@article {1456, title = {Association of weather variables with pathogens contributing to conjunctivitis worldwide.}, journal = {Clin Infect Dis}, year = {2024}, month = {2024 Aug 19}, abstract = {

PURPOSE: To identify weather variables associated with pathogens contributing to infectious conjunctivitis globally.

METHODS: Sample collection and pathogen identification from patients with acute infectious conjunctivitis was performed from 2017 to 2023. We linked pathogens identified from 13 sites across 8 countries with publicly available weather data by geographic coordinates. Mixed effects logistic regression analysis was performed to estimate the associations between temperature, precipitation, and relative humidity exposures, and the prevalence of infection types (RNA virus, DNA virus, bacteria, and fungus).

RESULTS: 498 cases from the United States, India, Nepal, Thailand, Burkina Faso, Niger, Vietnam, and Israel were included in the analysis. 8-day average precipitation (mm) was associated with increased odds of RNA virus infection (odds ratio (OR)=1.47, 95\% confidence interval (CI): 1.12 to 1.93, P=0.01) and decreased odds of DNA infection (OR=0.62, 95\% CI: 0.46 to 0.82, P\<0.001). Relative humidity (\%) was associated with increased odds of RNA virus infections (OR=2.64, 95\% CI: 1.51 to 4.61, P\<0.001), and fungal infections (OR=2.35, 95\% CI: 1.19 to 4.66, P=0.01), but decreased odds of DNA virus (OR=0.58, 95\%CI: 0.37 to 0.90, P=0.02) and bacterial infections (OR=0.42, 95\% CI: 0.25 to 0.71, P\<0.001). Temperature ({\textdegree}C) was not associated with ocular infections for any pathogen type.

CONCLUSIONS: This study suggests that weather factors affect pathogens differently. Particularly, humidity and precipitation were predictors for pathogens contributing to conjunctivitis worldwide. Additional work is needed to clarify the effects of shifts in weather and environmental factors on ocular infectious diseases.

}, issn = {1537-6591}, doi = {10.1093/cid/ciae417}, author = {Yan, Daisy and Prajna, N Venkatesh and Lalitha, Prajna and Sansanayudh, Wiwan and Satitpitakul, Vannarut and Laovirojjanakul, Wipada and Chaudhary, Meenu and Bountogo, Mamadou and Sie, Ali and Coulibaly, Boubacar and Amza, Abdou and Nassirou, Beido and Almou, Ibrahim and Tran, Huy and Tran, Yen and Tsui, Edmund and Onclinx, Tania and Sella, Ruti and Goren, Lee and McClean, Esmeralda and Tham, Vivien and Chen, Cindi and Ruder, Kevin and Zhong, Lina and Liu, YuHeng and Yu, Danny and Abraham, Thomas and Lebas, Elodie and Arnold, Benjamin F and McLeod, Stephen D and Deiner, Michael S and Porco, Travis C and Seitzman, Gerami D and Lietman, Thomas M and Shantha, Jessica and Hinterwirth, Armin and Doan, Thuy} } @article {1356, title = {Pathogen Surveillance for Acute Infectious Conjunctivitis.}, journal = {JAMA Ophthalmol}, year = {2023}, month = {2023 Nov 02}, abstract = {

IMPORTANCE: Acute infectious conjunctivitis is a common ocular condition with major public health consequences.

OBJECTIVE: To assess regional variations and microbial etiologies of acute infectious conjunctivitis to guide treatment.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, patients with presumed acute infectious conjunctivitis were enrolled in the study at 5 sites (Honolulu, Hawaii; Los Angeles, San Francisco, and San Diego, California; and Petah-Tikva, Israel) from March 2021 to March 2023. Patients with allergic or toxic conjunctivitis were excluded.

MAIN OUTCOMES AND MEASURES: Pathogens were identified by unbiased RNA deep sequencing.

RESULTS: In all, 52 patients (mean [range] age, 48 [7-80] years; 31 females [60\%]) were enrolled at 5 sites (6 patients from Honolulu, 9 from San Diego, 11 from Los Angeles, 13 from San Francisco, and 13 from Petah-Tikva). RNA deep sequencing detected human adenovirus species D in one-quarter of patients (13 of 52). A wide range of pathogens, including human coronavirus 229E, SARS-CoV-2, and herpes simplex virus type 1, was also identified, as well as several bacteria and fungi. Moreover, 62\% (32 of 52) of patients presented with purulent discharge, while only 8\% (4 of 52) of patients had confirmed bacterial pathogens.

CONCLUSION AND RELEVANCE: In this cross-sectional study, pathogens associated with acute infectious conjunctivitis varied between all 5 sites in the US and Israel. Purulent discharge was a common presenting sign in this study, with a low specificity for bacteria-associated conjunctivitis, suggesting that further diagnostic workup may be necessary to inform antibiotic stewardship. Additional research on cost-effectiveness of using RNA deep sequencing is needed to ascertain whether it is better to monitor patients clinically until resolution of disease.

