Positive detection of SARS-CoV-2 combined HSV1 and HHV6B virus nucleic acid in tear and conjunctival secretions of a non-conjunctivitis COVID-19 patient with obstruction of common lacrimal duct

Abstract

Background: The current outbreak of COVID-19 has spread rapidly all over the world. Respiratory droplets and contaction with infected patients are the two major transmission routes. However, the value of tear virus nucleic acid is still not clear. We dynamic detected the SARS-CoV-2 in eye sample of one COVID-19 patient with obstruction of common lacrimal ducts.

Methods: Besides the routine examination, nasopharyngeal and eye swab were continuously measured by polymerase chain reaction assay and next-generation sequencing (NGS). Gene detection was performed for drug use guidance, and flow cytometry was performed to analyse the lymphocyte subsets.

Results: Nasopharyngeal swabs were positive for 22 days, but eye swabs were still continuously positive for 2 weeks after nasopharyngeal swabs turned negative. The low level of lymphocyte and the high level IL-6 lasted for almost 4 weeks, then became near normal. Next-generation sequencing (NGS) confirmed the existing of SARS-CoV-2, HSV1 and HHV6B virus nucleic acid. The gene detection for drug use guidance showed the genetic locus ABCB1 (3435T>C) rs1045642 belonged to type CC and it mean the efficiency of lopinavir-ritonavir would be significantly decreased. The flow cytometry of lymphocyte subsets showed PD-1⁺ CD95⁺ cells was accounting for 94.8% in CD3⁺ CD8⁺ T subset and for 94.8% in CD3⁺ TCRγδ⁺ T subset.

Conclusions: As obstruction of common lacrimal duct, positively detection in one eye for 2 weeks more after nasopharyngeal swab became negative. More eye swabs should be collected from COVID-19 patients, especially from those immunocompromised, those with eye symptoms and those had a history of ocular diseases.

Fig. 1

The change of granulocyte (A) and IL‐6 (B) in the whole course. Each datum was relative to the normal value, respectively.

Fig. 2

(A) The whole clinical course and results of swabs and treatments of this patient. (B) The NGS detection of SARS‐CoV‐2 (n = 6), HSV1 (n = 36) and HHV6B (n = 4). (C) The results of gene detection of lopinavir–ritonavir for drug use guidance. (D) The whole changes of C _t value in swabs.

Fig. 3

Flow cytometry results of lymphocyte subsets: (A) PD‐1⁺ CD95⁺ cells were accounting for 94.8% in CD3⁺ CD8⁺ T subset and (B) for 94.8% in CD3⁺ TCRγδ⁺ T subset.