151
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Dockery DM, Rowe SG, Murphy MA, Krzystolik MG. The Ocular Manifestations and Transmission of COVID-19: Recommendations for Prevention. J Emerg Med 2020; 59:137-140. [PMID: 32456959 PMCID: PMC7205711 DOI: 10.1016/j.jemermed.2020.04.060] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Coronavirus disease-2019 (COVID-19), caused by a novel coronavirus termed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has been linked to ocular signs and symptoms in several case reports. Research has demonstrated that SARS-CoV-2 is spread primarily through close contact via respiratory droplets, but there is the possibility for ocular transmission, with the conjunctiva as a conduit as well as a source of infection. DISCUSSION Ocular manifestations of SARS-CoV-2 include follicular conjunctivitis, and have been repeatedly noted as an initial or subsequent symptom of COVID-19-positive patients. Particularly in patients with ocular manifestations, there is evidence that the virus may present in tears, based on the detection of SARS-CoV-2 in conjunctival swab samples via reverse transcription polymerase chain reaction. The virus may therefore be transmittable from the ocular surface to a new host via contact with the ocular mucosa, tears, or subsequent fomites. CONCLUSIONS All health care professionals should ask patients about ocular symptoms consistent with SARS-CoV-2, and use eye protection such as goggles or face shields as part of the standard personal protective equipment for high-risk patients in addition to wearing of masks by both the patient and provider, and should consider tears to be potentially infectious.
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Affiliation(s)
- Dominique M Dockery
- Department of Ophthalmology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Susannah G Rowe
- Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts
| | - Marjorie A Murphy
- Department of Ophthalmology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Magdalena G Krzystolik
- Department of Ophthalmology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Ophthalmology (Retina Section), Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
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152
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Aiello F, Gallo Afflitto G, Mancino R, Li JPO, Cesareo M, Giannini C, Nucci C. Coronavirus disease 2019 (SARS-CoV-2) and colonization of ocular tissues and secretions: a systematic review. Eye (Lond) 2020; 34:1206-1211. [PMID: 32424327 PMCID: PMC7232062 DOI: 10.1038/s41433-020-0926-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/16/2020] [Accepted: 04/22/2020] [Indexed: 12/14/2022] Open
Abstract
Coronavirus disease 19 (COVID-19) has been described to potentially be complicated by ocular involvement. However, scant information is available regarding severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) and ocular structures tropism. We conducted a systematic review of articles referenced in PubMed, Cochrane Library, Web of Science and Chinese Clinical Trial Register (ChiCTR) from December 20, 2019 to April 6, 2020, providing information on the presence of SARS-CoV-2 in cornea, conjunctiva, lacrimal sac, and tears. We excluded ongoing clinical studies as for unobtainable conclusive results. Of 2422 articles, 11 met the inclusion criteria for analysis and were included in the study. None of the studies were multinational. Among the 11 selected papers there were three original articles, one review, four letters, two editorials, and one correspondence letter. Globally, 252 SARS-CoV-2 infected patients were included in our review. The prevalence of ocular conjunctivitis complicating the course of COVID-19 was demonstrated to be as high as 32% in one study only. Globally, three patients had conjunctivitis with a positive tear-PCR, 8 patients had positive tear-PCR in the absence of conjunctivitis, and 14 had conjunctivitis with negative tear-PCR. The majority of the available data regarding SARS-CoV-2 colonization of ocular and periocular tissues and secretions have to be considered controversial. However, it cannot be excluded that SARS-CoV-2 could both infect the eye and the surrounding structures. SARS-CoV-2 may use ocular structure as an additional transmission route, as demonstrated by the COVID-19 patients' conjunctival secretion and tears positivity to reverse transcriptase-PCR SARS-CoV-2-RNA assay.
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Affiliation(s)
- Francesco Aiello
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | - Gabriele Gallo Afflitto
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Raffaele Mancino
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | | | - Massimo Cesareo
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Clarissa Giannini
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Carlo Nucci
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
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153
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Seah I, Su X, Lingam G. Revisiting the dangers of the coronavirus in the ophthalmology practice. Eye (Lond) 2020; 34:1155-1157. [PMID: 32029919 PMCID: PMC7091733 DOI: 10.1038/s41433-020-0790-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 01/27/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Ivan Seah
- Department of Ophthalmology, National University Hospital, Singapore, Singapore.
| | - Xinyi Su
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Gopal Lingam
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
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154
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Ho D, Low R, Tong L, Gupta V, Veeraraghavan A, Agrawal R. COVID-19 and the Ocular Surface: A Review of Transmission and Manifestations. Ocul Immunol Inflamm 2020; 28:726-734. [PMID: 32543262 DOI: 10.1080/09273948.2020.1772313] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE The outbreak of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has reached pandemic proportions within an unprecedented span of time. It is controversial whether the virus can be transmitted via tears and its ocular implications have not been widely studied. In this article, the current evidence related to ocular transmission and ocular manifestations is reviewed. RESULTS Several mechanisms for the ocular transmission of the virus are proposed with highlight on the nasolacrimal system as a conduit between the eye and the respiratory tract, and the role of the lacrimal gland in hematogenous spread. Ocular surface manifestations such as conjunctivitis are more commonly reported. CONCLUSION The exact pathophysiology of ocular transmission of the virus remains incompletely understood, although there is preliminary evidence of SARS-CoV-2 being detected in ocular secretions. The ocular tropism of the virus and its potential to cause localized ocular disease are worth considering.
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Affiliation(s)
- Dawn Ho
- Department of Ophthalmology, National Healthcare Group Eye Institute , Singapore, Singapore
| | - Rebecca Low
- Department of Ophthalmology, National Healthcare Group Eye Institute , Singapore, Singapore
| | - Louis Tong
- Singapore Eye Research Institute , Singapore, Singapore.,Department of Cornea and External Diseases, Singapore National Eye Centre , Singapore, Singapore.,Department of Ophthalmology, Duke-NUS Medical School , Singapore, Singapore
| | - Vishali Gupta
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | | | - Rupesh Agrawal
- Department of Ophthalmology, National Healthcare Group Eye Institute , Singapore, Singapore.,Singapore Eye Research Institute , Singapore, Singapore.,Department of Ophthalmology, Duke-NUS Medical School , Singapore, Singapore.,Department of Uveitis, Moorfields Eye Hospital NHS Foundation Trust , London, UK
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155
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Singh G, Sharma PK, Malviya R, Awasthi R. Novel corona virus disease (COVID-19) and ophthalmic manifestations: Clinical evidences. Dermatol Ther 2020; 33:e13814. [PMID: 32526073 PMCID: PMC7300514 DOI: 10.1111/dth.13814] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/06/2020] [Accepted: 06/09/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Geetanjali Singh
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Pramod Kumar Sharma
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Rishabha Malviya
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Rajendra Awasthi
- Amity Institute of Pharmacy, Amity University, Noida, Uttar Pradesh, India
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156
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Bostanci Ceran B, Ozates S. Ocular manifestations of coronavirus disease 2019. Graefes Arch Clin Exp Ophthalmol 2020; 258:1959-1963. [PMID: 32504100 PMCID: PMC7274940 DOI: 10.1007/s00417-020-04777-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/14/2020] [Accepted: 06/01/2020] [Indexed: 12/11/2022] Open
Abstract
Purpose Coronavirus disease 2019 (COVID-19) is an ongoing global public health problem, and most of the COVID-19 research is focused mainly on the respiratory system because of life-threatening results. However, manifestations in other organs should not be ignored since they can also be a mode of transmission. We sought to describe the ocular manifestations of COVID-19 and investigate the association between ocular involvement and clinical presentation and laboratory outcomes. Methods This cross-sectional study was conducted between March 1, 2020, and April 30, 2020. Ninety-three sequentially hospitalized and clinically confirmed COVID-19 patients were included in the study. The systemic and ocular symptoms, clinical findings, and laboratory outcomes were recorded. Results Of the 93 COVID-19 patients, 54 (58.1%) were male, and 39 (41.9%) were female. Mean age of the patients was 39.4 ± 21.9 (min 7, max 88) years. Twenty patients (n 21.5%) had at least one ocular abnormality. Most common findings included hyperemia (n = 20), epiphora (n = 9), increased secretion (n = 6), chemosis (n = 3), follicular conjunctivitis (n = 2), and episcleritis (n = 2). The most common symptom was photophobia (n 15). Patients with ocular involvement were more likely to have higher neutrophil counts (p = 0.001), and increased CRP (p < 0.001), PCT (p = 0.001), and ESR levels (p < 0.001). Mean lymphocyte count was statistically lower in patients with ocular manifestations (p = 0.001). Mean age and number of patients with fever over 37.3 °C in the ocular involvement group was found to be higher (p < 0.001, p = 0.006, respectively). Conclusion Older age, high fever, increased neutrophil/lymphocyte ratio, and high levels of acute phase reactants seemed to be risk factors for ocular involvement.
