Pathogen Surveillance for Acute Infectious Conjunctivitis
Authors: Tsui Edmund , Sella Ruti , Tham Vivien , Kong Alan W. , McClean Esmeralda , Goren Lee , Bahar Irit , Cherian Nina , Ramirez Joana , Hughes Reginald E. , Privratsky Joseph K. , Onclinx Tania , Feit-Leichman Rachel , Cheng Angel , Molina Iliana , Kim Phillip , Yu Carol , Ruder Kevin , Tan Alexander , Chen Cindi , Liu YuHeng , Abraham Thomas , Hinterwirth Armin , Zhong Lina , Porco Travis C. , Lietman Thomas M. , Seitzman Gerami D. , Doan Thuy ,   SCORPIO Study Group, Prajna Lalitha , Prajna N. Venkatesh , Gunasekaran Ramesh , Sharma Sankalp Singh , Teja Vishnu , Chaudhary Meenu , Sitaula Sanjeeta , Sié Ali , Coulibaly Boubacar , Bountogo Mamadou , Somkijrungroj Thanapong , Satitpitakul Vannarut , Tran Huy , Mai Linh Hoàng , Xuân Thảo Hạ , Tran Yen , Urzua Cristhian A. , Vega Fabian , Salgado Felipe , Cuitino Loreto , Pérez Fernando Pérez , Macías Martínez Jaime , Lansingh Van Charles , Thanapaisal Sukhumal , Laovirojjanakul Wipada , McKie George , Chavez Kenia , Redd Travis , Chamberlain Winston , Sansanayudh Wiwan , Yakoura Abba Kaka Hajia , Amza Abdou , Youssoufou Souley Abdoul Salam , Nouhou Diori Adam , Nassirou Beido , Kadri Boubacar , Mariama Boubacar , Ibrahim Cissé Mamadou , Roufaye Lamine Aboubacar , Boulhassane Ramatou , Ali Saley , Abdou Zakou , Kelliher Clare , Green Laura , Ong Hon Shing , Mehta Jod , Liu Yu-Chi , Hwang De-Kuang , Fan Nai-Wen , Chiong Hong Sheng , Lacorzana Javier , Cabrera-Aguas Maria , Watson Stephanie , Lebas Elodie , Colby Emily , McLeod Stephen , Kanai Kuniyoshi , Whiteside Meredith , Yeh Steven , Fashina Tolulope , Chodosh James , Tarkap Bridgit , Garap Jambi N. , Mangot Magdalene , Amel Edwin , Taleo Fasihah , Kasso Johnson , Willie Kalbule , Nanu Madopule , Rymill Prudence , Solomon Anthony W. 
Published: November 2023

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.