Positive detection of SARS-CoV-2 combined HSV1 and HHV6B virus nucleic acid in tear and conjunctival secretions of a non-conjunctivitis COVID-19 patient with obstruction of common lacrimal duct.

BACKGROUND: The current outbreak of COVID-19 has spread rapidly all over the world. Respiratory droplets and contaction with infected patients are the two major transmission routes. However, the value of tear virus nucleic acid is still not clear. We dynamic detected the SARS-CoV-2 in eye sample of one COVID-19 patient with obstruction of common lacrimal ducts. METHODS: Besides the routine examination, nasopharyngeal and eye swab were continuously measured by polymerase chain reaction assay and next-generation sequencing (NGS). Gene detection was performed for drug use guidance, and flow cytometry was performed to analyse the lymphocyte subsets. RESULTS: Nasopharyngeal swabs were positive for 22 days, but eye swabs were still continuously positive for 2 weeks after nasopharyngeal swabs turned negative. The low level of lymphocyte and the high level IL-6 lasted for almost 4 weeks, then became near normal. Next-generation sequencing (NGS) confirmed the existing of SARS-CoV-2, HSV1 and HHV6B virus nucleic acid. The gene detection for drug use guidance showed the genetic locus ABCB1 (3435T>C) rs1045642 belonged to type CC and it mean the efficiency of lopinavir-ritonavir would be significantly decreased. The flow cytometry of lymphocyte subsets showed PD-1+  CD95+ cells was accounting for 94.8% in CD3+  CD8+ T subset and for 94.8% in CD3+  TCRγδ+ T subset. CONCLUSIONS: As obstruction of common lacrimal duct, positively detection in one eye for 2 weeks more after nasopharyngeal swab became negative. More eye swabs should be collected from COVID-19 patients, especially from those immunocompromised, those with eye symptoms and those had a history of ocular diseases.

[Results of using Solanum tuberosum sprouts extract for the treatment of ophthalmoherpes].

The efficacy, tolerability and safety of the extract of Solanum tuberosum sprouts (Panavir eyedrops) have been studied on the model of ophthalmic disorder in rabbits caused by herpes simplex virus (HSV) type 1. It is established that Panavir applied via 6 instillations per day for a period of days has potent therapeutic efficacy and prevents the development of gross corneal opacity in rabbits. Instillation of Panavir eyedrops does not cause irritation, toxic and allergic effects and are well tolerated by rabbits. The fastest and most pronounced effect of Panavir eyedrops was observed in the treatment of epithelial keratitis, as well as for not prolonged persistence of HSV. The effectiveness of Panavir eyedrops is comparable with that of the reference preparation OphthalmoferonR.

[Use conditions of boric acid solution in the eye: handling and occurrence of contamination]. / Uso ocular de água boricada: condições de manuseio e ocorrência de contaminação.

PURPOSE: To evaluate use conditions and detect contamination in bottles of boric acid solution. METHODS: A convenience sample of 42 recruited patients using boric acid solution came to the Ophthalmology Emergency Room of the São Paulo Hospital from February to March of 2003. Cultures were taken from material of the conjunctival sac, inner surface of bottle edge, inner part of cap and from 1 ml of boric acid solution of each bottle. RESULTS: Of the 42 boric acid solution bottles, 17 (40.5%) showed contamination: 1 (2.4%) in the solution, 17 (40.5%) in the inner cap and 6 (14.3%) in the inner part of the bottle edge. Of the 17 contaminated bottles, 10 (58.8%) were handled inappropriately and 13 (76.5%) of the bottles were not discharged after first use. The most common microorganisms found in the caps and edges of the bottles were Staphylococcus sp (69.6%), followed by Gram-positive bacillus (26.1%). Sixteen bottles (38.1%) had been opened more than a month ago and 5 (31.3%) of those showed contamination. The boric acid solution bottle directions shown on the labels were incomplete and not clear. The use of boric acid solution was on recommendation of their own, friends or relatives in 26 (61.9%) cases; pharmacists in 8 (19.0%) cases, ophthalmologists in 5 (11.9%) cases and general practitioners in 3 (7.1%) cases. CONCLUSION: In most cases, the topic use of boric acid solution was recommended by non-physicians. The bottles, in general, were handled inappropriately, and hence presented a much higher level of contamination that did the boric acid solution inside. The lower level of contamination in the solution is possibly associated with the anti-septic characteristics of the boric acid solution.

Uso ocular de água boricada: condições de manuseio e ocorrência de contaminação / Use conditions of boric acid solution in the eye: handling and occurrence of contamination

OBJETIVOS: Avaliar as condições de uso de água boricada e verificar a contaminação dos frascos e seu conteúdo. MÉTODOS: Foram selecionados, por critério de conveniência, quarenta e dois pacientes, usuários de água boricada, que compareceram ao Pronto-Socorro de Oftalmologia do Hospital São Paulo, em fevereiro e março de 2003. Foi colhido material para cultura do saco conjuntival, da superfície interna da borda do frasco, da superfície interna da tampa, além de 1 ml de solução do frasco. RESULTADOS: Dos 42 recipientes de água boricada, 17 (40,5 por cento) apresentavam contaminação, sendo 1 (2,4 por cento) no conteúdo liquido, 17 (40,5 por cento) na parte interna da tampa e 6 (14,3 por cento) na parte interna da borda do frasco. Dos 17 frascos contaminados, 10 (58,8 por cento) tiveram suas tampas manuseadas de maneira inadequada e 13 (76,5 por cento) frascos já haviam sido usados em outras ocasiões. Os microrganismos mais encontrados nas tampas e bordas foram Staphylococcus sp (69,6 por cento) e bacilos Gram-positivos (26,1 por cento). Dezesseis (38,1 por cento) frascos foram abertos há mais de um mês e, destes, 5 (31,3 por cento) apresentaram contaminação. A instrução de uso nos rótulos dos frascos era inconsistente. A utilização de água boricada foi por conta própria, por indicação de amigos ou parentes em 26 (61,9 por cento) casos; indicação de farmacêuticos em 8 (19,0 por cento); de oftalmologistas em 5 (11,9 por cento) e de clínicos gerais em 3 (7,1 por cento). CONCLUSÃO: A indicação de uso tópico oftálmico de água boricada foi feita, na maioria, por leigos. Os frascos, em geral, eram manipulados de maneira inadequada, apresentando contaminação em uma proporção de casos muito maior do que a contaminação do líquido. Essa porcentagem menor de contaminação do conteúdo provavelmente está associada às características anti-sépticas do produto.

