1
|
Lallier S, Deaner JD, Feng H, Jaffe GJ. PSEUDOMONAS ENDOPHTHALMITIS AFTER 0.59 MG FLUOCINOLONE ACETONIDE SURGICAL IMPLANT IN A PATIENT WITH A LONG-STANDING CRAWFORD TUBE. Retin Cases Brief Rep 2023; 17:515-518. [PMID: 37643034 DOI: 10.1097/icb.0000000000001237] [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: 08/31/2023]
Abstract
PURPOSE The purpose of this study was to report a case of Pseudomonas aeruginosa endophthalmitis after surgical 0.59 mg fluocinolone acetonide implant in a patient with a long-standing Crawford tube. METHODS This was a retrospective case review. RESULTS A 52-year-old woman with a history of bilateral sarcoid-associated panuveitis and nasolacrimal duct obstructions treated with dacryocystorhinostomies and long-standing Crawford tubes underwent placement of a surgical fluocinolone acetonide implant. The Crawford tube was visible throughout the surgery and notably exhibited small amounts of rotation and prolapse with manipulation of the eye. On postoperative Day 4, the patient presented urgently with pain and decreased visual acuity. Endophthalmitis was suspected, and a vitreous tap and intravitreal injections of vancomycin and amikacin were performed. Cultures grew P. aeruginosa. Initially she responded to treatment with no evidence of intraocular infection or inflammation by postoperative Week 3. However, at postoperative Week 4, the patient returned with a yellow purulent subconjunctival nodule and surrounding scleral injection. A second nodule appeared 2 weeks later. The patient was treated with topical and systemic antibiotics. The nodules responded well to treatment showing notable consolidation and revealing an area of scleral thinning as they regressed. CONCLUSION We present a case of P. aeruginosa endophthalmitis and presumed scleritis after the surgical fluocinolone acetonide implant placement in an eye with a Crawford nasolacrimal tube effectively treated with topical, intravitreal, and systemic antibiotics. Long-standing nasolacrimal duct hardware may allow reflux of nasopharyngeal and nasolacrimal bacteria, contaminating the ocular surface during surgery.
Collapse
Affiliation(s)
- Scott Lallier
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | | | | | | |
Collapse
|
2
|
Shah S, Wozniak RAF. Staphylococcus aureus and P seudomonas aeruginosa infectious keratitis: key bacterial mechanisms that mediate pathogenesis and emerging therapeutics. Front Cell Infect Microbiol 2023; 13:1250257. [PMID: 37671149 PMCID: PMC10475732 DOI: 10.3389/fcimb.2023.1250257] [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: 06/29/2023] [Accepted: 08/04/2023] [Indexed: 09/07/2023] Open
Abstract
Bacterial keratitis (bacterial infection of the cornea) is a major cause of vision loss worldwide. Given the rapid and aggressive nature of the disease, immediate broad-spectrum antibiotics are essential to adequately treat this disease. However, rising antibiotic resistance continues to accelerate, rendering many commonly used therapeutics increasingly ineffective. As such, there is a significant effort to understand the basic pathogenesis of common causative organisms implicated in keratitis in part, to fuel the development of novel therapies to treat this blinding disease. This review explores two common causes of bacterial keratitis, Staphylococcus aureus and Pseudomonas aeruginosa, with regards to the bacterial mediators of virulence as well as novel therapies on the horizon.
