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SARS-CoV-2 on Ocular Surfaces in a Cohort of Patients With COVID-19 From the Lombardy Region, Italy.
JAMA Ophthalmol. 2021 09 01; 139(9):956-963.JO

Abstract

Importance

Since February 2020, coronavirus disease 2019 (COVID-19) has spread rapidly all over the world, with an epidemiological cluster in Lombardy, Italy. The viral communicability may be mediated by various body fluids, but insufficient information is available on the presence of the virus in human tears.

Objectives

To investigate the rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in tears collected from patients with COVID-19 by means of real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) assay and to assess the association of virus presence with concomitant clinical conditions.

Design, Setting, and Participants

Cross-sectional study conducted between April 9 and May 5, 2020. The setting was intensive care units at Azienda Socio-Sanitaria Territoriale (ASST) Sette-Laghi Hospital, University of Insubria, in Varese, Lombardy, Italy. A conjunctival swab was performed in 91 patients hospitalized for COVID-19, which was clinically diagnosed by rRT-PCR assay on nasopharyngeal swabs and by radiological imaging. Conjunctival swabs from 17 additional healthy volunteer participants with no symptoms of COVID-19 were examined to evaluate the availability and applicability of the conjunctival swab test.

Exposure

SARS-CoV-2 detection by means of rRT-PCR assay performed on the collected samples obtained by conjunctival swabs.

Main Outcomes and Measures

Conjunctival swab and nasopharyngeal swab results are reported, as well as demographic and clinical data.

Results

A total of 108 participants (mean [SD] age, 58.7 [14.2] years; 55 female and 53 male) were tested for SARS-CoV-2 using rRT-PCR assay, including 91 patients hospitalized with COVID-19 and 17 were healthy volunteers. SARS-CoV-2 was found on the ocular surface in 52 of 91 patients with COVID-19 (57.1%; 95% CI, 46.3%-67.5%), with a wide variability in the mean viral load from both eyes. Among a subset of 41 patients, concordance of 63.0% (95% CI, 41.0%-81.0%) was found between positive conjunctival and nasopharyngeal swab test results when performed within 2 days of each other. In 17 of these patients, nasopharyngeal swab results were negative for SARS-CoV-2. In 10 of these 17 patients, conjunctival swab results were positive for the virus.

Conclusions and Relevance

In this study, SARS-CoV-2 RNA was found on the ocular surface in a large part of this cohort of patients with COVID-19, although the infectivity of this material could not be determined. Because patients may have positive test results with a conjunctival swab and negative results with a nasopharyngeal swab, use of the slightly invasive conjunctival swab may be considered as a supplementary diagnostic test.

Authors+Show Affiliations

Unit of Ophthalmology, Azienda Socio-Sanitaria Territoriale (ASST) dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy.Unit of Ophthalmology, Azienda Socio-Sanitaria Territoriale (ASST) dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy.Unit of Ophthalmology, Azienda Socio-Sanitaria Territoriale (ASST) dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy.Laboratory of Microbiology, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy.Laboratory of Medicine, Service of Cytogenetics and Medical Genetics, ASST dei Sette Laghi, Varese, Italy.Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.Unit of Infectious and Tropical Diseases, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy.Unit of Oral Medicine and Pathology, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy.Unit of Pathology, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy.Unit of High Intensity Medicine, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy.Cardiosurgery Intensive Care Unit, ASST dei Sette Laghi, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.Transplants Intensive Care Unit, ASST dei Sette Laghi, Varese, Italy.Intensive Care Unit, ASST dei Sette Laghi, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.Unit of Ophthalmology, ASST dei Sette Laghi, Varese, Italy.Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy.Unit of General, Emergency and Transplant Surgery, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy.Chief Medical Officer, ASST dei Sette Laghi, Varese, Italy.Unit of Oral Medicine and Pathology, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy. Chancellor, University of Insubria, Varese, Italy.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33662099

