ABSTRACT
Purpose : Coronavirus-19 (COVID-19) has been associated with ophthalmic manifestations. The relationship between tear film SARS-CoV-2 RNA, timing of illness and eye disease are unknown. We evaluated hospitalized COVID-19 inpatients for retinopathy and tear film viral RNA. Methods : Hospitalized COVID-19 inpatients were offered enrollment from January-June 2021. Full dilated ophthalmic examination and conjunctival swabs were taken for triplex RT-PCR for SARS-CoV-2 RNA targeting N2, E and RNAse P. Demographic, clinical outcomes and laboratory data were collected. Univariate and multivariate analyses of systemic disease and laboratory risk factors for retinopathy and SARS-CoV-2 RNA detection were assessed. Results : Sixty patients were prospectively enrolled in this cross-sectional, observational study. The mean age was 58.8 years (Standard deviation [SD] 15.2 years) and 29 (48%) were female. Retinopathy associated with COVID-19 in 12 of 60 patients (20%). Univariate analyses revealed that younger age, greater body mass index (BMI) and extracorporeal membrane (ECMO) requirement were associated with increased odds of COVID-19 retinopathy. The mean age (SD) of patients with COVID-19 retinopathy was 49.0. (11.6) compared to 61.2 (15.1) years in individuals without retinopathy (p=0.01). The mean BMI was 38.8 (9.8) in patients with retinopathy compared to 31.8 (9.0) in those without retinal disease findings (p=0.04). ECMO requirement was observed in 33% of patients with retinopathy compared to 8% in those without retinopathy (p=0.04). Multivariate analyses trended towards increased risk of retinopathy with younger age (aOR 0.95 (95% CI 0.90- 1.01, p=0.095) and with increased BMI (aOR. 1.08, 95% CI 1.00-1.18, p=0.056). Fifteen of 60 patients (25%) tested positive in their tear film for SARS-CoV-2 RNA with a trend towards a shorter length of illness and hospitalization in patients who were positive. The N2 gene was particularly sensitive with 18 of 19 eyes (94.7%) showing N2-positivity (with or without E gene detection), including 2 patients in whom the B.117 / B.1.525 alpha or ?United Kingdom? variant was detected. Conclusions : A 20% rate of retinopathy was observed and SARS-CoV-2 RNA within tear film was detected in 25% of hospitalized COVID-19 patients. Continued infection control precautions are required given the risk of viral RNA in tear film, which may also be sensitive for the detection of COVID-19 variants.
ABSTRACT
Purpose of Study A subset of children and adolescents who have been infected with SARS-CoV-2 can experience recurrent or persistent symptoms beyond the typical recovery period. The constellation of findings that occur post-infection is known Post-Acute Sequelae of Covid-19 (PASC). Relatively little is known about this condition in the pediatric population. This study aimed to explore the clinical spectrum and outcomes of children and adolescents diagnosed with PASC within a large healthcare system. Methods Used In this cross-sectional study, encounter- and patient-level data were extracted from the electronic health records (EHR) of patients <21 years who had at least one health care visit between 5/1/21 and 9/30/21 in an ambulatory site affiliated with the Yale-New Haven Health System. Individuals with a PASC-associated encounter were identified using Systematized Nomenclature of Medicine (SNOMED) codes, the standard for encoding patient conditions in the EHR. Free-text data fields denoting the 'reason for visit' were also queried to optimize case-finding. Descriptive statistics were used to summarize demographics, clinical characteristics, and management of pediatric patients with PASC. Summary of Results During the study period, there were 66,590 pediatric patients with an encounter in the health system, of which 1,520 had a Covid-19-related encounter diagnosis, and 37 had PASC. The mean age for PASC was 16 years (± 4), and 65% were female. Most identified their race/ ethnicity as either White (59%), Black (5%), or Hispanic (32%). The most common comorbidities included atopy (32%), asthma (22%), and obesity (12%). Approximately 28% of children diagnosed with PASC had no prior medical history, and 30% were previously active in sports before Covid- 19. In the acute phase of the disease, most (88%) had a mild illness, and only 12% required hospitalization. The median time between acute Covid-19 and their PASC encounter was 3 weeks (IQR 1-5). The most prevalent symptoms are shown in figure 1. Patients with PASC had a mean follow-up of 2.6 months. Medical utilization was high, with an average of 3 medical encounters per patient (range 1-12). Most (75%) had minimal to no limitations in daily functioning, though at least 5% experienced severe limitations and reported high rates of school absenteeism. Out of the 31 patients screened for depression, 8 (26%) tested positive. Cardiology and pulmonology evaluated 72% and 48% of PASC cases, respectively, yet only 8% found abnormalities in their work-up. Conclusions This study highlights the wide range of clinical symptoms children and adolescents can experience post-Covid- 19. PASC can occur even after mild SARS-COV-2 infections and may lead to severe limitations. To better understand the true risk SARS-CoV-2 poses to children, more research is needed to quantify the long-term outcomes of infection and the impact PASC has on quality of life. (Figure Presented).