Collapse
Affiliation(s)
| | - Rachel A. F. Wozniak
- Department of Ophthalmology, The University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| |
Collapse
|
3
|
Cho CH, Lee SB. Comparative Analysis of the Clinical Aspects and Treatment Outcomes of Stenotrophomonas maltophilia Keratitis and Pseudomonas aeruginosa Keratitis. Eye Contact Lens 2021; 47:456-464. [PMID: 33416222 DOI: 10.1097/icl.0000000000000771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We analyzed the clinical aspects and treatment outcomes of Stenotrophomonas maltophilia (SM) keratitis and Pseudomonas aeruginosa (PA) keratitis. METHODS Medical records of 55 inpatients with culture-proven SM (n=21) and PA (n=34) keratitis were retrospectively reviewed. Predisposing factors, clinical characteristics, and treatment outcomes were compared between the SM and PA groups. RESULTS The mean symptom duration was longer in the SM group than in the PA group (10.4:4.3 days; P=0.012). The most common predisposing factor was corneal trauma (47.6%) in the SM group and contact-lens wear (38.2%) in the PA group. There were no differences in the mean epithelial defect size (12.7:11.9 mm2; P=0.861), hypopyon (33.3%:44.1%; P=0.428), surgical treatment (4.8%:14.7%; P=0.390), or poor clinical outcomes (26.8%:30.3%; P=0.760) between the SM and PA groups. In multivariate logistic regression, risk factors for poor clinical outcomes were hypopyon (odds ratio [OR], 52.00; P=0.010) in the SM group and symptom duration≥7 days (OR, 44.32; P=0.015), age≥60 years (OR, 21.13; P=0.019), and hypopyon (OR, 15.20; P=0.038) in the PA group. CONCLUSION Compared with PA keratitis, SM keratitis had slower progression, and its clinical characteristics and treatment results were not worse. In both groups, hypopyon was the risk factor for a poor clinical outcome.
Collapse
Affiliation(s)
- Chan-Ho Cho
- Department of Ophthalmology (C.-H.C.), Inje University Haeundae Paik Hospital, Busan, South Korea ; and Department of Ophthalmology (C.-H.C., S.-B.L.), Yeungnam University College of Medicine, Daegu, South Korea
| | | |
Collapse
|
4
|
Ung L, Chodosh J. Foundational concepts in the biology of bacterial keratitis. Exp Eye Res 2021; 209:108647. [PMID: 34097906 PMCID: PMC8595513 DOI: 10.1016/j.exer.2021.108647] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/28/2021] [Accepted: 05/27/2021] [Indexed: 12/12/2022]
Abstract
Bacterial infections of the cornea, or bacterial keratitis (BK), are notorious for causing rapidly fulminant disease and permanent vision loss, even among treated patients. In the last sixty years, dramatic upward trajectories in the frequency of BK have been observed internationally, driven in large part by the commercialization of hydrogel contact lenses in the late 1960s. Despite this worsening burden of disease, current evidence-based therapies for BK - including broad-spectrum topical antibiotics and, if indicated, topical corticosteroids - fail to salvage vision in a substantial proportion of affected patients. Amid growing concerns of rapidly diminishing antibiotic utility, there has been renewed interest in urgently needed novel treatments that may improve clinical outcomes on an individual and public health level. Bridging the translational gap in the care of BK requires the identification of new therapeutic targets and rational treatment design, but neither of these aims can be achieved without understanding the complex biological processes that determine how bacterial corneal infections arise, progress, and resolve. In this chapter, we synthesize the current wealth of human and animal experimental data that now inform our understanding of basic BK pathophysiology, in context with modern concepts in ocular immunology and microbiology. By identifying the key molecular determinants of clinical disease, we explore how novel treatments can be developed and translated into routine patient care.
Collapse
Affiliation(s)
- Lawson Ung
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
5
|
Enzor R, Bowers EM, Perzia B, Perera C, Palazzolo L, Mammen A, Dhaliwal DK, Kowalski RP, Jhanji V. Comparison of Clinical Features and Treatment Outcomes of Pseudomonas aeruginosa Keratitis in Contact Lens and Non-Contact Lens Wearers. Am J Ophthalmol 2021; 227:1-11. [PMID: 33657419 DOI: 10.1016/j.ajo.2021.02.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare the outcomes of Pseudomonas aeruginosa keratitis (PAK) in contact lens wearers (CLWs) and non-contact lens wearers (non-CLWs) and identify risk factors for poor visual acuity (VA) outcomes in each group. DESIGN Retrospective cohort study METHODS: Two hundred fourteen consecutive cases of PAK were included between January 2006 and December 2019. Clinical features, microbiologic results, and treatment course were compared between CLW and non-CLW groups. Analyses of clinical features predicting poor final VA were performed. RESULTS This study identified 214 infected eyes in 207 patients with PAK, including 163 eyes (76.2%) in CLWs and 51 eyes (23.8%) in non-CLWs. The average age was 39.2 years in CLWs and 71.9 years in non-CLWs (P < .0001). The average logMAR visual acuity (VA) at presentation was 1.39 in CLWs and 2.17 in non-CLWs (P < .0001); average final VA was 0.76 in CLWs and 1.82 in non-CLWs (P < .0001). Stromal necrosis required a procedural or surgical intervention in 13.5% of CLWs and 49.0% of non-CLWs (P < .0001). A machine learning-based analysis yielded a list of clinical features that most strongly predict a poor VA outcome (worse than 20/40), including worse initial VA, older age, larger size of infiltrate or epithelial defect at presentation, and greater maximal depth of stromal necrosis. CONCLUSIONS Non-CLWs have significantly worse VA outcomes and required a higher rate of surgical intervention, compared with CLWs. Our study elucidates risk factors for poor visual outcomes in non-CLWs with PAK.
