Unilateral Conjunctivitis Research Articles

Ocular Manifestations of Enterovirus: An Important Emerging Pathogen

In this retrospective study of 12,289 ocular specimens tested for viral PCR, 0.66% were enterovirus positive. Unilateral conjunctivitis and keratitis were the main manifestations. Enterovirus infections are mostly self-limiting and have a good visual prognosis.

WIDENING OF THE NIKTITAN MEMBRANE IN THE EYE OF DOMESTIC CATS WITH CHLAMYDIOSIS SUSPECT

Feline chlamydiosis or chlamydia is an infection caused by a bacterial organism. A local cat named Mio, male, orange and white, aged about 4 months, weighing 1.2 kg, had complaints of sneezing, red eyes and runny nose in the left eye since 2 weeks ago. The condition of the eye has gotten worse since a week ago with the white membrane covering the eyeball. Respiratory examination showed abnormal results, namely the case cat experienced sneezing and had a serous discharge. On examination the eye looks swollen and there is a mucopurulent discharge. The pupil reflex of the left eye is not visible because the nictitan membrane covers almost the entire eyeball. The Schirmer test showed that the case cat was producing excessive tears. Examination using an ophthalmoscope, the pupil of the cat's eye in the left case was not detected due to being covered by a shifting nictitating membrane. the fluorescen test showed a negative result, which means that there was no ulcer on the cornea. CBC examination results showed that the cat had leukocytosis and thrombocytosis. The case cat was diagnosed with dilation of the nictitating membrane and unilateral conjunctivitis with suspected chlamydiosis. Therapy is carried out by administering antibiotics, anti-inflammatory drugs, and vitamins. Evaluation on the 8th day after administration of therapy showed slightly improved results. In the left eye inflammation has started to improve. In addition, the mucus in the left eye also began to decrease. We recommend that treatment of case cats be continued for up to 3 weeks and a PCR test should be carried out so that the cause of infection in case cats can be known for sure.

Hemophilus influenzae subconjunctival abscess in an adult patient: A case report

Subconjunctival abscesses following bacterial conjunctivitis are rare as few bacterial species can penetrate intact conjunctiva. This case reports a Hemophilus influenzae (HI) subconjunctival abscess in an immunocompetent adult. This case presented as unilateral bacterial conjunctivitis, with significant redness and discharge. However, the presumed conjunctivitis did not show any improvement with the initial topical antibiotics treatment. Further examination revealed a superior conjunctival abscess with purulent discharge; hence, the patient was started on topical and oral antibiotics, with complete resolution in 4 weeks. Bacteriological cultures of the discharge revealed HI. This case highlights the importance of a comprehensive clinical examination and the use of microbiology investigations to aid in the diagnosis of atypical conjunctivitis cases.

Esporotricose infantojuvenil: Um relato de caso de síndrome oculoglandular de Parinaud

Parinaud's oculoglandular syndrome (PCOS) is a rare clinical condition consisting of unilateral granulomatous conjunctivitis, accompanied by pre-auricular or submandibular satellite lymphadenopathy. According to studies published over the years, the main etiologic agent of PCOS is Bartonella hanselae, which causes Bartonellosis, also known as cat-scratch disease, an infectious disease with a good prognosis that in most cases develops after the close contact or scratching of a domestic cat (Felis sylvestris catus). Other microorganisms can also cause PCOS, including viruses, parasites, bacteria and even fungi. In the fungi kingdom, the infection can be caused by the fungus of the genus Sporothrix ssp, occurring through zoonotic transmission or by direct contact with the agent through bites, scratches and secretions of an infected animal. Although the cutaneous form is more frequent in endemic areas, the ocular form has been increasingly diagnosed. Similar to other clinical conjunctivitis, it can lead to a delay in the initiation of treatment, increasing the risk of sequelae in the eye and prolonging the time required for healing. Thus, knowledge of this form is essential for early diagnosis, therapy and more effective clinical evolution. The present study is a case report of an 8-year-old male child and his clinical course during the diagnosis of sporotrichosis with Parinaud's Oculoglandular Syndrome.

