Ranzenigo Martina, Bruzzesi Elena, Galli Laura, Castagna Antonella, Ferrari Giulio
Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Vita-Salute San Raffaele University, Milan, Italy.
J Ophthalmic Inflamm Infect. 2021 Sep 22;11(1):35. doi: 10.1186/s12348-021-00264-0.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can induce conjunctivitis signs and symptoms. However, limited information is available on their impact on COVID-19 disease phenotype. Quantification of ocular signs/symptoms can provide a rapid, non-invasive proxy for predicting clinical phenotype. Moreover, the existence and entity of conjunctival viral shedding is still debated. This has relevant implications to manage disease spread. The purpose of this study was to investigate conjunctivitis signs and symptoms and their correlation with clinical parameters, conjunctival viral shedding in patients with COVID-19.
Fifty-three patients hospitalized between February 25th and September 16th, 2020 at the San Raffaele Hospital, in Milan, Lombardy, Italy with a confirmed diagnosis of SARS-CoV-2 were evaluated. Presence of interstitial pneumonia was confirmed with computed tomography scan imaging. Ocular signs and symptoms, anosmia/ageusia, clinical/laboratory parameters, and reverse transcriptase-polymerase chain reaction (RT-PCR) from nasopharyngeal and conjunctival swabs for COVID-19 virus were analyzed.
Forty-six out of 53 patients showed a positive nasopharyngeal swab for SARS-CoV-2 infection at the time of conjunctival evaluation. All the conjunctival swabs were negative. Conjunctivitis symptoms were present in 37% of patients. Physician-assessed ocular signs were detected in 28% of patients. Patients with ocular symptoms or signs tended to be older: 76.8 years (62.4-83.3) vs 57.2 years (48.1-74.0), p = 0.062 and had a longer hospitalization: 38 days (18-49) vs. 14 days (11-21), p = 0.005. Plasma levels of Interleukin-6 were higher in patients with signs or symptoms in comparison with those without them: 43.5 pg/ml (19.7-49.4) vs. 8 pg/ml (3.6-20.7), p = 0.02. Red cell distribution width was also significantly higher: 15 (14.3-16.7) vs 13.2 (12.4-14.4), p = 0.001.
We found that over a third of the patients had ocular signs or symptoms. These had higher prevalence in patients with a more severe infection. No viral shedding was detected in the conjunctiva. Our results suggest that prompt detection of conjunctivitis signs/symptoms can serve as a helpful proxy to predict COVID-19 clinical phenotype.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）可诱发结膜炎的体征和症状。然而，关于其对新冠肺炎疾病表型的影响，现有信息有限。眼部体征/症状的量化可为预测临床表型提供一种快速、非侵入性的替代指标。此外，结膜病毒脱落的存在及其性质仍存在争议。这对控制疾病传播具有重要意义。本研究的目的是调查新冠肺炎患者的结膜炎体征和症状及其与临床参数、结膜病毒脱落的相关性。
对2020年2月25日至9月16日在意大利伦巴第大区米兰圣拉斐尔医院住院的53例确诊感染SARS-CoV-2的患者进行评估。通过计算机断层扫描成像确认间质性肺炎的存在。分析眼部体征和症状、嗅觉/味觉减退、临床/实验室参数，以及鼻咽和结膜拭子检测新冠肺炎病毒的逆转录聚合酶链反应（RT-PCR）结果。
在进行结膜评估时，53例患者中有46例鼻咽拭子检测出SARS-CoV-2感染呈阳性。所有结膜拭子均为阴性。37%的患者出现结膜炎症状。28%的患者经医生评估有眼部体征。有眼部症状或体征的患者往往年龄较大：76.8岁（62.4 - 83.3岁） vs 57.2岁（48.1 - 74.0岁），p = 0.062；住院时间也更长：38天（18 - 49天） vs 14天（11 - 21天），p = 0.005。有体征或症状的患者血浆白细胞介素-6水平高于无体征或症状的患者：43.5 pg/ml（19.7 - 49.4 pg/ml） vs 8 pg/ml（3.6 - 20.7 pg/ml），p = 0.02。红细胞分布宽度也显著更高：15（14.3 - 16.7） vs 13.2（12.4 - 14.4），p = 0.001。
我们发现超过三分之一的患者有眼部体征或症状。这些在感染较严重的患者中患病率更高。未在结膜中检测到病毒脱落。我们的结果表明，及时检测结膜炎体征/症状可作为预测新冠肺炎临床表型的有用替代指标。