Collapse
|
6
|
Subedi D, Vijay AK, Willcox M. Overview of mechanisms of antibiotic resistance in Pseudomonas aeruginosa: an ocular perspective. Clin Exp Optom 2021; 101:162-171. [DOI: 10.1111/cxo.12621] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/18/2017] [Accepted: 06/19/2017] [Indexed: 12/30/2022] Open
Affiliation(s)
- Dinesh Subedi
- School of Optometry and Vision Science, Faculty of Science, The University of New South Wales, Sydney, New South Wales, Australia,
| | - Ajay Kumar Vijay
- School of Optometry and Vision Science, Faculty of Science, The University of New South Wales, Sydney, New South Wales, Australia,
| | - Mark Willcox
- School of Optometry and Vision Science, Faculty of Science, The University of New South Wales, Sydney, New South Wales, Australia,
| |
Collapse
|
7
|
Kaul S, Jain N, Pandey J, Nagaich U. Investigating The Retention Potential of Chitosan Nanoparticulate Gel: Design, Development, In Vitro & Ex Vivo Characterization. ACTA ACUST UNITED AC 2019; 15:41-67. [PMID: 31612834 PMCID: PMC8493795 DOI: 10.2174/1574891x14666191014141558] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/22/2019] [Accepted: 08/23/2019] [Indexed: 11/24/2022]
Abstract
Introduction The main purpose of the research was to develop, optimize and characterize tobramycin sulphate loaded chitosan nanoparticles based gel in order to ameliorate its therapeutic efficacy, precorneal residence time, stability, targeting and to provide controlled release of the drug. Methods Box-Behnken design was used to optimize formulation by 3-factors (chitosan, STPP and tween 80) and 3-levels. Developed formulation was subjected for characterizations such as shape and surface morphology, zeta potential, particle size, in vitro drug release studies, entrapment efficiency of drug, visual inspection, pH, viscosity, spreadability, drug content, ex vivo transcorneal permeation studies, ocular tolerance test, antimicrobial studies, isotonicity evaluation and histopathology studies. Results Based on the evaluation parameters, the optimized formulation showed a particle size of 43.85 ± 0.86 nm and entrapment efficiency 91.56% ± 1.04, PDI 0.254. Cumulative in vitro drug release was up to 92.21% ± 1.71 for 12 hours and drug content was found between 95.36% ± 1.25 to 98.8% ± 1.34. TEM analysis unfolded spherical shape of nanoparticles. TS loaded nanoparticulate gel exhibited significantly higher transcorneal permeation as well as bioadhesion when compared with marketed formulation. Ocular tolerance was evaluated by HET-CAM test and formulation was non-irritant and well-tolerated. Histopathology studies revealed that there was no evidence of damage to the normal structure of the goat cornea. As per ICH guidelines, stability studies were conducted and were subjected for 6 months. Conclusion Results revealed that the developed formulation could be an ideal substitute for conventional eye drops for the treatment of bacterial keratitis.
