key: cord-0740842-1pte52nm
authors: Goyal, Mallika; Murthy, Somasheila I; Annum, Sridhar
title: Response comment on: Retinal manifestations in patients following COVID-19 infection
date: 2021-10-03
journal: Indian J Ophthalmol
DOI: 10.4103/ijo.ijo_2100_21
sha: cd8029809301132a646b24c0490799b86869f9ec
doc_id: 740842
cord_uid: 1pte52nm

nan

We thank the authors for their interest. [1] We respectfully disagree that "most cases were from the side effects of systemic steroids/medications" alone. We have already acknowledged the contributory role of steroids in the discussion section; however, we cannot disregard the role of COVID-19 in our cases. [2] In Case 1, steroids were used for 5 days only and not expected to cause endogenous endophthalmitis in a young, otherwise immunocompetent, previously nondiabetic patient. COVID-19 and host immunity-virus interplay were a factor here. [3, 4] In our experience, systemic investigations (such as blood/urine cultures/abdominal ultrasound) sans constitutional symptoms are rarely positive, and he had recently undergone a complete workup following recovery.

For COVID-19 treatment during late 2020-early 2021, systemic steroids were not in rampant usage unlike the practice patterns noted later. Case 2 was a well-controlled diabetic for a few years. We believe immunosuppression was caused additionally by the primary COVID-19 infection, as reported earlier, [3, 4] with a specific vulnerability to fungal infections due to a decrease in CD4+ and CD8+ T-cells. Invasive candidiasis coinfection in COVID-19 infection has been reported to be independent of steroid use. [4] In Case 3, propagation of tubercular infection was possibly due to immune-deviation caused by COVID-19 as the latter causes cytokine over-expression, which can predispose to tuberculosis. [4] The Infectious Disease specialists did not consider sputum culture as there was no history of productive cough/fever during their evaluation. The whole-body positive emission tomography/computed tomography (PET/CT) scan was negative.

In Case 6, there was no history of airway intubation, cardiopulmonary resuscitation, or prone position. The hemorrhages were due to her severe thrombocytopenia, as reported in literature. [5] In conclusion, while we agree that steroids/diabetes may have contributed to the immunosuppression in two of the three infective cases, the specific immune dysregulation caused by COVID-19 infection was the most important predisposing factor.

Funding was provided by Hyderabad Eye Research Foundation, Hyderabad, India for Dr. Somasheila I Murthy. The funders had no role in the preparation, review, or approval of the manuscript.

Comment on: Retinal manifestations in patients following COVID-19 infection

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Prevalence and outcomes of co-infection and superinfection with SARS-CoV-2 and other pathogens: A systematic review and meta-analysis

Active tuberculosis, sequelae and COVID-19 co-infection: First cohort of 49 cases

Response comment on: Retinal manifestations in patients following COVID-19 infection

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