1
|
Schulgit M, Mammo DA, Srivastava SK. Postoperative Inflammation After Anterior Segment Surgery. JAMA Ophthalmol 2024; 142:486-487. [PMID: 38573613 DOI: 10.1001/jamaophthalmol.2024.0580] [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: 04/05/2024]
Abstract
A 71-year-old woman had 2 months of worsening vision and pain in her right eye. Examination revealed retrocorneal plaque, peaking of the pupil, and temporal prominent scleral vessels with inferotemporal scleral thinning. What would you do next?
Collapse
Affiliation(s)
- Matthew Schulgit
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Danny A Mammo
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | | |
Collapse
|
2
|
Maheshwari S, Parakh S, Das SM, Ahuja A, Jha SN, Agrawal R, Gupta V, Luthra S. Multifocal Serpiginoid Choroiditis Due to Mycobacterium Mageritense following Laparoscopic Hysterectomy in an Immunocompetent Host. Ocul Immunol Inflamm 2023; 31:236-241. [PMID: 35050821 DOI: 10.1080/09273948.2021.2018713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To report nontubercular choroiditis, caused by Mycobacterium mageritense isolated using MALDI-TOF MS, following laparoscopic hysterectomy in an immunocompetent patient. CASE REPORT A 42-year-old female presented with gradual, painless diminution of vision in the right eye for six weeks. She had undergone laparoscopic hysterectomy two months back. BCVA was 2/60 OD. Clinical presentation and imaging all pointed to a diagnosis of serpiginous-like choroiditis. Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS) had led to isolation of Mycobacterium mageritense. Patient was treated with systemic antibiotics. At 3 months follow up, BCVA improved to 6/60; fundus showed healed choroiditis and chorioretinal thinning. CONCLUSION Atypical mycobacterial infections associated with laparoscopic surgeries can rarely lead to debilitating systemic bacteremia resulting in profound visual impairment. The importance of timely diagnosis using specific and sophisticated methods such as MALDI-TOF MS as well as maintaining aseptic precautions perioperatively during major surgeries cannot be overemphasized.
Collapse
Affiliation(s)
| | - Shweta Parakh
- Drishti Eye Institute, Drishti Eye Institute, Dehradun, India
| | | | - Alok Ahuja
- Dr. Ahuja's Pathology and Imaging Centre, Dr. Ahuja's Pathology and Imaging Centre, Dehradun, India
| | - Shashi Nath Jha
- Sir Ganga Ram Hospital, Sir Ganga Ram Hospital, New Delhi, India
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saurabh Luthra
- Drishti Eye Institute, Drishti Eye Institute, Dehradun, India
| |
Collapse
|
3
|
Mosenia A, Nguyen AH, Mandel MR, Seitzman GD. Nocardia sienata: a new causative species of infectious keratitis. BMJ Case Rep 2022; 15:e247850. [PMID: 35338040 PMCID: PMC8961103 DOI: 10.1136/bcr-2021-247850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 11/03/2022] Open
Abstract
A 25-year-old man presented with a 2-month history of progressively worsening left eye pain and an atypical corneal ring infiltrate. His condition deteriorated despite topical antibiotic therapy. Cultures for bacteria, fungus and acanthamoeba, repeated twice, all demonstrated no growth. On third corneal scraping, culture on Middlebrook agar grew colonies after 3 weeks of incubation. Sixteen-second deep sequencing identified Nocardia sienata as the pathogen. This species of Nocardia has not previously been described as a causative pathogen for infectious keratitis. Sloughing and loose epithelium with recurrent filament formation are unusual in infectious keratitis and could be associated with this species. In culture-negative cases, clinicians should consider Nocardia as a cause of keratitis despite its rarity outside of south Asia and use steroids cautiously. Next generation sequencing technology may facilitate identification of the causate of keratitis and can be especially useful in culture-negative cases and with unexpected pathogens.