Collapse
Affiliation(s)
- Shreya Kaul
- Department of Pharmaceutics, Amity Institute of Pharmacy, Amity University, Noida, Uttar Pradesh, 201301, India
| | - Neha Jain
- Department of Pharmaceutics, Amity Institute of Pharmacy, Amity University, Noida, Uttar Pradesh, 201301, India
| | - Jaya Pandey
- School of Studies in Pharmaceutical Sciences, Jiwaji University, Gwalior, Madhya Pradesh, India
| | - Upendra Nagaich
- Department of Pharmaceutics, Amity Institute of Pharmacy, Amity University, Noida, Uttar Pradesh, 201301, India
| |
Collapse
|
8
|
Extensively and pan-drug resistant Pseudomonas aeruginosa keratitis: clinical features, risk factors, and outcome. Graefes Arch Clin Exp Ophthalmol 2015; 254:315-22. [DOI: 10.1007/s00417-015-3208-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 10/20/2015] [Accepted: 10/23/2015] [Indexed: 11/26/2022] Open
|
9
|
Tatke G, Kumari H, Silva-Herzog E, Ramirez L, Mathee K. Pseudomonas aeruginosa MifS-MifR Two-Component System Is Specific for α-Ketoglutarate Utilization. PLoS One 2015; 10:e0129629. [PMID: 26114434 PMCID: PMC4482717 DOI: 10.1371/journal.pone.0129629] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 05/10/2015] [Indexed: 12/31/2022] Open
Abstract
Pseudomonas aeruginosa is a Gram-negative, metabolically versatile opportunistic pathogen that elaborates a multitude of virulence factors, and is extraordinarily resistant to a gamut of clinically significant antibiotics. This ability, in part, is mediated by two-component regulatory systems (TCS) that play a crucial role in modulating virulence mechanisms and metabolism. MifS (PA5512) and MifR (PA5511) form one such TCS implicated in biofilm formation. MifS is a sensor kinase whereas MifR belongs to the NtrC superfamily of transcriptional regulators that interact with RpoN (σ54). In this study we demonstrate that the mifS and mifR genes form a two-gene operon. The close proximity of mifSR operon to poxB (PA5514) encoding a ß-lactamase hinted at the role of MifSR TCS in regulating antibiotic resistance. To better understand this TCS, clean in-frame deletions were made in P. aeruginosa PAO1 creating PAO∆mifS, PAO∆mifR and PAO∆mifSR. The loss of mifSR had no effect on the antibiotic resistance profile. Phenotypic microarray (BioLOG) analyses of PAO∆mifS and PAO∆mifR revealed that these mutants were unable to utilize C5-dicarboxylate α-ketoglutarate (α-KG), a key tricarboxylic acid cycle intermediate. This finding was confirmed using growth analyses, and the defect can be rescued by mifR or mifSR expressed in trans. These mifSR mutants were able to utilize all the other TCA cycle intermediates (citrate, succinate, fumarate, oxaloacetate or malate) and sugars (glucose or sucrose) except α-KG as the sole carbon source. We confirmed that the mifSR mutants have functional dehydrogenase complex suggesting a possible defect in α-KG transport. The inability of the mutants to utilize α-KG was rescued by expressing PA5530, encoding C5-dicarboxylate transporter, under a regulatable promoter. In addition, we demonstrate that besides MifSR and PA5530, α-KG utilization requires functional RpoN. These data clearly suggests that P. aeruginosa MifSR TCS is involved in sensing α-KG and regulating its transport and subsequent metabolism.