Microsporidial keratoconjunctivitis - first outbreak in Japan.

Most cases of microsporidial keratoconjunctivitis are found in the Southern hemisphere. Our purpose was to investigate the first outbreak of microsporidial keratoconjunctivitis in Japan among healthy, immunocompetent soccer players from the same team during a 1-month period. This study is an observational case series. The medical records were analyzed for five cases with microsporidial keratoconjunctivitis who presented within September 2022. All five cases were males between 28 and 36 years old. These previously healthy individuals belonged to the same football team. Their eyes were considered susceptible to contaminated water or dirt from the turf at game and practice sites. All cases involved unilateral conjunctivitis, with scattered round white lesions that showed positive fluorescein staining in the corneal epithelium. All cases experienced diminution of vision in the affected eye. In three cases, direct smears showed spores of approximately 2-3μm in diameter. Polymerase chain reaction (PCR) analysis of corneal scrapes revealed partial amplification of microsporidial 18S ribosomal RNA gene in four cases. Sequences of PCR products from all four cases showed 100% identity with strains of Vittaforma corneae previously reported from an outbreak in Singapore. All cases were treated with topical therapy, including voriconazole, fluorometholone, and levofloxacin. Four eyes underwent corneal scraping. After treatment, all eyes healed without residual opacities. Only a few sporadic case reports of this disease have previously been reported in Japan. We detected V. corneae in our case series, representing what appears to be the first outbreak of microsporidial keratoconjunctivitis in Japan. Exposure to contaminated water or soil, in addition to inadequate sanitary facilities, represents a potential source of infection. Further investigations to clarify the characteristics of microsporidia seem warranted.

Ocular tuberculosis presenting with a conjunctival granuloma

An 18-year-old female patient was referred with complaints of tearing and redness in the left eye for 3 months after a mild ocular trauma with a turkey feather. She was treated with topical antibiotics and corticosteroids with no improvement. Slit-lamp examination of the left eye showed a vascularized lesion with a polypoidal appearance due to multiple contiguous micronodules on the temporal and inferior bulbar conjunctiva. Results of the anterior and posterior segment examination were unremarkable in both eyes. A biopsy specimen of the conjunctival mass showed multiple tuberculoid granulomas composed of epithelioid histiocytes with associated Langhan's type multinucleate giant cells and a necrotic nodule surrounded by histiocytes and giant cells. The Mantoux test was positive with induration of 15mm. The patient was prescribed antituberculosis therapy. Three months after treatment initiation, the conjunctival lesions had resolved. Mycobacterium tuberculosis should be considered in cases of unilateral chronic recalcitrant conjunctivitis. Biopsy of a conjunctival mass is of utmost importance to establish a definite diagnosis.

P162 Parinaud's Oculoglandular Syndrome as an atypical manifestation of sporotrichosis in Brazil

