Prevalence, Patterns, and Predictors of the Presence of SARS-CoV-2 RNA and Culturable Virus in Tears of a Case-Ascertained Household Cohort
TAKE-HOME MESSAGE
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An analysis of tear samples from a cohort of symptomatic patients who tested positive for COVID-19 but were not hospitalized showed that 12% of the patients had RNA-positive tears (half of whom had culturable virus) at a median of 7 days after the onset of symptoms. The risk factors for the presence of the virus in tears included cancer and kidney disease.
- Although current infection guidelines do not include precautions for tear transmission, eye care providers should be aware of this possibility.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
To investigate the prevalence, patterns, and predictors of SARS-CoV-2 RNA and culturable virus in tears of case-ascertained household cohort.
DESIGN
Prospective, longitudinal case-ascertained household cohort identified through convenience sampling.
METHODS
This analysis was restricted to individuals who were non-hospitalized, symptomatic, and tested positive for SARS-CoV-2 by nasal RT-PCR. Tears and anterior nasal biospecimens were serially collected throughout the acute period. Tears specimens were collected by the study staff using Schirmer test strips, and nasal specimens were self-collected. For both, SARS-CoV-2 RNA was quantified using qRT-PCR and culturable virus was detected using presence of cytopathic effect (CPE) in tissue culture; positive CPE was confirmed by a qRT-PCR step. A series of cross-sectional unadjusted analyses were performed investigating the relationship between different sociodemographic determinants and biological factors associated with tears RNA positivity.
RESULTS
Among the 83 SARS-CoV-2 infected participants, ten (12%) had at least one RNA positive tears specimen. Amongst these ten, five (50%) had concurrent presence of culturable virus, at a median of 7 days post symptom onset (IQR: 4-7 days) (absolute range: 4-8 days).
CONCLUSIONS
In this longitudinal cohort, we found evidence of culturable virus in the tears of a small proportion of non-hospitalized SARS-CoV-2 infected individuals. Current public health infection precautions do not account for transmission via tears, so these findings may improve our understanding of potential sources of SARS-CoV-2 transmission and contribute to developing future guidelines.
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Additional Info
Prevalence, patterns, and predictors of SARS-CoV-2 RNA and culturable virus in tears of case-ascertained household cohort
Am J Ophthalmol 2024 Apr 23;[EPub Ahead of Print], M So, SA Goldberg, S Lu, M Garcia-Knight, MC Davidson, M Tassetto, VW Murray, K Anglin, J Pineda-Ramirez, JY Chen, PR Rugart, ET Richardson, MB Hagen, CM Midgley, R Andino, GD Seitzman, J Gonzales, MJ Peluso, JN Martin, JD KellyFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
SARS-CoV-2 is mainly spread through respiratory droplets, with ocular fluid and other mucous membranes as potential infectious sources. In trying to better understand and build evidence for the detection of RNA or culturable virus, specifically in tears, the authors prospectively analyzed data from 83 non-hospitalized and symptomatic individuals who tested positive for SARS-CoV-2 and SARS-CoV-2 RNA via nasopharyngeal PCR.
The patients were identified through a convenience sampling method from testing sites affiliated with the University of California, San Francisco. During the acute infectious period, tear specimens were collected by the study staff, and nasal specimens were self-collected by the symptomatic individual in the longitudinal cohort serially. Self-collection of nasal specimens was performed daily for 2 weeks and then every few days thereafter for up to 1 month. The authors quantified SARS-CoV-2 RNA using reverse-transcription PCR and assigned a qualitative "yes" or "no" value to the culturable virus based on the presence of cytopathic effect. A total of 10 patients (12%) had RNA positivity on PCR testing during the serial testing, and only 1 patient had positivity at more than one timepoint. A small percentage of infectious individuals with a culturable virus had received the full series of COVID-19 vaccination. These findings were comparable to those of previous studies.
Finding evidence of a small proportion of culturable virus in tears within the cohort, the authors concluded that the clinical transmission of SARS-CoV-2 (or SARS-CoV-2 RNA) via the tears should still be accounted for. They suggest that current universal precautions for public health may not be sufficient when encountering ocular fluids, such as tears; however, further studies and guidelines may be needed as there were some limitations in this study, such as the study being conducted before the emergence of the Omicron strains, not ascertaining ocular symptoms, and using a convenience sample only.