Collapse
Affiliation(s)
- Arman Mosenia
- School of Medicine, UC San Francisco, San Francisco, California, USA
| | - Anh H Nguyen
- University of California San Francisco, San Francisco, California, USA
| | - Mark R Mandel
- California Pacific Medical Center, San Francisco, California, USA
| | - Gerami D Seitzman
- Ophthalmology, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
4
|
Sharma K, Menia N, Bajgai P, Sharma M, Sharma A, Katoch D, Singh R. Nontubercular Mycobacteria Associated Uveitis in HIV Positive Patients. Ocul Immunol Inflamm 2020; 30:21-28. [PMID: 32813606 DOI: 10.1080/09273948.2020.1788610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To report clinical features and outcomes of nontuberculous mycobacteria (NTM) presenting as uveitis in HIV positive patients. MATERIALS AND METHODS Retrospective study of HIV positive patients who were diagnosed as uveitis due to NTM. RESULTS Six eyes of four HIV positive patients with NTM were studied. Average age at presentation was 35.5 years (range 30-38). With specific PCR primers, Mycobacterium avium was detected in three patients (75%) and Mycobacterium fortuitum in one patient (25%). Culture was positive in two cases. Two eyes (33.33%) each had endophthalmitis and necrotizing retinitis like picture, one eye (16.66%) each had chorioretinitis and frosted branch angitis like. Visual acuity improved in two eyes (33.33%), worsened in three eyes (50%), and remained unchanged in one eye (16.6%). CONCLUSIONS NTM infection is a unique entity in immunosuppressed with poor visual outcome. PCR forms a useful tool for rapid diagnosis and timely initiation of specific anti-tuberculosis therapy.
Collapse
Affiliation(s)
- Kusum Sharma
- Department of Microbiology, Post Graduate Institute Medical Education and Research, Chandigarh, India
| | - Nitin Menia
- Advanced Eye Centre, Post Graduate Institute Medical Education and Research, Chandigarh, India
| | - Priya Bajgai
- Department of Ophthalmology, Vitreoretina and Uveitis Services, Nepal Eye Hospital, Kathmandu, Nepal
| | - Megha Sharma
- Department of Microbiology, Post Graduate Institute Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Post Graduate Institute Medical Education and Research, Chandigarh, India
| | - Deeksha Katoch
- Advanced Eye Centre, Post Graduate Institute Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Advanced Eye Centre, Post Graduate Institute Medical Education and Research, Chandigarh, India
| |
Collapse
|
5
|
Egrilmez S, Yildirim-Theveny Ş. Treatment-Resistant Bacterial Keratitis: Challenges and Solutions. Clin Ophthalmol 2020; 14:287-297. [PMID: 32099313 PMCID: PMC6996220 DOI: 10.2147/opth.s181997] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 12/10/2019] [Indexed: 12/18/2022] Open
Abstract
Bacterial keratitis is an important ophthalmic emergency and one of the most common causes of corneal blindness. The main causes of treatment resistance in bacterial keratitis are failure to eliminate predisposing factors, misdiagnosis and mistreatment. At first, exogenous, local and systemic predisposing factors that disturbing ocular surface must be eliminated to improve corneal ulcers and to prevent recurrences. Smears and scrapings for staining and culture are indispensable diagnostic tools for cases of sight-threatening keratitis (centrally located, multifocal, characterized by melting, painful). Main treatment agents in bacterial keratitis treatment are topical antibiotics. Until the results of culture antibiograms reach the ophthalmologist, empirical antibiotic selections based on direct microscopic examination and gram stain findings are the most appropriate initial treatment approach currently. S. aureus and coagulase-negative staphylococci (CoNS), the most common gram-positive agents, have resistance rates of more than 30% for fluoroquinolone and methicillin. Multidrug resistance rates are similarly high in these microorganisms. P. aeruginosa is the most common gram-negative micro-organism, in case of multidrug-resistant isolates, both functional and anatomical prognosis of the eyes are very poor. In cases of sight-threatening and resistant keratitis, antibiotic susceptibility testing containing imipenem, colistin, and linezolid is seeming to be an important requirement. Despite its efficiency limited to superficial cases, a nonpharmaceutical anti-infective treatment option such as corneal crosslinking for bacterial keratitis is an emerging hope, while antibiotic resistance increases. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/wQSeNbG9dtI
Collapse
|
6
|
Buchieri MV, Cimino M, Rebollo-Ramirez S, Beauvineau C, Cascioferro A, Favre-Rochex S, Helynck O, Naud-Martin D, Larrouy-Maumus G, Munier-Lehmann H, Gicquel B. Nitazoxanide Analogs Require Nitroreduction for Antimicrobial Activity in Mycobacterium smegmatis. J Med Chem 2017; 60:7425-7433. [PMID: 28846409 DOI: 10.1021/acs.jmedchem.7b00726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In this study, we aimed to decipher the natural resistance mechanisms of mycobacteria against novel compounds isolated by whole-cell-based high-throughput screening (HTS). We identified active compounds using Mycobacterium aurum. Further analyses were performed to determine the resistance mechanism of M. smegmatis against one hit, 3-bromo-N-(5-nitrothiazol-2-yl)-4-propoxybenzamide (3), which turned out to be an analog of the drug nitazoxanide (1). We found that the repression of the gene nfnB coding for the nitroreductase NfnB was responsible for the natural resistance of M. smegmatis against 3. The overexpression of nfnB resulted in sensitivity of M. smegmatis to 3. This compound must be metabolized into hydroxylamine intermediate for exhibiting antibacterial activity. Thus, we describe, for the first time, the activity of a mycobacterial nitroreductase against 1 analogs, highlighting the differences in the metabolism of nitro compounds among mycobacterial species and emphasizing the potential of nitro drugs as antibacterials in various bacterial species.