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Affiliation(s)
- Basak Bostanci Ceran
- Department of Ophthalmology, Okan University School of Medicine, İstanbul, Turkey
| | - Serdar Ozates
- Department of Ophthalmology, Kars Harakani State Hospital, Yenişehir Mahallesi, İsmail Aytemiz Blv. No:55, Merkez, 36200, Kars, Turkey.
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157
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Kumar K, Prakash AA, Gangasagara SB, Rathod SBL, Ravi K, Rangaiah A, Shankar SM, Basawarajappa SG, Bhushan S, Neeraja TG, Khandenahalli S, Swetha M, Gupta P, Sampritha UC, Prasad GNS, Jayanthi CR. Presence of viral RNA of SARS-CoV-2 in conjunctival swab specimens of COVID-19 patients. Indian J Ophthalmol 2020; 68:1015-1017. [PMID: 32461418 PMCID: PMC7508154 DOI: 10.4103/ijo.ijo_1287_20] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose: To detect the presence of viral RNA of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in conjunctival swab specimens of coronavirus disease-19 (COVID-19) patients. Methods: Forty-five COVID-19 patients positive for real-time reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 in nasopharyngeal swab with or without ocular manifestations were included in the study. The conjunctival swab of each patient was collected by an ophthalmologist posted for COVID duty. Results: Out of 45 patients, 35 (77.77%) were males and the rest were females. The mean age was 31.26 ± 12.81 years. None of the patients had any ocular manifestations. One (2.23%) out of 45 patients was positive for RT-PCR SARS-CoV-2 in the conjunctival swab. Conclusion: This study shows that SARS-CoV-2 can be detected in conjunctival swabs of confirmed cases of COVID-19 patients. Though the positivity rate of detecting SARS-CoV-2 in conjunctival swabs is very less, care should be exercised during the ocular examination of patients of COVID-19.
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Affiliation(s)
- Kiran Kumar
- Department of Ophthalmology, Minto Ophthalmic Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Akshata A Prakash
- Department of Ophthalmology, Minto Ophthalmic Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Suresh Babu Gangasagara
- Department of Ophthalmology, Minto Ophthalmic Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Sujatha B L Rathod
- Department of Ophthalmology, Minto Ophthalmic Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - K Ravi
- Department of Medicine, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Ambica Rangaiah
- Department of Microbiology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | | | | | - Shashi Bhushan
- Department of Pulmonary Medicine, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - T G Neeraja
- Department of Ophthalmology, Minto Ophthalmic Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Srinivas Khandenahalli
- Department of Ophthalmology, Minto Ophthalmic Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - M Swetha
- Department of Ophthalmology, Minto Ophthalmic Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Priyam Gupta
- Department of Ophthalmology, Minto Ophthalmic Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - U C Sampritha
- Department of Ophthalmology, Minto Ophthalmic Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Guru N S Prasad
- Department of Ophthalmology, Minto Ophthalmic Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
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158
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Jones L, Walsh K, Willcox M, Morgan P, Nichols J. The COVID-19 pandemic: Important considerations for contact lens practitioners. Cont Lens Anterior Eye 2020; 43:196-203. [PMID: 32273245 PMCID: PMC7129028 DOI: 10.1016/j.clae.2020.03.012] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 03/29/2020] [Accepted: 03/29/2020] [Indexed: 01/08/2023]
Abstract
A novel coronavirus (CoV), the Severe Acute Respiratory Syndrome Coronavirus - 2 (SARS-CoV-2), results in the coronavirus disease 2019 (COVID-19). As information concerning the COVID-19 disease continues to evolve, patients look to their eye care practitioners for accurate eye health guidance. There is currently no evidence to suggest an increased risk of contracting COVID-19 through contact lens (CL) wear compared to spectacle lens wear and no scientific evidence that wearing standard prescription spectacles provides protection against COVID-19 or other viral transmissions. During the pandemic there will potentially be significant changes in access to local eyecare. Thus, it is imperative CL wearers are reminded of the steps they should follow to minimise their risk of complications, to reduce their need to leave isolation and seek care. Management of adverse events should be retained within optometric systems if possible, to minimise the impact on the wider healthcare service, which will be stretched. Optimal CL care behaviours should be the same as those under normal circumstances, which include appropriate hand washing (thoroughly with soap and water) and drying (with paper towels) before both CL application and removal. Daily CL cleaning and correct case care for reusable CL should be followed according to appropriate guidelines, and CL exposure to water must be avoided. Where the availability of local clinical care is restricted, practitioners could consider advising patients to reduce or eliminate sleeping in their CL (where patients have the appropriate knowledge about correct daily care and access to suitable lens-care products) or consider the option of moving patients to daily disposable lenses (where patients have appropriate lens supplies available). Patients should also avoid touching their face, including their eyes, nose and mouth, with unwashed hands and avoid CL wear altogether if unwell (particularly with any cold or flu-like symptoms).
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Affiliation(s)
- Lyndon Jones
- School of Optometry & Vision Science, Centre for Ocular Research & Education (CORE), University of Waterloo, Waterloo, Ontario, Canada.
| | - Karen Walsh
- Centre for Ocular Research & Education (CORE), University of Waterloo, Waterloo, Ontario, Canada.
| | - Mark Willcox
- School of Optometry and Vision Science, UNSW, Sydney, Australia.
| | | | - Jason Nichols
- University of Alabama at Birmingham, Birmingham, AL, USA.
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159
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Bozkurt B, Eğrilmez S, Şengör T, Yıldırım Ö, İrkeç M. The COVID-19 Pandemic: Clinical Information for Ophthalmologists. Turk J Ophthalmol 2020; 50:59-63. [PMID: 32366061 PMCID: PMC7204903 DOI: 10.4274/tjo.galenos.2020.29805] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Banu Bozkurt
- Selçuk University Faculty of Medicine, Department of Ophthalmology, Konya, Turkey
| | - Sait Eğrilmez
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey (E)
| | - Tomris Şengör
- İstanbul Bilim University Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey (E)
| | - Özlem Yıldırım
- Mersin University Faculty of Medicine, Department of Ophthalmology, Mersin, Turkey
| | - Murat İrkeç
- Hacettepe University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey (E)
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160
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De Simone B, Chouillard E, Di Saverio S, Pagani L, Sartelli M, Biffl WL, Coccolini F, Pieri A, Khan M, Borzellino G, Campanile FC, Ansaloni L, Catena F. Emergency surgery during the COVID-19 pandemic: what you need to know for practice. Ann R Coll Surg Engl 2020; 102:323-332. [PMID: 32352836 PMCID: PMC7374780 DOI: 10.1308/rcsann.2020.0097] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Several articles have been published about the reorganisation of surgical activity during the COVID-19 pandemic but few, if any, have focused on the impact that this has had on emergency and trauma surgery. Our aim was to review the most current data on COVID-19 to provide essential suggestions on how to manage the acute abdomen during the pandemic. METHODS A systematic review was conducted of the most relevant English language articles on COVID-19 and surgery published between 15 December 2019 and 30 March 2020. FINDINGS Access to the operating theatre is almost exclusively restricted to emergencies and oncological procedures. The use of laparoscopy in COVID-19 positive patients should be cautiously considered. The main risk lies in the presence of the virus in the pneumoperitoneum: the aerosol released in the operating theatre could contaminate both staff and the environment. CONCLUSIONS During the COVID-19 pandemic, all efforts should be deployed in order to evaluate the feasibility of postponing surgery until the patient is no longer considered potentially infectious or at risk of perioperative complications. If surgery is deemed necessary, the emergency surgeon must minimise the risk of exposure to the virus by involving a minimal number of healthcare staff and shortening the occupation of the operating theatre. In case of a lack of security measures to enable safe laparoscopy, open surgery should be considered.
