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.

Pathogen Surveillance for Acute Infectious Conjunctivitis.

Clinical and molecular investigation of acute haemorrhagic conjunctivitis outbreak in North India (2023)

Conjunctivitis or ‘Pink Eye’ is the inflammation or infection of the Conjunctivitis, the membrane covering the white part of the inner eyelid. The Conjunctiva is the thin, clear, mucus membrane that covers the white of the eye and the inner eyelid. Viruses causes up to 80% of all cases acute Conjunctivitis. All broad- spectrum antibiotic eyedrops seen in general to be effective in treating bacterial Conjunctivitis. Acute bacterial Conjunctivitis is common in children, with more than 50% of conjunctivitis cases beings bacterial in origin as per the mentioned evidences the present Review was designed to study outbreak of pink eye in the years 2023 considering past 4 to 5 years consist in July 2023 conjunctivitis cases data in Gujrat [India]: 2.17 lac, Delhi NCR[India]:1032, Maharashtra [India]: 87.761 K, Lucknow [ Up-India]: 40 to 46 Daily. The diseases cause normally 7 to 10 days.

A Review: Pink Eye Outbreak in India

<title>Abstract</title> Purpose The study aims to investigate an outbreak of acute haemorrhagic conjunctivitis (AHC) reported in North India. Methods All patients presenting to the outpatient clinic department with signs and symptoms (symptoms onset within 36 hours) of AHC were enrolled in the study. The conjunctival swab samples were tested for the presence of enteroviruses and adenoviruses. Detailed clinical features of all positive patients were noted. Representative enterovirus-positive samples were sequenced for viral; protein 1 (VP1) gene for type identification. The sequences were analysed by the Basic Local Alignment Search Tool (BLAST) software and enterovirus genotyping tool v1.0. A maximum likelihood tree was constructed using MEGA11. Results Out of 133 samples tested, 75.1% (n = 100) samples were positive for enterovirus by real-time PCR. The average duration of onset was 16.9 hours. Subconjunctival haemorrhage was observed in 67% of the patients, while 30% of cases had conjunctival chemosis. The causative agent of the current outbreak was identified as Coxsackievirus A24v G-IV. A sequence homology of 96–99% and pairwise distance divergence of 2.9% was observed between study sequences and recent sequences of China outbreak. Mutation analysis showed four common mutations (T281C, A311G, T332C, and T395C) with those of Chinese sequences, however no new mutations were identified in current study sequences, suggesting a close relatedness to CVA24 sequences from China. Conclusions Coxsackievirus A24v continues to be an important agent of Acute Haemorrhagic conjunctivitis in North India. In view of its highly contagious nature, effective and timely public health measures are required to limit its spread. 

Clinical and molecular investigation of Acute Haemorrhagic Conjunctivitis outbreak in North India

In January 2024, the Kenya Ministry of Health issued an outbreak alert following a surge in acute hemorrhagic conjunctivitis (AHC) cases along the Kenyan coast. Our investigations identified coxsackievirus A24 variant (CV-A24v) as the causative agent. In this study, we developed a novel whole genome sequencing assay for CV-A24v, and used it to recover three near complete genomes from the 2024 AHC outbreak in Kenya. This method will support future studies on CV-A24v genomic epidemiology and evolution across Kenya and beyond.

Coxsackievirus A24 variant whole genome sequencing from clinical samples using a three overlapping amplicons strategy

ABSTRACT. The first manifestation of a viral infection may be conjunctivitis. There are limited data on the etiology of viral conjunctivitis in Vanuatu, a country in the South Pacific Ocean. Patients presenting to one of two Vanuatu health centers with presumed infectious conjunctivitis were eligible if symptom onset was within 14 days of screening. Conjunctival and anterior nasal swabs were obtained and subjected to unbiased RNA deep sequencing (RNA-seq) to identify DNA and RNA viruses. For samples collected from May to November 2021, RNA-seq identified a viral etiology in 12/48 patients. Human adenovirus species were the most common viruses (58%) detected, followed by human herpes viruses (cytomegalovirus, varicella zoster virus, and human herpes 7 virus). Rhinovirus C, Epstein-Barr virus, and bocavirus were also detected. In summary, the etiology for viral conjunctivitis in Vanuatu appears broad. Unbiased testing may be useful for disease surveillance.

/pdf/viruses-associated-with-acute-conjunctivitis-in-vanuatu-na34ejw8.pdf

Viruses Associated with Acute Conjunctivitis in Vanuatu

SIGNIFICANCE Acute infectious conjunctivitis poses significant challenges to eye care providers. It can be highly transmissible, and because etiology is often presumed, correct treatment and management can be difficult. This study uses unbiased deep sequencing to identify causative pathogens of infectious conjunctivitis, potentially allowing for improved approaches to diagnosis and management. PURPOSES This study aimed to identify associated pathogens of acute infectious conjunctivitis in a single ambulatory eye care center. CASE REPORTS This study included patients who presented to the University of California Berkeley eye center with signs and symptoms suggestive of infectious conjunctivitis. From December 2021 to July 2021, samples were collected from seven subjects (ages ranging from 18 to 38). Deep sequencing identified associated pathogens in five of seven samples, including human adenovirus D, Haemophilus influenzae, Chlamydia trachomatis, and human coronavirus 229E. CONCLUSIONS Unbiased deep sequencing identified some unexpected pathogens in subjects with acute infectious conjunctivitis. Human adenovirus D was recovered from only one patient in this series. Although all samples were obtained during the COVID-19 pandemic, only one case of human coronavirus 229E and no SARS-CoV-2 were identified.

Case Series: Unbiased Deep Sequencing Analysis of Acute Infectious Conjunctivitis in an Ambulatory Eye Center in Berkeley, California

Purpose: The purpose of this study was to identify pathogens associated with the 2022 conjunctivitis outbreak in Tamil Nadu, India. Methods: This prospective study was conducted in November 2022. Patients with presumed acute infectious conjunctivitis presenting to the Aravind Eye Clinic in Madurai, India, were eligible. Anterior nares and conjunctival samples from participants were obtained and processed for metagenomic RNA deep sequencing (RNA-seq). Results: Samples from 29 patients were sequenced. A pathogen was identified in 28/29 (97%) patients. Coxsackie virus A24v, a highly infectious RNA virus, was the predominant pathogen and detected in 23/29 patients. Human adenovirus D (HAdV-D), a DNA virus commonly associated with conjunctivitis outbreaks, was detected in the remaining patients (5/29). Hemorrhagic conjunctiva was documented in both HAdV-D and Coxsackie virus A24v affected patients but was not the predominant clinical presentation. Phylogenetic analysis of Coxsackie virus A24v revealed a recent divergence from the 2015 outbreak. Conclusions: Coxsackie virus A24v and HAdV-D were cocirculating during the 2022 conjunctivitis outbreak in Tamil Nadu, India. Clinical findings were similar between patients with HAdV-D and Coxsackie virus A24v–associated conjunctivitis. As high-throughput sequencing technologies become more readily available and cost-effective, unbiased pathogen surveillance may prove useful for outbreak surveillance and control. 

Apollo Rising: Acute Conjunctivitis Outbreak in India, 2022

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Viruses Associated with Acute Conjunctivitis in Vanuatu

Case Series: Unbiased Deep Sequencing Analysis of Acute Infectious Conjunctivitis in an Ambulatory Eye Center in Berkeley, California

Apollo Rising: Acute Conjunctivitis Outbreak in India, 2022