Collapse
Affiliation(s)
- Maria V Buchieri
- Unité de Génétique Mycobactérienne, Institut Pasteur , 25 Rue du Docteur Roux, 75724 Paris Cedex 15, France
| | - Mena Cimino
- Unité de Génétique Mycobactérienne, Institut Pasteur , 25 Rue du Docteur Roux, 75724 Paris Cedex 15, France
| | - Sonia Rebollo-Ramirez
- MRC Centre for Molecular Bacteriology & Infection, Imperial College London , London SW7 2AZ, United Kingdom
| | - Claire Beauvineau
- PSL Research University,CNRS, INSERM, Chemical Library, Institut Curie UMR9187/U1196, UMR3666/U1143 , 91405 Orsay Cedex, France
| | - Alessandro Cascioferro
- Unité de Pathogénomique Mycobactérienne Intégrée, Institut Pasteur , 75724 Paris Cedex 15, France
| | - Sandrine Favre-Rochex
- Unité de Génétique Mycobactérienne, Institut Pasteur , 25 Rue du Docteur Roux, 75724 Paris Cedex 15, France
| | - Olivier Helynck
- Unité de Chimie et Biocatalyse, Département de Biologie Structurale et Chimie, Institut Pasteur , 25 Rue du Docteur Roux, 75724 Paris Cedex 15, France
| | - Delphine Naud-Martin
- PSL Research University,CNRS, INSERM, Chemical Library, Institut Curie UMR9187/U1196, UMR3666/U1143 , 91405 Orsay Cedex, France
| | - Gerald Larrouy-Maumus
- MRC Centre for Molecular Bacteriology & Infection, Imperial College London , London SW7 2AZ, United Kingdom
| | - Hélène Munier-Lehmann
- Unité de Chimie et Biocatalyse, Département de Biologie Structurale et Chimie, Institut Pasteur , 25 Rue du Docteur Roux, 75724 Paris Cedex 15, France
| | - Brigitte Gicquel
- Unité de Génétique Mycobactérienne, Institut Pasteur , 25 Rue du Docteur Roux, 75724 Paris Cedex 15, France
| |
Collapse
|
7
|
Discovery of novel antimycobacterial drug therapy in biofilm of pathogenic nontuberculous mycobacterial keratitis. Ocul Surf 2017; 15:770-783. [PMID: 28662943 DOI: 10.1016/j.jtos.2017.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/14/2017] [Accepted: 06/24/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE The potential of slow-growing mycobacteria to form biofilms in human tissues contributes to the problem of establishing an effective treatment strategy. The purpose of this study was to examine new antibiotic strategies to enhance current treatment options for these infections. METHODS Sensitivities of Mycobacterium fortuitum ATCC 49404 and Mycobacterium chelonae ATCC 35752 were evaluated for different antimicrobials singly and in combination using broth microdilution and FICI (Fractional Inhibitory Concentration Index) synergy screening. Anti-biofilm effects were evaluated in an 8-well chamber slide biofilm model. The efficacy of a new treatment strategy was validated using the novel neutropenic mouse keratitis model and monitored by slit-lamp microscopy, confocal microscopy, and colony forming unit measurements. RESULTS We reported the very first evidence that these organisms develop corneal biofilms by the accumulation of extracellular DNA (eDNA) and the presence of microcolonies using a novel mycobacterial neutropenic mouse keratitis model. The combination of amikacin and gatifloxacin or besifloxacin was more effective than the current gold-standard drug, amikacin, and we developed a novel treatment strategy (amikacin + gatifloxacin + DNase), the destruction of biofilm matrix component, eDNA, which increased the efficacy of the new antibiotic combination for treating mycobacterial infection in in vitro (P = 0.002) and in vivo (P = 0.001) compared to its respective control. CONCLUSION Biofilms have a role in mycobacterial keratitis leading to poor treatment outcomes in clinical practice and the use of combination therapy (amikacin + gatifloxacin + DNase) could be a useful new treatment option.