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Affiliation(s)
- B De Simone
- Centre Hospitalier Intercommunal Poissy/Saint-Germain-en-Laye, France
| | - E Chouillard
- Centre Hospitalier Intercommunal Poissy/Saint-Germain-en-Laye, France
| | | | | | | | - WL Biffl
- Scripps Memorial Hospital, La Jolla, CA, US
| | | | - A Pieri
- Bolzano Central Hospital, Italy
| | - M Khan
- Brighton and Sussex University Hospitals NHS Trust, UK
| | - G Borzellino
- San Giovanni Decollato-Andosilla Hospital, Civita Castellana, Italy
| | | | | | - F Catena
- University Hospital of Parma, Italy
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161
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García Lorente M, Zamorano Martín F, Soler-Ferrández F, Rocha de Lossada C. ¿Cumplimos correctamente los protocolos de prevención en oftalmología?: a propósito de la última epidemia por coronavirus. ARCHIVOS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGÍA 2020; 95:259-260. [PMID: 32241584 PMCID: PMC7270795 DOI: 10.1016/j.oftal.2020.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 11/04/2022]
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162
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Abstract
Coronavirus disease 2019 (COVID-19) is caused by a highly contagious RNA virus termed as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Ophthalmologists are at high-risk due to their proximity and short working distance at the time of slit-lamp examination. Eye care professionals can be caught unaware because conjunctivitis may be one of the first signs of COVID-19 at presentation, even precluding the emergence of additional symptoms such as dry cough and anosmia. Breath and eye shields as well as N95 masks, should be worn while examining patients with fever, breathlessness, or any history of international travel or travel from any hotspot besides maintaining hand hygiene. All elective surgeries need to be deferred. Adults or children with sudden-onset painful or painless visual loss, or sudden-onset squint, or sudden-onset floaters or severe lid oedema need a referral for urgent care. Patients should be told to discontinue contact lens wear if they have any symptoms of COVID-19. Cornea retrieval should be avoided in confirmed cases and suspects, and long-term preservation medium for storage of corneas should be encouraged. Retinal screening is unnecessary for coronavirus patients taking chloroquine or hydroxychloroquine as the probability of toxic damage to the retina is less due to short-duration of drug therapy. Tele-ophthalmology and artificial intelligence should be preferred for increasing doctor-patient interaction.
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Affiliation(s)
- Parul Chawla Gupta
- Department of Ophthalmology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - M Praveen Kumar
- Department of Pharmacology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Jagat Ram
- Department of Ophthalmology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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163
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García Lorente M, Zamorano Martín F, Soler-Ferrández F, Rocha de Lossada C. Do we correctly comply with prevention protocols in ophthalmology? About the latest coronavirus epidemic. ARCHIVOS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGÍA (ENGLISH EDITION) 2020. [PMCID: PMC7174177 DOI: 10.1016/j.oftale.2020.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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164
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Xie HT, Jiang SY, Xu KK, Liu X, Xu B, Wang L, Zhang MC. SARS-CoV-2 in the ocular surface of COVID-19 patients. EYE AND VISION 2020; 7:23. [PMID: 32355863 PMCID: PMC7183451 DOI: 10.1186/s40662-020-00189-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/12/2020] [Indexed: 12/26/2022]
Abstract
The 2019 novel coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread globally, while the routes of transmission of this virus are still controversial. We enrolled 33 patients, without any ocular manifestation, with their ocular surface swabs collected for virus detection. RNA was detected strong positive in samples of both eyes from two patients. Therefore, SARS-CoV-2 may exist in the normal ocular surface of COVID-19 patients, suggesting that this virus might be spread through conjunctival contact.
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Affiliation(s)
- Hua-Tao Xie
- 1Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Shi-Yun Jiang
- 1Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Kang-Kang Xu
- 1Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Xin Liu
- 1Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Bing Xu
- 1Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Lin Wang
- 2Department of Clinical Laboratory, Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Ming-Chang Zhang
- 1Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
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165
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Scalinci SZ, Trovato Battagliola E. Conjunctivitis can be the only presenting sign and symptom of COVID-19. IDCases 2020; 20:e00774. [PMID: 32373467 PMCID: PMC7195291 DOI: 10.1016/j.idcr.2020.e00774] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 12/11/2022] Open
Abstract
Five cases of non-remitting conjunctivitis turned out to be the sole presenting sign and symptom of COVID-19. These patients tested positive on RT-PCR of naso-pharyngeal swabs and developed no fever, malaise, or respiratory symptoms throughout the course of their illness. They all fully recovered. In the current efforts to fight the spread of this virus, authors want to emphasize that atypical clinical presentations of COVID-19 can occur and a high level of suspicion should be maintained. Ocular involvement and transmission of SARS-CoV-2 should never be overlooked. In fact, conjunctival mucosae are susceptible to respiratory viruses and remain an important point of entry. For this reason, eye protection in the form of goggles or a face shield should be considered essential for all healthcare providers, even when taking care of patients who are not showing typical symptoms of COVID-19.
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166
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Sun CB, Wang YY, Liu GH, Liu Z. Role of the Eye in Transmitting Human Coronavirus: What We Know and What We Do Not Know. Front Public Health 2020; 8:155. [PMID: 32391309 PMCID: PMC7193031 DOI: 10.3389/fpubh.2020.00155] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/14/2020] [Indexed: 01/08/2023] Open
Abstract
The outbreak of the current 2019 novel coronavirus (2019-nCoV, now named SARS-CoV-2) infection has become a worldwide health threat. Currently, more information is needed so as to further understand the transmission and clinical characteristics of 2019-nCoV infection and the infection control procedures required. Recently, the role of the eye in transmitting 2019-nCoV has been intensively discussed. Previous investigations of other highly infectious human CoVs, that is, severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV), may provide useful information. In this review, we describe the genomics and morphology of human CoVs, the epidemiology, systemic and ophthalmic manifestations, and mechanisms of human CoV infection, and recommendations for infection control procedures. The role of the eye in the transmission of 2019-nCoV is discussed in detail. Although the conjunctiva is directly exposed to extraocular pathogens, and the mucosa of the ocular surface and upper respiratory tract are connected by the nasolacrimal duct and share the same entry receptors for some respiratory viruses, the eye is rarely involved in human CoV infection, conjunctivitis is quite rare in patients with 2019-nCoV infection, and the CoV RNA positive rate by RT-PCR test in tears and conjunctival secretions from patients with 2019-nCoV and SARS-CoV infection is also extremely low. This suggests that the eye is neither a preferred organ of human CoV infection nor a preferred gateway of entry for human CoVs for infecting the respiratory tract. However, pathogens that the ocular surface is exposed to might be transported to nasal and nasopharyngeal mucosa by constant tear rinsing through the lacrimal duct system and then cause respiratory tract infection. Considering that close doctor-patient contact is quite common in ophthalmic practice and is apt to transmit human CoVs by droplets and fomites, strict hand hygiene and proper personal protection are highly recommended for health care workers to avoid hospital-related viral transmission during ophthalmic practice.
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Affiliation(s)
- Chuan-bin Sun
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yue-ye Wang
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Geng-hao Liu
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhe Liu
- Department of Ophthalmology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
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167
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Kuo IC. A Rashomon Moment? Ocular Involvement and COVID-19. Ophthalmology 2020; 127:984-985. [PMID: 32359841 PMCID: PMC7194809 DOI: 10.1016/j.ophtha.2020.04.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 12/30/2022] Open
Affiliation(s)
- Irene C. Kuo
- Correspondence: Irene C. Kuo, MD, Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, 4924 Campbell Blvd#100, Baltimore, MD 21236.
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168
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Sustainable practice of ophthalmology during COVID-19: challenges and solutions. Graefes Arch Clin Exp Ophthalmol 2020; 258:1427-1436. [PMID: 32314034 PMCID: PMC7170732 DOI: 10.1007/s00417-020-04682-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 03/27/2020] [Accepted: 04/01/2020] [Indexed: 01/05/2023] Open
Abstract
Purpose The Coronavirus (COVID-19) outbreak is rapidly emerging as a global health threat. With no proven vaccination or treatment, infection control measures are paramount. In this article, we aim to describe the impact of COVID-19 on our practice and share our strategies and guidelines to maintain a sustainable ophthalmology practice. Methods Tan Tock Seng Hospital (TTSH) Eye Centre is the only ophthalmology department supporting the National Centre for Infectious Diseases (NCID), which is the national screening center and the main center for management of COVID-19 patients in Singapore. Our guidelines during this outbreak are discussed. Results Challenges in different care settings in our ophthalmology practice have been identified and analyzed with practical solutions and guidelines implemented in anticipation of these challenges. First, to minimize cross-infection of COVID-19, stringent infection control measures were set up. These include personal protective equipment (PPE) for healthcare workers and routine cleaning of “high-touch” surfaces. Second, for outpatient care, a stringent dual screening and triaging process were carried out to identify high-risk patients, with proper isolation for such patients. Administrative measures to lower patient attendance and reschedule appointments were carried out. Third, inpatient and outpatient care were separated to minimize interactions. Last but not least, logistics and manpower plans were drawn up in anticipation of resource demands and measures to improve the mental well-being of staff were implemented. Conclusion We hope our measures during this COVID-19 pandemic can help ophthalmologists globally and serve to guide and maintain safe access in ophthalmology clinics when faced with similar disease outbreaks.
