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Morettin CE, Harthan JS, Huecker JB, Perera CD, Than T, Whiteside M, Johnson SD, Shorter E, Migneco MK, Olson CK, Alferez CS, Camp D, Hartwick ATE, Gordon MO. Correlation of Adenoviral Titers with Severity of Adenoviral Conjunctivitis and Time to Viral Clearance for 21 Days. Optom Vis Sci 2023; 100:187-193. [PMID: 36749104 PMCID: PMC10038925 DOI: 10.1097/opx.0000000000001999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
SIGNIFICANCE This investigation reports the correlation of conjunctival viral titers in adenoviral conjunctivitis with patient-reported symptoms and clinician-graded signs for 21 days of follow-up. PURPOSE Adenoviral conjunctivitis is a highly contagious viral eye infection with significant morbidity and economic impact. This study investigates whether severity of signs and symptoms and time to viral clearance are correlated with conjunctival viral titers at baseline and during 21 days of follow-up. METHODS The Reducing Adenoviral Patient Infected Days study was a pilot study of the efficacy of a single in-office administration of ophthalmic 5% povidone-iodine. This article outlines longitudinal analyses after the primary outcome report. Of 212 participants screened, 28 participants with quantitative polymerase chain reaction-confirmed adenoviral conjunctivitis were randomized and had follow-up visits on days 1, 2, 4, 7, 14, and 21. At each visit, clinician-graded signs, participant-reported symptoms, and a conjunctival swab for quantitative polymerase chain reaction analysis were obtained. The correlation of viral titers with symptoms and signs was calculated: (1) cross-sectionally at each visit and (2) longitudinally for 21 days using a repeated-measures mixed-effects model. RESULTS Twenty-five of 28 participants had sufficient data for this report. Higher viral titers for 21 days were correlated with greater severity of symptoms (tearing, matting, and redness, r ≥ 0.70; P < .02) and greater severity of clinical signs (bulbar redness and serous discharge, r ≥ 0.60; P < .01). Eyes with highest baseline viral titers required longer time to viral clearance ( r = 0.59, P = .008). Signs and symptoms persisted in approximately half of the eyes even after viral clearance. CONCLUSIONS Higher conjunctival viral titers across 21 days were strongly correlated with more severe signs and symptoms and longer time to viral clearance. Our results also indicate that symptoms and signs can persist after viral clearance.
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Affiliation(s)
| | | | - Julia B Huecker
- Washington University School of Medicine, St. Louis, Missouri
| | | | - Tammy Than
- Carl Vinson VA Medical Center, Dublin, Georgia
| | | | - Spencer D Johnson
- Northeastern State University Oklahoma College of Optometry, Tahlequah, Oklahoma
| | | | - Mary K Migneco
- Washington University School of Medicine, St. Louis, Missouri
| | | | | | - Devon Camp
- Washington University School of Medicine, St. Louis, Missouri
| | | | - Mae O Gordon
- Washington University School of Medicine, St. Louis, Missouri
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Johnson D, Liu D, Simel D. Does This Patient With Acute Infectious Conjunctivitis Have a Bacterial Infection?: The Rational Clinical Examination Systematic Review. JAMA 2022; 327:2231-2237. [PMID: 35699701 DOI: 10.1001/jama.2022.7687] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
IMPORTANCE Acute infectious conjunctivitis is characterized by ocular redness and discharge, and is a common clinical entity. Evidence-based tools to aid the clinical diagnosis of viral vs bacterial conjunctivitis are lacking and may contribute to overprescribing of topical antibiotics. OBJECTIVE To determine the relative prevalence of viral vs bacterial conjunctivitis in adults and children, and to determine which symptoms or signs are suggestive of a viral vs bacterial etiology. DATA SOURCES A MEDLINE search (January 1946-March 2022) yielded 1891 articles. Included articles were rated using a quality score based on a modified Rational Clinical Examination grading system. Methodological quality levels 1 through 4 required a microbiological reference standard for diagnosis, whereas quality level 5 (the lowest quality) used a clinical reference standard for diagnosis. STUDY SELECTION Consecutive series of patients presenting with acute infectious conjunctivitis and case series of viral or bacterial conjunctivitis alone. Thirty-two studies were included in a meta-analysis to determine prevalence and diagnostic accuracy measures; 27 used a microbiological reference standard for diagnosis and 5 used a clinical reference standard for diagnosis. RESULTS In studies involving children (5 studies; 881 patients; mean age, 4.7 years [age range, 1 month-18 years]), the prevalence of bacterial conjunctivitis was higher than viral conjunctivitis (71% vs 16%, respectively, P = .01). In the only study of adults (n = 207 patients; mean age, 25.7 years), the prevalence of viral conjunctivitis was higher than bacterial conjunctivitis (78% vs 16%, respectively, P < .001). For the primary analysis of level 1 (n = 6) and level 2 (n = 5) studies (1725 patients total), the clinical findings that best distinguished a viral etiology for conjunctivitis from a bacterial etiology included pharyngitis (sensitivity range, 0.55-0.58; specificity range, 0.89-0.94; positive likelihood ratio [LR] range, 5.4-9.9), preauricular lymphadenopathy (sensitivity range, 0.17-0.31; specificity range, 0.93-0.94; positive LR range, 2.5-5.6), and contact with another person with red eye (sensitivity, 0.18 [95% CI, 0.14-0.22]; specificity, 0.93 [95% CI, 0.90-0.95]; positive LR, 2.5 [95% CI, 1.6-3.7]). Mucopurulent ocular discharge (sensitivity, 0.76 [95% CI, 0.60-0.87); specificity, 0.66 [95% CI, 0.58-0.73]; positive LR, 2.1 [95% CI, 1.7-2.6]) and otitis media (sensitivity, 0.24 [95% CI, 0.20-0.29]; specificity, 0.91 [95% CI, 0.85-0.94]; positive LR, 2.5 [95% CI, 1.5-4.4]) were associated with the presence of bacterial conjunctivitis. CONCLUSIONS AND RELEVANCE In this review, bacterial conjunctivitis was more common than viral conjunctivitis in children and viral conjunctivitis was more common than bacterial conjunctivitis in adults, although the prevalence estimates were based on limited evidence. Symptoms and signs associated with a higher likelihood of viral conjunctivitis in adults and children included concomitant pharyngitis, an enlarged preauricular node, and contact with another person with red eye, and signs associated with a higher likelihood of bacterial conjunctivitis included the presence of mucopurulent discharge and otitis media, but no single symptom or sign differentiated the 2 conditions with high certainty.
