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Zhang J, Lu X, Cheng Z, Zou D, Shi W, Wang T. Alterations of conjunctival microbiota associated with orthokeratology lens wearing in myopic children. BMC Microbiol 2023; 23:397. [PMID: 38087200 PMCID: PMC10717905 DOI: 10.1186/s12866-023-03042-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 10/03/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Orthokeratology (OK) lens wear increases the risk of bacterial infection, but little is known about the microbiota of the conjunctival sac in myopic children wearing OK lenses. This study aimed to investigate the changes of conjunctival microbiota in children after treatment with OK lenses using 16 S rDNA sequencing. METHODS Twenty-eight myopic children who had been continuously wearing OK lenses for 12 to 13 months were enrolled in this prospective study. Twenty-two gender- and age-matched myopic children who had not worn OK lenses or discontinued OK lens wear at least 1 year ago were recruited as controls. Conjunctival swabs from each participant were collected for exploration of the microbiota profiles, targeting the V3-V4 regions of the 16 S rRNA gene by MiSeq sequencing. The differences in the microbial community structure and diversity were also compared between groups. RESULTS The bacterial alpha diversity indices in the OK lens group were not different from those in the non-wearer group (P > 0.05, Wilcoxon test), while beta diversity examined using principle coordinate analysis of unweighted UniFrac divided the two groups into different clusters. Proteobacteria, Bacteroidetes, and Firmicutes were the abundant phyla in the conjunctival sac microbiota in both groups (P < 0.05, Mann-Whitney U test). Among children in the OK lens group, the Linear discriminant analysis Effect Size identified the compositional changes in OK lens-associated bacteria. Key functional genera such as Blautia, Parasutterella, and Muribaculum were enriched, whereas Brevundimonas, Acinetobacter, Proteus, and Agathobacter decreased significantly (P < 0.05, Mann-Whitney U test). Phylogenetic investigation of communities by reconstruction of unobserved states also showed altered bacterial metabolic pathways in OK lens-associated microbiota. Moreover, using receiver operating characteristic curves, Brevundimonas, Acinetobacter, Proteus, and Agathobacter alone (the area under the curve was all > 0.7500) or in combination (the area under the curve was 0.9058) were revealed to discriminate OK lens wearers from controls. CONCLUSIONS The relative abundance of the microbial community in the conjunctival sac of myopic children can alter after OK lens wear. Brevundimonas, Acinetobacter, Proteus, and Agathobacter may be candidate biomarkers to distinguish between OK lens wearers and non-wearers.
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Affiliation(s)
- Ju Zhang
- Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China
| | - Xiuhai Lu
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, China
| | - Zhiwei Cheng
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, China
| | - Dulei Zou
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China
- Medical College, Qingdao University, Qingdao, China
| | - Weiyun Shi
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, China.
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China.
| | - Ting Wang
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, China.
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China.
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Sajiki AF, Koyanagi Y, Ushida H, Kawano K, Fujita K, Okuda D, Kawabe M, Yamada K, Suzumura A, Kachi S, Kaneko H, Komatsu H, Usui Y, Goto H, Nishiguchi KM. Association Between Torque Teno Virus and Systemic Immunodeficiency in Patients With Uveitis With a Suspected Infectious Etiology. Am J Ophthalmol 2023; 254:80-86. [PMID: 37356647 DOI: 10.1016/j.ajo.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/27/2023] [Accepted: 06/03/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE To determine the correlation between the presence of torque teno virus (TTV) in the aqueous humor of patients with uveitis and clinical information, including immunodeficiency history. DESIGN Multicenter, retrospective, cross-sectional study. METHODS Fifty-eight patients with uveitis with a suspected infectious etiology and 24 controls with cataract or age-related macular degeneration were included. We used quantitative polymerase chain reaction to test all subjects for TTV and multiplex polymerase chain reaction to test uveitis subjects for common ocular pathogens. When possible, both serum and aqueous humor samples were tested. Ocular TTV positivity was compared with age, sex, and a history of systemic immunodeficiency with logistic analysis. RESULTS Ocular TTV positivity was found in 23%, 11%, and 0% of patients with herpetic uveitis, nonherpetic uveitis, and controls, respectively. Among patients with herpes infection, positivity for ocular TTV was found in 43%, 8%, 14%, and 50% of patients with cytomegalovirus retinitis, iridocyclitis, acute retinal necrosis, and Epstein-Barr virus-positive uveitis, respectively. Patients with cytomegalovirus retinitis showed a significantly higher rate of ocular TTV infection than controls (P = .008). Serum analysis revealed TTV positivity in 90% of patients with uveitis and in 100% of controls. Age- and gender-adjusted logistic analysis revealed a correlation between ocular TTV positivity and systemic immunodeficiency (P = .01), but no correlations between ocular TTV and age, gender, or viral pathogenic type. CONCLUSIONS These findings suggest that positivity for ocular TTV was correlated with a clinical history of systemic immunodeficiency.