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169
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Sadhu S, Agrawal R, Pyare R, Pavesio C, Zierhut M, Khatri A, Smith JR, de Smet MD, Biswas J. COVID-19: Limiting the Risks for Eye Care Professionals. Ocul Immunol Inflamm 2020; 28:714-720. [PMID: 32310028 DOI: 10.1080/09273948.2020.1755442] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
After the outbreak of the disease COVID-19, it has reached pandemic proportions within a very short time. It is mainly transmitted human-to-human through direct contact with secretions from an infected person or through inhalation of droplets containing SARS-CoV-2. It is controversial whether the virus may be transmitted via tears. Exposed ocular surface can serve as a gateway in transmission and acquiring respiratory diseases. Considering the reported cases on healthcare workers indicating nosocomial transmission and the anatomical and physiological aspects it is perceived that ophthalmic healthcare professionals are at higher risk of contracting the virus by virtue of their job. In this narrative review we discuss current evidence around detection of SARS-CoV-2 in human tears and forms of transmissions reported to date. We also provide a comprehensive approach that may be implemented in an ophthalmic care facility to protect healthcare personnel, as well as patients, from contracting the virus.
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Affiliation(s)
- Soumen Sadhu
- Department of Optometry, The Sankara Nethralaya Academy, Unit of Medical Research Foundation, Sankara Nethralaya , Chennai, India
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital , Singapore, Singapore.,Singapore Eye Research Institute , Singapore, Singapore.,Department of Uveitis, Moorfields Eye Hospital, NHS Foundation Trust , London, UK
| | - Richa Pyare
- Department of Uvea, Medical Research Foundation, Sankara Nethralaya , Chennai, India
| | - Carlos Pavesio
- Department of Uveitis, Moorfields Eye Hospital, NHS Foundation Trust , London, UK
| | - Manfred Zierhut
- Department of Ophthalmology, University of Tuebingen , Tuebinbgen, Germany
| | - Anadi Khatri
- Department of Vitreo-Retina Services, Birat Eye Hospital , Biratnagar, Nepal.,Department of Ophthalmology, Birat Medical College and Teaching Hospital , Biratnagar, Nepal
| | - Justine R Smith
- Flinders University College of Medicine and Public Health , Adelaide, Australia
| | - Marc D de Smet
- MIOS sa-Medical/Surgical Retina and Ocular Inflammation , Lausanne, Switzerland
| | - Jyotirmay Biswas
- Department of Optometry, The Sankara Nethralaya Academy, Unit of Medical Research Foundation, Sankara Nethralaya , Chennai, India
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170
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Chen L, Liu M, Zhang Z, Qiao K, Huang T, Chen M, Xin N, Huang Z, Liu L, Zhang G, Wang J. Ocular manifestations of a hospitalised patient with confirmed 2019 novel coronavirus disease. Br J Ophthalmol 2020; 104:748-751. [PMID: 32265202 PMCID: PMC7211077 DOI: 10.1136/bjophthalmol-2020-316304] [Citation(s) in RCA: 247] [Impact Index Per Article: 61.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 12/19/2022]
Abstract
Purpose To report the ocular characteristics and the presence of viral RNA of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in conjunctival swab specimens in a patient with confirmed 2019 novel coronavirus disease (COVID-19). Participant and methods A 30-year-old man with confirmed COVID-19 and bilateral acute conjunctivitis which occurred 13 days after illness onset. Based on detailed ophthalmic examination, reverse transcription PCR (RT-PCR) was performed to detect SARS-CoV-2 virus in conjunctival swabs. The ocular characteristics, presence of viral RNA and viral dynamics of SARS-CoV-2 in the conjunctival specimens were evaluated. Results Slit lamp examination showed bilateral acute follicular conjunctivitis. RT-PCR assay demonstrated the presence of viral RNA in conjunctival specimen 13 days after onset (cycle threshold value: 31). The conjunctival swab specimens remained positive for SARS-CoV-2 on 14 and 17 days after onset. On day 19, RT-PCR result was negative for SARS-CoV-2. Conclusion SARS-CoV-2 is capable of causing ocular complications such as viral conjunctivitis in the middle phase of illness. Precautionary measures are recommended when examining infected patients throughout the clinical course of the infection. However, conjunctival sampling might not be useful for early diagnosis because the virus may not appear initially in the conjunctiva.
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Affiliation(s)
- Lu Chen
- Ophthalmology, Shenzhen Eye Hospital, Shenzhen, China
| | - Meizhou Liu
- Ophthalmology, Shenzhen Eye Hospital, Shenzhen, China
| | - Zheng Zhang
- The Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Kun Qiao
- The Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Ting Huang
- The Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Miaohong Chen
- Ophthalmology, Shenzhen Eye Hospital, Shenzhen, China
| | - Na Xin
- Ophthalmology, Shenzhen Eye Hospital, Shenzhen, China
| | - Zuliang Huang
- Ophthalmology, Shenzhen Eye Hospital, Shenzhen, China
| | - Lei Liu
- The Third People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Guoming Zhang
- Ophthalmology, Shenzhen Eye Hospital, Shenzhen, China
| | - Jiantao Wang
- Ophthalmology, Shenzhen Eye Hospital, Shenzhen, China
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171
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Yu AY, Tu R, Shao X, Pan A, Zhou K, Huang J. A comprehensive Chinese experience against SARS-CoV-2 in ophthalmology. EYE AND VISION (LONDON, ENGLAND) 2020; 7:19. [PMID: 32289038 PMCID: PMC7136699 DOI: 10.1186/s40662-020-00187-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 03/25/2020] [Indexed: 01/26/2023]
Abstract
The 2019 novel coronavirus disease (COVID-19) has now swept through the continents and poses a global threat to public health. Several investigations have been conducted to identify whether COVID-19 can be transmitted through the ocular route, and the conclusion is that it is a potential route but remains uncertain. Due to the face-to-face communication with patients, frequent exposure to tears and ocular discharge, and the unavoidable use of equipment which requires close proximity, ophthalmologists carry a high risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Based on 33 articles published by Chinese scholars, guidelines and clinical practice experience in domestic hospitals, we have summarized the Chinese experience through the lens of ophthalmology, hoping to make a contribution to protecting ophthalmologists and patients around the world.
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Affiliation(s)
- A-Yong Yu
- Eye Hospital of Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325000 Zhejiang P. R. China
| | - Ruixue Tu
- Eye Hospital of Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325000 Zhejiang P. R. China
| | - Xu Shao
- Eye Hospital of Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325000 Zhejiang P. R. China
| | - Anpeng Pan
- Eye Hospital of Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325000 Zhejiang P. R. China
| | - Kaijing Zhou
- Eye Hospital of Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325000 Zhejiang P. R. China
| | - Jinhai Huang
- Eye Hospital of Wenzhou Medical University, 270 Xueyuan West Road, Wenzhou, 325000 Zhejiang P. R. China
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172
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Gharebaghi R, Desuatels J, Moshirfar M, Parvizi M, Daryabari SH, Heidary F. COVID-19: Preliminary Clinical Guidelines for Ophthalmology Practices. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2020; 9:149-158. [PMID: 32490022 PMCID: PMC7141793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The zoonotic Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and its resultant human coronavirus disease (COVID-19) recently appeared as a global health threat that can cause severe respiratory infection and terminal respiratory distress. By the first week of April, more than 1.3 million people had been globally infected and more than 70,000 had lost their lives to this contagious virus. Clinical manifestations occur shortly after exposure, or a few days later. There is controversy regarding the transmission of the virus through the tear and conjunctiva; however, there are reports that the ocular surface might be a potential target for COVID-19. The ease of transmission of this virus at close proximity presents a risk to eyecare workers. Several recommendations have been issued by local and national organizations to address the issue of safe ophthalmic practice during the ongoing COVID-19 pandemic. These guidelines have numerous similarities; however, subtle differences exist. The purpose of this paper was to discuss measures, with a specific focus on standard precautions, to prevent further dissemination of COVID-19 at Eye Clinics. We have proposed procedures to triage suspected cases of COVID-19, considering emergency conditions.
