Ocular manifestations and viral shedding in tears of pediatric patients with coronavirus disease 2019: a preliminary report

Abstract

PURPOSETo evaluate ocular manifestations and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) prevalence in the tears of children with coronavirus disease 2019 . METHODSA total of 27 pediatric patients with confirmed COVID-19 infection hospitalized from March 16 to April 15, 2020, at the Bambino Ges u Children's Hospital were enrolled in the study. At admission, all patients showed ocular manifestations. Reverse transcriptase-polymerase chain reaction from nasopharyngeal and conjunctival swabs were performed every 2-3 days before discharge. RESULTSOf the 27 patients, 4 (15%) were asymptomatic, 15 (56%) showed respiratory symptoms, and 8 (30%) had gastrointestinal symptoms. At admission, nasopharyngeal swabs were positive for COVID-19 in all patients; on the second swabs, 7 children (26%) tested negative, and 20 remained positive for COVID-19. Ocular manifestations consistent with mild viral conjunctivitis were observed in 4 patients (15%). At first conjunctival swab, 3 patients (11%), 1 symptomatic and 2 asymptomatic for ocular infection, had positive findings for COVID-19; 2 became negative on the second test and 1 on the third. CONCLUSIONSIn our study cohort, ocular manifestations of COVID-19 seem to have had a milder clinical course in pediatric patients than in adults. Despite the low prevalence and rapid regression of viral presence in the conjunctiva, SARS-CoV-2 transmission through tears may be possible, even in patients without apparent ocular involvement. ( J AAPOS 2020;24: 212-215) S ince its onset in December 2019 in Wuhan (Hubei Province, China) the coronavirus disease 2019 (COVID-19) has quickly spread across the globe, causing a global pandemic, according to the World Health Organization (WHO). 1 The pathogen of COVID-19 is a novel coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that can cause multiple system infections but mainly respiratory tract infections, such as severe acute respiratory syndrome. 2,3 The most common signs and symptoms include fever, cough, fatigue, myalgia, dyspnea, diarrhea. 4,5 Compared with adults, children with COVID-19 seem to have lower incidence, shorter course of disease, and a more favorable clinical presentation and prognosis. 6,7 The transmission route of this novel coronavirus (SARS-CoV-2) remains unclear, and most authors report that it occurs mainly through direct contact or respiratory droplets. 4 Previous studies have investigated the viral presence in tears of patients with SARS-CoV-1 and SARS-CoV-2, reporting controversial results. [8][9][10][11][12][13][14] All of these studies were performed in adult patients. In this study we evaluated ocular involvement and the SARS-CoV-2 virus shedding in tears of 27 pediatric patients admitted to the Bambino Ges u Children's Hospital (BGCH) COVID Center in order to better understand the pathogenicity of SARS-CoV-2 in children's eyes. Subjects and MethodsThis study was approved by the Bambino Ges u Children's Hospital Ethics Committee and adhered to the tenets of the Declaratio...

Systematic Review of Ocular Involvement of SARS-CoV-2 in Coronavirus Disease 2019

“…One of the major conclusions which one can make from this systematic review is that the prevalence of ocular symptoms and signs is low and that conjunctivitis is a relatively rare occurrence. In this review, this prevalence ranges from 0 to 31.58% [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. This is in keeping with a previous large study from China which reported that nine patients (0.82%) out of 1099 laboratory-confirmed COVID-19 patients experienced conjunctival congestion [23].…”

“…It was also reported in a univariate analysis that patients with more severe pneumonia were more likely to experience ocular symptoms and signs, with higher levels of white blood cells, neutrophils, procalcitonin, C-reactive protein, and lactate dehydrogenase compared with patients without ocular symptoms and signs [8]. The ocular manifestations and prevalence of SARS-CoV-2 in 27 children were evaluated by Valente et al in a prospective case series [12]. Out of 27 patients, ocular symptoms and signs consistent with mild viral conjunctivitis including conjunctival injection and secretion were observed in four patients (14.81%).…”

“…The conjunctival swabs of the two asymptomatic patients and of the symptomatic patient became negative at the second swab (3 days) and at the third swab (6 days) respectively, whilst the nasopharyngeal swabs remained positive. The authors went on to suggest that the ocular manifestations of COVID-19 appeared to take a milder clinical course in the paediatric population compared with adults [12].…”

“…To this end, different research teams have performed reverse transcription polymerase chain reaction (RT-PCR) on ocular samples of tears and conjunctival secretions, and viral cultures. What has been reported is that COVID-19 can be accompanied by conjunctivitis with its attendant symptoms of conjunctival infection, epiphora, itch, discharge, etc., but this remains a relatively rare occurrence compared with the classic respiratory symptoms [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. It is questionable whether the eye is truly a portal of transmission.…”

Detection of SARS-CoV-2 in conjunctival secretions from patients without ocular symptoms

“…The clinical manifestations of SARS-CoV-2 infection, or Coronavirus disease 2019 (COVID- 19), range from asymptomatic or subclinical infections, to acute viral pneumonitis with respiratory failure and/or multi-organ dysfunction [5][6][7]. Case reports and small retrospective cohorts of conjunctivitis as a presenting feature of SARS-CoV-2 infection emerged since the early phase of the pandemic.…”