key: cord-0889423-xsjh3766
authors: Arshad, Yasir; Mahmood, Nayab; Zaidi, Syed Sohail Zahoor; Sharif, Salmaan; Ikram, Aamer; Ali, Muhammad Qaisar; Usman, Muhammad; Akhtar, Ribqa; Hassan, Muhammad; Salman, Muhammad; Adil, Naveed; Rana, Muhammad Suleman
title: Detection of SARS-CoV-2 in ophthalmic secretions in Pakistan: A preliminary report
date: 2020-08-25
journal: J Infect
DOI: 10.1016/j.jinf.2020.08.035
sha: 891e33a4c3e60df2dd16be44f553c41dc91b0832
doc_id: 889423
cord_uid: xsjh3766

nan

Out of total 35 patients, 25(71.4%) were male and 10(28.5%) were female. Age of the patients enrolled for this study was ranging from 20-65 years. Symptoms associated with suspected COVID-19 patients, 35(100%) had fever, 21(60%) had dry cough, and 17(48.6%) had difficulty in breathing. Low lymphocytes and platelet count was noted in both group. There was no any significant difference was observed in the hematological and biochemical markers between the both groups. All demographic, clinical and laboratory characteristics of patients given in the Table-1. Nucleic acid (RNA) was extracted from all samples including oropharyngeal and conjunctival swabs and were tested by using one-step real-time RT-PCR.

All 35 oropharyngeal swab samples were detected positive for SARS CoV-2, however out of total 35 conjunctival swab samples, 3(8.5%) were detected positive by using real-time RT-PCR. 2(66%) out of 3 conjunctival SARS-Cov-2 positive patients were having dry cough whereas 3(100%) patients were suffering from fever and difficulties in breathing.

There was no ocular manifestation observed among patients with positive conjunctival specimens and similar information has already been reported by the previous study [4] .

Results of the present study support the evidence that ophthalmic secretions may not be the main source of transmission for the novel SARS-CoV-2, but the role of eye in the transmission of this highly contagious virus must not be ignored. Our results are consistent with other reports although the percentage of positivity is low from ophthalmic secretions as compared to respiratory secretions; this route of transmission cannot be ruled out and needs for further detail investigation.

Previously, coronaviruses are reported as less infectious, causing common cold like symptoms by infecting upper respiratory tract. Because of the previous investigations on coronaviruses it is known that its spread occurs through infectious respiratory droplets and contaminated fomites. Therefore, primary source of sampling is the throat/nasal swab, and samples from the lower respiratory tract [5] . In the current pandemic situation, additional knowledge is required to understand the transmission patterns of SARS-CoV-2 in order to overcome the spread of this newly emerged virus. Tears can be a potential body fluid to harbor coronaviruses, as human eye conjunctiva usually remains exposed to respiratory droplets in air and if rubbed with contaminated hands. In 2004, SARScoronavirus was detected from tear samples in 37.5% positive cases and in another study, positivity of SARS-CoV-2 from conjunctival swabs was 16.6% which contributed to the evidence of eye as a carrier [6, 7] . It is already reported that many health care workers have been infected by COVID-19 and three ophthalmologists died of COVID-19 in Wuhan China [8] . Presence of SARS-CoV-2 up to 27 days after the onset of infection reported previously [9] is a matter of great concern. High infection rate and rapid spread of SARS-CoV-2 intrigued the need to investigate the possible role of eyes as shedding route or portal of entry of this SARS CoV-2. However, our study is limited by its small 

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Emerging threats from zoonotic coronaviruses-from SARS and MERS to 2019-nCoV

The severe acute respiratory syndrome coronavirus in tears

SARS-CoV-2 in the ocular surface of COVID-19 patients. Eye and Vision

New evidence of SARS-CoV-2 transmission through the ocular surface. Graefe's Archive for

Evaluation of ocular symptoms and tropism of SARS-CoV-2 in patients confirmed with COVID-19

The authors extend their gratitude to the patients and medical staff of Pakistan Institute of medical sciences (PIMS).

We declared that there is no conflict of interest

No funding source