ABSTRACT
Purpose : Coronavirus disease (COVID-19) has escalated to a global pandemic with increasing reports of ophthalmic disease. We report ophthalmic observations of hospitalized COVID-19 patients and correlate retinal disease findings with clinical and laboratory data. Methods : Retrospective review of COVID-19 patients who underwent ophthalmic exam during hospitalization within Emory Healthcare between April-July 2020. Results : Thirty-seven patients were examined with 23 (62%) females and a mean age of 54 years. 35 patients were admitted to the ICU. Ophthalmic manifestations included conjunctival injection in 12 eyes (17%), chemosis in 8 (11%) and retinopathy in 20 eyes (27%) with bilateral retinopathy in 6 patients (16%). No difference in baseline comorbidities or COVID-19 complication development was observed between patients with and without retinopathy. However, patients with retinopathy required ICU care for 1 week longer than those without retinopathy (27.6 vs 19.9 days p=0.19). The mean sequential organ failure assessment score at ICU admission was 6.18. All patients with retinopathy required both mechanical ventilation and vasopressors, while in patients without retinopathy, 15 (65%) and 12 (52%) required mechanical ventilation and vasopressors respectively (p=0.015, p=0.002). 6 patients with retinopathy required extracorporal membrane oxygenation compared to 1 without retinopathy (p=0.0070). While the mean peak D-Dimer was elevated at 18477, in the entire cohort, the peak D-Dimer was higher in patients with retinopathy (28,971 vs 12,575, p=0.0298). The fibrinogen nadir during hospitalization was on average 338 for the entire cohort, and reduced in patients with retinopathy (262 vs 381, p=0.029). Peak D-dimer analyses with a threshold of 16,508 showed an odds ratio of 16.7 (95% CI 3.11-89.3) for retinopathy. Fibrinogen nadir with a threshold of 367 showed odds ratio of 0.06 (95% CI 0.01-0.53) with 0.75 concordance. Conclusions : Retinopathy was the most common ophthalmic manifestation in a critically ill COVID-19 population, exceeding 25% of patients. Elevated D-dimers and a lower fibrinogen nadir in patients with retinopathy suggest a pathogenic relationship between coagulation pathways and retinal microangiopathy.
ABSTRACT
Recent Ebola epidemics, the ongoing COVID-19 pandemic, and emerging infectious disease threats have highlighted the importance of global infectious diseases and responses to public health emergencies. Ophthalmologists are essential health care workers who provide urgent and emergent vision care services during outbreaks and address the ocular consequences of epidemic and pandemic infectious diseases. In 2017, the World Health Organization (WHO) identified high priority pathogens likely to cause a future epidemic with the goal of guiding research and development to improve diagnostic tests, vaccines, and medicines. These measures were necessary to better inform and respond to public health emergencies. Given the ocular complications associated with emerging infectious diseases, there is a need to recognize the ophthalmic sequelae for future vision health preparedness for potential future outbreaks. The WHO High Priority pathogens list provides a roadmap for ophthalmologists and subspecialty providers that will guide strategic areas of research for clinical care and preparedness for future pandemic threats. This review summarizes these key viral pathogens, summarizes major systemic disease findings, and delineates relevant ocular complications of the WHO High Priority pathogens list, including Crimean-Congo hemorrhagic fever, Filovirus diseases (Ebola virus disease and Marburg hemorrhagic fever), human Coronaviruses, Lassa Fever, Nipah virus infection, Zika, and Rift Valley fever.