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Affiliation(s)
- Reza Gharebaghi
- Kish International Campus, University of Tehran, Tehran, Iran
- International Virtual Ophthalmic Research Center (IVORC)
| | - Jordan Desuatels
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Majid Moshirfar
- HDR Research Center, Hoopes Vision, Draper, UT, USA
- John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
- Utah Lions Eye Bank, Murray, UT, USA
| | - Maryam Parvizi
- Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Fatemeh Heidary
- Taleghani Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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173
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Lin JY, Kang EYC, Yeh PH, Ling XC, Chen HC, Chen KJ, Hwang YS, Lai CC, Wu WC. Proposed measures to be taken by ophthalmologists during the coronavirus disease 2019 pandemic: Experience from Chang Gung Memorial Hospital, Linkou, Taiwan. Taiwan J Ophthalmol 2020; 10:80-86. [PMID: 32874834 PMCID: PMC7442097 DOI: 10.4103/tjo.tjo_21_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/22/2020] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Although Taiwan was one of the first countries to develop coronavirus disease 2019 (COVID-19), with effective antiepidemic measures, Taiwan has effectively controlled the spread of the disease. The purpose of this article is to provide useful safety strategies for ophthalmologists in daily practice during the COVID-19 pandemic. MATERIALS AND METHODS Infection control strategies in the hospital and Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, are discussed. RESULTS Ophthalmologists are at high risk of contracting COVID-19 infection, as they have close contact with patients during ocular examinations, and are also facing high patient volume in outpatient clinics as well as emergency consultations. Furthermore, ocular symptoms, such as conjunctivitis, may be the presenting signs of COVID-19 infection. We provide our strategies, which include hospital's gate control with triage station, patient volume control, proper personal protective equipment, and consultation with telemedicine technology, to decrease the risk of cross-infection between medical staffs and patients. CONCLUSION To achieve the goal of preventing viral spread and maximizing patient and medical staffs' safety, besides providing proper protective equipment, it is also crucial for staffs and patients to strictly follow antiepidemic measures. We hope that our experience can help ophthalmologists and health-care workers to have a safer working environment when facing COVID-19 pandemic.
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Affiliation(s)
- Jui-Yen Lin
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | - Po-Han Yeh
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Xiao Chun Ling
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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174
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He F, Deng Y, Li W. Coronavirus disease 2019: What we know? J Med Virol 2020; 92:719-725. [PMID: 32170865 PMCID: PMC7228340 DOI: 10.1002/jmv.25766] [Citation(s) in RCA: 408] [Impact Index Per Article: 102.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/12/2020] [Indexed: 02/06/2023]
Abstract
In late December 2019, a cluster of unexplained pneumonia cases has been reported in Wuhan, China. A few days later, the causative agent of this mysterious pneumonia was identified as a novel coronavirus. This causative virus has been temporarily named as severe acute respiratory syndrome coronavirus 2 and the relevant infected disease has been named as coronavirus disease 2019 (COVID-19) by the World Health Organization, respectively. The COVID-19 epidemic is spreading in China and all over the world now. The purpose of this review is primarily to review the pathogen, clinical features, diagnosis, and treatment of COVID-19, but also to comment briefly on the epidemiology and pathology based on the current evidence.
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Affiliation(s)
- Feng He
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Deng
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weina Li
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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175
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Li JPO, Lam DSC, Chen Y, Ting DSW. Novel Coronavirus disease 2019 (COVID-19): The importance of recognising possible early ocular manifestation and using protective eyewear. Br J Ophthalmol 2020; 104:297-298. [PMID: 32086236 DOI: 10.1136/bjophthalmol-2020-315994] [Citation(s) in RCA: 201] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Dennis Shun Chiu Lam
- C-MER Dennis Lam Eye Center, C-Mer International Eye Care Group Limited, Hong Kong, Hong Kong.,International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), Shenzhen, China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Beijing, China
| | - Daniel Shu Wei Ting
- Moorfields Eye Hospital, London, UK .,Singapore National Eye Center, Singapore, Singapore.,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangzhou, China
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176
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Seah I, Agrawal R. Can the Coronavirus Disease 2019 (COVID-19) Affect the Eyes? A Review of Coronaviruses and Ocular Implications in Humans and Animals. Ocul Immunol Inflamm 2020; 28:391-395. [PMID: 32175797 PMCID: PMC7103678 DOI: 10.1080/09273948.2020.1738501] [Citation(s) in RCA: 421] [Impact Index Per Article: 105.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In December 2019, a novel coronavirus (CoV) epidemic, caused by the severe acute respiratory syndrome coronavirus - 2 (SARS-CoV-2) emerged from China. This virus causes the coronavirus disease 2019 (COVID-19). Since then, there have been anecdotal reports of ocular infection. The ocular implications of human CoV infections have not been widely studied. However, CoVs have been known to cause various ocular infections in animals. Clinical entities such as conjunctivitis, anterior uveitis, retinitis, and optic neuritis have been documented in feline and murine models. In this article, the current evidence suggesting possible human CoV infection of ocular tissue is reviewed. The review article will also highlight animal CoVs and their associated ocular infections. We hope that this article will serve as a start for further research into the ocular implications of human CoV infections.
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Affiliation(s)
- Ivan Seah
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,NHS Foundation Trust, Moorfields Eye Hospital, London, UK.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
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177
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Xia J, Tong J, Liu M, Shen Y, Guo D. Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection. J Med Virol 2020; 92:589-594. [PMID: 32100876 PMCID: PMC7228294 DOI: 10.1002/jmv.25725] [Citation(s) in RCA: 747] [Impact Index Per Article: 186.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 12/11/2022]
Abstract
Objective This study aimed to assess the presence of novel coronavirus in tears and conjunctival secretions of SARS–CoV‐2‐infected patients. Methods A prospective interventional case series study was performed, and 30 confirmed novel coronavirus pneumonia (NCP) patients were selected at the First Affiliated Hospital of Zhejiang University from 26 January 2020 to 9 February 2020. At an interval of 2 to 3 days, tear and conjunctival secretions were collected twice with disposable sampling swabs for reverse‐transcription polymerase chain reaction (RT‐PCR) assay. Results Twenty‐one common‐type and nine severe‐type NCP patients were enrolled. Two samples of tear and conjunctival secretions were obtained from the only one patient with conjunctivitis yielded positive RT‐PCR results. Fifty‐eight samples from other patents were all negative. Conclusion We speculate that SARS‐CoV‐2 may be detected in the tears and conjunctival secretions in NCP patients with conjunctivitis. SARS‐CoV‐2 may be detected in the tears and conjunctival secretions in NCP patients with conjunctivitis. SARS‐CoV‐2 was not detected in the conjunctival sac of NCP patients without conjunctivitis. The possibility of eye infection and the ocular route as a potential infection source should be considered and further examined, and scientific protection should be carried out.
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Affiliation(s)
- Jianhua Xia
- Department of Ophthalmology, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Jianping Tong
- Department of Ophthalmology, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Mengyun Liu
- Department of Ophthalmology, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Ye Shen
- Department of Ophthalmology, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Dongyu Guo
- Department of Ophthalmology, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, Zhejiang, China
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178
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Stepping up infection control measures in ophthalmology during the novel coronavirus outbreak: an experience from Hong Kong. Graefes Arch Clin Exp Ophthalmol 2020; 258:1049-1055. [PMID: 32124000 PMCID: PMC7087729 DOI: 10.1007/s00417-020-04641-8] [Citation(s) in RCA: 238] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose Coronavirus disease (COVID-19) has rapidly emerged as a global health threat. The purpose of this article is to share our local experience of stepping up infection control measures in ophthalmology to minimise COVID-19 infection of both healthcare workers and patients. Methods Infection control measures implemented in our ophthalmology clinic are discussed. The measures are based on detailed risk assessment by both local ophthalmologists and infection control experts. Results A three-level hierarchy of control measures was adopted. First, for administrative control, in order to lower patient attendance, text messages with an enquiry phone number were sent to patients to reschedule appointments or arrange drug refill. In order to minimise cross-infection of COVID-19, a triage system was set up to identify patients with fever, respiratory symptoms, acute conjunctivitis or recent travel to outbreak areas and to encourage these individuals to postpone their appointments for at least 14 days. Micro-aerosol generating procedures, such as non-contact tonometry and operations under general anaesthesia were avoided. Nasal endoscopy was avoided as it may provoke sneezing and cause generation of droplets. All elective clinical services were suspended. Infection control training was provided to all clinical staff. Second, for environmental control, to reduce droplet transmission of COVID-19, installation of protective shields on slit lamps, frequent disinfection of equipment, and provision of eye protection to staff were implemented. All staff were advised to measure their own body temperatures before work and promptly report any symptoms of upper respiratory tract infection, vomiting or diarrhoea. Third, universal masking, hand hygiene, and appropriate use of personal protective equipment (PPE) were promoted. Conclusion We hope our initial experience in stepping up infection control measures for COVID-19 infection in ophthalmology can help ophthalmologists globally to prepare for the potential community outbreak or pandemic. In order to minimise transmission of COVID-19, ophthalmologists should work closely with local infection control teams to implement infection control measures that are appropriate for their own clinical settings.