Collapse
Affiliation(s)
- Gorakh Tatke
- Department of Biological Sciences, College of Arts & Sciences, Florida International University, Miami, Florida, United States of America
- Department of Molecular Microbiology and Infectious Diseases, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Hansi Kumari
- Department of Molecular Microbiology and Infectious Diseases, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Eugenia Silva-Herzog
- Department of Molecular Microbiology and Infectious Diseases, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Lourdes Ramirez
- Department of Biological Sciences, College of Arts & Sciences, Florida International University, Miami, Florida, United States of America
| | - Kalai Mathee
- Department of Molecular Microbiology and Infectious Diseases, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
- * E-mail:
| |
Collapse
|
10
|
Tseng LP, Juan CY, Lin SL, Doran MR, Lin JJ, Hsu SH, Liao JW, Shen CI, Su HL. Nanohybrids of silver particles on clay platelets delaminate Pseudomonas biofilms. Nanomedicine (Lond) 2014; 9:1019-33. [DOI: 10.2217/nnm.13.53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To evaluate the effectiveness of novel nanohybrids, composed of silver nanoparticles and nanoscale silicate platelets, to clear Pseudomonas aeruginosa biofilms. Materials & methods: The nanohybrids were manufactured from an in situ reduction of silver salts in the silicate platelet dispersion, and then applied to biofilms in vitro and in vivo. Results: In reference to the biocidal effects of gentamycin, the nanohybrids mitigated the spreading of the biofilms, and initiated robust cell death and exfoliation from the superficial layers of the biofilms in vitro. In vivo, the nanohybrids exhibited significant therapeutic effects by eliminating established biofilms from infected corneas and promoting the recovery of corneal integrity. Conclusion: All of the evaluations indicate the high potency of the newly developed silver nanoparticle/nanoscale silicate platelet nanohybrids for eliminating biofilms. Original submitted 6 June 2012; revised submitted 13 February 2013
Collapse
Affiliation(s)
- Li-Ping Tseng
- Department of Life Sciences, National Chung Hsing University, Taiwan
| | - Chih-Yin Juan
- Department of Life Sciences, National Chung Hsing University, Taiwan
| | - Shiun-Long Lin
- Department of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Michael R Doran
- Stem Cell Therapies Laboratory, Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Jiang-Jen Lin
- Institute of Polymer Science & Engineering, National Taiwan University, Taipei, Taiwan
| | - Shan-Hui Hsu
- Institute of Polymer Science & Engineering, National Taiwan University, Taipei, Taiwan
| | - Jiunn-Wang Liao
- Graduate Institute of Veterinary Pathobiology, National Chung Hsing University, Taichung, Taiwan
| | - Ching-I Shen
- Department of Chemistry, Agricultural Biotechnology Center, National Chung Hsing University, Taichung, Taiwan
| | - Hong-Lin Su
- Department of Life Sciences, National Chung Hsing University, Taiwan
- Department of Physical Therapy, China Medical University, Taichung, Taiwan
| |
Collapse
|
11
|
Schmidtchen A, Holst E, Tapper H, Björck L. Elastase-producing Pseudomonas aeruginosa degrade plasma proteins and extracellular products of human skin and fibroblasts, and inhibit fibroblast growth. Microb Pathog 2003; 34:47-55. [PMID: 12620384 DOI: 10.1016/s0882-4010(02)00197-3] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Leg ulcers of venous origin represent a disease affecting 0.1-0.2% of the population. It is known that almost all chronic ulcers are colonized by different bacteria, such as staphylococci, enterococci and Pseudomonas aeruginosa. We here report that P. aeruginosa, expressing the major metalloproteinase elastase, induces degradation of complement C3, various antiproteinases, kininogens, fibroblast proteins, and proteoglycans (PG) in vitro, thus mimicking proteolytic activity previously identified in chronic ulcer fluid in vivo. Elastase-producing P. aeruginosa isolates were shown to significantly degrade human wound fluid as well as human skin proteins ex vivo. Elastase-containing conditioned P. aeruginosa medium and purified elastase inhibited fibroblast cell growth. These effects, in conjunction with the finding that proteinase production was detected in wound fluid ex vivo, suggest that bacterial proteinases play a pathogenic role in chronic ulcers.
