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COVID-19 Clinical Features

Infectious SARS-CoV-2 Detected in Ocular Fluids of a COVID-19 Patient

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BACKGROUND AND PURPOSE:

  • Conjunctivitis has been reported with SARS-CoV-2 infection
  • As with SARS, unprotected ocular exposure may be a route of infection
  • Colavita et al. (Annals of Internal Medicine, 2020) present their findings on the early detection of infectious SARS-CoV-2 in ocular fluids from a patient with the first confirmed case of COVID-19 in Italy

METHODS:

  • Case report
  • Setting
    • National Institute for Infectious Diseases (INMI), Rome
  • Patient
    • A 65-year old woman who travelled from Wuhan, China, to Italy
    • Confirmed infection with SARS-CoV-2 (real-time RT-PCR sputum assay)
  • To confirm infectivity of viral genome in ocular fluid samples
    • Ocular sample inoculated into Vero E6 cells (used to propagate and study viruses)

RESULTS:

  • Patient
    • Travel from Wuhan to Italy: January 23, 2020
    • Hospitalized: January, 29 2020 (1 day after symptom onset)
  • Presenting symptoms
    • Nonproductive cough
    • Sore throat
    • Rhinitis
    • Bilateral conjunctivitis
  • Day 4: Additional symptoms
    • Fever 38°C
    • Nausea
    • Vomiting
  • Conjunctivitis:
    • Improved at day 15 and was resolved at day 20
  • Viral RNA presence in ocular samples (using real-time RT-PCR)
    • Day 3: Virus first detected
    • Subsequent (almost) daily samples: Positive up to day 21
    • Day 27: SARS-CoV-2 RNA was again detected
  • SARS-CoV-2 RNA was detected in ocular swabs days after it was undetectable in nasal swabs (nasal swabs last positive on day 16)
    • Viral load in ocular samples were lower than in nasal swabs
    • Suggests sustained replication in conjunctiva
  • To confirm that virus in eye sample was still infectious, cytopathic effect was still observed 5 days after cells were inoculated with the virus

CONCLUSION:

  • Ocular fluids from COVID-19 can contain infectious SARS-CoV-2
    • Ocular involvement may occur early in the course of disease
  • The authors suggest
    • Ophthalmologists use proper PPE when performing eye exams, as ocular fluids may be a source of contagion
    • Transmission control: Reinforce avoidance of touching face and eyes

Learn More – Primary Sources:

SARS-CoV-2 Isolation From Ocular Secretions of a Patient With COVID-19 in Italy With Prolonged Viral RNA Detection

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Related ObG Topics:

Is Conjunctivitis a Feature of COVID-19 Infection?
Surgical Masks Reduce Viral Shedding
Loss of Taste and Smell: Key Symptoms of COVID-19 Infection

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