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179
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Kuo IC, O’Brien TP. COVID-19 and ophthalmology: An environmental work hazard. J Occup Health 2020; 62:e12124. [PMID: 32692449 PMCID: PMC7373079 DOI: 10.1002/1348-9585.12124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 03/25/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Irene C. Kuo
- Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Terrence P. O’Brien
- Bascom Palmer Eye InstituteUniversity of Miami Miller School of MedicineMiamiFLUSA
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180
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Talwar D, Kumar H, Thulasidas M. Non-contact tonometer use during the COVID-19 pandemic. Indian J Ophthalmol 2020; 68:1492-1494. [PMID: 32587215 PMCID: PMC7574106 DOI: 10.4103/ijo.ijo_1676_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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181
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Singh K, Bali J, Singh A, Sharma N. COVID 19: Understanding the Disease to Implement Containment Strategies. MAMC JOURNAL OF MEDICAL SCIENCES 2020. [DOI: 10.4103/mamcjms.mamcjms_27_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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182
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Hui DS, Zumla A. Severe Acute Respiratory Syndrome: Historical, Epidemiologic, and Clinical Features. Infect Dis Clin North Am 2019; 33:869-889. [PMID: 31668196 PMCID: PMC7127569 DOI: 10.1016/j.idc.2019.07.001] [Citation(s) in RCA: 309] [Impact Index Per Article: 61.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Severe acute respiratory syndrome coronavirus (SARS-CoV), emerged from China and rapidly spread worldwide. Over 8098 people fell ill and 774 died before the epidemic ended in July 2003. Bats are likely an important reservoir for SARS-CoV. SARS-like CoVs have been detected in horseshoe bats and civet cats. The main mode of transmission of SARS-CoV is through inhalation of respiratory droplets. Faeco-oral transmission has been recorded. Strict infection control procedures with respiratory and contact precautions are essential. Fever and respiratory symptoms predominate, and diarrhea is common. Treatment involves supportive care. There are no specific antiviral treatments or vaccines available.
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Affiliation(s)
- David S.C. Hui
- Department of Medicine and Therapeutics, Stanley Ho Center for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong,Corresponding author
| | - Alimuddin Zumla
- Center for Clinical Microbiology, University College London, Royal Free Campus 2nd Floor, Rowland Hill Street, London NW3 2PF, United Kingdom
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183
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Hui DS. Epidemic and Emerging Coronaviruses (Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome). Clin Chest Med 2017; 38:71-86. [PMID: 28159163 PMCID: PMC7131795 DOI: 10.1016/j.ccm.2016.11.007] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Bats are the natural reservoirs of severe acute respiratory syndrome (SARS)-like coronaviruses (CoVs) and likely the reservoir of Middle East respiratory syndrome (MERS)-CoV. The clinical features of SARS-CoV infection and MERS-CoV infection are similar but MERS-CoV infection progresses to respiratory failure more rapidly. Although the estimated pandemic potential of MERS-CoV is lower than that of SARS-CoV, the case fatality rate of MERS is higher. The transmission route and the possibility of other intermediary animal sources remain uncertain among many sporadic primary cases. Clinical trial options for MERS-CoV infection include monotherapy and combination therapy.
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Affiliation(s)
- David S Hui
- Department of Medicine & Therapeutics, Stanley Ho Center for Emerging Infectious Diseases, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China.
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184
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Nishtala K, Pahuja N, Shetty R, Nuijts RMMA, Ghosh A. Tear biomarkers for keratoconus. EYE AND VISION 2016; 3:19. [PMID: 27493978 PMCID: PMC4973115 DOI: 10.1186/s40662-016-0051-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 07/19/2016] [Indexed: 12/21/2022]
Abstract
Keratoconus is a progressive corneal thinning, ectatic condition, which affects vision. Recent advances in corneal topography measurements has helped advance proper diagnosis of this condition and increased research and clinical interests in the disease etiopathogenesis. Considerable progress has been achieved in understanding the progression of the disease and tear fluid has played a major role in the progress. This review discusses the importance of tear fluid as a source of biomarker for keratoconus and how advances in technology have helped map the complexity of tears and thereby molecular readouts of the disease. Expanding knowledge of the tear proteome, lipidome and metabolome opened up new avenues to study keratoconus and to identify probable prognostic or diagnostic biomarkers for the disease. A multidimensional approach of analyzing tear fluid of patients layering on proteomics, lipidomics and metabolomics is necessary in effectively decoding keratoconus and thereby identifying targets for its treatment.
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Affiliation(s)
| | - Natasha Pahuja
- Cornea Department, Narayana Nethralaya, Bangalore, India
| | - Rohit Shetty
- Cornea Department, Narayana Nethralaya, Bangalore, India
| | - Rudy M M A Nuijts
- Cornea Clinic, Department of Ophthalmology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Arkasubhra Ghosh
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India
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185
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Middle East respiratory syndrome coronavirus: another zoonotic betacoronavirus causing SARS-like disease. Clin Microbiol Rev 2015; 28:465-522. [PMID: 25810418 DOI: 10.1128/cmr.00102-14] [Citation(s) in RCA: 609] [Impact Index Per Article: 67.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The source of the severe acute respiratory syndrome (SARS) epidemic was traced to wildlife market civets and ultimately to bats. Subsequent hunting for novel coronaviruses (CoVs) led to the discovery of two additional human and over 40 animal CoVs, including the prototype lineage C betacoronaviruses, Tylonycteris bat CoV HKU4 and Pipistrellus bat CoV HKU5; these are phylogenetically closely related to the Middle East respiratory syndrome (MERS) CoV, which has affected more than 1,000 patients with over 35% fatality since its emergence in 2012. All primary cases of MERS are epidemiologically linked to the Middle East. Some of these patients had contacted camels which shed virus and/or had positive serology. Most secondary cases are related to health care-associated clusters. The disease is especially severe in elderly men with comorbidities. Clinical severity may be related to MERS-CoV's ability to infect a broad range of cells with DPP4 expression, evade the host innate immune response, and induce cytokine dysregulation. Reverse transcription-PCR on respiratory and/or extrapulmonary specimens rapidly establishes diagnosis. Supportive treatment with extracorporeal membrane oxygenation and dialysis is often required in patients with organ failure. Antivirals with potent in vitro activities include neutralizing monoclonal antibodies, antiviral peptides, interferons, mycophenolic acid, and lopinavir. They should be evaluated in suitable animal models before clinical trials. Developing an effective camel MERS-CoV vaccine and implementing appropriate infection control measures may control the continuing epidemic.
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Abstract
PURPOSE OF REVIEW This review compares the clinical features, laboratory aspects and treatment options of severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS). RECENT FINDINGS Bats are the natural reservoirs of SARS-like coronaviruses (CoVs) and are likely the reservoir of MERS coronavirus (MERS-CoV). Although a small number of camels have been found to have positive nasal swabs by real-time polymerase chain reaction and to carry antibody against MERS-CoV, the transmission route and the intermediary animal source remain uncertain amongst the sporadic primary cases. Both SARS-CoV and MERS-CoV may cause severe respiratory failure and extrapulmonary features such as diarrhoea, whereas mild or asymptomatic cases also occur in both conditions. In comparison with SARS, patients with MERS are older with male predominance, more comorbid illness and relatively lower human-to-human transmission potential. Although the viral kinetics of MERS-CoV remain unknown, nosocomial infections of MERS occur early within the first week of illness of the index case, whereas those of SARS occurred mainly in the second week of illness when the patient's upper airway viral load peaks on day 10 of illness. In-vitro data suggest that interferon (IFN) with or without ribavirin and mycophenolic acid may inhibit MERS-CoV, whereas protease inhibitors and IFN have inhibitory activity against SARS-CoV. SUMMARY Although there are some similarities in the clinical features, MERS progresses to respiratory failure much more rapidly than SARS. The higher case fatality rate of MERS is likely related to older age and comorbid illness. More studies are needed to understand MERS-CoV in order to guide public health infection control measures and treatment.