Collapse
Affiliation(s)
- Artur Schmidtchen
- Section for Dermatology, Department of Medical Microbiology, Dermatology and Infection, Biomedical Center B14, Lund University, Tornavägen 10, S-22184 Lund, Sweden.
| | | | | | | |
Collapse
|
12
|
Zegans ME, Becker HI, Budzik J, O'Toole G. The role of bacterial biofilms in ocular infections. DNA Cell Biol 2002; 21:415-20. [PMID: 12167244 DOI: 10.1089/10445490260099700] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There is increasing evidence that bacterial biofilms play a role in a variety of ocular infections. Bacterial growth is characterized as a biofilm when bacteria attach to a surface and/or to each other. This is distinguished from a planktonic or free-living mode of bacterial growth where these interactions are not present. Biofilm formation is a genetically controlled process in the life cycle of bacteria resulting in numerous changes in the cellular physiology of the organism, often including increased antibiotic resistance compared to growth under planktonic conditions. The presence of bacterial biofilms has been demonstrated on many medical devices including intravenous catheters, as well as materials relevant to the eye such as contact lenses, scleral buckles, suture material, and intraocular lenses. Many ocular infections often occur when such prosthetic devices come in contact with or are implanted in the eye. For instance, 56% of corneal ulcers in the United States are associated with contact lens wear. Bacterial biofilms may participate in ocular infections by allowing bacteria to persist on abiotic surfaces that come in contact with, or are implanted in the eye, and by direct biofilm formation on the biotic surfaces of the eye. An understanding of the role of bacterial biofilm formation in ocular infections may aid in the development of future antimicrobial strategies in ophthalmology. We review the current literature and concepts relating to biofilm formation and infections of the eye.
Collapse
Affiliation(s)
- Michael E Zegans
- Section of Ophthalmology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756-0001, USA.
| | | | | | | |
Collapse
|
13
|
Abstract
The editors of this Festschrift asked us to review the use of antibiotics for the treatment of bacterial conjunctivitis and keratitis over the past 25 years, a period coinciding with the life of the Castroviejo Corneal Society. We believe it is more appropriate to begin our review in the late 1960s. about the time that experimental and clinical studies and algorithms for the clinical care derived from these studies helped shape a more rigorous approach to therapy. Those years saw the introduction of antibiotics that were adapted for ophthalmic use, many of which are still being used today. We will give more weight to our review of keratitis than conjunctivitis.
Collapse
Affiliation(s)
- J Baum
- Boston Eye Associates, Chestnut Hill, MA 02467, USA
| | | |
Collapse
|
14
|
Hazes B, Sastry PA, Hayakawa K, Read RJ, Irvin RT. Crystal structure of Pseudomonas aeruginosa PAK pilin suggests a main-chain-dominated mode of receptor binding. J Mol Biol 2000; 299:1005-17. [PMID: 10843854 DOI: 10.1006/jmbi.2000.3801] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Fibers of pilin monomers (pili) form the dominant adhesin of Pseudomonas aeruginosa, and they play an important role in infections by this opportunistic bacterial pathogen. Blocking adhesion is therefore a target for vaccine development. The receptor-binding site is located in a C-terminal disulphide-bonded loop of each pilin monomer, but functional binding sites are displayed only at the tip of the pilus. A factor complicating vaccination is that different bacterial strains produce distinct, and sometimes highly divergent, pilin variants. It is surprising that all strains still appear to bind a common receptor, asialo-GM1. Here, we present the 1.63 A crystal structure of pilin from P. aeruginosa strain PAK. The structure shows that the proposed receptor-binding site is formed by two beta-turns that create a surface dominated by main-chain atoms. Receptor specificity could therefore be maintained, whilst allowing side-chain variation, if the main-chain conformation is conserved. The location of the binding site relative to the proposed packing of the pilus fiber raises new issues and suggests that the current fiber model may have to be reconsidered. Finally, the structure of the C-terminal disulphide-bonded loop will provide the template for the structure-based design of a consensus sequence vaccine.
Collapse
Affiliation(s)
- B Hazes
- Department of Medical Microbiology and Immunology, Canadian Bacterial Diseases Network, University of Alberta, Edmonton, Alberta, T6G 2H7, Canada.
| | | | | | | | | |
Collapse
|
15
|
Abstract
Endophthalmitis is an inflammatory reaction of intraocular fluids or tissues. Infectious endophthalmitis is one of the most serious complications of ophthalmic surgery. Occasionally, infectious endophthalmitis is the presenting feature of an underlying systemic infection. Successful management of infectious endophthalmitis depends on timely diagnosis and institution of appropriate therapy. Recognition of the different clinical settings in which endophthalmitis occurs and awareness of the highly variable presentation it may have facilitate timely diagnosis. Biopsy of intraocular fluid/tissue is the only method that permits reliable diagnosis and treatment. The different presenting clinical settings, a rational approach to diagnosis (i.e., when, what, and how to biopsy), and the treatment of infectious endophthalmitis are reviewed.