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Affiliation(s)
- Davin Johnson
- Department of Ophthalmology, Queen's University, Kingston, Ontario, Canada
| | - Daisy Liu
- Department of Ophthalmology, Queen's University, Kingston, Ontario, Canada
| | - David Simel
- Durham Veterans Affairs Medical Center, Durham, North Carolina
- Department of Medicine, School of Medicine, Duke University, Durham, North Carolina
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Van Gelder RN. Molecular Diagnostics for Ocular Infectious Diseases: LXXVIII Edward Jackson Memorial Lecture. Am J Ophthalmol 2022; 235:300-312. [PMID: 34921773 PMCID: PMC8863649 DOI: 10.1016/j.ajo.2021.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/26/2021] [Accepted: 12/03/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To review the use of molecular diagnostic techniques in the management of ocular infectious disease. DESIGN Retrospective review. METHODS A combination of literature review and personal recollections are used. RESULTS Although the broad term molecular diagnostics may encompass techniques to identify pathogens via protein or metabolomic signatures, this review concentrates on detection of pathogen nucleic acid as an indicator of infection. The introduction of the polymerase chain reaction (PCR) in 1985 opened a new era in analysis of nucleic acids. This technique was soon applied to the detection of potential pathogen DNA and RNA, including viruses, bacteria, and parasites in infectious eye disease. Advances in PCR have allowed class-specific diagnostics (ie, pan-bacterial and pan-fungal), quantitation of pathogen DNA, and multiplexed testing. The Human Genome Project in the early 2000s greatly accelerated development of DNA sequencers, ushering in the era of "Next Generation Sequencing" and permitting pathogen-agnostic methods for the detection of potential infectious agents. Most recently, new technologies such as nanopore sequencing have reduced both cost and equipment requirements for whole-genome sequencing; when coupled with real-time sequence analysis methods, these methods offer the promise of true, real-time, point-of-service ocular infectious disease diagnostics. CONCLUSIONS Molecular methods for pathogen detection have greatly advanced the diagnosis of ocular infectious disease. Further methodologic advances will have a direct impact on the management of these conditions.
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Affiliation(s)
- Russell N Van Gelder
- From the Departments of Ophthalmology, Biological Structure, and Laboratory Medicine and Pathology, and Roger and Angie Karalis Johnson Retina Center, University of Washington School of Medicine, Seattle, Washington, USA.
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Johnson SD, Harthan JS, Than T, Migneco MK, Shorter E, Whiteside MM, Morettin CE, Olson CK, Rosemann CA, Margolis MS, Haertter LW, Huecker JB, Rodic-Polic B, Buller RS, Storch GA, Gordon MO, Hartwick ATE. Predictive Accuracy and Densitometric Analysis of Point-of-Care Immunoassay for Adenoviral Conjunctivitis. Transl Vis Sci Technol 2021; 10:30. [PMID: 34431990 PMCID: PMC8399540 DOI: 10.1167/tvst.10.9.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose Accurate diagnosis of adenoviral conjunctivitis (Ad-Cs) is important for timely and appropriate patient management to reduce disease transmission. This study assessed the diagnostic accuracy of a commercially available point-of-care adenovirus immunoassay and determined whether its predictive accuracy is influenced by signal intensities of test result bands. Methods Point-of-care immunoassay (AdenoPlus) testing and quantitative polymerase chain reaction (qPCR) testing was performed on conjunctival swab samples obtained from eyes of 186 eligible adult participants with presumed infectious conjunctivitis and symptoms of ≤4 days. Masked observers assessed signal intensities of the immunoassay test and control bands using densitometry. Results Ad-Cs was confirmed by qPCR in 28 of the 56 eyes that tested positive on the AdenoPlus, a 50% positive predictive value (95% confidence interval [CI] = 36.9, 63.1). No adenovirus was detected by qPCR in 128 of 130 eyes that tested negative on AdenoPlus, a 98.5% negative predictive value (CI = 96.3, 100). Sensitivity and specificity were 93% (CI = 84.4, 100) and 82% (CI = 76.0, 88.1), respectively. Viral titers significantly correlated with ratio of test band signal intensities (R2 = 0.32, P = 0.002). Higher positive predictive value was associated with higher densitometry ratios (receiver operating characteristic [ROC] area = 0.71; 95% CI = 0.59, 0.83). Conclusions Densitometric analyses suggest that the diagnostic accuracy of AdenoPlus is influenced by the signal intensity of the test result bands. Visual comparison of the test band intensities by clinicians could reduce the false positive rate of point-of-care immunoassays and aid in the diagnosis of viral infections. Translational Relevance Ratiometric densitometry of point-of-care immunoassays could aid clinicians’ decision making in diagnosing infectious diseases, including Ad-Cs.
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Affiliation(s)
| | | | - Tammy Than
- Carl Vinson VA Medical Center, Dublin, GA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Mae O Gordon
- Washington University in St. Louis, St. Louis, MO, USA
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Santiago LA, Silva JMRD, Azevedo OGRD, Vasconcelos PRLD. Comparative study on the efficacy of non-steroidal, steroid and non-use of anti-inflammatory in the treatment of acute epidemic conjunctivitis. Acta Cir Bras 2020; 34:e201901206. [PMID: 32049186 PMCID: PMC7006370 DOI: 10.1590/s0102-865020190120000006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/03/2019] [Indexed: 01/14/2023] Open
Abstract
PURPOSE To evaluate the effects of prednisolone against sodium diclofenac both with ciprofloxacin compared to artificial tears on the symptoms and signs of acute viral conjunctivitis. METHODS Study included 37 patients diagnosed with acute conjunctivitis and distributed by three groups: A (1% prednisolone acetate + ciprofloxacin (0.3%); B (Sodium diclofenac (0.1%) + ciprofloxacin (0.3%) and C (artificial tears + ciprofloxacin (0.3%). Patients received medication 6/6 hours daily. Signs and symptoms (e.g. lacrimation, burning, photophobia, etc.) were scored at baseline and on the first, third, fifth and seventh days and in the end of treatment using a standardized questionnaire and slit lamp anterior segment examination. RESULTS All three groups demonstrated an improvement in the signs and symptoms of conjunctivitis in their follow-up visits. There was no significant difference in symptom and sign scores between Group A and B and B and C in the study visits ( p >0.05). However, the comparison between groups A and C showed a clinical trend (p=0.05) on third evaluation suggesting better clinical action using the corticosteroids. CONCLUSION The prednisolone acetate was not superior to the use of sodium diclofenac or artificial tears in relieving the signs and symptoms of viral conjunctivitis.