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Affiliation(s)
- Ai Fujita Sajiki
- From the Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan (A.F.S., Y.K., H.U., K.K., K.F., D.O., M.K., K.Y., A.S., H.K., K.M.N.).
| | - Yoshito Koyanagi
- From the Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan (A.F.S., Y.K., H.U., K.K., K.F., D.O., M.K., K.Y., A.S., H.K., K.M.N.)
| | - Hiroaki Ushida
- From the Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan (A.F.S., Y.K., H.U., K.K., K.F., D.O., M.K., K.Y., A.S., H.K., K.M.N.).
| | - Kenichi Kawano
- From the Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan (A.F.S., Y.K., H.U., K.K., K.F., D.O., M.K., K.Y., A.S., H.K., K.M.N.); Department of Ophthalmology, Yokkaichi Municipal Hospital, Yokkaichi, Japan (K.K.)
| | - Kosuke Fujita
- From the Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan (A.F.S., Y.K., H.U., K.K., K.F., D.O., M.K., K.Y., A.S., H.K., K.M.N.)
| | - Daishi Okuda
- From the Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan (A.F.S., Y.K., H.U., K.K., K.F., D.O., M.K., K.Y., A.S., H.K., K.M.N.)
| | - Mitsuki Kawabe
- From the Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan (A.F.S., Y.K., H.U., K.K., K.F., D.O., M.K., K.Y., A.S., H.K., K.M.N.)
| | - Kazuhisa Yamada
- From the Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan (A.F.S., Y.K., H.U., K.K., K.F., D.O., M.K., K.Y., A.S., H.K., K.M.N.)
| | - Ayana Suzumura
- From the Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan (A.F.S., Y.K., H.U., K.K., K.F., D.O., M.K., K.Y., A.S., H.K., K.M.N.)
| | - Shu Kachi
- Shohzankai Medical Foundation, Miyake Eye Hospital, Nagoya, Japan (S.K.)
| | - Hiroki Kaneko
- From the Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan (A.F.S., Y.K., H.U., K.K., K.F., D.O., M.K., K.Y., A.S., H.K., K.M.N.)
| | - Hiroyuki Komatsu
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan (H.K., Y.U., H.G.)
| | - Yoshihiko Usui
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan (H.K., Y.U., H.G.)
| | - Hiroshi Goto
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan (H.K., Y.U., H.G.)
| | - Koji M Nishiguchi
- From the Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan (A.F.S., Y.K., H.U., K.K., K.F., D.O., M.K., K.Y., A.S., H.K., K.M.N.)