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectivesInform the general practitioner about the possibilities of atypical manifestations secondary to sporotrichosis, such as ocular manifestations, unrelated to the classic finding of contiguous lymphocutaneous ulcers.MethodsThis is a single-center, cross-sectional, retrospective study with patients evaluated and seen from June 2018 to April 2022 at the Mycology Outpatient Clinic of Hospital Universitário Oswaldo Cruz, University of Pernambuco.All patients were evaluated by the same infectious disease physician throughout the course, from diagnosis to outpatient discharge.Scrapings and cultures were collected by the institution's specialized Mycology team. Biopsies were sent to the University Pathology Service (CIAP).ResultsDuring the 4-year period, 231 patients started their treatment for sporotrichosis following clinical, laboratory, and histopathological criteria. Of these, 9 (3,8%) had Parinaud's Oculoglandular Syndrome, unilateral granulomatous conjunctivitis associated with ipsilateral preauricular or submandibular lymphadenitis (Fig. 1). Of the 9 reported cases, 8 presented manifestations only in the conjunctiva (88%), and 1 case also presented palpebral involvement (12%).Since most patients had a late diagnosis due to the difficulty in carrying out the specific investigation of the agent by a non-specialized team, the diagnosis by scraping and culture was compromised by early treatment with antifungals, especially itraconazole. It is becoming common in the Northeast of Brazil that the association of sick cats with typical manifestations of sporotrichosis is the main epidemiological factor since our case series for infections caused by soil manipulation is low. Therefore, 55% (5/9) had a clinical-epidemiological diagnosis of sporotrichosis, with an excellent clinical response to itraconazole 200 mg/day, as well as the 4 patients with diagnoses confirmed by culture (Fig. 2). The antifungal was taken after lunch since a fatty diet interferes with improved medication absorption. All patients were instructed not to use medications with known interactions, especially proton pump inhibitors and alcohol use.ConclusionHuman sporotrichosis has become endemic in Latin America in the last two decades, bringing relevant morbidity to those infected. Zoonotic transmission by direct contact with infected sick cats has been gaining ground in Northeast Brazil, creating important epidemiology when typical sporotrichosis lesions appear following contact with these animals. Lymphocutaneous sporotrichosis is known to be the most common manifestation, but there is a need for care teams working in primary and secondary care to identify atypical manifestations and expand the investigation into the possibility of fungal infections. The epidemiology of the neighborhood associated with the presence and contact with sick cats with ulcerative lesions must be considered and taken into account.

Parinaud's oculoglandular syndrome

Parinaud's oculoglandular syndrome (POGS) is a rare condition characterized by unilateral granulomatous conjunctivitis and ipsilateral regional lymphadenopathy. Among all infectious agents, cat scratch disease (CSD), which is caused by Bartonella henselae, remains the commonest etiology agent of POGS. We present a case report of a 13-year-old boy who came to a tertiary center in Malaysia with left granulomatous conjunctivitis and subsequent necrotizing lesions involving left upper eyelid, left paranasal region, and left preauricular lymph nodes. With a poor initial treatment response and confusing investigation results, this interesting case describes the diagnostic dilemma in differentiating the etiological agents of POGS.

Atypical ocular Chlamydia trachomatis infections in two patients attending in a second-level hospital: a case report

AimTo report two atypical inclusion conjunctivitis cases due to Chlamydia trachomatis in young adults. MethodTranscription mediated amplification for C. trachomatis was performed using Aptima Combo 2 Assay (Hologic, Spain). ResultsThe first patient was managed as an orbital disorder because he had unilateral location, and ptosis was observed. Orbital nuclear magnetic resonance revealed normal results, and conjunctival biopsy did not indicate significant results. For the second patient, thyroid eye disease was suspected, but the orbital nuclear magnetic resonance revealed normal results. Conjunctival exudate samples were collected and sent to the Microbiology Laboratory where C. trachomatis was confirmed. Both patients demonstrated a great improvement with oral azithromycin 1 g. ConclusionInclusion conjunctivitis could present as unspecified unilateral or bilateral chronic conjunctivitis. Thus, suspecting it would be important in order to prevent spread and wasting diagnostic resources.