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Altan-Yaycioglu R, Sahinoglu-Keskek N, Canan H, Coban-Karatas M, Ulas B. Effect of diluted povidone iodine in adenoviral keratoconjunctivitis on the rate of subepithelial corneal infiltrates. Int J Ophthalmol 2019; 12:1420-1425. [PMID: 31544037 DOI: 10.18240/ijo.2019.09.08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/12/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the clinical characteristics of adenoviral keratoconjunctivitis, the management modalities, as well as the incidence of subepithelial corneal infiltrates (SEI). METHODS Patients with characteristic clinical symptoms and signs, who presented to our clinic within the first week of symptoms and received the diagnosis of adenoviral keratoconjunctivitis between January 2013 and April 2016, were included in the study. A total of 211 patients were included in the study. Patients were evaluated for the incidence of clinical signs, late complications, management preferences, and the effect of diluted povidone-iodine (d-PVP-I) 2%. RESULTS Patients' mean age was 33.03±14.76y. We observed an increase in the number of cases according to the years. At presentation and/or early follow-up, the clinical signs were conjunctival hyperemia (100%), conjunctival follicules (79.1%), edema of the eyelids (39.3%), chemosis (16.1%), pseudomembrane formation (16.6%), and corneal epitheliopathy (29.9%). During late follow-up 13.3% patients developed conjunctival subepithelial fibrosis, and 39.8% developed SEI. A significant decrease in the incidence of SEI development was observed in patients who used d-PVP-I 2% (P=0.032; 33.3% vs 45.9%, respectively in patients who received d-PVP-I 2% and who did not). CONCLUSION Adenoviral keratoconjunctivitis has a tremendous effect on patient's comfort and abilities in short-term. Additionally, almost half of the patients develop visual problems related to SEI. According to our clinical experience, using d-PVP-I 2% in the first days of adenoviral keratoconjunctivitis might be helpful in reducing the risk of SEI as a complication.
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Affiliation(s)
- Rana Altan-Yaycioglu
- Department of Ophthalmology, Baskent University School of Medicine, Adana 01130, Turkey
| | | | - Handan Canan
- Department of Ophthalmology, Baskent University School of Medicine, Adana 01130, Turkey
| | - Muge Coban-Karatas
- Department of Ophthalmology, Baskent University School of Medicine, Adana 01130, Turkey
| | - Burak Ulas
- Department of Ophthalmology, Baskent University School of Medicine, Adana 01130, Turkey
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Decoy Receptor Interactions as Novel Drug Targets against EKC-Causing Human Adenovirus. Viruses 2019; 11:v11030242. [PMID: 30870979 PMCID: PMC6466251 DOI: 10.3390/v11030242] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 01/30/2023] Open
Abstract
Epidemic keratoconjunctivitis (EKC) is a severe ocular disease and can lead to visual impairment. Human adenovirus type-37 (HAdV-D37) is one of the major causative agents of EKC and uses sialic acid (SA)-containing glycans as cellular receptors. Currently, there are no approved antivirals available for the treatment of EKC. Recently, we have reported that sulfated glycosaminoglycans (GAGs) bind to HAdV-D37 via the fiber knob (FK) domain of the viral fiber protein and function as decoy receptors. Based on this finding, we speculated that GAG-mimetics may act as artificial decoy receptors and inhibit HAdV-D37 infection. Repurposing of approved drugs to identify new antivirals has drawn great attention in recent years. Here, we report the antiviral effect of suramin, a WHO-approved drug and a widely known GAG-mimetic, against HAdV-D37. Commercially available suramin analogs also show antiviral effects against HAdV-D37. We demonstrate that suramin exerts its antiviral activity by inhibiting the attachment of HAdV-D37 to cells. We also reveal that the antiviral effect of suramin is HAdV species-specific. Collectively, in this proof of concept study, we demonstrate for the first time that virus binding to a decoy receptor constitutes a novel and an unexplored target for antiviral drug development.
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Gonzalez G, Yawata N, Aoki K, Kitaichi N. Challenges in management of epidemic keratoconjunctivitis with emerging recombinant human adenoviruses. J Clin Virol 2019; 112:1-9. [PMID: 30654207 DOI: 10.1016/j.jcv.2019.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/21/2018] [Accepted: 01/08/2019] [Indexed: 01/14/2023]
Abstract
Adenoviral epidemic keratoconjunctivitis (EKC) presents as severe conjunctival inflammations involving the cornea that can lead to the development of corneal opacities and blurred vision, which can persist for months. EKC is highly contagious and responsible for outbreaks worldwide, therefore accurate diagnosis and rapid containment are imperative. EKC is caused by a number of types within Human adenovirus species D (HAdV-D): 8, 37 and 64 (formerly known as 19a) and these types were considered the major causes of EKC for over fifty years. Nonetheless, recent improved molecular typing methodologies have identified recombinant HAdV-D types 53, 54 and 56, as newly emerging etiologic agents of EKC infections worldwide. EKC cases due to these recombinant types have potentially been underdiagnosed and underestimated as a source of new EKC outbreaks. Recombination events among circulating HAdV-D types represent a source of new infectious disease threats. Also, the growing number of adenoviral types enabled genomic and phenotypic comparisons to determine pathological properties related to EKC. This review covers the clinical features of EKC, current challenges in clinical practice and recent progress in EKC-related HAdV research, which focuses on the development of novel diagnostic and therapeutic approaches.
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Affiliation(s)
- Gabriel Gonzalez
- Division of Bioinformatics, Research Center for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | - Nobuyo Yawata
- Department of Medicine, Ophthalmology, Fukuoka Dental College, Fukuoka, Japan; Singapore Eye Research Institute, Singapore; Department of Ophthalmology, Kyushu University, Japan; Duke-NUS Medical School, Singapore
| | - Koki Aoki
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan; Department of Ophthalmology, Health Sciences University of Hokkaido, Sapporo, Japan
| | - Nobuyoshi Kitaichi
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan; Department of Ophthalmology, Health Sciences University of Hokkaido, Sapporo, Japan.
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Varu DM, Rhee MK, Akpek EK, Amescua G, Farid M, Garcia-Ferrer FJ, Lin A, Musch DC, Mah FS, Dunn SP. Conjunctivitis Preferred Practice Pattern®. Ophthalmology 2019; 126:P94-P169. [DOI: 10.1016/j.ophtha.2018.10.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 02/07/2023] Open
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Clinical case: severe course of adenoviral conjunctivitis with a hemorrhagic component complicated by a toxic-allergic reaction against a pregnancy. КЛИНИЧЕСКАЯ ПРАКТИКА 2018. [DOI: 10.17816/clinpract09176-81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
One of the manifestations of adenovirus keratoconjunctivitis – extensive subconjunctival hemorrhages – is the characteristic of rather rare hemorrhagic form of conjunctivitis of severe course. Patients, especially pregnant women, with clinical manifestations of adenoviral conjunctivitis of severe course with a hemorrhagic component complicated by a toxic-allergic reaction, require close attention not only from ophthalmologists. It is necessary to conduct a comprehensive examination, including: general blood test, coagulogram, consultation of the therapist. Clinical signs of deterioration, in the early days of the disease, against the backdrop of treatment, is a clinical feature of the course of adenovirus infection, which should be informed to the patient. The use of a complex approach using the domestic non-toxic inducer of interferon formation of Poludan (polyA:polyU complex) in instillations and injections, supplemented by scraping-massage with a glass rod of the tarsal conjunctiva, facilitating the elimination of adenovirus from conjunctival follicles, quickly and effectively reversed the phenomenon of severe AVC. The appointment of corticosteroid therapy, regardless of the severity of the toxic-allergic reaction, is shown no earlier than 7 days after the manifestation of the disease.
