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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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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.
Assuntos
Mpox , Estados Unidos/epidemiologia , Humanos , Pessoa de Meia-Idade , Face , Reação em Cadeia da Polimerase , Sintomas Prodrômicos , RNA ViralRESUMO
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 , Conjuntivite , Humanos , Doença Aguda , California/epidemiologia , COVID-19/diagnóstico , COVID-19/epidemiologia , Sequenciamento de Nucleotídeos em Larga Escala , PandemiasRESUMO
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 , Estudos Prospectivos , SARS-CoV-2RESUMO
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 , Cegueira , Humanos , Prevalência , Rosácea/diagnóstico , Rosácea/terapiaRESUMO
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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Conjuntivite/diagnóstico , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Metagenômica/métodos , Adulto , Idoso , Conjuntivite/microbiologia , DNA Bacteriano/análise , DNA Fúngico/análise , DNA Viral/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemAssuntos
Úlcera da Córnea/diagnóstico , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Fúngicas/diagnóstico , Área Sob a Curva , Bactérias/classificação , Córnea , Úlcera da Córnea/microbiologia , Diagnóstico Diferencial , Técnicas de Diagnóstico Oftalmológico , Sistemas Inteligentes , Infecções Oculares Bacterianas/microbiologia , Infecções Oculares Fúngicas/microbiologia , Fungos/classificação , Humanos , Curva ROC , EspecializaçãoAssuntos
Perfuração da Córnea/etiologia , Endoftalmite/complicações , Infecções Oculares Bacterianas/complicações , Infecções Pneumocócicas/complicações , Idoso de 80 Anos ou mais , Biópsia , Perfuração da Córnea/diagnóstico , Endoftalmite/diagnóstico , Endoftalmite/microbiologia , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/microbiologia , Humanos , Masculino , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/microbiologia , Ruptura Espontânea , Streptococcus pneumoniae/isolamento & purificação , Tomografia Computadorizada por Raios X , UltrassonografiaAssuntos
Úlcera da Córnea/diagnóstico , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Fúngicas/diagnóstico , Metagenômica , Infecções Estafilocócicas/diagnóstico , Infecções Estreptocócicas/diagnóstico , Úlcera da Córnea/microbiologia , DNA Bacteriano/genética , Testes Diagnósticos de Rotina , Infecções Oculares Bacterianas/microbiologia , Infecções Oculares Fúngicas/microbiologia , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Metagenoma , RNA Bacteriano/genética , Infecções Estafilocócicas/microbiologia , Staphylococcus/genética , Staphylococcus/isolamento & purificação , Infecções Estreptocócicas/microbiologia , Streptococcus/genética , Streptococcus/isolamento & purificaçãoAssuntos
Infecções por Coronavirus , Coronavirus , Pandemias , Pneumonia Viral , Betacoronavirus , COVID-19 , Humanos , SARS-CoV-2 , Lágrimas , Eliminação de Partículas ViraisAssuntos
Pesquisa Biomédica/tendências , Síndromes do Olho Seco/tratamento farmacológico , Síndromes do Olho Seco/diagnóstico , Ácidos Graxos Ômega-3/administração & dosagem , Humanos , Avaliação de Resultados em Cuidados de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoAssuntos
Infecções Oculares Fúngicas/microbiologia , Micoses/microbiologia , Scedosporium/isolamento & purificação , Doenças da Esclera/microbiologia , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Terapia Combinada , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/terapia , Humanos , Masculino , Micoses/diagnóstico , Micoses/terapia , Procedimentos Cirúrgicos Oftalmológicos , Doenças da Esclera/diagnóstico , Doenças da Esclera/terapiaAssuntos
Doenças da Túnica Conjuntiva/diagnóstico , Doenças da Córnea/diagnóstico , Infecções Oculares/diagnóstico , Sequenciamento de Nucleotídeos em Larga Escala , Metagenoma , Doenças da Esclera/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Bactérias/genética , Doenças da Túnica Conjuntiva/microbiologia , Doenças da Túnica Conjuntiva/parasitologia , Doenças da Córnea/microbiologia , Doenças da Córnea/parasitologia , Infecções Oculares/microbiologia , Infecções Oculares/parasitologia , Feminino , Fungos/genética , Humanos , Masculino , Pessoa de Meia-Idade , Parasitos/genética , Reação em Cadeia da Polimerase , Estudos Retrospectivos , Doenças da Esclera/microbiologia , Doenças da Esclera/parasitologiaAssuntos
Infecções Bacterianas/complicações , Úlcera da Córnea/etiologia , Saúde Global , Doenças Negligenciadas/epidemiologia , Antibacterianos/uso terapêutico , Úlcera da Córnea/tratamento farmacológico , Úlcera da Córnea/prevenção & controle , Países em Desenvolvimento , Promoção da Saúde/organização & administração , Humanos , Hanseníase/complicações , Oncocercose Ocular/complicações , Tracoma/complicaçõesRESUMO
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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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.
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OBJECTIVES: To determine the associated pathogen during the 2023 conjunctivitis outbreak in Vietnam METHODS: RNA-sequencing was used to identify pathogens before and during the outbreak. RESULTS: 24 patients with infectious conjunctivitis between March and October 2023 from Hai Yen Vision Institute in Vietnam were swabbed. Coxsackievirus A24v was the most common pathogen identified. Phylogenetic analysis of these strains demonstrates similarities to the Coxsackievirus identified in the 2022 India outbreak. Human adenovirus D was also circulating. Ocular findings of tearing, purulence, and itching were common in this outbreak. CONCLUSIONS: Multiple viruses can co-circulate during conjunctivitis outbreaks. Hemorrhagic conjunctivitis, commonly associated with coxsackievirus conjunctivitis, was not a common clinical sign in this outbreak. Repeat genetic surveillance, with the notable inclusion of RNA virus detection strategies, is important for outbreak detection.