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Asao K, Hashida N, Maruyama K, Motooka D, Tsukamoto T, Usui Y, Nakamura S, Nishida K. Comparative evaluation of 16S rRNA metagenomic sequencing in the diagnosis and understanding of bacterial endophthalmitis. BMJ Open Ophthalmol 2023; 8:e001342. [PMID: 37709670 PMCID: PMC10503327 DOI: 10.1136/bmjophth-2023-001342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVE To evaluate the usefulness of metagenomic analysis in the search for causative organisms of bacterial endophthalmitis. METHODS AND ANALYSIS Twenty-one consecutive treatment-naïve patients (13 men and 8 women; mean age, 60.8±19.8 years) with suspected endophthalmitis were recruited. Vitrectomy was performed to diagnose and treat endophthalmitis. Bacterial culture and metagenomic analysis of the vitreous body were performed. Extracted DNA was analysed using 16S rRNA sequences, and libraries were sequenced on an Illumina MiSeq sequencer. To compare the bacterial composition in each case, α and β diversities were determined. RESULTS Patients were categorised into three groups: endophthalmitis cases with matching predominant organisms according to metagenomic analysis and bacterial culture, those with negative results for bacterial culture and those with negative results in both cases. In 7 of 15 culture-negative cases, results from metagenomic analysis could detect pathogens. The diversity of bacterial populations was significantly lower in the group with positive results for predominant bacteria according to culture and metagenomic analysis. All patients with uveitis were included in the group for which the causative pathogen could not be determined by culture or metagenomic analysis. The structures of bacterial populations significantly differed between the positive and negative groups by culture and metagenomic analysis. CONCLUSIONS Metagenomic analysis could be useful for prompt detection of causative pathogens, for precise diagnosis of infection, and as a marker of inflammation processes such as uveitis.
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Affiliation(s)
- Kazunobu Asao
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Noriyasu Hashida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kazuichi Maruyama
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Department of Vision Informatics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Daisuke Motooka
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Department of Infection Metagenomics, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka, Japan
| | - Teruhisa Tsukamoto
- Biology and Translational Research Unit, Department of Medical Innovations, New Drug Research Division, Otsuka Pharmaceutical. Co. Ltd, Naruto, Tokushima, Japan
| | - Yoshihiko Usui
- Department of Ophthalmology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Shota Nakamura
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Department of Infection Metagenomics, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Levin HJ, Mehta MS, Storey PP, Patel SN, Kuley B, Wibbelsman TD, Obeid A, Garg S, Vander J, Dunn JP, Ho AC. Endophthalmitis following cataract surgery: visual outcomes, microbial spectrum and complications. Curr Opin Ophthalmol 2023; 34:237-242. [PMID: 36943680 DOI: 10.1097/icu.0000000000000951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
PURPOSE OF REVIEW The aim of this study was to update visual outcomes, microbial spectrum and complications in eyes with endophthalmitis following cataract surgery. RECENT FINDINGS A single-institution, retrospective review of eyes treated for endophthalmitis following cataract surgery between 2 January 2014 and 10 January 2017. This study included 112 cases of endophthalmitis following cataract surgery, 58 of which were culture-positive (51.8%). The most isolated organisms were coagulase-negative Staphylococci (56.9%). Oral flora were present in 17.2% of cases. At 6 months, 71.7% of patients achieved visual acuity of at least 20/200 and 51.7% achieved at least 20/40 or better. Visual acuity was better in culture-negative vs. culture-positive cases (∼20/290 vs. ∼20/80, P = 0.03), and in nonoral flora-associated vs. oral flora-associated culture-positive cases (∼CF vs. ∼20/150, P < 0.01). SUMMARY Following postcataract surgery endophthalmitis, approximately 70% of eyes achieved vision of 20/200 or better and half achieved vision of 20/40 or better 6 months after treatment. Poor visual outcomes were seen in eyes with positive bacterial cultures and with oral flora.
