Duration of viral load, clinical signs, and symptoms in qPCR-confirmed adenoviral conjunctivitis

Abstract

Purpose : The proportion of infectious conjunctivitis cases that have viral etiologies are estimated to be as high as 80%, with most viral infections attributed to adenoviruses. Although generally self-limiting, the duration of adenovirus conjunctivitis (Ad-Cs) has not been fully elucidated. The purpose of this report is to evaluate the duration of detectable viral titers and clinical signs and symptoms in untreated individuals with qPCR-confirmed Ad-Cs.

Methods : Individuals ≥18 years with red eye symptoms of 4 days or less were enrolled in a double-masked, randomized clinical trial of the safety and efficacy of a single, in-office administration of 5% povidone iodine (Reducing Adenoviral Patient Infected Days, RAPID, study). Only participants in the control arm (in-office saline lavage and prescribed at-home artificial tears) who tested positive by both point-of-care immunoassay antigen and qPCR testing are included in this report. Participant-reported symptoms, clinician-graded signs, and PCR-determined viral titers were completed at baseline, days 1-2, 4, 7, 14, and 21.

Results : Of 212 screened participants, 28 participants tested positive at baseline for Ad-Cs with both point-of-care immunoassay testing and qPCR. These 28 participants were randomized to treatment with PVP-I (n=16) or to the saline control group (n=12). All participants in the saline control group who completed follow-up examinations at day 1-2 (9 of 9) and day 4-5 visit (8 of 8) had detectable virus. On day 7, 56% (5 of 9) had detectable viral titers. By day 14 the majority (75%, 6 of 8) of participants had no detectable viral titers and by day 21, no participant had detectable viral titers. On day 21, several participants reported blurry vision (5 of 7), discomfort (2 of 7) or redness (1 of 7) and masked clinicians noted conjunctival redness and follicular conjunctivitis (4 of 7) as well as bulbar edema (3 of 7).

Conclusions : Several participant-reported symptoms and clinical signs persisted after viral titers were no longer detectable by qPCR. Hence, using symptoms and signs to determine school or work furlough may result in longer than necessary time off.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.