of Human adenovirus species D (HAdV-D) isolated (4, 8, 37, 3), where HAdV-D8 was the most dominant. Contact with infected patient, follicular conjunctivitis and subepithelial corneal infiltrates are useful features for clinical diagnosis of adenoviral conjunctivitis. CONCLUSION: HAdV was significant etiological factor of acute follicular conjunctivitis. Accurate diagnosis of adenoviral conjunctivitis is essential for appropriate management, reducing permanent visual impairment and to limit the transmission of the virus within the community.
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Adenovírus Humanos , Conjuntivite Viral , Conjuntivite , Ceratoconjuntivite , Humanos , Egito/epidemiologia , Ceratoconjuntivite/diagnóstico , Ceratoconjuntivite/epidemiologia , Conjuntivite Viral/diagnóstico , Conjuntivite Viral/epidemiologia , Túnica Conjuntiva , Adenovírus Humanos/genética , DNA Viral/genética , DNA Viral/análiseRESUMO
Importance: Acute infectious conjunctivitis is characterized by ocular redness and discharge, and is a common clinical entity. Evidence-based tools to aid the clinical diagnosis of viral vs bacterial conjunctivitis are lacking and may contribute to overprescribing of topical antibiotics. Objective: To determine the relative prevalence of viral vs bacterial conjunctivitis in adults and children, and to determine which symptoms or signs are suggestive of a viral vs bacterial etiology. Data Sources: A MEDLINE search (January 1946-March 2022) yielded 1891 articles. Included articles were rated using a quality score based on a modified Rational Clinical Examination grading system. Methodological quality levels 1 through 4 required a microbiological reference standard for diagnosis, whereas quality level 5 (the lowest quality) used a clinical reference standard for diagnosis. Study Selection: Consecutive series of patients presenting with acute infectious conjunctivitis and case series of viral or bacterial conjunctivitis alone. Thirty-two studies were included in a meta-analysis to determine prevalence and diagnostic accuracy measures; 27 used a microbiological reference standard for diagnosis and 5 used a clinical reference standard for diagnosis. Results: In studies involving children (5 studies; 881 patients; mean age, 4.7 years [age range, 1 month-18 years]), the prevalence of bacterial conjunctivitis was higher than viral conjunctivitis (71% vs 16%, respectively, P = .01). In the only study of adults (n = 207 patients; mean age, 25.7 years), the prevalence of viral conjunctivitis was higher than bacterial conjunctivitis (78% vs 16%, respectively, P < .001). For the primary analysis of level 1 (n = 6) and level 2 (n = 5) studies (1725 patients total), the clinical findings that best distinguished a viral etiology for conjunctivitis from a bacterial etiology included pharyngitis (sensitivity range, 0.55-0.58; specificity range, 0.89-0.94; positive likelihood ratio [LR] range, 5.4-9.9), preauricular lymphadenopathy (sensitivity range, 0.17-0.31; specificity range, 0.93-0.94; positive LR range, 2.5-5.6), and contact with another person with red eye (sensitivity, 0.18 [95% CI, 0.14-0.22]; specificity, 0.93 [95% CI, 0.90-0.95]; positive LR, 2.5 [95% CI, 1.6-3.7]). Mucopurulent ocular discharge (sensitivity, 0.76 [95% CI, 0.60-0.87); specificity, 0.66 [95% CI, 0.58-0.73]; positive LR, 2.1 [95% CI, 1.7-2.6]) and otitis media (sensitivity, 0.24 [95% CI, 0.20-0.29]; specificity, 0.91 [95% CI, 0.85-0.94]; positive LR, 2.5 [95% CI, 1.5-4.4]) were associated with the presence of bacterial conjunctivitis. Conclusions and Relevance: In this review, bacterial conjunctivitis was more common than viral conjunctivitis in children and viral conjunctivitis was more common than bacterial conjunctivitis in adults, although the prevalence estimates were based on limited evidence. Symptoms and signs associated with a higher likelihood of viral conjunctivitis in adults and children included concomitant pharyngitis, an enlarged preauricular node, and contact with another person with red eye, and signs associated with a higher likelihood of bacterial conjunctivitis included the presence of mucopurulent discharge and otitis media, but no single symptom or sign differentiated the 2 conditions with high certainty.