Case Series of Parinaud’s Oculoglandular Syndrome Caused by Fungal Infection

We report 5 cases of fungal-related Parinaud’s oculoglandular syndrome (POS), presenting to Hospital Sultanah Aminah from June 2017 to June 2019. This is a retrospective case series. Four patients presented with unilateral POS while another patient presented with unilateral granulomatous conjunctivitis which did not respond to a two-week course of oral doxycycline (4 patients) or a three-day course of oral azithromycin (1 patient). While all patients had contact with cats, only one had a history of being scratched by a cat. Three patient’s pet cats were receiving treatment for ‘Sporo’ skin infection by their veterinarians while another two patients had no history suggestive of their cats having active infection. The first patient who presented with POS following her cat scratching her leg, had a skin biopsy done and received a course of antifungal antibiotics from a dermatologist when it was discovered that the cat had a fungal skin infection. Both her leg skin lesion and POS completely resolved. Conjunctival biopsies were performed in other 4 patients at 2 weeks to 1 month after their first presentation in view of poor response to antibiotics. Two patients’ conjunctival fungal culture and sensitivity showed a growth of Sporothrix schenkii. Both symptoms and conjunctival lesions resolved completely after taking a course of oral Itraconazole for 6 weeks (1 patient), 3 months (3 patients) and 4 months (1 patient). POS is most commonly caused by Bartonella hensalae infection related to a cat’s scratch. Detailed history taking is important in diagnosing infection by other microorganisms such as fungi especially when the lesion does not respond to conventional antibiotic therapy. Besides clinical monitoring, conjunctival culture and sensitivity support the diagnosis.

Management of traumatic ulcerative keratitis in a Red Serow

Red Serow Capricornis rubidus is an elusive herbivore native to the montane forests of the Himalaya. Currently it is categorized as ‘Vulnerable’ in the IUCN Red List and placed under Schedule I species of the Wildlife Protection Act, 1972. A serow was presented with complaints of mild inappetence, irritability, sporadic scratching of head over the enclosure barrier and serous ocular discharge from the left eye. Based on detail clinical examination, the animal was diagnosed with unilateral conjunctivitis, corneal oedema, and ulcerative keratitis. A combination of Xylazine @ 1.5mg/ kg body weight and Zolatile® (zolazepam and tiletamine) @ 2.5 mg/kg body weight was used to chemically restrain the animal, followed by auriculo-palpebral nerve block using 1 ml of 2 % lignocaine hydrochloride. The affected eye was adequately cleaned with isotonic sterile Normal Saline solution (NSS). Combination of 0.5 ml of ceftriaxone and 0.5 ml of flubiprofen was injected into upper and lower palpebral conjunctiva. The cornea and the third eyelid flap were carefully sutured using 5-0 and 3-0 Vicryl, respectively. Finally, tarsorrhaphy was done using 2-0 nylon. Post-operative care consisted of an antibiotic regimen of Cephalaxin @ 20 mg/ kg body weight b-i.d-twice in a day for seven days along with probiotic supplement (Vizylac®) and Vitamin A capsules (Aquasol A®) orally once daily for the next 30 days. The animal showed complete recovery within 30 days of proper treatment, monitoring, care and management.

SARS-COV-2 viral load in tears of patients with COVID-19 in the early symptomatic stages: comparison of two different tear sampling methods.

PurposeTo evaluate the presence of SARS-CoV-2 virus in tears of patients with COVID-19 in the early symptomatic stages and to compare two different sampling methods.Materials and methodIn this cross-sectional study, tears sampling was performed in COVID-19 patients admitted within the first 7 days of symptom onset. The samples were collected with both conjunctival swabs and Schirmer strips. Each specimen was analyzed via RT-PCR. The viral load was evaluated in terms of the cycle threshold value. Ocular and systemic symptoms and comorbidities of the patients were also recorded.ResultsForty patients were included. The average time from the initiation of symptoms was 3.15 days. Unilateral conjunctivitis has been observed in 5% of patients and foreign body sensation in 7.5% of patients. No viral RNA was detected in the tear samples of the patients with ocular findings. The positivity rate for SARS-CoV-2 in tears was 2.5% (n = 1). None of the samples collected by Schirmer test strips yielded positive polymerase chain reaction result for SARS-COV-2. The Ct value of the positive conjunctival swab was 36.03 and the nasopharyngeal Ct value of the same patient was 25.68.ConclusionThe SARS-CoV-2 viral shedding rate has been determined as 2.5% in the tears of early symptomatic stage COVID-19 patients. The viral load of the tears was lower than the naso-oropharynx. The conjunctival swab method is recommended in tear collection to evaluate the presence of SARS-CoV-2 by RT-PCR analysis in low viral load tears.