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Role of the Adenoplus test in refractory, recurrent and clinically undiagnosed conjunctivitis. Can J Ophthalmol 2018; 53:529-532. [DOI: 10.1016/j.jcjo.2017.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/02/2017] [Accepted: 12/05/2017] [Indexed: 11/24/2022]
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Landis ZC, Pantanelli SM. Corneal and Conjunctival Infectious Disease Diagnostics. Int Ophthalmol Clin 2018; 57:1-11. [PMID: 28590277 DOI: 10.1097/iio.0000000000000182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Human adenovirus (HAdV) is a ubiquitous virus that infects the mucosa of the eye. It is the most common cause of infectious conjunctivitis worldwide, affecting people of all ages and demographics. Pharyngoconjunctival fever outbreak is due to HAdV types 3, 4, and 7, whereas outbreaks of epidemic keratoconjunctivitis are usually caused by HAdV types 8, 19, 37, and 54. Primary cellular receptors, such as CAR, CD46, and sialic acid interact with fiber-knob protein to mediate adenoviral attachment to the host cell, whereas adenoviral penton base–integrin interaction mediates internalization of adenovirus. Type 1 immunoresponse to adenoviral ocular infection involves both innate immunity mediated by natural killer cells and type 1 interferon, as well as adaptive immunity mediated mainly by CD8 T cells. The resulting ocular manifestations are widely variable, with pharyngoconjunctival fever being the most common, manifesting clinically with fever, pharyngitis, and follicular conjunctivitis. Epidemic keratoconjunctivitis, however, is the severest form, with additional involvement of the cornea leading to development of subepithelial infiltrates. Because there is currently no US Food and Drug Administration-approved treatment for adenoviral ocular infection, current management is palliative. The presence of sight-threatening complications following ocular adenoviral infection warrants the necessity for developing antiadenoviral therapy with enhanced therapeutic index. Future trends that focus on adenoviral pathogenesis, including adenoviral protein, which utilize host receptors to promote infection, could be potential therapeutic targets, yielding shorter active disease duration and reduced disease burden.
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Affiliation(s)
- DeGaulle I Chigbu
- Pennsylvania College of Optometry, Salus University, Elkins Park, PA, USA,
| | - Bisant A Labib
- Pennsylvania College of Optometry, Salus University, Elkins Park, PA, USA,
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Lee CS, Lee AY, Akileswaran L, Stroman D, Najafi-Tagol K, Kleiboeker S, Chodosh J, Magaret A, Wald A, Van Gelder RN. Determinants of Outcomes of Adenoviral Keratoconjunctivitis. Ophthalmology 2018; 125:1344-1353. [PMID: 29602567 DOI: 10.1016/j.ophtha.2018.02.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 02/07/2018] [Accepted: 02/12/2018] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To determine host and pathogen factors predictive of outcomes in a large clinical cohort with keratoconjunctivitis. DESIGN Retrospective analyses of the clinical and molecular data from a randomized, controlled, masked trial for auricloscene for keratoconjunctivitis (NVC-422 phase IIB, NovaBay; clinicaltrials.gov identifier, NCT01877694). PARTICIPANTS Five hundred participants from United States, India, Brazil, and Sri Lanka with clinical diagnosis of keratoconjunctivitis and positive rapid test results for adenovirus. METHODS Clinical signs and symptoms and bilateral conjunctival swabs were obtained on days 1, 3, 6, 11, and 18. Polymerase chain reaction (PCR) analysis was performed to detect and quantify adenovirus in all samples. Regression models were used to evaluate the association of various variables with keratoconjunctivitis outcomes. Time to resolution of each symptom or sign was assessed by adenoviral species with Cox regression. MAIN OUTCOME MEASURES The difference in composite scores of clinical signs between days 1 and 18, mean visual acuity change between days 1 and 18, and time to resolution of each symptom or sign. RESULTS Of 500 participants, 390 (78%) showed evidence of adenovirus by PCR. Among adenovirus-positive participants, adenovirus D species was most common (63% of total cases), but a total of 4 species and 21 different types of adenovirus were detected. Adenovirus D was associated with more severe signs and symptoms, a higher rate of subepithelial infiltrate development, and a slower decline in viral load compared with all other adenovirus species. The clinical courses of all patients with non-adenovirus D species infection and adenovirus-negative keratoconjunctivitis were similar. Mean change in visual acuity between days 1 and 18 was a gain of 1.9 letters; worse visual outcome was associated with older age. CONCLUSIONS A substantial proportion of keratoconjunctivitis is not associated with a detectable adenovirus. The clinical course of those with adenovirus D keratoconjunctivitis is significantly more severe than those with non-adenovirus D species infections or adenovirus-negative keratoconjunctivitis; high viral load at presentation and non-United States origin of participants is associated with poorer clinical outcome.
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Affiliation(s)
- Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington.
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | | | - David Stroman
- NovaBay Pharmaceuticals, Inc., Emeryville, California
| | | | | | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Amalia Magaret
- Department of Biostatistics, University of Washington, Seattle, Washington; Department of Laboratory Medicine, University of Washington, Seattle, Washington; Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Anna Wald
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington
| | - Russell N Van Gelder
- Department of Ophthalmology, University of Washington, Seattle, Washington; Departments of Biological Structure and Pathology, University of Washington, Seattle, Washington
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Carnt N, Samarawickrama C, White A, Stapleton F. The diagnosis and management of contact lens-related microbial keratitis. Clin Exp Optom 2017; 100:482-493. [PMID: 28815736 DOI: 10.1111/cxo.12581] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/22/2017] [Accepted: 05/27/2017] [Indexed: 01/10/2023] Open
Abstract
Contact lens-associated microbial keratitis poses a diagnostic dilemma for optometrists on two fronts. The distinction between sterile inflammation and microbial infection is often blurred. In addition, there is a requirement with nearly 50 per cent of the Australian and New Zealand optometric profession being therapeutically endorsed, to distinguish between cases of infection that can be managed in the community verses those that require escalation to public hospitals that have access to laboratory diagnostic tools and advanced imaging techniques, such as in vivo confocal microscopy. Pattern recognition and incorporation of knowledge of aetiology and risk factors assists optometrists to decide on optimal management strategies. Skilled optometrists will utilise emerging diagnostic and therapeutic technologies to ensure safe management strategies and better outcomes for these cases.