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187
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Ranjan R, Ranjan S. Ocular Pathology: Role of Emerging Viruses in the Asia-Pacific Region-A Review. Asia Pac J Ophthalmol (Phila) 2014; 3:299-307. [PMID: 26107917 DOI: 10.1097/apo.0000000000000021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The role of viral infections in ocular pathology varies greatly, involving all the components of the eye. Some viruses like herpes simplex, herpes zoster, adenovirus, enterovirus 70, influenza virus, human immunodeficiency virus, and cytomegalovirus are well-known for their role in ocular pathology. In recent years, emerging and resurging viral infections represent an important public health problem. The Asia-Pacific region has witnessed a number of pandemic and epidemic outbreaks caused by these viruses during the last 2 decades. The number of ocular complications being reported in patients of these viral infections has also increased significantly during this period. Ophthalmologists and physicians should be aware of ocular manifestations of newly emerging or resurging viral diseases. We conducted a review of the literature published during the last 20 years with the objectives of finding out outbreaks of emerging and reemerging viruses in the Asia-Pacific region and finding out any ocular involvement in these viral infections. An iterative search of the MEDLINE and the Google databases was made using the search terms emerging virus, ocular manifestations, ocular complications, Chikungunya, Dengue, Japanese encephalitis, West Nile fever, Kyasanur forest disease, Rift valley fever, Hantavirus, Henipavirus, Influenza virus, Enterovirus 71, and Asia-Pacific region, separately and with reported ocular involvement in combination. This review article discusses the epidemiology and the systemic and ocular manifestations of all emerging viral infections with reported ocular involvement in the Asia-Pacific region.
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Affiliation(s)
- Ratnesh Ranjan
- From the *Drishti Eye Hospital, Bangalore, India; and the †Department of Microbiology, MS Ramaiah Medical College, Bangalore, India
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188
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Schürch AC, Schipper D, Bijl MA, Dau J, Beckmen KB, Schapendonk CME, Raj VS, Osterhaus ADME, Haagmans BL, Tryland M, Smits SL. Metagenomic survey for viruses in Western Arctic caribou, Alaska, through iterative assembly of taxonomic units. PLoS One 2014; 9:e105227. [PMID: 25140520 PMCID: PMC4139337 DOI: 10.1371/journal.pone.0105227] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 07/18/2014] [Indexed: 12/16/2022] Open
Abstract
Pathogen surveillance in animals does not provide a sufficient level of vigilance because it is generally confined to surveillance of pathogens with known economic impact in domestic animals and practically nonexistent in wildlife species. As most (re-)emerging viral infections originate from animal sources, it is important to obtain insight into viral pathogens present in the wildlife reservoir from a public health perspective. When monitoring living, free-ranging wildlife for viruses, sample collection can be challenging and availability of nucleic acids isolated from samples is often limited. The development of viral metagenomics platforms allows a more comprehensive inventory of viruses present in wildlife. We report a metagenomic viral survey of the Western Arctic herd of barren ground caribou (Rangifer tarandus granti) in Alaska, USA. The presence of mammalian viruses in eye and nose swabs of 39 free-ranging caribou was investigated by random amplification combined with a metagenomic analysis approach that applied exhaustive iterative assembly of sequencing results to define taxonomic units of each metagenome. Through homology search methods we identified the presence of several mammalian viruses, including different papillomaviruses, a novel parvovirus, polyomavirus, and a virus that potentially represents a member of a novel genus in the family Coronaviridae.
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Affiliation(s)
- Anita C. Schürch
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Debby Schipper
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maarten A. Bijl
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jim Dau
- Alaska Department of Fish and Game, Kotzebue, Alaska, United States of America
| | - Kimberlee B. Beckmen
- Alaska Department of Fish and Game, Division of Wildlife Conservation, Fairbanks, Alaska, United States of America
| | | | - V. Stalin Raj
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Albert D. M. E. Osterhaus
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
- Viroclinics Biosciences, Rotterdam, The Netherlands
| | - Bart L. Haagmans
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Morten Tryland
- Research Group for Arctic Infection Biology, Department of Arctic and Marine Biology, UiT - the Arctic University of Norway, Tromsø, Norway
- Genøk - Centre for Biosafety, Tromsø, Norway
| | - Saskia L. Smits
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
- Viroclinics Biosciences, Rotterdam, The Netherlands
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189
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190
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Abstract
Respiratory viruses (including adenovirus, influenza virus, respiratory syncytial virus, coronavirus, and rhinovirus) cause a broad spectrum of disease in humans, ranging from mild influenza-like symptoms to acute respiratory failure. While species D adenoviruses and subtype H7 influenza viruses are known to possess an ocular tropism, documented human ocular disease has been reported following infection with all principal respiratory viruses. In this review, we describe the anatomical proximity and cellular receptor distribution between ocular and respiratory tissues. All major respiratory viruses and their association with human ocular disease are discussed. Research utilizing in vitro and in vivo models to study the ability of respiratory viruses to use the eye as a portal of entry as well as a primary site of virus replication is highlighted. Identification of shared receptor-binding preferences, host responses, and laboratory modeling protocols among these viruses provides a needed bridge between clinical and laboratory studies of virus tropism.
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Affiliation(s)
- Jessica A Belser
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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191
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Affiliation(s)
- David S C Hui
- Division of Respiratory Medicine, Stanley Ho Center for Emerging Infectious Diseases, Prince of Wales Hospital, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China.
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192
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Sinclair RG, Choi CY, Riley MR, Gerba CP. Pathogen surveillance through monitoring of sewer systems. ADVANCES IN APPLIED MICROBIOLOGY 2009; 65:249-69. [PMID: 19026868 PMCID: PMC7112011 DOI: 10.1016/s0065-2164(08)00609-6] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ryan G Sinclair
- Department of Soil, Water and Environmental Science, University of Arizona, Tucson, Arizona 85721, USA
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193
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Clinical features, pathogenesis and immunobiology of severe acute respiratory syndrome. Curr Opin Pulm Med 2008; 14:241-7. [PMID: 18427248 DOI: 10.1097/mcp.0b013e3282fb81b2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Severe acute respiratory syndrome coronavirus is a novel virus responsible for the major pandemic in 2003, and it re-emerged in China in late 2003 and 2004 following resumption of wild animal trading activities. Over the past few years, research work has looked into factors that may lead to super-spreading events, clinical/laboratory parameters that may differentiate severe acute respiratory syndrome from other causes of community-acquired pneumonia, the origin of severe acute respiratory syndrome, reservoir host distribution and transmission routes. A better understanding of these issues may help prevent and control future outbreaks of severe acute respiratory syndrome. RECENT FINDINGS Bats are natural reservoirs of severe acute respiratory syndrome like coronaviruses. The human and civet isolates of severe acute respiratory syndrome coronavirus nestle phylogenetically within the spectrum of severe acute respiratory syndrome like coronaviruses. Severe acute respiratory syndrome has the potential of being converted from droplet to airborne transmission. When evaluating epidemiologically high-risk patients with community-acquired pneumonia and no immediate alternative diagnosis, a low absolute neutrophil count on presentation, along with poor responses after 72 h of antibiotic treatment, may raise the index of suspicion for severe acute respiratory syndrome. SUMMARY The presence of severe acute respiratory syndrome like coronaviruses in horseshoe bats raises the possible role of bats in previous and potentially future severe acute respiratory syndrome outbreaks in human. Healthcare workers should take adequate respiratory protection in addition to strict contact and droplet precautions when managing patients with severe acute respiratory syndrome.