Citation

Azzolini, Claudio, et al. "SARS-CoV-2 On Ocular Surfaces in a Cohort of Patients With COVID-19 From the Lombardy Region, Italy." JAMA Ophthalmology, vol. 139, no. 9, 2021, pp. 956-963.
Azzolini C, Donati S, Premi E, et al. SARS-CoV-2 on Ocular Surfaces in a Cohort of Patients With COVID-19 From the Lombardy Region, Italy. JAMA Ophthalmol. 2021;139(9):956-963.
Azzolini, C., Donati, S., Premi, E., Baj, A., Siracusa, C., Genoni, A., Grossi, P. A., Azzi, L., Sessa, F., Dentali, F., Severgnini, P., Minoja, G., Cabrini, L., Chiaravalli, M., Veronesi, G., Carcano, G., Maffioli, L. S., & Tagliabue, A. (2021). SARS-CoV-2 on Ocular Surfaces in a Cohort of Patients With COVID-19 From the Lombardy Region, Italy. JAMA Ophthalmology, 139(9), 956-963. https://doi.org/10.1001/jamaophthalmol.2020.5464
Azzolini C, et al. SARS-CoV-2 On Ocular Surfaces in a Cohort of Patients With COVID-19 From the Lombardy Region, Italy. JAMA Ophthalmol. 2021 09 1;139(9):956-963. PubMed PMID: 33662099.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - SARS-CoV-2 on Ocular Surfaces in a Cohort of Patients With COVID-19 From the Lombardy Region, Italy. AU - Azzolini,Claudio, AU - Donati,Simone, AU - Premi,Elias, AU - Baj,Andreina, AU - Siracusa,Claudia, AU - Genoni,Angelo, AU - Grossi,Paolo A, AU - Azzi,Lorenzo, AU - Sessa,Fausto, AU - Dentali,Francesco, AU - Severgnini,Paolo, AU - Minoja,Giulio, AU - Cabrini,Luca, AU - Chiaravalli,Maurizio, AU - Veronesi,Giovanni, AU - Carcano,Giulio, AU - Maffioli,Lorenzo S, AU - Tagliabue,Angelo, PY - 2022/03/04/pmc-release PY - 2021/3/5/pubmed PY - 2021/9/30/medline PY - 2021/3/4/entrez SP - 956 EP - 963 JF - JAMA ophthalmology JO - JAMA Ophthalmol VL - 139 IS - 9 N2 - Importance: Since February 2020, coronavirus disease 2019 (COVID-19) has spread rapidly all over the world, with an epidemiological cluster in Lombardy, Italy. The viral communicability may be mediated by various body fluids, but insufficient information is available on the presence of the virus in human tears. Objectives: To investigate the rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in tears collected from patients with COVID-19 by means of real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) assay and to assess the association of virus presence with concomitant clinical conditions. Design, Setting, and Participants: Cross-sectional study conducted between April 9 and May 5, 2020. The setting was intensive care units at Azienda Socio-Sanitaria Territoriale (ASST) Sette-Laghi Hospital, University of Insubria, in Varese, Lombardy, Italy. A conjunctival swab was performed in 91 patients hospitalized for COVID-19, which was clinically diagnosed by rRT-PCR assay on nasopharyngeal swabs and by radiological imaging. Conjunctival swabs from 17 additional healthy volunteer participants with no symptoms of COVID-19 were examined to evaluate the availability and applicability of the conjunctival swab test. Exposure: SARS-CoV-2 detection by means of rRT-PCR assay performed on the collected samples obtained by conjunctival swabs. Main Outcomes and Measures: Conjunctival swab and nasopharyngeal swab results are reported, as well as demographic and clinical data. Results: A total of 108 participants (mean [SD] age, 58.7 [14.2] years; 55 female and 53 male) were tested for SARS-CoV-2 using rRT-PCR assay, including 91 patients hospitalized with COVID-19 and 17 were healthy volunteers. SARS-CoV-2 was found on the ocular surface in 52 of 91 patients with COVID-19 (57.1%; 95% CI, 46.3%-67.5%), with a wide variability in the mean viral load from both eyes. Among a subset of 41 patients, concordance of 63.0% (95% CI, 41.0%-81.0%) was found between positive conjunctival and nasopharyngeal swab test results when performed within 2 days of each other. In 17 of these patients, nasopharyngeal swab results were negative for SARS-CoV-2. In 10 of these 17 patients, conjunctival swab results were positive for the virus. Conclusions and Relevance: In this study, SARS-CoV-2 RNA was found on the ocular surface in a large part of this cohort of patients with COVID-19, although the infectivity of this material could not be determined. Because patients may have positive test results with a conjunctival swab and negative results with a nasopharyngeal swab, use of the slightly invasive conjunctival swab may be considered as a supplementary diagnostic test. SN - 2168-6173 UR - https://www.unboundmedicine.com/medline/citation/33662099/SARS_CoV_2_on_Ocular_Surfaces_in_a_Cohort_of_Patients_With_COVID_19_From_the_Lombardy_Region_Italy_ L2 - https://jamanetwork.com/journals/jamaophthalmology/fullarticle/10.1001/jamaophthalmol.2020.5464 DB - PRIME DP - Unbound Medicine ER -