June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Reducing Adenoviral Patient Infected Days (RAPID) Study: Association of Clinical Signs and Symptoms with qPCR confirmed Adenoviral Conjunctivitis
Author Affiliations & Notes
  • Ellen Shorter
    Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, United States
  • Mary Migneco
    Washington University in St. Louis, St. Louis, Missouri, United States
  • Jennifer S Harthan
    Illinois College of Optometry, Chicago, Illinois, United States
  • Meredith Whiteside
    University of California School of Optometry, Berkeley, California, United States
  • Christina Morettin
    Illinois College of Optometry, Chicago, Illinois, United States
  • Tammy Than
    University of Alabama, Birmingham, Birmingham, Alabama, United States
  • Spencer Johnson
    Northeastern State University, Tahlequah, Oklahoma, United States
  • Julia Huecker
    Washington University in St. Louis, St. Louis, Missouri, United States
  • Andrew T E Hartwick
    Ohio State University, Columbus, Ohio, United States
  • Mae O Gordon
    Washington University in St. Louis, St. Louis, Missouri, United States
  • Footnotes
    Commercial Relationships   Ellen Shorter, None; Mary Migneco, None; Jennifer Harthan, None; Meredith Whiteside, None; Christina Morettin, None; Tammy Than, None; Spencer Johnson, None; Julia Huecker, None; Andrew Hartwick, None; Mae Gordon, None
  • Footnotes
    Support  NIH R34 EY023633-01A1
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 4360. doi:
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      Ellen Shorter, Mary Migneco, Jennifer S Harthan, Meredith Whiteside, Christina Morettin, Tammy Than, Spencer Johnson, Julia Huecker, Andrew T E Hartwick, Mae O Gordon; Reducing Adenoviral Patient Infected Days (RAPID) Study: Association of Clinical Signs and Symptoms with qPCR confirmed Adenoviral Conjunctivitis. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4360.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : There is no FDA-approved treatment for Adenoviral conjunctivitis (Ad-Cs), a highly contagious eye infection. The RAPID study group is a multi-centered clinical trial enrolling patients with suspected Ad-Cs to test the effectiveness of 5% ophthalmic Betadine treatment. Here, we report the clinical signs and symptoms found in red eye-presenting individuals during their initial screening visit, and compare the results for those with and without molecularly-confirmed Ad-Cs.

Methods : Eligibility included informed consent, age 18 or older, and presentation with a red eye with symptoms ≤4 days. Patients rated the severity of ten ocular symptoms on a scale of 0 (not bothersome) to 10 (very bothersome). Clinicians performed slit lamp examination and rated eight clinical signs of the first affected eye on a scale of 1 (absent), to 5 (severe). Conjunctival swabs were performed, and the presence of adenovirus in these samples was assessed using quantitative polymerase chain reaction (qPCR) assays.

Results : Conjunctival swabs were obtained from 52 subjects on their screening visit, of which 25% (n=13) tested positive for Ad-Cs with qPCR. For patient-reported symptoms, there was a statistically significant difference between qPCR positive and negative subjects for 6 of the 10 queried symptoms: itching (p=0.0003), overall discomfort (p=0.0035), eyelid swelling (p=0.02), blurred vision (p=0.02), light sensitivity (p=0.02) and gritty/sandy sensation (p= 0.022). There was also a statistically significant difference between qPCR positive and negative subjects in 3 of the 6 clinical signs: lid edema (p=0.0012), clear serous discharge (p=0.04) and bulbar redness (p=0.04). Palpable pre-auricular node was present in 38.5% (5 of 13) of the qPCR positive patients and 10% (4 of 39) of the qPCR negative patients (p=0.02).

Conclusions : No single sign or symptom clearly distinguished molecularly-confirmed Ad-Cs subjects from other red eye-presenting subjects. The considerable overlap may indicate why it is difficult to clinically diagnose Ad-Cs. The subjects with confirmed Ad-Cs had more serous discharge, greater bulbar redness and had a higher incidence of palpable pre-auricular nodes. Interestingly, conjunctival follicular response, which is often emphasized in the textbook diagnosis of Ad-Cs, was not statistically significant in this sample.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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