Collapse
Affiliation(s)
- M S Kresloff
- Department of Ophthalmology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark 07103-2499, USA
| | | | | |
Collapse
|
16
|
Abstract
Corneal infections cause by micro-organisms are the most serious complications of wearing contact lenses. The paper presents the first case of contact lens-associated keratitis caused by the protozoon Acanthamoeba sp. identified in Slovenia so far. The identification of Acanthamoeba as a cause of keratitis in a soft contact lens wearer alerted us to the fact that this health issue should be given more attention in the future.
Collapse
Affiliation(s)
- J Logar
- Department of Parasitology, Institute of Microbiology and Immunology, Medical Faculty, University of Ljubljana, Slovenia
| | | |
Collapse
|
17
|
Sankaridurg PR, Willcox MD, Sharma S, Gopinathan U, Janakiraman D, Hickson S, Vuppala N, Sweeney DF, Rao GN, Holden BA. Haemophilus influenzae adherent to contact lenses associated with production of acute ocular inflammation. J Clin Microbiol 1996; 34:2426-31. [PMID: 8880493 PMCID: PMC229286 DOI: 10.1128/jcm.34.10.2426-2431.1996] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Ten episodes of adverse responses to contact lens wear, including contact lens-induced acute red eye (CLARE), in which Haemophilus influenzae was isolated from contact lenses and/or from one of the external ocular sites at the time of the event, are described. All episodes occurred in patients wearing disposable hydrogel lenses on a 6-night extended-wear schedule. Two of the patients had recurrent episodes. H. influenzae was usually isolated in large numbers, and other bacteria or fungi colonizing the contact lens or the external ocular surface were usually present in low numbers. Those patients who were colonized with H. influenzae were more than 100 times as likely to have had a CLARE or infiltrative response than those subjects who were not colonized with this bacterium. H. influenzae colonization of the contact lens and eye may be subsequent to colonization of the nasopharynx because four of the seven patients presented with fever at the time of the event, with concurrent upper respiratory tract infection. Contact lens wearers should be made aware of the potential risk of CLARE associated with the wearing of contact lenses for extended periods during and subsequent to upper respiratory tract infection.
Collapse
|
18
|
Hay J, Seal DV. Contact lens wear by hospital health care staff: is there cause for concern? J Hosp Infect 1995; 30 Suppl:275-81. [PMID: 7560962 DOI: 10.1016/0195-6701(95)90030-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Microbial keratitis can occur in association with contact lens wear. The absolute risk of infection is low but may be enhanced as a consequence of increased exposure to potentially pathogenic microbes in a hospital setting. There is variation in risk depending on type of lens worn and its modality of use. Extended-wear lenses carry the greatest risk. Pseudomonas aeruginosa and Acanthamoeba are causes of potentially devastating ocular infections in contact lens wearers. The risk of these infections could be reduced by fastidious hygiene practice. Hydrogen peroxide disinfection is recommended when a storage case is included in the care regimen. This should be cleaned thoroughly and dried prior to disinfection and never exposed to tap water. Daily wear of one-day 'disposable' soft contact lenses or use of rigid gas permeable lenses is recommended for hospital staff. Contact lenses should be removed immediately and discarded or disinfected if the eye becomes contaminated and/or use of an eyewash is required.
Collapse
Affiliation(s)
- J Hay
- Tennent Institute of Ophthalmology, Western Infirmary, Glasgow, UK
| | | |
Collapse
|
19
|
Portolés M, Refojo MF. The role of tear deposits on hydrogel contact lenses induced bacterial keratitis: Pseudomonas aeruginosa adhesives. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1994; 350:421-6. [PMID: 8030512 DOI: 10.1007/978-1-4615-2417-5_73] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- M Portolés
- Schepens Eye Research Institute, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114
| | | |
Collapse
|