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Affiliation(s)
- Hannah J Levin
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Maitri S Mehta
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
- Department of Ophthalmology, Emory University, Atlanta, Georgia
| | - Philip P Storey
- Austin Retina Associates, University of Texas Dell Medical School, Austin, Texas, USA
| | - Samir N Patel
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Brandon Kuley
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Turner D Wibbelsman
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Anthony Obeid
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Sunir Garg
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | - James Vander
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | - James P Dunn
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Allen C Ho
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
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Naik P, Gandhi J, Joseph J. Recent Advances and Ongoing Challenges in the Diagnosis of Culture Negative Endophthalmitis. Semin Ophthalmol 2023; 38:92-98. [PMID: 35982639 DOI: 10.1080/08820538.2022.2113101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Culture negative (CN) but presumed infectious endophthalmitis poses a huge diagnostic challenge in terms of clinical management. This article outlines the current state of knowledge of infectious endophthalmitis with negative cultures and summarizes the recommendations for the work up of this condition along with providing a simple algorithm, by putting into context the recent concerns about over-diagnosing endophthalmitis. METHODS We searched the PubMed and Scopus databases for large hospital based studies on diagnosis of endophthalmitis, with emphasis on culture-negative infections in October 2021. Only clinical studies written in English were included. Basic science studies, letters to the editor and case reports on endophthalmitis were excluded. RESULTS Twenty studies were included in this study. The prevalence of CN endophthalmitis ranged from 40% to 70%. Recent advances in PCR along with high throughput sequencing have helped identify the etiological agent in most cases but these technologies are not easily available, requires advanced bioinformatic analysis and are not cost effective. Role of other inflammatory and relatively low-cost biomarkers in diagnosing a presumed infection is yet to be validated clinically but hold promise in helping ophthalmologists identify the causative agent. CONCLUSIONS CN endophthalmitis is a relatively frequent finding and should not be labelled as sterile endophthalmitis. Recent advances provide a new perspective for ophthalmologist in diagnosis of presumed infectious endophthalmitis and further studies are needed to confirm their utility in clinical settings.
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Affiliation(s)
- Poonam Naik
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India.,Manipal Academy of Higher Education, Manipal, India
| | - Jaishree Gandhi
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India.,Manipal Academy of Higher Education, Manipal, India
| | - Joveeta Joseph
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
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Chun LY, Dahmer DJ, Amin SV, Hariprasad SM, Skondra D. Update on Current Microbiological Techniques for Pathogen Identification in Infectious Endophthalmitis. Int J Mol Sci 2022; 23:11883. [PMID: 36233183 PMCID: PMC9570044 DOI: 10.3390/ijms231911883] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/19/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Infectious endophthalmitis is a vision-threatening medical emergency that requires prompt clinical diagnosis and the initiation of treatment. However, achieving precision in endophthalmitis management remains challenging. In this review, we provide an updated overview of recent studies that are representative of the current trends in clinical microbiological techniques for infectious endophthalmitis.
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Affiliation(s)
- Lindsay Y. Chun
- Department of Ophthalmology and Visual Science, The University of Chicago Hospitals and Health System, Chicago, IL 60637, USA
| | - Donavon J. Dahmer
- College of Medicine, University of South Alabama, Mobile, AL 36688, USA
| | - Shivam V. Amin
- Department of Ophthalmology and Visual Science, The University of Chicago Hospitals and Health System, Chicago, IL 60637, USA
| | - Seenu M. Hariprasad
- Department of Ophthalmology and Visual Science, The University of Chicago Hospitals and Health System, Chicago, IL 60637, USA
| | - Dimitra Skondra
- Department of Ophthalmology and Visual Science, The University of Chicago Hospitals and Health System, Chicago, IL 60637, USA
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Low L, Nakamichi K, Akileswaran L, Lee CS, Lee AY, Moussa G, Murray PI, Wallace GR, Van Gelder RN, Rauz S. Deep Metagenomic Sequencing for Endophthalmitis Pathogen Detection Using a Nanopore Platform. Am J Ophthalmol 2022; 242:243-251. [PMID: 35660421 PMCID: PMC9850836 DOI: 10.1016/j.ajo.2022.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate the utility of nanopore sequencing for identifying potential causative pathogens in endophthalmitis, comparing culture results against full-length 16S rRNA nanopore sequencing (16S Nanopore), whole genome nanopore sequencing (Nanopore WGS), and Illumina (Illumina WGS). DESIGN Cross-sectional diagnostic comparison. METHODS Patients with clinically suspected endophthalmitis underwent intraocular vitreous biopsy as per standard care. Clinical samples were cultured by conventional methods, together with full-length 16S rRNA and WGS using nanopore and Illumina sequencing platforms. RESULTS Of 23 patients (median age 68.5 years [range 47-88]; 14 males [61%]), 18 cases were culture-positive. Nanopore sequencing identified the same cultured organism in all of the culture-positive cases and identified potential pathogens in two culture-negative cases (40%). Nanopore WGS was able to additionally detect the presence of bacteriophages in three samples. The agreements at genus level between culture and 16S Nanopore, Nanopore WGS, and Illumina WGS were 75%, 100%, and 78%, respectively. CONCLUSIONS Whole genome sequencing has higher sensitivity and provides a viable alternative to culture and 16S sequencing for detecting potential pathogens in endophthalmitis. Moreover, WGS has the ability to detect other potential pathogens in culture-negative cases. Whilst Nanopore and Illumina WGS provide comparable data, nanopore sequencing provides potential for cost-effective point-of-care diagnostics.