COVID-19 and the Human Eye: Conjunctivitis, a Lone COVID-19 Finding – A Case-Control Study

Objectives: COVID-19 has varied clinical manifestations, from asymptomatic to severe cases, and conjunctivitis is one of them, but sometimes a lone initial symptom is found to be present. The aim of this study was to identify the prevalence of conjunctivitis as the first symptom in COVID-19 patients in a primary healthcare unit. Methodology: A retrospective study was conducted, analyzing the presenting complains/symptoms and results of COVID-19-confirmatory tests. Results: Out of the 672 cases that were sent for RT-PCR testing, only 121 (18%) were found to be positive. Among these, 2.67% patients had both conjunctivitis and COVID-19, 77.77% patients had unilateral eye affected, while 22.22% had bilateral conjunctivitis of varying degrees. Fifteen patients diagnosed to have both acute conjunctivitis and COVID-19 presented other symptoms associated with COVID-19 infection. Three patients had only acute conjunctivitis during their entire course of COVID-19. Conclusions: Conjunctivitis is a symptom of COVID-19 and may be the first sign of the infection, until the onset of the classical manifestations; such patients may continue to be a viral reservoir. Physicians should not miss unilateral conjunctivitis as it can be the only presenting complaint of COVID-19 during the initial phase, which might worsen if undetected and can aid in the spread of the contagion.

Conjunctivitis and other ocular manifestation following COVID-19; updated information about transmission of COVID-19 by eye

Coronavirus disease 2019 (COVID-19) was reported in Wuhan, in late December 2019 and was became a pandemic health problem worldwide. In this review, the current evidence related to the ocular transmission of SARS-CoV-2 and its common manifestations was studied. According to this review, 7% to 69.4% of patients had at least an ocular symptom following COVID-19. Ocular symptom are bilateral or unilateral conjunctivitis, increased secretion, eye itching and foreign body sensation, epiphora, dry eye, conjunctival congestion, eye pink, conjunctival hyperemia, and chemosis. SARS-CoV-2 particles were found in tears and conjunctiva. Therefore, the transmission of COVID-19 by conjunctiva is possible. Then, it is essential to wear eye shield to protect against developing ocular involvement by COVID-19 because personal glasses and contact lenses cannot protect from COVID-19.

Incidence of Severe Acute Respiratory Syndrome Coronavirus-2 (Sars-Cov-2) Antigen Presence in Adenovirus-Negative Conjunctivitis with Viral Infection Appearance

This study aimed to investigate the incidence of the novel coronavirus (SARS-CoV-2) infection (COVID-19) in adenovirus-negative conjunctivitis in Japan. Twelve patients with unilateral or bilateral conjunctivitis with preauricular lymphadenopathy or serous discharge and an initial clinical diagnosis of viral conjunctivitis from April 1, 2020 to September 30, 2020, with negative adenovirus antigen test were included in this study. The residual smeared conjunctiva sample for the adenovirus antigen test was preserved by freezing at –70 °C in a completely anonymized manner. Seven to 180 days after preservation, the samples were tested using the SARS-CoV-2 antigen kit (ESPLINE® SARS-CoV-2 kit, Lot number, K4B00810; FUJIREBIO, Tokyo, Japan). One sample (8.8%) tested positive for the SARS-CoV-2 antigen. None of the patients exhibited systemic symptoms, including pneumonia. No medical staff related to these patients exhibited any infectious findings. These results suggest that the possibility of COVID-19 should be considered with care in daily medical examinations for conjunctivitis, including epidemic keratoconjunctivitis.

Comparative study of topical regimen for adenoviral kearoconjunctivitis by 0.1% fluorometholone with and without polyvinyl alcohol iodine.