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Affiliation(s)
- Nicole Carnt
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia.,The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Chameen Samarawickrama
- The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew White
- The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
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Paulini I, Siqueira-Silva J, Thomaz L, Rocha L, Harsi C, Bellei N, Granato C. Development of a prototype immunochromatographic test for rapid diagnosis of respiratory adenovirus infection. Braz J Infect Dis 2017. [PMID: 28623675 PMCID: PMC9425546 DOI: 10.1016/j.bjid.2017.03.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Human adenoviruses comprise an important group of etiologic agents that are responsible for various diseases in adults and children, such as respiratory, ocular, gastroenteric, and urinary infections. In immunocompromised and organ-transplanted individuals, these agents can cause generalized infections. Rapid diagnostic methods for detecting these infectious agents are not widely available. The aim of this work was to produce monoclonal and polyclonal anti-adenovirus antibodies to be used in a rapid diagnostic test for respiratory infections. Adenovirus hexons were satisfactorily purified by ultracentrifugation and chromatography. After virus purification, anti-hexon monoclonal antibodies were produced and characterized, following classical methods. Antibodies were specific for adenoviruses 2, 3, 5, and 41. The proposed immunochromatographic test was standardized using colloidal gold. The standardization of the rapid test was sufficient to detect adenovirus antigens (in nasopharyngeal lavage samples) with sensitivity of 100% and specificity of 85% when compared to direct immunofluorescence. The immunochromatographic assay prototype was sufficiently sensitive to detect B (3), C (2 and 5), and F (41) adenovirus samples. Although based on preliminary data, the test demonstrated the same performance as direct immunofluorescence, but with the advantage of being a point-of-care test. Further studies are still needed to confirm its effectiveness in clinical practice.
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Affiliation(s)
- Inarei Paulini
- Universidade Federal de São Paulo, Departamento de Medicina, Laboratório de Virologia, Disciplina de Infectologia, São Paulo, SP, Brazil.
| | - Joselma Siqueira-Silva
- Universidade de São Paulo, Instituto de Biociências, Departamento de Microbiologia, Laboratório de Adenovírus, São Paulo, SP, Brazil
| | - Luciana Thomaz
- Instituto de Biociências, Departamento de Microbiologia, Laboratório de Micologia, São Paulo, SP, Brazil
| | - Leticia Rocha
- Instituto Butantan, Laboratório de Bacteriologia, São Paulo, SP, Brazil
| | - Charlotte Harsi
- Universidade de São Paulo, Instituto de Biociências, Departamento de Microbiologia, Laboratório de Adenovírus, São Paulo, SP, Brazil
| | - Nancy Bellei
- Universidade Federal de São Paulo, Departamento de Medicina, Laboratório de Virologia, Disciplina de Infectologia, São Paulo, SP, Brazil
| | - Celso Granato
- Universidade Federal de São Paulo, Departamento de Medicina, Laboratório de Virologia, Disciplina de Infectologia, São Paulo, SP, Brazil
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18
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Asena L, Şıngar Özdemir E, Burcu A, Ercan E, Çolak M, Altınörs DD. Comparison of clinical outcome with different treatment regimens in acute adenoviral keratoconjunctivitis. Eye (Lond) 2017; 31:781-787. [PMID: 28157224 DOI: 10.1038/eye.2017.4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 10/28/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeTo compare the clinical outcome with different treatment regimens in Acute Adenoviral Keratoconjunctivitis (AAK).MethodsThe records of 110 patients diagnosed as AAK in two tertiary eye care centers were evaluated retrospectively. The treatment regimen, follow-up duration, time until improvement of the symptoms, visual acuity, clinical findings, Schirmer's test and the Ocular Surface Disease Index (OSDI) score at the first day, first week and third week were recorded. The Kruskal-Wallis Test and Chi-square test were used for comparison of quantitative and categorical variables, respectively.ResultsForty six patients were receiving topical corticosteroids (Group 1), 32 topical 2% Cyclosporin A (CsA) (Group 2) and 32 only artificial tears (Group 3). Mean time until resolution of the symptoms was lowest in Group 1 (9.5±4.9 days) and highest in Group 3 (13.3±4.2 days)(p: 0.001). OSDI scores at the first and third weeks were highest in Group 3 (52.4±16.4 and 32.3±13.0) and lowest in Group 1 (41.0±21.3 and 23.9±13.2)(p: 0.01 and p: 0.009). At day 21, percentage of the patients with subepthelial infiltrates was the highest in Group 3 (63.4%) and lowest in Group 1 (42.5%).ConclusionsThe symptoms were less severe and had a shorter duration with topical corticosteroids and CsA when compared with palliative therapy. Topical 2% CsA may inhibit development of corneal subepithelial infiltrates when used in the acute phase of infection, similar to corticosteroids.
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Affiliation(s)
- L Asena
- Department of Ophthalmology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - E Şıngar Özdemir
- Department of Ophthalmology, Ankara Education and Research Hospital, Ankara, Turkey
| | - A Burcu
- Department of Ophthalmology, Ankara Education and Research Hospital, Ankara, Turkey
| | - E Ercan
- Department of Ophthalmology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - M Çolak
- Department of Biostatistics, Baskent University, Health Sciences Faculty, Ankara, Turkey
| | - D D Altınörs
- Department of Ophthalmology, Baskent University Faculty of Medicine, Ankara, Turkey
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19
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Oh JJ, Rho CR. Causes of epidemic keratoconjunctivitis and therapeutic measures. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2017. [DOI: 10.5124/jkma.2017.60.6.491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jeong Jae Oh
- Department of Ophthalmology and Visual Science, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Daejeon, Korea
| | - Chang Rae Rho
- Department of Ophthalmology and Visual Science, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Daejeon, Korea
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20
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Jhanji V, Chan TC, Li EY, Agarwal K, Vajpayee RB. Adenoviral keratoconjunctivitis. Surv Ophthalmol 2015; 60:435-43. [DOI: 10.1016/j.survophthal.2015.04.001] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 04/08/2015] [Accepted: 04/13/2015] [Indexed: 11/27/2022]
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21
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Andalibi S, Haidara M, Bor N, Levin M. An Update on Neonatal and Pediatric Conjunctivitis. CURRENT OPHTHALMOLOGY REPORTS 2015. [DOI: 10.1007/s40135-015-0080-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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22
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Choi S, Moon SW, Shin JH, Park HK, Jin KH. Label-Free Biochemical Analytic Method for the Early Detection of Adenoviral Conjunctivitis Using Human Tear Biofluids. Anal Chem 2014; 86:11093-9. [DOI: 10.1021/ac5025478] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Samjin Choi
- Department
of Biomedical Engineering, College of Medicine, Kyung Hee University, Seoul 130-701, Korea