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Conjuntivite Bacteriana , Conjuntivite Viral , Doença Aguda , Adolescente , Adulto , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/epidemiologia , Criança , Pré-Escolar , Conjuntivite/epidemiologia , Conjuntivite/microbiologia , Conjuntivite/virologia , Conjuntivite Bacteriana/complicações , Conjuntivite Bacteriana/diagnóstico , Conjuntivite Bacteriana/epidemiologia , Conjuntivite Viral/diagnóstico , Conjuntivite Viral/epidemiologia , Humanos , Lactente , Faringite/complicações , Prevalência , Sensibilidade e Especificidade , Supuração/complicaçõesRESUMO
Purpose To evaluate the ocular surface properties in epidemic keratoconjunctivitis (EKC) patients during healing process, and to detect the damage on conjunctival goblet cells. Methods Bilateral EKC patients confirmed with polymerase chain reaction (PCR) testing were included. Firstly (Group 1) and secondly (Group 2) affected eyes were compared. Ocular surface parameters were performed at the first visit and first month. Results The study included 34 eyes of 17 patients. The mean age was 44.54 ± 16.80 (21-70) years (FM/M 20/14). The ocular findings in Groups 1 and 2 were not significant. For Groups 1 and 2, OSDI was 53.53 ± 23.01 and 35.90 ± 22.19 (p 0.03), tear osmolarity was 309.12 ± 19.38 and 297.47 ± 8.27 mOsm/µL (p 0.029), OSSS was 1.00 ± 0.79 and 0.18 ± 0.39 (p 0.001), T-BUT was 3.59 ± 2.29 and 6.00 ± 1.83 s (p 0.002), and Schirmer's 1 test was 10.94 ± 8.42 and 16.76 ± 9.05 mm (p 0.061), respectively. In Groups 1 and 2, the IC was Grade (G) 0 in 23.5% and 17.6%, G1 in 35.3% and 41.2%, and G2 in 41.2% and 41.2%, respectively. The ocular surface properties were worse in Group 1 than Group 2, and the difference was significant except for Schirmer's 1 test and IC. Conclusions Dry eye disorder is a complication of EKC and may cause a significant decrease in quality of life.
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Conjuntivite Viral , Síndromes do Olho Seco , Ceratoconjuntivite , Adulto , Túnica Conjuntiva , Conjuntivite Viral/complicações , Conjuntivite Viral/diagnóstico , Síndromes do Olho Seco/complicações , Síndromes do Olho Seco/diagnóstico , Humanos , Ceratoconjuntivite/diagnóstico , Pessoa de Meia-Idade , Qualidade de Vida , LágrimasRESUMO
CLINICAL RELEVANCE: This study identifies key signs and symptoms of acute conjunctivitis, that when combined with a point-of-care test, can improve clinician accuracy of diagnosing adenoviral conjunctivitis. BACKGROUND: Adenoviral conjunctivitis is a common ocular infection with the potential for high economic impact due to widespread outbreaks and subsequent furloughs from work and school. In this report, we describe clinical signs and participant-reported symptoms that most accurately identify polymerase chain reaction (PCR)-confirmed adenoviral conjunctivitis. METHODS: Adults with 'red eye' symptoms of four days or less were enrolled. Participants rated 10 ocular symptoms from 0 (not bothersome) to 10 (very bothersome), and indicated the presence or absence of systemic flu-like symptoms. Clinicians determined the presence or absence of swollen lymph nodes and rated the severity of eight ocular signs using a 5-point scale. An immunoassay targeting adenovirus antigen was utilised for the point-of-care test, and conjunctival swab samples were obtained for subsequent adenovirus detection by PCR analyses. Univariate and multivariate logistic regression models were used to identify symptoms and signs associated with PCR-confirmed adenoviral conjunctivitis. The diagnostic accuracy of these clinical findings, and the potential benefit of incorporating point-of-care test results, was assessed by calculating areas under the receiver operating characteristic curves (AUC). RESULTS: Clinician-rated bulbar conjunctival redness, participant-rated eyelid swelling and overall ocular discomfort had the best predictive value in the multivariate logistic regression model with an AUC of 0.83. The addition of the point-of-care test results to these three clinical sign/symptom scores improved diagnostic accuracy, increasing the AUC to 0.94. CONCLUSIONS: Conjunctival redness severity and participant-reported eyelid swelling and overall discomfort, along with adenoviral point-of-care test results, were highly predictive in identifying individuals with PCR-confirmed adenoviral conjunctivitis. Improved diagnostic accuracy by clinicians at the initial presenting visit could prevent unnecessary work furloughs and facilitate earlier treatment decisions.