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Affiliation(s)
- Liying Low
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, United Kingdom,Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Kenji Nakamichi
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Lakshmi Akileswaran
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Cecilia S. Lee
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Aaron Y. Lee
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - George Moussa
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Philip I. Murray
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, United Kingdom,Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Graham R. Wallace
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, United Kingdom
| | - Russell N. Van Gelder
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Saaeha Rauz
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, Washington, United States of America
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Application of High-Throughput Sequencing Technology in Identifying the Pathogens in Endophthalmitis. J Ophthalmol 2022; 2022:4024260. [PMID: 36065285 PMCID: PMC9440830 DOI: 10.1155/2022/4024260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/20/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022] Open
Abstract
Infectious endophthalmitis is an important cause of vision loss worldwide. It is an inflammatory reaction caused by bacteria, fungi, and other micro-organisms and often occurs as a complication of intraocular surgery, especially following cataract surgery or intravitreal injection. The focus of the prevention and treatment of infectious endophthalmitis is the early detection of microbial flora, such as fungi or bacteria. Current identification methods for bacteria include Gram staining-based, culture-based, and polymerase chain reaction (PCR)-based methods. The matrix-assisted laser desorption/ionization time-of-flight mass spectrometry technology is now the standard identification method of bacteria and fungi after their isolation in culture. The remarkable sensitivity of PCR technology for the direct detection of micro-organisms in clinical samples makes it particularly useful in culture-positive and culture-negative endophthalmitis. Furthermore, PCR increases the rate of microorganism detection in intraocular samples by 20% and can provide a microbiology diagnosis in approximately 44.7–100% of the culture-negative cases. This review aims to introduce the development of different methods for the detection and identification of micro-organisms causing endophthalmitis through a literature review; introduce the research status of the first, second, and third-generation sequencing technologies in infectious endophthalmitis; and understand the research status of endophthalmitis microbial flora. For slow-growing and rare micro-organisms, high-throughput sequencing (HTS) offers advantages over conventional methods and provides a basis for the identification of pathogens in endophthalmitis cases with negative culture. It is a reliable platform for the identification of pathogenic bacteria of infectious endophthalmitis in the future and provides a reference for the clinical diagnosis and treatment of infectious endophthalmitis. The application of HTS technology may also be transformative for clinical microbiology and represents an exciting future direction for the epidemiology of ocular infections.
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Chiquet C, Bron AM, Lundström M, Maurin M. Acute postoperative endophthalmitis: Microbiology from the laboratory to the bedside. Surv Ophthalmol 2022; 67:1698-1710. [PMID: 35843367 DOI: 10.1016/j.survophthal.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 06/30/2022] [Accepted: 07/11/2022] [Indexed: 11/26/2022]
Abstract
Postoperative endophthalmitis is a dreaded complication of intraocular surgery. Acute presentations need prompt management and good knowledge of differential diagnoses. In the last 10 years, progress in direct microbial detection and identification from intraocular samples included the use of blood culture systems and, more recently, matrix-assisted laser desorption ionization time-of-flight mass spectrometry, improving the rate of bacterial identification. Whatever the method used, diagnostic sensitivity is better for vitreous samples than for aqueous humor samples. Besides, molecular biology techniques have further improved the identification rate of infectious agents in intraocular samples. They also provide faster results compared to culture-based techniques. Quantitative real-time PCR (qPCR) can also determine the bacterial load in intraocular samples. Several studies have shown that intraocular bacterial loads in endophthalmitis patients are usually high, which helps differentiating infection from contamination. The prognostic value of qPCR remains to be validated. Whole genome DNA sequencing technologies facilitate direct and sequencing of single DNA molecules. They have the potential to increase the rate of microbiological identification. Some antibiotic resistance markers (e.g., methicillin resistance in staphylococci and vancomycin resistance in enterococci) may be detected earlier using molecular techniques (usually real-time PCR tests). Early determination of the involved microorganism and their antibiotic resistances can help establishing an earlier therapeutic strategy.