PURPOSE: To evaluate use conditions and detect contamination in bottles of boric acid solution. METHODS: A convenience sample of 42 recruited patients using boric acid solution came to the Ophthalmology Emergency Room of the São Paulo Hospital from February to March of 2003. Cultures were taken from material of the conjunctival sac, inner surface of bottle edge, inner part of cap and from 1 ml of boric acid solution of each bottle. RESULTS: Of the 42 boric acid solution bottles, 17 (40.5 percent) showed contamination: 1 (2.4 percent) in the solution, 17 (40.5 percent) in the inner cap and 6 (14.3 percent) in the inner part of the bottle edge. Of the 17 contaminated bottles, 10 (58.8 percent) were handled inappropriately and 13 (76.5 percent) of the bottles were not discharged after first use. The most common microorganisms found in the caps and edges of the bottles were Staphylococcus sp (69.6 percent), followed by Gram-positive bacillus (26.1 percent). Sixteen bottles (38.1 percent) had been opened more than a month ago and 5 (31.3 percent) of those showed contamination. The boric acid solution bottle directions shown on the labels were incomplete and not clear. The use of boric acid solution was on recommendation of their own, friends or relatives in 26 (61.9 percent) cases; pharmacists in 8 (19.0 percent) cases, ophthalmologists in 5 (11.9 percent) cases and general practitioners in 3 (7.1 percent) cases. CONCLUSION: In most cases, the topic use of boric acid solution was recommended by non-physicians. The bottles, in general, were handled inappropriately, and hence presented a much higher level of contamination that did the boric acid solution inside. The lower level of contamination in the solution is possibly associated with the anti-septic characteristics of the boric acid solution.

Evaluation of sampling technique and transport media for the diagnostics of adenoviral eye infections. Adenovirus sampling and transport.

BACKGROUND: Human adenoviruses (HAdV) may cause pharyngoconjunctival fever, follicular conjunctivitis or epidemic keratoconjunctivitis (EKC). Especially, outbreaks of the latter may lead to severe economic losses when preventive measures are implemented too late. Thus, a safe sampling method, proper specimen transport conditions and a fast and sensitive diagnostic technique is mandatory. METHODS: Two commercially available virus transport systems (VTS) were compared with two NaCl-moisturised sampling devices, one of which comprises Dacron-tipped plastic-shafted swabs and the other a cotton-tipped wood-shafted swab, available in most ophthalmologists' offices. Downstream methods for specific detection of HAdV included direct immunofluorescence assay (IFA) of conjunctival swabs, virus isolation by cell culture and quantitative real-time polymerase chain reaction (qPCR). Furthermore, the influence of application of local anaesthetics prior to swabbing on subsequent detection of HAdV was investigated. RESULTS: Application of local anaesthetics had a positive influence on the amount of swabbed cells, thus increasing the chance of obtaining positive results by IFA. Neither isolation of HAdV by cell culture nor by qPCR was negatively influenced by this pretreatment. Surprisingly, both commercially available VTS performed significantly worse than the NaCl-moisturised swabs. This was shown with regard to virus recovery rates in cell culture as well as viral genome copy numbers in the qPCR. CONCLUSIONS: Based on our results, the following recommendations are provided to improve sampling, transport and diagnostic techniques regarding conjunctival swabs for diagnosis of human adenovirus infection: (1) application of local anaesthetics, (2) NaCl-moisturised VTS for shipment of specimens, and (3) detection of HAdV by qPCR. The latter method proved to be superior to virus isolation by cell culture, including subsequent identification by IFA, because it is faster, more sensitive and allows simultaneous handling of a number of samples. Hence, countermeasures to prevent further virus spread in an outbreak situation can be implemented earlier, thus reducing the number of subsequent adenoviral infections.

Hyperfocal cryotherapy of multiple Molluscum contagiosum lesions in patients with the acquired immune deficiency syndrome.

BACKGROUND: Patients with the acquired immune deficiency syndrome are at risk for the development of multiple lesions of Molluscum contagiosum on the eyelids. In this setting, traditional methods of treatment frequently are ineffective and pose risks to the patient as well as to the treating physician. METHODS: A technique was developed that combined lidocaine/prilocaine topical anesthesia with hyperfocal cryotherapy. Twelve patients with multiple M. contagiosum lesions of the eyelids were treated. Initially, two methods were used: one application for 30 seconds or two applications for 20 seconds. RESULTS: Lesions treated with two 20-second applications regressed. Most of those lesions treated for 30 seconds regressed. No scarring, lash complications, ptosis, or damage to the underlying cornea or deeper ocular structures was observed in any patient. CONCLUSIONS: Hyperfocal cryotherapy is an effective therapy for multiple M. contagiosum lesions of the periorbital region, posing minimal risk to the patient and physician. It is particularly useful in patients who are positive for the human immunodeficiency virus, who frequently have multiple lesions, are likely to have recurrent disease, and who pose risks of disease transmission to the medical personnel caring for them.