Assuntos
Infecções por Adenovirus Humanos , Conjuntivite Viral , Conjuntivite , Infecções por Adenovirus Humanos/diagnóstico , Infecções por Adenovirus Humanos/tratamento farmacológico , Adulto , Conjuntivite/diagnóstico , Conjuntivite Viral/diagnóstico , Conjuntivite Viral/tratamento farmacológico , Humanos , Testes Imediatos , Reação em Cadeia da Polimerase/métodosRESUMO
PURPOSE: To determine the characteristics of conjunctivitis associated with human adenovirus E4 (AdV E4). METHODS: Samples and outcomes from 500 patients with conjunctivitis were obtained from the NVC-422 randomized controlled clinical trial comparing auriclosene to placebo. Molecular typing identified 36 cases associated with AdV E4. Signs and symptoms at presentation and at the day 18 endpoint were compared with the larger cohort of 262 subjects with conjunctivitis caused by due to AdV D8. Full viral genomes of 22 AdV E4 isolates were reconstructed. RESULTS: AdV E4 was the most frequently identified adenoviral type in conjunctivitis cases from the United States. Signs and symptoms at presentation were comparable to those associated with AdV D8. Viral load at presentation was comparable between groups but resolution was more rapid in the AdV E4 group. Clinical signs were fully resolved by day 18 in 26 of 36 (72%) patients with AdV E4. Subepithelial infiltrates developed in 12 of 36 (33%) patients with AdV E4 compared with 98 of 215 (45%) patients with AdV D8 (P = .0001). One hundred twenty-four polymorphisms were observed among 22 whole viral genome sequences, which clustered into 3 clades. Patients in each clade developed subepithelial infiltrates. Neither single nucleotide polymorphism analysis nor machine learning approaches identified specific sequence features predictive of presenting signs or outcome. CONCLUSIONS: AdV E4 conjunctivitis may be indistinguishable at presentation from AdV D8-associated disease. Resolution of viral load for AdV E4 appears more rapid than for AdV D8, and the risk for subepithelial infiltrates appears lower. Multiple substrains of AdV E4 are in circulation but all appeared equivalently pathogenic for conjunctivitis. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Infecções por Adenovirus Humanos , Adenovírus Humanos , Conjuntivite Viral , Conjuntivite , Adenoviridae , Infecções por Adenovirus Humanos/diagnóstico , Infecções por Adenovirus Humanos/epidemiologia , Adenovírus Humanos/genética , Conjuntivite/diagnóstico , Conjuntivite Viral/diagnóstico , HumanosRESUMO
ABSTRACT: As the understanding of COVID-19 infection becomes better, it is being recognized as a complex multisystem pathology rather than just affecting the lungs. Several ocular findings have been documented by researchers in individuals infected with COVID-19, and ocular symptoms may even be the first presenting feature of COVID-19 infection in 2.26% individuals. Several countries have started vaccination with inactivated or live vaccines to combat this pandemic, and varied side effects have been reported after vaccination. Few cases of herpes zoster have previously been reported in elderly patients with comorbidities after receiving COVID-19 vaccines. In this article, the authors described 2 interesting cases of herpes zoster ophthalmicus (HZO) after receiving a live COVID-19 vaccine. The first case was a 35-year-old immunocompetent man who developed HZO 3 days postvaccine. The second case was a 40-year-old immunocompetent man who developed HZO 28 days postvaccine. To the best of our knowledge, no literature to date has described HZO after live vaccine.