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Affiliation(s)
- Christophe Chiquet
- Department of Ophthalmology, University Hospital of Grenoble, France; Grenoble Alpes University, Grenoble, France; HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.
| | - Alain M Bron
- Department of Ophthalmology, University Hospital, Dijon, France; Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, F-21000, Dijon, France
| | - Mats Lundström
- Department of Clinical Sciences, Ophthalmology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Max Maurin
- Laboratoire de Bactériologie, Institut de Biologie et Pathologie, CHU, Grenoble, Alpes; University Grenoble Alpes, CNRS, Grenoble, INP; CHU Grenoble Alpes, TIMC-IMAG, 38000, Grenoble, France
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Zhu J, Xia H, Tang R, Ng TK, Yao F, Liao X, Zhang Q, Ke X, Shi T, Chen H. METAGENOMIC NEXT-GENERATION SEQUENCING DETECTS PATHOGENS IN ENDOPHTHALMITIS PATIENTS. Retina 2022; 42:992-1000. [PMID: 35019890 DOI: 10.1097/iae.0000000000003406] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To investigate the utility of metagenomic next-generation sequencing (mNGS) in identifying the pathogens in endophthalmitis. METHODS In this prospective study, 36 cases of endophthalmitis were recruited. All patients received surgical treatment and intraocular drug lavage. The samples of vitreous or aqueous humor were extracted for mNGS and microbiological culture. The diagnostic performance of pathogens was compared between mNGS and culture. RESULTS The positive rates of mNGS and culture were 88.89% (32/36) and 27.78% (10/36), respectively. There was a statistically significant difference between mNGS and culture (Chi-square = 27.657; P < 0.01). Staphylococcus epidermidis, Streptococcus pneumoniae, and Klebsiella pneumoniae were the most pathogenic bacteria in traumatic, postoperative, and endogenous endophthalmitis, respectively. The concordance of pathogen identified by mNGS and culture was 70% for culture-positive cases. Antibiotic resistance genes were identified in 9 cases. There was a marginal correlation between the final visual acuity and the microbial sequence read (Spearman correlation coefficient = 0.498; P = 0.05). CONCLUSION Metagenomic next-generation sequencing has a higher positive rate of identifying pathogens in endophthalmitis than in culture. It can also provide information on antibiotic resistance and visual prognosis. However, caution must be taken when interpreting the results of mNGS because they may not be concordant with culture.
