Abstract
Purpose: The putative presence of SARS-CoV-2 in ocular specimen puts healthcare workers at risk. We thoroughly examined conjunctival swabs and tear fluid in a large cohort of COVID-19 patients.
Methods: A total of 243 symptomatic laboratory-confirmed COVID-19 patients were included in this observational multicenter study. Conjunctival swabs were analyzed by reverse transcription polymerase chain reaction for detection of SARS-CoV-2 RNA. Next-generation sequencing and phylogenetic analysis were performed to identify viral strains and to determine tissue tropism. Schirmer tear samples from 43 hospitalized COVID-19 patients and 25 healthy controls were analyzed by multiplex cytokine immunoassays.
Results: Viral SARS-CoV-2 RNA was detected in conjunctival swabs from 17 (7.0%) of 243 COVID-19 patients. Conjunctival samples were positive for viral SARS-CoV-2 RNA as long as 12 days after disease onset. Cycle threshold (Ct) values for conjunctival swabs (mean 34.5 ± 5.1) were significantly higher than nasopharyngeal swabs (mean 16.7 ± 3.6). No correlation between Ct values of conjunctival and nasopharyngeal swabs was observed. The majority of positive conjunctival samples were detected only once and primarily during the first visit. Next-generation sequencing analysis revealed that the virus strain found in the conjunctiva was most often identical to the one found in the nasopharynx. Tear cytokine levels IL-1β and IL-6 were elevated in COVID-19 patients compared to healthy controls.
Conclusions: Conjunctival samples that were positive for SARS-CoV-2 RNA contained the same viral strain as the nasopharynx.
Translational relevance: The presence of SARS-CoV-2 viral RNA and elevated cytokines in tear fluid confirm the involvement of the ocular surface in COVID-19 disease.
【초록키워드】 SARS-CoV-2, Cytokines, Healthcare workers, IL-6, Sequencing, risk, cytokine, healthcare worker, COVID-19 disease, immunoassays, Nasopharyngeal swab, reverse transcription polymerase chain reaction, polymerase chain reaction, Phylogenetic analysis, cycle threshold, nasopharyngeal swabs, symptomatic, Next-generation sequencing, nasopharynx, Conjunctival swab, Ocular surface, Conjunctiva, large cohort, reverse transcription, SARS-CoV-2 RNA, Swab, multicenter, multiplex, correlation, threshold, COVID-19 patients, hospitalized COVID-19 patient, IL-1β, SARS-CoV-2 viral RNA, COVID-19 patient, Ct values, disease onset, tissue tropism, Chain Reaction, viral strain, viral strains, first visit, cycle, healthy control, specimen, healthy controls, no correlation, positive, laboratory-confirmed, Sequencing analysis, conjunctival swabs, conjunctival, virus strain, ocular, Tear, polymerase chain, analyzed, identify, performed, examined, elevated, majority, determine, significantly higher, cytokine level, 【제목키워드】 COVID-19, investigation, Tear,