- Healthcare
Industry Research Institute, Kyung Hee University, Seoul 130-701, Korea
- Department
of Medical Engineering, College of Medicine, Kyung Hee University, Seoul 130-701, Korea
| | - Sung Woon Moon
- Department
of Ophthalmology, Kyung Hee University, Seoul 130-701, Korea
| | - Jae-Ho Shin
- Department
of Ophthalmology, Kyung Hee University, Seoul 130-701, Korea
| | - Hun-Kuk Park
- Department
of Biomedical Engineering, College of Medicine, Kyung Hee University, Seoul 130-701, Korea
- Healthcare
Industry Research Institute, Kyung Hee University, Seoul 130-701, Korea
- Department
of Medical Engineering, College of Medicine, Kyung Hee University, Seoul 130-701, Korea
| | - Kyung-Hyun Jin
- Department
of Ophthalmology, Kyung Hee University, Seoul 130-701, Korea
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23
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Özen Tunay Z, Ozdemir O, Petricli IS. Povidone iodine in the treatment of adenoviral conjunctivitis in infants. Cutan Ocul Toxicol 2014; 34:12-5. [PMID: 24678746 DOI: 10.3109/15569527.2014.888077] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Adenoviral conjunctivitis. OBJECTIVE To examine the effects of conjunctival irrigation with povidone iodine in infants with adenoviral conjunctivitis. MATERIAL AND METHODS An outbreak of adenovirus conjunctivitis occurred between September and December 2012 at the neonatal intensive care unit of our hospital. Forty-three infants with adenoviral conjunctivitis were examined in this study. Thirty-five eyes of 35 infants who had detailed ophthalmological examination and clinical scoring were included. The conjunctiva of 15 infants (Group 1) were irrigated with povidone iodine 2.5% solution and then treated with preservative-free artificial tears and preservative-free antibiotic drops. Twenty infants (Group 2) were treated only with the same drops with the same posology, without conjunctival irrigation with povidone iodine. Patients were examined two times a week until the complete recovery. Lid edema, conjunctival chemosis, fragility of conjunctival vasculature, pseudomembrane formation, and corneal involvement were scored clinically. RESULTS Twenty patients (57%) were female and 15 patients (43%) were male and mean age was 3.1 months (ranged from 1 to 4 months). No relation was found between gender and clinical scores. Statistically significant lower clinical scores were obtained from Group 1. The median recovery time was earlier in Group 1 (7 d) than Group 2 (12 d) (p = 0.001). CONCLUSION Conjunctival irrigation with 2.5% povidone iodine is effective in the treatment of adenoviral conjunctivitis in infants.
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Affiliation(s)
- Zuhal Özen Tunay
- Department of Ophthalmology, Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey and
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24
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Ghebremedhin B. Human adenovirus: Viral pathogen with increasing importance. Eur J Microbiol Immunol (Bp) 2014; 4:26-33. [PMID: 24678403 DOI: 10.1556/eujmi.4.2014.1.2] [Citation(s) in RCA: 206] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 12/21/2013] [Indexed: 11/19/2022] Open
Abstract
The aim of this review is to describe the biology of human adenovirus (HAdV), the clinical and epidemiological characteristics of adenoviral epidemic keratoconjunctivitis and to present a practical update on its diagnosis, treatment, and prophylaxis. There are two well-defined adenoviral keratoconjunctivitis clinical syndromes: epidemic keratoconjunctivitis (EKC) and pharyngoconjunctival fever (PCF), which are caused by different HAdV serotypes. The exact incidence of adenoviral conjunctivitis is still poorly known. However, cases are more frequent during warmer months. The virus is endemic in the general population, and frequently causes severe disease in immunocompromised patients, especially the pediatric patients. Contagion is possible through direct contact or fomites, and the virus is extremely resistant to different physical and chemical agents. The clinical signs or symptoms of conjunctival infection are similar to any other conjunctivitis, with a higher incidence of pseudomembranes. In the cornea, adenoviral infection may lead to keratitis nummularis. Diagnosis is mainly clinical, but its etiology can be confirmed using cell cultures, antigen detection, polymerase chain reaction or immunochromatography. Multiple treatments have been tried for this disease, but none of them seem to be completely effective. Prevention is the most reliable and recommended strategy to control this contagious infection.
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25
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Schwartz SG, Flynn Jr HW, Scott IU. Endophthalmitis: classification and current management. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.2.3.385] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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26
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27
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Li J, Yang Y, Lin C, Li W, Yang Y, Zhang Y, Jia L, Li X, Chen L, Wang Q. Etiology of Acute Conjunctivitis Due to Coxsackievirus A24 Variant, Human Adenovirus, Herpes Simplex Virus, and Chlamydia in Beijing, China. Jpn J Infect Dis 2014; 67:349-55. [DOI: 10.7883/yoken.67.349] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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28
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Abstract
IMPORTANCE Conjunctivitis is a common problem. OBJECTIVE To examine the diagnosis, management, and treatment of conjunctivitis, including various antibiotics and alternatives to antibiotic use in infectious conjunctivitis and use of antihistamines and mast cell stabilizers in allergic conjunctivitis. EVIDENCE REVIEW A search of the literature published through March 2013, using PubMed, the ISI Web of Knowledge database, and the Cochrane Library was performed. Eligible articles were selected after review of titles, abstracts, and references. FINDINGS Viral conjunctivitis is the most common overall cause of infectious conjunctivitis and usually does not require treatment; the signs and symptoms at presentation are variable. Bacterial conjunctivitis is the second most common cause of infectious conjunctivitis, with most uncomplicated cases resolving in 1 to 2 weeks. Mattering and adherence of the eyelids on waking, lack of itching, and absence of a history of conjunctivitis are the strongest factors associated with bacterial conjunctivitis. Topical antibiotics decrease the duration of bacterial conjunctivitis and allow earlier return to school or work. Conjunctivitis secondary to sexually transmitted diseases such as chlamydia and gonorrhea requires systemic treatment in addition to topical antibiotic therapy. Allergic conjunctivitis is encountered in up to 40% of the population, but only a small proportion of these individuals seek medical help; itching is the most consistent sign in allergic conjunctivitis, and treatment consists of topical antihistamines and mast cell inhibitors. CONCLUSIONS AND RELEVANCE The majority of cases in bacterial conjunctivitis are self-limiting and no treatment is necessary in uncomplicated cases. However, conjunctivitis caused by gonorrhea or chlamydia and conjunctivitis in contact lens wearers should be treated with antibiotics. Treatment for viral conjunctivitis is supportive. Treatment with antihistamines and mast cell stabilizers alleviates the symptoms of allergic conjunctivitis.
