Pathogens associated with acute infectious conjunctivitis vary by region, as shown in a cross-section.
Among 52 patients from 4 sites in the U. S. In the U. S. and one in Israel, deep RNA sequencing detected human adenovirus species D in a quarter of patients, with a wide variety of pathogens, adding human coronavirus 229E, SARS-CoV-2, and herpes simplex virus. . Type 1 was also identified, reported Thuy Doan, MD, PhD, of the University of California, San Francisco, and colleagues.
Of those patients, 62% had purulent discharge, considered a sign of bacterial infection, however, only 8% of patients were shown to have bacterial conjunctivitis. The majority (54%) were inflamed with viruses that do not respond to antibiotics. noted the authors in JAMA Ophthalmology.
“This study demonstrates that it is more complicated to detect pathogens through their clinical presentation than we imagine,” said co-author Gerami D. Seitzman, MD, also of the University of California, San Francisco. Pathogens are different depending on geography. In some places, it will be viral, but in others, it will be pathogens that the doctor had no idea about. “
As Seitzman told MedPage Today, “Conjunctivitis remains a public health concern. For example, Pakistan recently closed more than 50,000 with more than 300,000 documented cases of conjunctivitis. Lately, the etiology is unknown. “
This examines situations that call for classical ideals about conjunctivitis, he said. “Classically, we are taught that most cases of conjunctivitis are viral in origin, although the culprit pathogens are rarely confirmed. In addition, we are taught, and we are “taught that if a patient has tears, their etiology is most likely viral. And if you have purulent discharge, it’s most likely bacterial. “
But it turns out that pathogenic reasons vary greatly from position to position, he added.
Study co-author Edmund Tsui, MD, of UCLA’s Stein Eye Institute in Los Angeles, told MedPage Today that the RNA tests used in the study cannot be broadcast in prime time.
“Insurance still doesn’t cover it because it’s not a clinical control of infectious eye diseases,” he explained. “Over time, this generation will become less expensive and more available. It’s great for follow-up because it’s “unbiased. ” This means that sequencing will allow us to know the pathogens present in the sample. In the case of culture or PCR [polymerase chain reaction], the doctor has to “guess” which media or primers to check.
Anat Galor, MD, MSPH, an ophthalmologist at the University of Miami who was not involved in this study, praised the studies in an interview with MedPage Today, noting that the findings underscore the need for more testing for conjunctivitis.
“Our clinical diagnosis is correct, but not excellent. Anyone who thinks they’re 100 percent right deserves to read this,” he said. “Fortunately, maximal conjunctivitis is self-limiting. But diagnostic tests will make it less difficult to treat properly. the disease and that he wants to be sent home to avoid infecting others. “
As for broader testing, Galor agreed that deep RNA sequencing testing is still practical in the clinic, but added that there is a lot of interest in larger testing.
In the future, Tsui noted that “conjunctivitis may be one of the first symptoms of an epidemic or pandemic. “(Seitzman noted that COVID-19 was first detected through an ophthalmologist. The Chinese ophthalmologist, who is credited with spreading the disease, died of COVID-19 after being censored by the government. )
“Public oversight is vital and it’s vital to pay attention to infectious eye diseases,” Tsui added.
For this cross-sectional study, Doan and colleagues collected eye and nose samples from 52 patients with acute infectious conjunctivitis in Hawaii, California, and Israel from March 2021 to March 2023. The average age was 48 years and 60% were women. or venomous conjunctivitis were excluded.
Using deep RNA sequencing to read over the samples, the team discovered human adenovirus species D in thirteen patients from California and two cases of human adenovirus species B from Israel. There have been two cases of Epstein-Barr virus, three cases of herpes simplex virus. type 1, two cases of varicella-zoster virus, one case of human metapneumovirus, one case of SARS-CoV-2, three cases of human coronavirus 229E, one case of molluscum contagiosum, four cases of bacteria, and two cases of fungi. No pathogens were discovered in 18 cases.
The researchers noted the limitations of their study, adding that its small size, small number of engagement sites, and lack of “traditional microbial detection by polymerase chain reaction or culture, any type of diagnostic test is rarely performed on an outpatient basis for presumptive cases. “”Acute infectious conjunctivitis.
They also said that no charge data had been collected, so there’s no way to know if this type of test is effective.
Randy Dotinga is a freelance medical journalist and scientist in San Diego.
The study was funded by the National Eye Institute and an unlimited Research to Prevent Blindness grant at the Department of Ophthalmology at the University of California, San Francisco.
Doan disclosed any conflicts of interest. Seitzman said he earned consulting fees from Dompé. Tsui said he won consulting fees from EyePoint Pharmaceuticals, Kowa and Cylite, as well as a grant from Pfizer. His co-author said he won grants from the National Institutes of Health.
Galor reported any disclosures.