Collapse
|
8
|
Nontuberculous Mycobacterial Ocular Infections: A Systematic Review of the Literature. BIOMED RESEARCH INTERNATIONAL 2015; 2015:164989. [PMID: 26106601 PMCID: PMC4461732 DOI: 10.1155/2015/164989] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 02/20/2015] [Accepted: 02/20/2015] [Indexed: 11/01/2022]
Abstract
Nontuberculous or atypical mycobacterial ocular infections have been increasing in prevalence over the past few decades. They are known to cause periocular, adnexal, ocular surface and intraocular infections and are often recalcitrant to medical therapy. These infections can potentially cause detrimental outcomes, in part due to a delay in diagnosis. We review 174 case reports and series on nontuberculous mycobacterial (NTM) ocular infections and discuss etiology, microbiology, risk factors, diagnosis, clinical presentation, and treatment of these infections. History of interventions, trauma, foreign bodies, implants, contact lenses, and steroids are linked to NTM ocular infections. Steroid use may prolong the duration of the infection and cause poorer visual outcomes. Early diagnosis and initiation of treatment with multiple antibiotics are necessary to achieve the best visual outcome.
Collapse
|
9
|
Moorthy RS, Valluri S, Rao NA. Nontuberculous mycobacterial ocular and adnexal infections. Surv Ophthalmol 2012; 57:202-35. [PMID: 22516536 DOI: 10.1016/j.survophthal.2011.10.006] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 10/01/2011] [Accepted: 10/04/2011] [Indexed: 10/28/2022]
Abstract
The nontuberculous (also called "atypical") mycobacteria have become increasingly important causes of systemic as well as ocular morbidity in recent decades. All ocular tissues can become infected with these organisms, particularly in patients who are predisposed following ocular trauma, surgery, use of corticosteroids, or are immunocompromised. Because of their relative resistance to available antibiotics, multidrug parenteral therapy continues to be the mainstay of treatment of more serious ocular and adnexal infections caused by nontuberculous mycobacteria (NTM). Periocular cutaneous, adnexal, and orbital NTM infections remain rare and require surgical debridement and long-term parenteral antibiotic therapy. NTM scleritis may occur after trauma or scleral buckling and can cause chronic disease that responds only to appropriate antibiotic therapy and, in some cases, surgical debridement and explant removal. NTM infectious keratitis following trauma or refractive surgical procedures is commonly confused with other infections such as Herpes simplex keratitis and requires aggressive topical therapy and possible surgical debridement, particularly in those cases occuring after laser in situ keratomileusis. Only 18 cases of endophthalmitis due to NTM have been reported. Systemic and intraocular antibiotic therapy and multiple vitrectomies may be needed in NTM endophthalmitis; the prognosis remains poor, however. Disseminated NTM choroiditis in acquired immune deficiency syndrome patients with immune reconstitution during highly active anti-retroviral therapy is a rare infection that can present as a necrotizing chorioretinitis with dense vitritis, mimicking many other entities and needs to be recognized so that timely, life-saving treatment can be administered. Regardless of which ocular tissue is infected, all NTM ocular infections present similar challenges of recognition and of therapeutic intervention. We clarify diagnosis and delineate modern, effective therapy for these conditions.
