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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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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.
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.
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).
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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