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COVID-19/prevenção & controle , ChAdOx1 nCoV-19/efeitos adversos , Conjuntivite Viral/etiologia , Herpes Zoster Oftálmico/etiologia , Vacinação/efeitos adversos , Aciclovir/uso terapêutico , Administração Oftálmica , Administração Oral , Adulto , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Conjuntivite Viral/diagnóstico , Conjuntivite Viral/tratamento farmacológico , Quimioterapia Combinada , Herpes Zoster Oftálmico/diagnóstico , Herpes Zoster Oftálmico/tratamento farmacológico , Humanos , Masculino , Moxifloxacina/uso terapêutico , SARS-CoV-2/imunologia , Valaciclovir/uso terapêutico , Acuidade Visual/fisiologiaRESUMO
The novel pandemic coronavirus disease 2019 (COVID-19) leading to health and economic problems worldwide is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although COVID-19 mainly occurs as a lower respiratory tract infection, there is multiorgan involvement in infected patients. The disease is transmitted from person to person through air droplets or contact with contaminated surfaces. SARS-CoV-2 leads to this systemic involvement by attaching to angiotensin-converting enzyme 2 (ACE2) receptors located on several human cells. Since SARS-CoV-2 RNA has been found in tears of infected patients, ocular surface may allow the virus to transmit to nasopharynx via the nasolacrimal duct. This narrative review aims to sum up all segmental ocular complications, ocular adverse effects of COVID-19 treatment, and preventive measures suggested to minimize the SARS-CoV-2 transmission between patients and ophthalmologists by reviewing currently available literature.
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COVID-19/diagnóstico , Infecções Oculares Virais/diagnóstico , SARS-CoV-2 , Lágrimas/virologia , COVID-19/prevenção & controle , COVID-19/virologia , Teste de Ácido Nucleico para COVID-19 , Conjuntivite Viral/diagnóstico , Conjuntivite Viral/prevenção & controle , Conjuntivite Viral/virologia , Encefalite Viral/diagnóstico , Encefalite Viral/prevenção & controle , Encefalite Viral/virologia , Infecções Oculares Virais/prevenção & controle , Infecções Oculares Virais/virologia , Humanos , Medicina Preventiva/métodos , Doenças Retinianas/diagnóstico , Doenças Retinianas/prevenção & controle , Doenças Retinianas/virologia , SARS-CoV-2/patogenicidadeRESUMO
Purpose: To evaluate and establishe the number of patients with ocular manifestations in the early phase of systemic COVID-19 infection.Methods: A cross-sectional study was performed in a COVID-19 referral center regarding ocular findings in patients with COVID-19 in the first few days of the disease. The patients were submitted to a clinical examination, an ophthalmic exam and a RT-PCR for SARS-COV-2.Results: Out of 1740 patients, we reported 108 patients with ocular manifestations. Forty-nine with markedly conjunctivitis had conjunctival swab positive for SARS-COV-2, four of them developed keratitis. There were mostly no evidence of retinopathy nor decrease in visual acuity. They had no marked clinical symptoms, which can contribute and demonstrate that the virus may cause ocular disease as an only finding or in the very early stage of the infection.Conclusion: Patients were in the first days of COVID-19 infection, presented ocular manifestations suggested to be related to the virus and need to be aware of the pathways of transmissions.
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COVID-19/complicações , Túnica Conjuntiva/patologia , Conjuntivite Viral/diagnóstico , Infecções Oculares Virais/diagnóstico , RNA Viral/análise , SARS-CoV-2/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , COVID-19/epidemiologia , COVID-19/virologia , Túnica Conjuntiva/virologia , Conjuntivite Viral/etiologia , Conjuntivite Viral/virologia , Estudos Transversais , Infecções Oculares Virais/etiologia , Infecções Oculares Virais/virologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Fatores de Tempo , Adulto JovemRESUMO
ABSTRACT: The coronavirus disease 2019 global pandemic is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several ophthalmic manifestations have been reported to be associated with SARS-CoV-2 infection, including conjunctivitis, acute sixth nerve palsy, and multiple cranial neuropathies. We present a unique case of unilateral phlyctenular keratoconjunctivitis in a 5-year-old boy in the setting of SARS-CoV-2 infection.