Collapse
Affiliation(s)
- Ramana S Moorthy
- Indiana University Medical Center, Department of Ophthalmology, Vincent Hospital, Indianapolis, IN 46260, USA.
| | | | | |
Collapse
|
10
|
Mycobacterium abscessus corneal ulcer following sutured clear corneal cataract incision. Jpn J Ophthalmol 2010; 54:499-500. [DOI: 10.1007/s10384-010-0846-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 04/26/2010] [Indexed: 11/26/2022]
|
11
|
Abstract
PURPOSE To describe the microbiologic diagnosis of putative Mycobacterium chelonae keratitis in a soft contact lens wearer by initial evaluation of Gram- and Kinyoun (acid fast)-stained smears of fluid from patient's contact lens care system. METHODS Corneal ulcer of suspected Acanthamoeba etiology developed in a 28-year-old soft contact lens wearer. After corneal scrapings were negative, microbiologic consultation led to evaluation of stained smears and culture of fluid from patient's contact lens care system. RESULTS Gram stain of smears showed a polymicrobic flora distinguished by numerous gram-positive, beaded, tightly banded, "diphtheroid-like" bacilli strongly suggestive of a rapidly growing mycobacterial species. Kinyoun-stained smears revealed innumerable acid-fast bacilli singly and in tightly woven bundles (cords), which culturally proved to be M. chelonae. Treatment with ciprofloxacin and amikacin resolved the ulcer. CONCLUSION Diagnosis of M. chelonae keratitis in contact lens wearers is often delayed or even overlooked. Additionally, in the absence of overt corneal injury, eg, trauma or surgery, a source for the infecting mycobacterial species in the setting of contact lens wear has not been identified. If searched for, however, as in the present case, the patient's contact lens care system may serve as the reservoir for the microorganism. Staining for acid-fast bacilli is further recommended when smears of contact lens care solution of a patient with a corneal ulcer shows the presence of gram-positive "diphtheroid-like" organisms.
Collapse
Affiliation(s)
- Edward J Bottone
- Division of Infectious Diseases, The Mount Sinai Hospital, New York, NY 10029, USA.
| | | |
Collapse
|
12
|
Adan CBD, Sato EH, Sousa LB, Oliveira RS, Leão SC, Freitas D. An experimental model of mycobacterial infection under corneal flaps. Braz J Med Biol Res 2004; 37:1015-21. [PMID: 15264008 DOI: 10.1590/s0100-879x2004000700010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In order to develop a new experimental animal model of infection with Mycobacterium chelonae in keratomileusis, we conducted a double-blind prospective study on 24 adult male New Zealand rabbits. One eye of each rabbit was submitted to automatic lamellar keratotomy with the automatic corneal shaper under general anesthesia. Eyes were immunosuppressed by a single local injection of methyl prednisolone. Twelve animals were inoculated into the keratomileusis interface with 1 microl of 10(6) heat-inactivated bacteria (heat-inactivated inoculum controls) and 12 with 1 microl of 10(6) live bacteria. Trimethoprim drops (0.1%, w/v) were used as prophylaxis for the surgical procedure every 4 h (50 microl, qid). Animals were examined by 2 observers under a slit lamp on the 1st, 3rd, 5th, 7th, 11th, 16th, and 23rd postoperative days. Slit lamp photographs were taken to document clinical signs. Animals were sacrificed when corneal disease was detected and corneal samples were taken for microbiological analysis. Eleven of 12 experimental rabbits developed corneal disease, and M. chelonae could be isolated from nine rabbits. Eleven of the 12 controls receiving a heat-inactivated inoculum did not develop corneal disease. M. chelonae was not isolated from any of the control rabbits receiving a heat-inactivated inoculum, or from the healthy cornea of control rabbits. Corneal infection by M. chelonae was successfully induced in rabbits submitted to keratomileusis. To our knowledge, this is the first animal model of M. chelonae infection following corneal flaps for refractive surgery to be described in the literature and can be used for the analysis of therapeutic responses.
Collapse
Affiliation(s)
- C B D Adan
- Departamento de Oftalmologia, Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil.
| | | | | | | | | | | |
Collapse
|
13
|
Daines BS, Vroman DT, Sandoval HP, Steed LL, Solomon KD. Rapid diagnosis and treatment of mycobacterial keratitis after laser in situ keratomileusis. J Cataract Refract Surg 2003; 29:1014-8. [PMID: 12781292 DOI: 10.1016/s0886-3350(02)01613-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report the results of laser in situ keratomileusis (LASIK) in a 51-year-old woman with subsequent mycobacterial keratitis diagnosed by staining with acid-fast and fluorochrome methods, a technique known to have good sensitivity and specificity for mycobacteria. A rapid diagnosis was made without waiting for cultures, and treatment was instituted, including tapering of topical steroids and appropriate antibiotic therapy. The result was preservation of the LASIK flap and a favorable visual outcome at 6 months.