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Affiliation(s)
- Junfeng Zhu
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Honghe Xia
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Ruqing Tang
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Tsz Kin Ng
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Fen Yao
- Department of Pharmacology, Shantou University Medical College, Shantou, China
| | - Xulong Liao
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Qi Zhang
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Xixuan Ke
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Tingkun Shi
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Haoyu Chen
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou, China
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PATEL SAMIRN, CAI LOUISZ, MAHMOUDZADEH RAZIYEH, SALABATI MIRATAOLLAH, MAGAN TEJAL, OBEID ANTHONY, SOARES REBECCAR, HINKLE JOHNW, HSU JASON, DUNN JAMESP, VANDER JAMESF, GARG SUNIRJ. Endophthalmitis After Intravitreal Anti-Vascular Endothelial Factor Injections: Outcomes of Eyes Managed Without Microbiologic Cultures. Am J Ophthalmol 2022; 235:1-6. [PMID: 34461083 DOI: 10.1016/j.ajo.2021.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To evaluate outcomes of eyes that developed endophthalmitis after intravitreal anti-vascular endothelial growth factor injections that were managed without microbiologic cultures. DESIGN Retrospective, single-center, comparative cohort study. METHODS We included all eyes with postinjection endophthalmitis from July 1, 2013, to September 1, 2019. Endophthalmitis cases were divided into the culture group if treated with intravitreal antibiotics and a vitreous or aqueous tap sent for microbiologic sampling or into the no culture group if treated with immediate injection of intravitreal antibiotics with an anterior chamber paracentesis that was not sent for microbiologic sampling. The main outcome measures were visual acuity, the incidence of retinal detachment, and the need for additional procedures. RESULTS Of 165 endophthalmitis cases identified, 119 (72%) were in the culture group and 46 (28%) were in the no culture group. At endophthalmitis presentation, eyes in the culture group had a mean logMAR VA of 1.98 (∼20/1900) compared with 1.90 (∼20/1600) for eyes in the no culture group (P = .589). At the 6-month follow-up, the mean vision loss was 5.5 lines lost from baseline for the culture group compared with 2.5 lines lost for the no culture group (P = .017). Eyes in the culture group required a subsequent pars plana vitrectomy in 29 of 119 cases (24%) compared with 7 of 46 cases (15%) in the no culture group (P = .29). Six of 119 eyes (5%) in the culture group developed secondary retinal detachments compared with none in the no culture group (P = .143). CONCLUSIONS When access to microbiologic facility is not available, the management of postinjection endophthalmitis using intravitreal antibiotics without microbiologic cultures may be an acceptable treatment strategy.
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Van Gelder RN. Molecular Diagnostics for Ocular Infectious Diseases: LXXVIII Edward Jackson Memorial Lecture. Am J Ophthalmol 2022; 235:300-312. [PMID: 34921773 PMCID: PMC8863649 DOI: 10.1016/j.ajo.2021.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/26/2021] [Accepted: 12/03/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To review the use of molecular diagnostic techniques in the management of ocular infectious disease. DESIGN Retrospective review. METHODS A combination of literature review and personal recollections are used. RESULTS Although the broad term molecular diagnostics may encompass techniques to identify pathogens via protein or metabolomic signatures, this review concentrates on detection of pathogen nucleic acid as an indicator of infection. The introduction of the polymerase chain reaction (PCR) in 1985 opened a new era in analysis of nucleic acids. This technique was soon applied to the detection of potential pathogen DNA and RNA, including viruses, bacteria, and parasites in infectious eye disease. Advances in PCR have allowed class-specific diagnostics (ie, pan-bacterial and pan-fungal), quantitation of pathogen DNA, and multiplexed testing. The Human Genome Project in the early 2000s greatly accelerated development of DNA sequencers, ushering in the era of "Next Generation Sequencing" and permitting pathogen-agnostic methods for the detection of potential infectious agents. Most recently, new technologies such as nanopore sequencing have reduced both cost and equipment requirements for whole-genome sequencing; when coupled with real-time sequence analysis methods, these methods offer the promise of true, real-time, point-of-service ocular infectious disease diagnostics. CONCLUSIONS Molecular methods for pathogen detection have greatly advanced the diagnosis of ocular infectious disease. Further methodologic advances will have a direct impact on the management of these conditions.
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Affiliation(s)
- Russell N Van Gelder
- From the Departments of Ophthalmology, Biological Structure, and Laboratory Medicine and Pathology, and Roger and Angie Karalis Johnson Retina Center, University of Washington School of Medicine, Seattle, Washington, USA.
