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Tsui E, Sella R, Tham V, Kong AW, McClean E, Goren L, Bahar I, Cherian N, Ramirez J, Hughes RE, Privratsky JK, Onclinx T, Feit-Leichman R, Cheng A, Molina I, Kim P, Yu C, Ruder K, Tan A, Chen C, Liu Y, Abraham T, Hinterwirth A, Zhong L, Porco TC, Lietman TM, Seitzman GD, Doan T. Pathogen Surveillance for Acute Infectious Conjunctivitis. JAMA Ophthalmol 2023; 141:1140-1144. [PMID: 37917077 PMCID: PMC10623299 DOI: 10.1001/jamaophthalmol.2023.4785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/31/2023] [Indexed: 11/03/2023]
Abstract
Importance Acute infectious conjunctivitis is a common ocular condition with major public health consequences. Objective To assess regional variations and microbial etiologies of acute infectious conjunctivitis to guide treatment. Design, Setting, and Participants In this cross-sectional study, patients with presumed acute infectious conjunctivitis were enrolled in the study at 5 sites (Honolulu, Hawaii; Los Angeles, San Francisco, and San Diego, California; and Petah-Tikva, Israel) from March 2021 to March 2023. Patients with allergic or toxic conjunctivitis were excluded. Main Outcomes and Measures Pathogens were identified by unbiased RNA deep sequencing. Results In all, 52 patients (mean [range] age, 48 [7-80] years; 31 females [60%]) were enrolled at 5 sites (6 patients from Honolulu, 9 from San Diego, 11 from Los Angeles, 13 from San Francisco, and 13 from Petah-Tikva). RNA deep sequencing detected human adenovirus species D in one-quarter of patients (13 of 52). A wide range of pathogens, including human coronavirus 229E, SARS-CoV-2, and herpes simplex virus type 1, was also identified, as well as several bacteria and fungi. Moreover, 62% (32 of 52) of patients presented with purulent discharge, while only 8% (4 of 52) of patients had confirmed bacterial pathogens. Conclusion and Relevance In this cross-sectional study, pathogens associated with acute infectious conjunctivitis varied between all 5 sites in the US and Israel. Purulent discharge was a common presenting sign in this study, with a low specificity for bacteria-associated conjunctivitis, suggesting that further diagnostic workup may be necessary to inform antibiotic stewardship. Additional research on cost-effectiveness of using RNA deep sequencing is needed to ascertain whether it is better to monitor patients clinically until resolution of disease.
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Affiliation(s)
- Edmund Tsui
- Ocular Inflammatory Disease Center, UCLA Stein Eye Institute, Los Angeles, California
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Ruti Sella
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vivien Tham
- Pacific Vision Institute of Hawaii, Honolulu, Hawaii
- Department of Ophthalmology, University of Hawaii John A. Burns School of Medicine, Honolulu
| | - Alan W. Kong
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Esmeralda McClean
- Shiley Eye Institute, University of California, San Diego, San Diego
| | - Lee Goren
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva, Israel
| | - Irit Bahar
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nina Cherian
- Ocular Inflammatory Disease Center, UCLA Stein Eye Institute, Los Angeles, California
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Joana Ramirez
- Ocular Inflammatory Disease Center, UCLA Stein Eye Institute, Los Angeles, California
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Reginald E. Hughes
- Ocular Inflammatory Disease Center, UCLA Stein Eye Institute, Los Angeles, California
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Joseph K. Privratsky
- Ocular Inflammatory Disease Center, UCLA Stein Eye Institute, Los Angeles, California
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Tania Onclinx
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Rachel Feit-Leichman
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Angel Cheng
- Pacific Vision Institute of Hawaii, Honolulu, Hawaii
| | - Iliana Molina
- Shiley Eye Institute, University of California, San Diego, San Diego
| | - Phillip Kim
- Shiley Eye Institute, University of California, San Diego, San Diego
| | - Carol Yu
- Shiley Eye Institute, University of California, San Diego, San Diego
| | - Kevin Ruder
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco
| | - Alexander Tan
- Pacific Vision Institute of Hawaii, Honolulu, Hawaii
| | - Cindi Chen
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco
| | - YuHeng Liu
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco
| | - Thomas Abraham
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco
| | - Armin Hinterwirth
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco
| | - Lina Zhong
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco
| | - Travis C. Porco
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco
- Department of Ophthalmology, University of California, San Francisco, San Francisco
| | - Thomas M. Lietman
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco
- Department of Ophthalmology, University of California, San Francisco, San Francisco
| | - Gerami D. Seitzman
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco
- Department of Ophthalmology, University of California, San Francisco, San Francisco
| | - Thuy Doan
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco
- Department of Ophthalmology, University of California, San Francisco, San Francisco
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Weinberg DA, Tham V, Hardin N, Antley C, Cohen AJ, Hunt K, Glasgow BJ, Baylis HI, Shorr N, Goldberg RA. Eyelid mucous membrane grafts: a histologic study of hard palate, nasal turbinate, and buccal mucosal grafts. Ophthalmic Plast Reconstr Surg 2007; 23:211-6. [PMID: 17519659 DOI: 10.1097/iop.0b013e318050d2d1] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To histologically evaluate the outcome of mucous membrane grafts to the eyelid. METHODS Case series of 31 eyes from 24 patients who underwent transplantation of hard palate (25 eyes), buccal (1 eye), or nasal turbinate (5 eyes) mucosa to the posterior eyelid surface. These grafts were biopsied at 0.5 months to 84 months (mean, 20 months) postoperatively. They were examined with light microscopy and compared with either the donor mucosa from the same patient (2 patients) or the typical donor site histology (22 patients). RESULTS Graft biopsies revealed general epithelial morphology that was quite similar to the respective donor sites in virtually all cases. Six (25%) of 24 hard palate graft biopsies, which were obtained at 8 months to 49 months (mean, 22 months) postoperatively, displayed orthokeratosis alternating with parakeratosis, while 12 (50%) demonstrated parakeratosis alone, and another 6 (25%) showed adjacent regions of parakeratotic and nonkeratinized epithelium. No hard palate grafts showed complete absence of keratinization after transplantation. Other significant findings included loss of goblet cells in nasal turbinate grafts and few submucosal glands remaining in any specimen. CONCLUSIONS Full-thickness mucosal grafts typically maintain their native epithelial morphology following transplantation to the ocular surface. Submucosal glands usually do not survive transplantation, which could be the result of intentional thinning of the graft at the time of transplantation. Contrary to the opinion that hard palate graft epithelium usually undergoes metaplasia from keratinized to nonkeratinized within 6 months following transplantation to the eye, all hard palate grafts in this study remained orthokeratotic and/or parakeratotic.
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Affiliation(s)
- David A Weinberg
- Ophthalmic Plastic Surgery Service, Division of Ophthalmology, Department of Surgery, University of Vermont College of Medicine, Burlington, VT, USA.
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