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194
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Yusifov TN, Abduragimov AR, Narsinh K, Gasymov OK, Glasgow BJ. Tear lipocalin is the major endonuclease in tears. Mol Vis 2008; 14:180-8. [PMID: 18334931 PMCID: PMC2254967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2007] [Accepted: 01/18/2008] [Indexed: 10/31/2022] Open
Abstract
PURPOSE Human endonucleases are integral to apoptosis in which unwanted or potentially harmful cells are eliminated. The rapid turnover of ocular surface epithelium and microbial colonization of the eyelids are continual sources of DNA in tears. Here, we determine the principal sources of endonuclease activity in tears. METHODS Endonucleases in human tears were identified after Sephadex G100 gel filtration. DNA hydrolyzing activity was measured by the conversion pUC19 plasmid DNA to its circular form in agarose gels. Fractions with endonuclease activity were further isolated using a combination ConA-Sepharose DNA, oligo (dT) cellulose, and anion exchange chromatographies. The molecular weights of the DNA hydrolyzing proteins were estimated in zymograms and by calibration of size exclusion chromatography. DNase activities were characterized for activity at a variety of pH and ion concentrations as well as in the presence of inhibitors including NiCl(2), ZnCl(2), G-actin, and aurintricarboxylic acid (ATA). To determine the mode of hydrolysis, the cleaved ends of the DNA digested by tear DNases were analyzed by 3' and 5' end labeling using either terminal deoxynucleotidyl transferase or polynucleotide kinase with or without pretreatment with alkaline phosphatase. RESULTS Tear lipocalin (TL) accounts for over 75% of the DNA catalytic activity in tears while a second endonuclease, approximately 34 kDa, is responsible for less than 24% of the activity. Both are Mg(2+) dependent enzyme endonucleases that are enhanced by Ca(2+), active at physiologic pH, inhibited by aurintricarboxylic acid, and catalyze hydrolysis of DNA to produce 3'-OH/5'P ends. However, the two enzymes can be distinguished by the inhibitory effect of NiCl(2) and the sizes of the cleaved DNA fragments. CONCLUSIONS Two magnesium dependent extracellular endonucleases were identified in tears that are different from other major human extracellular nucleases. TL is the principal endonuclease in human tear fluid. Tear endonucleases have unique characteristics that differ from other known human endonucleases.
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195
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Sinclair RG, Choi CY, Riley MR, Gerba CP. Pathogen surveillance through monitoring of sewer systems. ADVANCES IN APPLIED MICROBIOLOGY 2008. [PMID: 19026868 DOI: 10.1016/s0065-2164(08)00609-6.pmid:19026868;pmcid:pmc7112011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Affiliation(s)
- Ryan G Sinclair
- Department of Soil, Water and Environmental Science, University of Arizona, Tucson, Arizona 85721, USA
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196
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Severe acute respiratory syndrome coronavirus as an agent of emerging and reemerging infection. Clin Microbiol Rev 2007; 20:660-94. [PMID: 17934078 DOI: 10.1128/cmr.00023-07] [Citation(s) in RCA: 657] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Before the emergence of severe acute respiratory syndrome (SARS) coronavirus (SARS-CoV) in 2003, only 12 other animal or human coronaviruses were known. The discovery of this virus was soon followed by the discovery of the civet and bat SARS-CoV and the human coronaviruses NL63 and HKU1. Surveillance of coronaviruses in many animal species has increased the number on the list of coronaviruses to at least 36. The explosive nature of the first SARS epidemic, the high mortality, its transient reemergence a year later, and economic disruptions led to a rush on research of the epidemiological, clinical, pathological, immunological, virological, and other basic scientific aspects of the virus and the disease. This research resulted in over 4,000 publications, only some of the most representative works of which could be reviewed in this article. The marked increase in the understanding of the virus and the disease within such a short time has allowed the development of diagnostic tests, animal models, antivirals, vaccines, and epidemiological and infection control measures, which could prove to be useful in randomized control trials if SARS should return. The findings that horseshoe bats are the natural reservoir for SARS-CoV-like virus and that civets are the amplification host highlight the importance of wildlife and biosecurity in farms and wet markets, which can serve as the source and amplification centers for emerging infections.
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197
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Abstract
The outbreak of severe acute respiratory syndrome (SARS) in 2003 alerted the world to the new face of pandemic disease: highly contagious and fatal infections for which no vaccines are available and current drugs are largely ineffective. As a practitioner providing primary care, the optometrist must be familiar with new and evolving infections present in today’s society. Though they may be viewed as extreme events, scenarios such as the re‐emergence of SARS, the affliction posed by the H5N1 strain of avian influenza and the threat of a bioterrorist attack have all been described. In the event that such events occur, there is the potential for the spread of some highly virulent, transmissible disease. This paper highlights these public health threats and discusses several areas that the optometrist may want to consider regarding infection control in an era in which a highly transmissible disease is being spread from person to person.
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198
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Abstract
Severe acute respiratory syndrome (SARS) is caused by a coronavirus (CoV), SARSCoV. SARS-CoV belongs to the family Coronaviridae, which are enveloped RNA viruses in the order Nidovirales. Global research efforts are continuing to increase the understanding of the virus, the pathogenesis of the disease it causes (SARS), and the “heterogeneity of individual infectiousness” as well as shedding light on how to prepare for other emerging viral diseases. Promising drugs and vaccines have been identified. The milestones achieved have resulted from a truly international effort. Molecular studies dissected the adaptation of this virus as it jumped from an intermediary animal, the civet, to humans, thus providing valuable insights into processes of molecular emergence.
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Affiliation(s)
- Tommy R Tong
- Department of Pathology, Princess Margaret Hospital, Laichikok, Kowloon, Hong Kong, China
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199
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Chan WM, Liu DTL, Chan PKS, Chong KKL, Yuen KSC, Chiu TYH, Tam BSM, Ng JSK, Lam DSC. Precautions in ophthalmic practice in a hospital with a major acute SARS outbreak: an experience from Hong Kong. Eye (Lond) 2006; 20:283-9. [PMID: 15877099 PMCID: PMC7091695 DOI: 10.1038/sj.eye.6701885] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Many new infectious diseases in humans have been derived from animal sources in the past 20 years. Some are highly contagious and fatal. Vaccination may not be available and antiviral drugs are not effective enough. Infectious control is important in clinical medicine and in Ophthalmology. Severe acute respiratory syndrome (SARS), as an example, is a highly contagious respiratory disease that has recently been reported in Asia, North America, and Europe. Within a matter of weeks, the outbreak has evolved to become a global health threat and more than 30 countries have been afflicted with a novel Coronavirus strain (SARS-CoV) that is the aetiologic agent of SARS. The primary route of transmission of SARS appears involving close person-to-person contact through droplets. Ophthalmologists may be particularly susceptible to the infection as routine ophthalmic examinations like direct ophthalmoscopy and slit-lamp examination are usually performed in a setting that has close doctor-patient contact. Being the Ophthalmology Department of the only hospital in the world that has just gone through the largest outbreak of SARS, we would like to share our strategy, measures, and experiences of preventing contracting or spreading of SARS infection as an infection control model. SARS is one of the many viruses against which personnel will need protecting in an ophthalmic setting. The experiences attained and the measures established might also apply to other infectious conditions spreading by droplets such as the avian influenza with H5N1.
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Affiliation(s)
- W-M Chan
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
- Department of Ophthalmology and Visual Sciences, Hong Kong Eye Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - D T L Liu
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - P K S Chan
- Department of Microbiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, People's Republic of China
| | - K K L Chong
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - K S C Yuen
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - T Y H Chiu
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - B S M Tam
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - J S K Ng
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
- Department of Ophthalmology and Visual Sciences, Hong Kong Eye Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - D S C Lam
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
- Department of Ophthalmology and Visual Sciences, Hong Kong Eye Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
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200
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Leong HN, Chan KP, Oon LLE, Koay ESC, Ng LC, Lee MA, Barkham T, Chen MIC, Heng BH, Ling AE, Leo YS. Clinical and Laboratory Findings of SARS in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2006. [DOI: 10.47102/annals-acadmedsg.v35n5p332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Introduction: Singapore was one of 29 countries worldwide affected by severe acute respiratory syndrome (SARS) in 2003.
Materials and Methods: There were 238 cases identified during the outbreak. We performed a retrospective analysis of the clinical and laboratory data of 234 patients admitted to Tan Tock Seng Hospital and Singapore General Hospital.
Results: The mean age of patients was 21 years, 31.6% of patients were males and 41.8% were healthcare workers. At presentation, the common symptoms were fever, myalgia, cough and headache; rhinorrhoea was uncommon. On admission, 21% had leukopenia, 18% had thrombocytopaenia, 29% had hyponatraemia, 31% had hypokalaemia, 21% had transaminitis. Polymerase chain reaction (PCR) testing of respiratory and stool samples provided the best yield at the end of the first week of illness. Thirty-two patients were initially not recognised as probable SARS and were reclassified when the serology test results were available. The chief reasons for not identifying these patients early were persistently normal chest X-rays (68.8%), very mild presentation (43.8%) and the presence of a concomitant illness (12.5%). Overall, 12% of the patients were probable SARS with atypical presentations. Overall mortality was 11.8%.
Conclusion: Patients infected with the SARS coronavirus had a wide clinical presentation with non-specific symptoms.
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