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COVID-19/diagnóstico , Conjuntivite Viral/diagnóstico , Infecções Oculares Virais/diagnóstico , Ceratoconjuntivite/diagnóstico , SARS-CoV-2/patogenicidade , Administração Oral , Antibacterianos/administração & dosagem , Ácido Ascórbico/administração & dosagem , Azitromicina/administração & dosagem , COVID-19/virologia , Teste de Ácido Nucleico para COVID-19 , Pré-Escolar , Conjuntivite Viral/tratamento farmacológico , Conjuntivite Viral/virologia , Quimioterapia Combinada , Infecções Oculares Virais/tratamento farmacológico , Infecções Oculares Virais/virologia , Fluormetolona/uso terapêutico , Glucocorticoides/uso terapêutico , Humanos , Ceratoconjuntivite/tratamento farmacológico , Ceratoconjuntivite/virologia , Masculino , Soluções Oftálmicas , Microscopia com Lâmpada de Fenda , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia , Tratamento Farmacológico da COVID-19RESUMO
Purpose: To evaluate the presence of SARS-CoV-2 in conjunctival secretions of COVID-19 patients.Material and Methods: In this retrospective study, the records were examined of patients who were treated in the hospital with the diagnosis of COVID-19 between March-May 2020 and were referred to the eye clinic due to ocular symptoms. Conjunctival swabs from both confirmed and suspected COVID-19 cases during hospitalization were analyzed.Results: A total of 35 patients (22 suspected, 13 laboratory-confirmed COVID-19) were referred to the eye clinic. Conjunctival swab samples from 3 patients yielded positive PCR results. These three patients were being treated in the intensive care unit, and all were suspected COVID-19 patients.Conclusion: SARS-CoV-2 may be detected in patients with suspected COVID-19. Even with conjunctivitis findings, SARS-CoV-2 may not be detected in most conjunctiva swab samples of COVID-19 patients.
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COVID-19/virologia , Túnica Conjuntiva/metabolismo , Conjuntivite Viral/diagnóstico , Infecções Oculares Virais/diagnóstico , Adulto , Idoso , COVID-19/metabolismo , Túnica Conjuntiva/patologia , Túnica Conjuntiva/virologia , Conjuntivite Viral/metabolismo , Conjuntivite Viral/virologia , Infecções Oculares Virais/metabolismo , Infecções Oculares Virais/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , RNA Viral/análise , Estudos Retrospectivos , SARS-CoV-2/genética , Manejo de EspécimesRESUMO
IMPORTANCE: Adenoviral conjunctivitis is highly contagious, can be associated with systemic infections, and can cause chronic visual impairment. It accounts for a large proportion of acute conjunctivitis. Outbreaks of epidemic keratoconjunctivitis (EKC) are costly in terms of productivity loss from work furloughs and spread to patients and have resulted in clinic and departmental closures. OBJECTIVE: To examine the institutional cost savings of a policy to diagnose adenoviral conjunctivitis and triage and furlough medical center employees with this condition to prevent outbreaks. DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study assessed Johns Hopkins Medicine employees with red eye from November 1, 2011, through October 31, 2018, who were triaged at the occupational health clinic whose conditions were diagnosed using polymerase chain reaction (PCR) validated for adenoviral conjunctivitis. INTERVENTIONS: Only employees with positive PCR test results were furloughed, with furlough length tailored to subtype (a minimum of 2 weeks for EKC and 1 week otherwise). MAIN OUTCOMES AND MEASURES: Total number of furloughs avoided and cost savings associated with reducing unnecessary furloughs. RESULTS: Of 2142 employees with red eye, 1520 (71.0%) underwent PCR testing; 130 (8.6%) had positive adenoviral PCR test results, of whom 41 (31.5%) had EKC. Furloughing 130 employees with positive PCR test results vs furloughing all 1520 employees clinically suspected of having adenoviral conjunctivitis represented an estimated annual savings of $442â¯073, or $3â¯094â¯511 during 7 years. The cost of performing PCR on employees suspected of having adenoviral conjunctivitis was 5.0% of the cost associated with furloughing all employees with red eye. No outbreaks occurred. CONCLUSIONS AND RELEVANCE: In this quality improvement study, this policy, notable for development and use of PCR for adenoviral conjunctivitis on a large scale, resulted in substantial cost savings from fewer work furloughs compared with the number of employees who would have been furloughed based on clinical diagnosis. These results may provide impetus for policy adoption by other institutions and for development of a rapid, sensitive, and specific diagnostic test for adenoviral conjunctivitis.
