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. 2023 Dec 1;141(12):1140-1144.
doi: 10.1001/jamaophthalmol.2023.4785.

Pathogen Surveillance for Acute Infectious Conjunctivitis

Edmund Tsui  1   2 , Ruti Sella  3   4 , Vivien Tham  5   6 , Alan W Kong  2 , Esmeralda McClean  7 , Lee Goren  3 , Irit Bahar  3   4 , Nina Cherian  1   2 , Joana Ramirez  1   2 , Reginald E Hughes Jr  1   2 , Joseph K Privratsky  1   2 , Tania Onclinx  2 , Rachel Feit-Leichman  2 , Angel Cheng  5 , Iliana Molina  7 , Phillip Kim  7 , Carol Yu  7 , Kevin Ruder  8 , Alexander Tan  5 , Cindi Chen  8 , YuHeng Liu  8 , Thomas Abraham  8 , Armin Hinterwirth  8 , Lina Zhong  8 , Travis C Porco  8   9 , Thomas M Lietman  8   9 , Gerami D Seitzman  8   9 , Thuy Doan  8   9 ; SCORPIO Study Group
Collaborators, Affiliations

Pathogen Surveillance for Acute Infectious Conjunctivitis

Edmund Tsui et al. JAMA Ophthalmol. .

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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Conflict of interest statement

Conflict of Interest Disclosures: Dr Tsui reported receiving consulting fees from Eyepoint Pharmaceuticals, Kowa, and Cylite and receiving grants from Pfizer during the conduct of the study. Dr Lietman reported receiving grants from the National Institutes of Health during the conduct of the study. Dr Seitzman reported receiving consulting fees from Dompé outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Associated Pathogens of Presumed Acute Infectious Conjunctivitis at 5 Sites
EBV indicates Epstein-Barr virus; HAdV-B, human adenovirus species B; HAdV-D, human adenovirus species D; HSV type 1, herpes simplex virus type 1; VZV, varicella-zoster virus; and HMPV, human metapneumovirus.
See this image and copyright information in PMC

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