The aim of this study was to compare the efficacy of the topical regimens of iodine/steroids vs. antibiotics/steroids in acute to subacute adenoviral keratoconjunctivitis. A prospective open-label study. Nineteen patients diagnosed with unilateral or bilateral adenoviral conjunctivitis at less than 1week from onset were enrolled in this study. Patients were divided randomly into two groups; group 1 was treated with 1.5% levofloxacin with 0.1% fluorometholone administered four times a day and group 2 was treated with a sixfold dilution of polyvinyl alcohol iodine (PAI) solution with 0.1% fluorometholone four times a day. Conjunctival samples from all affected eyes were obtained for real-time PCR. The total scores of acute signs (i.e., eyelid edema, conjunctival injecton, conjunctival discharge, follicules, pseudomembranes, subconjunctival hemorrhage) and symptoms, HAdV DNA copy number, and the presence of multiple subepithelial corneal infiltrates (MSI) were evaluated every 5 visits up to Day 30 after diagnosis. Comparing the total scores of acute signs and symptoms and viral load, we observed no significant differences between the two groups. At day 15 after diagnosis the proportion of patients with MSI in group 2 (35.7%) was significantly lower than in group 1 (0%). The impact of topical iodine/steroid therapy on acute signs and symptoms associated with adenoviral conjunctivitis is limited and not substantially different in the responses to antibiotics/steroids. However, this regimen results in a significant decrease in the incidence of MSI during the subacute phase of infection.

PRIMARY CONJUNCTIVAL TUBERCULOSIS: A CASE REPORT

A 11 year old female was referred from ophthalmology clinic to pulmonary medicine department for further evaluation of a case of unilateral conjunctivitis not responding to treatment as suspected case of conjuctival tuberculosis. In the right eye, bulbar conjunctiva in supranasal quadrant polypoidal appearance was seen and there was subconjunctival cystic nodular mass in the superior conjunctival fornix. Systemic examination was unremarkable. Microbiological and histopathological examination of excision biopsy of the subconjunctival cyst revealed a granulomatous inflammation but acid fast bacilli was negative. Tissue sample was subjected to CBNAAT (Cartridge based nucleic acid amplification technique) examination in which mycobacterium tuberculosis was detected and sensitive to rifampicin. Patient was started on anti tuberculosis treatment under NTEP (national tuberculosis elimination programme) and full remission was achieved with 6 months of anti tuberculosis treatment. Although primary tuberculous conjunctivitis is a very rare condition, it should be considered in the differential diagnosis of treatment-resistant unilateral conjunctivitis. For definitive diagnosis, microbiological, histopathological and molecular examinations should be performed in conjunctival samples.

Unilateral acute conjunctivitis caused by Oestrus ovis larva: A rare case report from Western India

Unilateral acute conjunctivitis caused by Oestrus ovis larva: A rare case report from Western India

Primary Conjunctival Tuberculosis.

A 12-year-old girl was referred to our clinic because of unilateral conjunctivitis not responding to treatment. In the left eye, lower bulbar and tarsal conjunctiva had a polypoidal appearance due to micronodules and there was a subconjunctival nodular mass in the inferior fornix. Systemic examination was unremarkable except for a left preauricular lymphadenopathy. Excision biopsy of the subconjunctival mass revealed a granulomatous inflammation with caseation necrosis, but acid-fast bacilli (AFB) was negative. Fine needle-aspiration biopsy of the preauricular lymph node was performed. In microbiological examination, both AFB and mycobacterial culture were positive. The isolated mycobacteria strains were identified as Mycobacterium tuberculosis complex and full remission was achieved with 6 months of anti-tuberculosis treatment. Although primary tuberculous conjunctivitis is a very rare condition, it should be considered in the differential diagnosis of treatment-resistant unilateral conjunctivitis. For definitive diagnosis, microbiological and histopathological examinations should be performed both in conjunctiva and regional lymph node.

Has respiratory cryptosporidiosis spread to black grouse Tetrao tetrix?

Infection by Cryptosporidium baileyi was first confirmed in red grouse in northern England in 2010 and within three years spread to 48 per cent of moors. These form the last...