}, issn = {2168-6173}, doi = {10.1001/jamaophthalmol.2023.4785}, author = {Tsui, Edmund and Sella, Ruti and Tham, Vivien and Kong, Alan W and McClean, Esmeralda and Goren, Lee and Bahar, Irit and Cherian, Nina and Ramirez, Joana and Hughes, Reginald E and Privratsky, Joseph K and Onclinx, Tania and Feit-Leichman, Rachel and Cheng, Angel and Molina, Iliana and Kim, Phillip and Yu, Carol and Ruder, Kevin and Tan, Alexander and Chen, Cindi and Liu, YuHeng and Abraham, Thomas and Hinterwirth, Armin and Zhong, Lina and Porco, Travis C and Lietman, Thomas M and Seitzman, Gerami D and Doan, Thuy} } @article {921, title = {Outcomes of uveitic macular edema in the First-line Antimetabolites as Steroid-sparing Treatment (FAST) Uveitis Trial.}, journal = {Ophthalmology}, year = {2022}, month = {2022 Feb 07}, abstract = {

PURPOSE: To evaluate the outcomes of uveitic macular edema at 6 months and 12 months in patients treated with methotrexate or mycophenolate mofetil.

DESIGN: Subanalysis of a block-randomized, observer-masked, multi-center clinical trial.

SUBJECTS/PARTICIPANTS: Patients were enrolled into the First-line Antimetabolites as Steroid-sparing Treatment (FAST) uveitis trial between August 2013 and August 2017.

METHODS/INTERVENTION/TESTING: Patients were randomized to oral methotrexate 25mg weekly or mycophenolate mofetil 1.5g twice daily for 12 months, along with a corticosteroid taper. In addition to standardized clinical examination, all patients underwent spectral domain optical coherence tomography imaging at each visit. At the 6-month primary endpoint, patients who achieved treatment success continued the same treatment for a subsequent 6 months and treatment failures switched to the other treatment group.

MAIN OUTCOME MEASURES: Pre-specified primary outcome at 6 months and 12 months outcomes of central subfield thickness and visual acuity.

RESULTS: Of 216 patients in the FAST Trial, 42 eyes of 30 patients in the methotrexate group and 55 eyes of 41 patients in the mycophenolate group had uveitic macular edema. Baseline median central subfield thickness was 359μm and 342μm in the methotrexate and mycophenolate groups, respectively. At 12 months, for those who stayed on the same treatment, macular thickness decreased from baseline by 23 μm (IQR, -39.0 to 13) and 18 μm (IQR, -68.5 to 9), in the methotrexate and mycophenolate groups, respectively, (P=0.76). In patients who switched treatment at 6 months, macular thickness decreased from baseline by 12.5 μm (IQR, -29.8 to -2.3) and 92 μm (IQR, -240 to -18) in the methotrexate and mycophenolate groups, respectively, (P=0.23). At 12 months, 7/19 (37\%) eyes on methotrexate had resolution of macular edema compared to 15/25 (60\%) eyes on mycophenolate (P=0.10). For those that switched treatments, 8/17 (47\%) eyes on methotrexate and 6/11 (55\%) eyes on mycophenolate had improvement of macular edema, (P=0.92) CONCLUSIONS: Treatment with methotrexate or mycophenolate mofetil for uveitic macular edema results in similar improvements in macular thickness at 6 and 12 months. At 12 months, approximately half of eyes in each antimetabolite group still had persistent macular edema.

}, issn = {1549-4713}, doi = {10.1016/j.ophtha.2022.02.002}, author = {Tsui, Edmund and Rathinam, Sivakumar R and Gonzales, John A and Thundikandy, Radhika and Kanakath, Anuradha and Balamurugan, S and Vedhanayaki, R and Lim, Lyndell L and Suhler, Eric B and Al-Dhibi, Hassan A and Doan, Thuy and Keenan, Jeremy and Ebert, Caleb D and Kim, Eric and Madow, Brian and Porco, Travis C and Acharya, Nisha R} } @article {181, title = {Clinical Course of Preexisting Uveitis during Treatment of Lung Cancer with Durvalumab.}, journal = {Ocul Immunol Inflamm}, volume = {28}, year = {2020}, month = {2020 05 18}, pages = {566-570}, issn = {1744-5078}, doi = {10.1080/09273948.2019.1678652}, author = {Ahmad, Tessnim R and Doan, Thuy and Gonzales, John A and Acharya, Nisha R and Tsui, Edmund} } @article {111, title = {Letermovir for the Management of Cytomegalovirus-associated Uveitis.}, journal = {Ocul Immunol Inflamm}, year = {2019}, month = {2019 Oct 22}, pages = {1-6}, abstract = {

: To investigate the use of letermovir 480 mg daily for the treatment of cytomegalovirus (CMV)-associated uveitis (AU). : Retrospective case series of CMV-AU patients on letermovir. : Six eyes of five patients (mean age 54 years) were included. Mean follow-up time was 10 months. Four patients had CMV anterior uveitis and one patient had bilateral CMV retinitis. All were treated initially with valganciclovir 900 mg twice daily. Transition to letermovir was due to cytopenias (n = 3), transaminitis (n = 1), and persistent inflammation on valganciclovir (n = 1). At the initiation of letermovir, mean visual acuity (VA) was 0.35 logMAR and IOP was 14 mmHg. One of the six eyes had a recurrence of anterior uveitis due to self-discontinuation of letermovir. No adverse events were observed. At last follow-up, no patients had active inflammation. Mean VA was 0.08 logMAR and IOP was 9 mmHg. : Letermovir may be an alternative treatment for CMV-AU in patients with persistent inflammation or side effects on valganciclovir.

}, issn = {1744-5078}, doi = {10.1080/09273948.2019.1662062}, author = {Tsui, Edmund and Gonzales, John A and Shantha, Jessica G and Acharya, Nisha and Doan, Thuy} }