Collapse
Affiliation(s)
- Bradley S Daines
- Magill Research Center for Vision Correction, Department of Ophthalmology, Storm Eye Institute, 167 Ashley Avenue, Charleston, SC 29425, USA
| | | | | | | | | |
Collapse
|
14
|
Becero F, Maestre JR, Buezas V, Sánchez P, Martínez L, Ortigueira R. [Keratitis due to Mycobacterium chelonae after refractive surgery with LASIK]. Enferm Infecc Microbiol Clin 2002; 20:44-5. [PMID: 11820986 DOI: 10.1016/s0213-005x(02)72736-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
15
|
Sridhar MS, Gopinathan U, Garg P, Sharma S, Rao GN. Ocular nocardia infections with special emphasis on the cornea. Surv Ophthalmol 2001; 45:361-78. [PMID: 11274691 DOI: 10.1016/s0039-6257(00)00207-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Nocardia are aerobic, gram-positive, nonmotile and branching filamentous bacteria. Corneal infection by Nocardia is rare. Trauma is the most common predisposing factor. Isolated case reports of nocardial infection associated with contact lens wear and laser in situ keratomileusis (LASIK) have been reported. The clinical picture usually consists of superficial patchy infiltrates, which may be arranged in a wreath pattern. Presence of gram-positive, branching, beaded filaments that stain with 1% acid-fast stain (using 1% sulfuric acid, modified Kinyoun's method) in smears of corneal scrapings is suggestive of nocardial infection. Nocardia grow on commonly used media as tiny, white, dry colonies. Available knowledge and clinical experience suggest that although sulfacetamide eyedrops can be tried as the initial drug, trimethoprim-sulfamethoxazole and amikacin are effective drugs. Once therapy is initiated, the infiltrate responds promptly and resolves, forming a corneal scar with or without vascularization, and good visual recovery can be expected.
Collapse
Affiliation(s)
- M S Sridhar
- Cornea Center, L.V. Prasad Eye Institute, Hyderabad, India
| | | | | | | | | |
Collapse
|
16
|
Abstract
OBJECTIVE To review the epidemiology, clinical manifestations, diagnosis, and treatment of nontuberculous mycobacterial infections other than Mycobacterium avium complex (MAC). DATA SOURCES A MEDLINE search of English-language literature pertaining to nontuberculous mycobacteria other than MAC was performed. Additional literature was obtained from reference lists of pertinent articles identified through the search. STUDY SELECTION AND DATA EXTRACTION All articles were considered for possible inclusion in the review. Information judged by the author to be pertinent was selected for discussion. DATA SYNTHESIS Mycobacterial infections, including those caused by nontuberculous mycobacteria other than MAC, have assumed greater importance over the past decade, due in part to the changing spectrum of immunosuppression as manifested by organ transplantation and HIV infection. Many pathogenic nontuberculous mycobacteria have been identified that are associated with a wide variety of localized, organ-specific, and systemic infections. Of concern, these organisms exhibit variable, species-specific susceptibility to traditional antimycobacterial drugs and other antimicrobials. In addition, long treatment courses and adjunctive surgical therapy are often required to effect cure. Important antimicrobials for the management of these infections include cefoxitin, imipenem/cilastatin, aminoglycosides (other than streptomycin), tetracyclines, macrolides, and trimethoprim/sulfamethoxazole, as well as traditional antimycobacterials. CONCLUSIONS Nontuberculous mycobacteria have assumed an increasing role in disease etiology in both nonimmunocompromised and immunocompromised individuals. Advent of rapid diagnostic techniques and susceptibility testing has allowed the clinician to identify these organisms and initiate effective treatment on a more timely basis with an improved chance for cure. Few therapeutic agents are available for treatment of these infections, many of which are not considered classic antimycobacterials.
Collapse
Affiliation(s)
- D R Guay
- Section of Clinical Pharmacology, St. Paul-Ramsey Medical Center, MN 55101, USA
| |
Collapse
|
17
|
El-Asrar AM, Tabbara KF. Chronic endophthalmitis after extracapsular cataract extraction caused by Mycobacterium chelonae subspecies abscessus. Eye (Lond) 1995; 9 ( Pt 6):798-801. [PMID: 8849553 DOI: 10.1038/eye.1995.198] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
|
18
|
Affiliation(s)
- B D Allan
- Corneal and External Disease Service, Moorfields Eye Hospital, London
| | | |
Collapse
|