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

ImportanceAcute infectious conjunctivitis is a common ocular condition with major public health consequences.ObjectiveTo assess regional variations and microbial etiologies of acute infectious conjunctivitis to guide treatment.Design, Setting, and ParticipantsIn 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 MeasuresPathogens were identified by unbiased RNA deep sequencing.ResultsIn 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 RelevanceIn 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.