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Infecções por Adenovirus Humanos , Adenovírus Humanos , Conjuntivite Viral , Centros Médicos Acadêmicos , Infecções por Adenovirus Humanos/diagnóstico , Infecções por Adenovirus Humanos/epidemiologia , Infecções por Adenovirus Humanos/prevenção & controle , Adenovírus Humanos/genética , Conjuntivite Viral/diagnóstico , Conjuntivite Viral/prevenção & controle , Redução de Custos , Humanos , PolíticasRESUMO
PURPOSE: The aim of this study was to determine the frequency and various types of ophthalmic manifestation of patients with COVID-19. METHODS: This is a prospective observational study conducted on patients with SARS-Co-V-2 infection, at a dedicated tertiary COVID-19 hospital in South India from April 1 to July 31, 2020. At the time of their admission to the COVID hospital, demographic data such as name, age, sex was recorded. A thorough history regarding the onset, duration, progression, nature of symptoms and its associated factors, medication history, treatment history were elicited and documented. Ocular examination was performed under torchlight by an ophthalmologist posted for COVID duty. Further investigations including imaging were sought for, depending on clinical indications. Serial follow-up examinations of all patients were carried out every 72 hours or when patients complained of any ocular symptoms whichever earlier, until discharge. All relevant data were compiled and statistically analyzed. RESULTS: A total of 2742 patients were examined. Of them, 1461 (53.28%) were males and 1281 (46.72%) were females. The mean age (±SD) was 39.46 ± 17.63 years. None of the patients in our study had any ocular symptoms or signs as the presenting complaint at the time of their admission. On subsequent follow-up, only 20 (0.72%) developed ocular manifestations, of which 19 (95%) had features suggestive of Bilateral viral conjunctivitis. However, 1 (5%) patient had orbital cellulitis secondary to pansinusitis. CONCLUSION: Ophthalmic manifestations in the clinical spectrum of COVID-19 infection are uncommon and unlikely to be the presenting clinical impression. However, it has broadened our view to a wider spectrum of COVID-19 presentations enhancing our clinical acumen for staunch detection of COVID-19 suspects in our daily practice, augmenting early diagnosis and management and also break the chain of transmission for the greater good of humanity.
Assuntos
COVID-19/complicações , Conjuntivite Viral/etiologia , Infecções Oculares Virais/etiologia , Pandemias , SARS-CoV-2 , Adulto , Idoso , COVID-19/epidemiologia , Conjuntivite Viral/diagnóstico , Conjuntivite Viral/epidemiologia , Infecções Oculares Virais/diagnóstico , Infecções Oculares Virais/epidemiologia , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel virus causing an ongoing pandemic in 2020. Although the symptomatic patients infected by SARS-CoV-2 generally show respiratory distress, atypical manifestations such as conjunctivitis are also observed. A series of cases are reported in which reverse transcriptase polymerase chain reaction (RT-PCR) testing on tears had demonstrated the presence of the virus. However, the transmission of the virus through ocular fluids remains unknown. CASE DESCRIPTION: In this case report, the development of conjunctivitis is presented as the sole symptom of a new coronavirus disease 2019 (COVID-19) in an emergency health care worker. The patient's first application was to the ophthalmology clinic due to redness, stinging, tearing, and photophobia for one day in the right eye. The patient had no symptoms of fever, cough, shortness of breath, or fatigue. Two days later, the RT-PCR test, blood analysis, and chest computed tomography (CT) were applied to the patient for being in contact with a COVID positive patient. Conjunctival swabs did not identify SARS-CoV-2 by RT-PCR. However, nasopharyngeal swab and blood test confirmed the diagnosis of COVID-19. Chest CT did not show pneumonia. CONCLUSION: This phenomenon shows that conjunctivitis may occur as a sole manifestation of COVID-19 which needs to be carefully evaluated by health care workers and eye care professionals during the pandemic.