CLINICAL GUIDELINES

[Pages:2]CLINICAL GUIDELINES

Conjunctivitis Testing

AMERICAN ACADEMY OF OPHTHALMOLOGY

Published the Conjunctivitis Preferred Practice Pattern in 2011, which can be accessed online at PracticeGuidelines/PPP_Content.aspx

Diagnostic Tests Most cases of conjunctivitis can be diagnosed on the basis of history and examination. However, in some cases additional diagnostic tests are helpful. Viral Diagnostic Tests Viral cultures are not routinely used to establish a diagnosis. A rapid, in-office immunodiagnostic test using antigen detection is available for adenovirus conjunctivitis. In a study of 186 patients with acute conjunctivitis, this test had a sensitivity of 88% to 89% and a specificity of 91% to 94%.33 Immunodiagnostic tests may be available for other viruses, but these are not validated for ocular specimens. Polymerase chain reaction (PCR) may be used to detect viral deoxyribonucleic acid. Availability will vary depending on laboratory policy.

Reference [33] Sambursky R, Tauber S, Schirra F, et al. The RPS adeno detector for diagnosing adenoviral conjunctivitis. Ophthalmology. 2006 Oct;113(10):1758-64.

AMERICAN ACADEMY OF PEDIATRICS

Published the Red Book in 2012, which can be accessed online at Diagnostic Tests The preferred methods for diagnosis of adenovirus infection include cell culture, antigen detection, and DNA detection. Adenoviruses associated with respiratory tract disease can be isolated from pharyngeal and eye secretions and feces by inoculation of specimens into susceptible cell cultures. A pharyngeal or ocular isolate is more suggestive of recent infection than is a fecal isolate, which may indicate either recent infection or prolonged carriage. Rapid detection of adenovirus antigens is possible in a variety of body fluids by commercial immunoassay techniques, including direct fluorescent assay. These rapid assays can be useful for diagnosis of respiratory tract infections, ocular disease, and diarrheal disease. Enteric adenovirus types 40 and 41 usually cannot be isolated in standard cell cultures.

Rapid Pathogen Screening, Inc. 7227 Delainey Court ? Sarasota, FL 34240 USA ? +1.941.556.1850 ?

?2012 Rapid Pathogen Screening, Inc. All Rights Reserved. FORM-MKT-098.0

To order, call 877.921.0080, email info@, or visit .

CLINICAL GUIDELINES

Conjunctivitis Testing

AMERICAN COLLEGE OF PHYSICIANS

Published the Physicians Information and Eduction Resource (PIER) in 2012, which can be accessed online at . physicians/diseases/d169

Rationale Although most conjunctivitis can be diagnosed on history and physical examination as infectious, the nature of the infectious agent, a virus or bacteria, is often difficult to determine. In-office testing for adenovirus may assist in establishing a correct diagnosis, but in some unusual cases and in patients unresponsive to treatment, special tests may be indicated. Evidence A prospective, masked clinical trial of a 10-minute in-office immunoassay for detecting adenovirus conjunctivitis showed a sensitivty of 89% and specificity of 94% compared to PCR, whereas viral cell culture showed a sensitivity of 91% and specificity of 100%. 24

References [24] Sambursky R, Tauber S, Schirra F, et al. The RPS adeno detector for diagnosing adenoviral conjunctivitis. Ophthalmology. 2006 Oct;113(10):1758-64. . [Date accessed: 2012 Sep 17] In: PIER [online database]. Philadelphia, American College of Physicians, 2012. ? 2012 by the American College of Physicians. Used with permission.

UPTODATE

An online, evidence-based, clinical decision support system authored by physicians. The conjunctivitis topic was last updated in 2012 and can be accessed online at

Diagnostic Tests A rapid (10 minute) test for adenoviral conjunctivitis is now available. Adenovirus is the major cause of viral conjunctivitis and likely accounts for a significant proportion of clinical encounters for conjunctivitis.

This test has reasonable sensitivity and specificity under study conditions13 and might aid clinicians in determining a viral, as opposed to bacterial etiology, thereby avoiding empiric antibiotic therapy. Elimination of empiric antibiotic therapy has theoretical benefits including prescription drug savings, avoidance of side effects, and reduction of antibiotic resistance. A modelled cost effectiveness analysis suggests a potential for significant cost savings with point of care testing.14

References [13] Sambursky R, Tauber S, Schirra F, et al. The RPS adeno detector for diagnosing adenoviral conjunctivitis. Ophthalmology. 2006 Oct;113(10):1758-64. [14] Udeh BL, Schneider JE, Ohsfeldt RL. Cost effectiveness of a point-of-care test for adenoviral conjunctivitis. Am J Med Sci. 2008 Sep;336(3):254-64.

To order, call 877.921.0080, email info@, or visit .

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