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13
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Hatcher JB, de Castro-Abeger A, LaRue RW, Hingorani M, Mawn L, Donahue SP, Sternberg P, Shieh C. MRSA Decolonization and the Eye: A Potential New Tool for Ophthalmologists. Semin Ophthalmol 2022; 37:541-553. [DOI: 10.1080/08820538.2022.2039220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Jeremy B Hatcher
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Alex de Castro-Abeger
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Richard W LaRue
- Department of Medicine, Division of Infectious Disease, Vanderbilt Medical Center, Nashville, TN, United States
| | - Melanie Hingorani
- Department of Paediatrics, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Louise Mawn
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sean P Donahue
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Paul Sternberg
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Christine Shieh
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, United States
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Tabl A, Masoud M, Abdelhalim G, Tabl M. Outcomes of early vitrectomy for endophthalmitis after cataract surgery in delta population, Egypt, 2015–2020. JOURNAL OF THE EGYPTIAN OPHTHALMOLOGICAL SOCIETY 2022. [DOI: 10.4103/ejos.ejos_14_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Elevated levels of Merkel cell polyoma virus in the anophthalmic conjunctiva. Sci Rep 2021; 11:15366. [PMID: 34321490 PMCID: PMC8319407 DOI: 10.1038/s41598-021-92642-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 06/03/2021] [Indexed: 01/09/2023] Open
Abstract
The human ocular surface hosts a paucibacterial resident microbiome and virome. The factors contributing to homeostasis of this mucosal community are presently unknown. To determine the impact of ocular enucleation and prosthesis placement on the ocular surface microbiome, we sampled conjunctival swabs from 20 anophthalmic and 20 fellow-eye intact conjunctiva. DNA was extracted and subjected to quantitative 16S rDNA PCR, biome representational karyotyping (BRiSK), and quantitative PCR (qPCR) confirmation of specific organisms. 16S ribosomal qPCR revealed equivalent bacterial loads between conditions. Biome representational in silico karyotyping (BRiSK) demonstrated comparable bacterial fauna between anophthalmic and intact conjunctiva. Both torque teno virus and Merkel cell polyoma virus (MCPyV) were detected frequently in healthy and anophthalmic conjunctiva. By qPCR, MCPyV was detected in 19/20 anophthalmic samples compared with 5/20 fellow eyes. MCPyV copy number averaged 891 copies/ng in anophthalmic conjunctiva compared with 193 copies/ng in fellow eyes (p < 0.001). These results suggest that enucleation and prosthesis placement affect the ocular surface flora, particularly for the resident virome. As MCPyV has been shown to be the etiologic cause of Merkel cell carcinoma, understanding the mechanisms by which the ocular surface regulates this virus may have clinical importance.
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Sabapathypillai SL, James HR, Lyerla RRL, Hassman L. The Next Generation of Ocular Pathogen Detection. Asia Pac J Ophthalmol (Phila) 2021; 10:109-113. [PMID: 33512832 DOI: 10.1097/apo.0000000000000366] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
ABSTRACT Metagenomic next-generation sequencing is a powerful method for pathogen detection that combines advanced genome sequencing technology with cutting-edge bioinformatics to analyze microbial populations. Metagenomic next-generation sequencing has the potential to identify uncommon, unculturable, and even previously unidentified pathogens from a clinical isolate. Of particular interest to ophthalmology, this robust data extraction can occur from very small volume clinical samples. Here we discuss the opportunities and limitations of this technique and their current and future application to ophthalmic diagnostics.
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Affiliation(s)
- Sharon L Sabapathypillai
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, MO
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Abstract
PURPOSE OF REVIEW Prevention and management of postcataract endophthalmitis remain quite relevant for anterior segment and vitreoretinal surgeons. Although the Endophthalmitis Vitrectomy Study, published in 1996, remains the only level 1 evidence for the management of postcataract endophthalmitis, recent advances have resulted in an evolution of practice patterns. The aim of this review is to summarize the literature regarding postcataract endophthalmitis with a focus on the last 18 months. RECENT FINDINGS The IRIS registry indicates the rates of endophthalmitis are decreasing in the United States, and the outcomes appear to be improving. Intracameral moxifloxacin has become more widely accepted and intracameral vancomycin has been shown to be associated with retinal vasculitis. The role of systemic antibiotics and vitrectomy is unclear and practice patterns vary widely. SUMMARY Although practice patterns vary, prevention and treatment of endophthalmitis after cataract surgery continues to improve. More uniform guidelines regarding surgical and medical therapy are necessary but the standard of prompt referral to a vitreoretinal specialist for immediate intravitreal antibiotics remains the most important intervention in the management of postcataract endophthalmitis.
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