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Affiliation(s)
- Amir A Azari
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison
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29
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Gadaria-Rathod N, Fernandez KB, Kheirkhah A, Asbell PA. New insights into infectious keratitis. Int Ophthalmol Clin 2013; 53:163-172. [PMID: 23221892 DOI: 10.1097/iio.0b013e3182713413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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30
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González-López JJ, Morcillo-Laiz R, Muñoz-Negrete FJ. Adenoviral keratoconjunctivitis: an update. ACTA ACUST UNITED AC 2012; 88:108-15. [PMID: 23473088 DOI: 10.1016/j.oftal.2012.07.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 06/25/2012] [Accepted: 07/06/2012] [Indexed: 12/01/2022]
Abstract
The objective of this review is to describe the clinical and epidemiological characteristics of adenoviral conjunctivitis, as well as to present a practical update on its diagnosis, treatment and prophylaxis. There are two well-defined adenoviral keratoconjunctivitis clinical syndromes: epidemic keratoconjunctivitis and pharyngoconjunctival fever, which are caused by different adenovirus serotypes. The exact incidence of adenoviral conjunctivitis is unknown. However, cases are more frequent during warmer months. Contagion is possible through direct contact or fomites and the virus is extremely resistant to different physical and chemical agents. The symptomatology of conjunctival infection is similar to any other conjunctivitis, with a higher incidence of pseudomembranes. In the cornea, adenoviral infection may lead to keratitis nummularis. Diagnosis is mainly clinical, but its etiology can be confirmed using cell cultures, polymerase chain reaction or immunochromatography. Multiple treatments have been tried for this disease, but none of them seem to be completely effective. Prevention is the most reliable way to control this contagious infection.
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Affiliation(s)
- J J González-López
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
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31
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Abstract
PURPOSE OF REVIEW Adenoviral infection is common, can be severe, and may cause significant morbidity. RECENT FINDINGS Ophthalmologists and optometrists are often guilty of spreading adenovirus because it is highly contagious and has 53 serotypes with variable morphology. Adenovirus is often difficult to diagnose based on clinical appearance and, in the early stages, is associated with a red eye or superficial keratitis common to herpes and other infections. This difficulty results in the indiscriminate use of antibiotics, which are expensive and of no established value in treating a viral infection. The difficulty of accurate diagnosis also makes the use of newer proposed treatments less valuable and even potentially hazardous. SUMMARY New diagnostic tests such as the Rapid Pathogen Screening (RPS) Adeno Detector that are practical, rapid, and inexpensive to use in the office may obviate these problems.
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32
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Abstract
Conjunctivitis is a common problem in primary health care. Inflammation of the conjunctiva may result from infection or noninfectious causes. Microbial conjunctivitis may be caused by bacteria, viruses, or parasites. Although usually a benign, self-limited disease in healthy individuals, serious complications (eg, keratitis) may be sight-threatening. Accurate diagnosis and specific treatment of conjunctivitis remain challenging. History taking and physical examination are occasionally insufficient for correct diagnosis, thus laboratory testing may play a vital role in identification of specific pathogen(s). However, diagnostic testing has several limitations, including time-consuming methods, increased cost, and requirement for expertise in performance and interpretation. Treatment with empirical topical antibiotics for suspected infectious conjunctivitis is controversial. Although antibiotic treatment can diminish risk of adverse events and shorten the course of disease, drug resistance, toxicity, and expense are important considerations in management of acute infectious conjunctivitis.
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Jin XH, Ishii A, Aoki K, Ishida S, Mukasa K, Ohno S. Detection of human adenovirus hexon antigen using carbon nanotube sensors. J Virol Methods 2011; 171:405-7. [DOI: 10.1016/j.jviromet.2010.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Revised: 12/05/2010] [Accepted: 12/13/2010] [Indexed: 10/18/2022]
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34
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35
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Practical Ophthalmic Microbiology for the Detection of Corneal Pathogens. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00018-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Numerous point-of-care tests (POCTs) are available to diagnose viral infections in both hospital and community settings. The ideal POCT is rapid, sensitive, specific, and simple to perform. This chapter will describe the benefits of POCTs, factors that can influence the accuracy of POCTs and highlight some limitations of POCT strategies. The sensitivity, specificity, and turn-around time of available POCTs are included for common conditions including respiratory viral infections (e.g. influenza, RSV) and blood-borne viral infections (e.g. HIV).
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Affiliation(s)
- Christopher C Blyth
- Centre for Infectious Diseases and Microbiology Laboratory Services, Westmead Hospital, Sydney, NSW, Australia
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37
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Abstract
OBJECTIVE Acute conjunctivitis is an extremely common condition and can be associated with significant morbidity and economic burden. Despite this, considerable controversy exists pertaining to the prevalence, diagnosis, management, and treatment of the condition. A panel of ophthalmology experts was assembled to review and discuss the current evidence based literature as it pertains to each of these persistent controversies. METHODS AND SCOPE An acute conjunctivitis round table symposium was convened at the American Academy of Ophthalmology meeting in Atlanta, November 2008. The expert panelists consisted of four academic ophthalmologists in the field of cornea and external disease, whose discussion was informed by an English language literature survey carried out on the PubMed database for the period of January 1972 to October 2008. A narrative summary was generated from the literature review and direct transcription of this event, from which this Review article was developed. FINDINGS AND CONCLUSIONS Considerable light has been shed on acute microbial conjunctivitis and especially those cases caused by adenovirus. Many of the myths that have perpetuated for years have been debunked by emerging evidence. The advent and the implementation of better diagnostic tools and anti-viral medications will help clinicians to improve their diagnostic accuracy, improve management and treatment decisions, and ultimately benefit patients while saving overall healthcare costs.
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Affiliation(s)
- Terrence P O'Brien
- University of Miami Miller School of Medicine, Department of Ophthalmology, Bascom Palmer at Palm Beach Gardens, Palm Beach Gardens, FL 33418, USA.
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38
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Siamak NM, Kowalski RP, Thompson PP, Romanowski EG, Shanks RMQ, Gordon YJ. RPS Adeno Detector. Ophthalmology 2009; 116:591-591.e1. [PMID: 19264216 DOI: 10.1016/j.ophtha.2008.10.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 10/23/2008] [Indexed: 11/15/2022] Open
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Levent F, Greer JM, Snider M, Demmler-Harrison GJ. Performance of a new immunochromatographic assay for detection of adenoviruses in children. J Clin Virol 2008; 44:173-5. [PMID: 19101199 DOI: 10.1016/j.jcv.2008.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Revised: 11/03/2008] [Accepted: 11/04/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Adenoviruses are a prominent cause of respiratory, ocular, gastrointestinal, and disseminated diseases in healthy and immunocompromised children. An accurate rapid diagnostic assay may impact clinical decision-making. OBJECTIVES Evaluate the performance of a new rapid assay for detection of adenoviruses directly in pediatric clinical specimens. STUDY DESIGN The rapid assay was performed on adenovirus culture-positive original samples and on an equal number of culture-negative samples matched by patient age and specimen type. Discrepant results were resolved using a polymerase chain reaction (PCR) assay. RESULTS 200 adenovirus culture-positive and 200 adenovirus culture-negative samples were evaluated from 315 different patients. Overall sensitivity was 55% and specificity was 98.9%. The assay was most sensitive in children 5 years old and younger and most specific in respiratory samples. CONCLUSIONS The rapid assay was highly specific for detecting adenovirus infections in children. However, since this rapid assay had only moderate to low sensitivity, samples with negative rapid assay results should have additional testing for adenovirus performed by either viral culture or PCR.
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Affiliation(s)
- Fatma Levent
- Baylor College of Medicine, Department of Pediatrics, Section of Infectious Diseases, Houston, TX, USA.
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40
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Abstract
BACKGROUND Conjunctivitis is a relatively common condition of the eye that can be caused by a number of different pathogens including bacteria and viruses. Clinical differentiation between adenoviral and bacterial conjunctivitis is difficult, often resulting in misdiagnosis and the provision of inappropriate treatment. METHODS A cost-effectiveness analysis was performed from a societal perspective using primary, secondary, published literature, and expert opinion data sources. The incremental costs and effects (cases of unnecessary antibiotic treatment avoided) for a rapid point-of-care test for adenoviral conjunctivitis (RPS Adeno Detector) were modeled. RESULTS Using base case values, the incremental cost of using no point-of-care test compared with the point-of-care test is $71.30 with 0.1786 cases of unnecessary antibiotic treatment. Extrapolating these costs to the entire U.S. population per annum, society could potentially save nearly $430 million currently spent on unnecessary medical care and avoid over 1 million cases of unnecessary antibiotic treatment. The no-point-of-care test strategy is both more costly and less effective; indicating that the point-of-care test strategy is the most cost-effective option. The results were robust to variation in key model parameters. CONCLUSIONS Through the use of a rapid point-of-care test for adenovirus, much of the cost to society caused by acute conjunctivitis can be avoided through more timely and accurate diagnosis.
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41
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Pelletier J, Haim L, Patel NS. Comment on "Clinical Features of Bacterial Conjunctivitis in Children". Acad Emerg Med 2007. [DOI: 10.1111/j.1553-2712.2007.tb01878.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pelletier J, Haim L, Patel NS. Comment on "Clinical features of bacterial conjunctivitis in children". Acad Emerg Med 2007; 14:759-60; author reply 760. [PMID: 17656612 DOI: 10.1197/j.aem.2007.03.1348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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43
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Reuter G, Meleg E, Kiss G, Albert N, Fekete Z, Szûcs G. Molecular detection of adenovirus type 8 epidemic keratoconjunctivitis in Hungary. Orv Hetil 2007; 148:1311-5. [PMID: 17611181 DOI: 10.1556/oh.2007.28076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Bevezetés:
A heveny kötőhártya-gyulladás (conjunctivitis) fertőzéses és nem fertőzéses eredetű lehet. A fertőzéses eredetű járványos conjunctivitisek (conjunctivitis epidemica) kórokozói vírusok, ezen belül elsősorban az adenovírusok különböző típusai.
Célkitűzés:
A szerzők célja egy keratoconjunctivitis járvány epidemiológiai leírása volt a virális kórokozó molekuláris kimutatásával.
Módszer:
A járvány – részben retrospektív – felderítésében klasszikus járványügyi módszereket alkalmaztak. A laboratóriumi etiológiai vizsgálat az adenovírus hexon régiójának kimutatásával polimeráz láncreakcióval (PCR), majd szekvenálással történt frissen gyűjtött conjunctiva-váladékból.
Eredmények:
A keratoconjunctivitis járványban összesen 60-an betegedtek meg 2006. október 9. és december 18-a között hét baranyai településen. A betegek átlagéletkora 51,2 év volt. A vezető tünetek a conjunctiva belövelltsége (100%), a könnyezés (94%), az idegentest-érzés (83%) és a homályos látás (76%) voltak. Az esetek felében mindkét szem érintett volt. A fertőzés közvetlen kontaktussal terjedt részben nosocomiálisan, a szemészeti szakellátás során. Nyolc conjunctivaváladékból 5-ben (62,5%) genetikailag azonos, 8-as típusú adenovírust lehetett kimutatni (HAdV8/Baranya/2006/HUN; EF210714), mely 100%-ban azonos volt egy Ausztriában 2004-ben kimutatott adenovírussal (DQ149614).
Következtetések:
A részben a szemészeti ellátáshoz kapcsolódó nosocomiális keratoconjunctivitis-járványt az adenovírus 8-as típusa okozta. A megbetegedés klinikai felismerése, laboratóriumi diagnosztikája és a járványügyi intézkedések együttesen szükségesek a keratoconjunctivitis-fertőzések és a következményes járvány megelőzéséhez.
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MESH Headings
- Acute Disease
- Adenovirus Infections, Human/diagnosis
- Adenovirus Infections, Human/epidemiology
- Adenovirus Infections, Human/virology
- Adenoviruses, Human/genetics
- Adenoviruses, Human/isolation & purification
- Adult
- Aged
- Conjunctivitis, Viral/diagnosis
- Conjunctivitis, Viral/epidemiology
- Conjunctivitis, Viral/virology
- Cross Infection/diagnosis
- Cross Infection/epidemiology
- Cross Infection/virology
- DNA, Viral/isolation & purification
- Disease Outbreaks
- Female
- Humans
- Hungary/epidemiology
- Keratoconjunctivitis/diagnosis
- Keratoconjunctivitis/epidemiology
- Keratoconjunctivitis/virology
- Male
- Middle Aged
- Polymerase Chain Reaction
- Sequence Analysis, DNA
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Affiliation(s)
- Gábor Reuter
- Allami Népegészségügyi és Tisztiorvosi Szolgálat Baranya Megyei Intézete, Regionális Virológiai Laboratórium, Pécs, Hungary.
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The prevalence of adenoviral conjunctivitis at the Wills Eye Hospital Emergency Room. ACTA ACUST UNITED AC 2007; 78:236-9. [PMID: 17478342 DOI: 10.1016/j.optm.2006.11.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Revised: 11/22/2006] [Accepted: 11/23/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the prevalence of adenoviral conjunctivitis by analyzing data from a prospective clinical study of 50 consecutive patients presenting to the Wills Eye Hospital Emergency Room (WEH ER) with a clinical diagnosis of infectious conjunctivitis from July 2003 to October 2003. METHODS The polymerase chain reaction (PCR) was used to evaluate all cases of clinically diagnosed infectious conjunctivitis. Based on the laboratory findings, the prevalence of adenovirus was determined. RESULTS Of the 50 consecutive patients with acute infectious conjunctivitis, 31 patients were PCR positive for adenovirus. CONCLUSIONS The prevalence of adenoviral conjunctivitis was found by PCR to represent 62% of all patients presenting with a clinical diagnosis of infectious conjunctivitis from July 2003 to October 2003.
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