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Chen X, Lv X, Yang L, Bai F, Liu X. Etiology, Pathogens, Clinical Features and Treatment of Bacterial Scleritis. Semin Ophthalmol 2023:1-8. [PMID: 36794923 DOI: 10.1080/08820538.2023.2177117] [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: 02/17/2023]
Abstract
We retrospectively reviewed literature reports on pathogens, clinical features, diagnosis, treatment, and clinical and visual outcomes in patients with bacterial scleritis over the past decade. Eye surgery and trauma are the most common causes of bacterial infections. Subtenon triamcinolone acetonide injection, intravitreal ranibizumab, and wearing contact lenses are also causes of bacterial scleritis. Pseudomonas aeruginosa is the most common pathogenic microorganism causing bacterial scleritis. Mycobacterium tuberculosis ranks second. The main symptoms of bacterial scleritis are red and painful eyes. The patient's visual acuity decreased significantly. Bacterial scleritis caused by Pseudomonas aeruginosa often manifests as necrotizing scleritis, tuberculous scleritis and syphilitic scleritis are mostly nodular scleritis. Bacterial scleritis often involves the cornea, and approximately 37.6% (32 eyes) of patients had corneal bacterial infection. Hyphema was present in 18.8% (16 eyes). Elevated intraocular pressure was observed in 36.5% (31 eyes) of patients. Bacterial culture was an effective method of diagnosis. Most bacterial scleritis cases require both aggressive medical and surgical treatment, and the drug choice must be based on antibiotic susceptibility testing.
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Affiliation(s)
- Xiangtong Chen
- Ophthalmologic Center of the Second Hospital, Jilin University, Changchun, P.R. China.,Clinical College, Jilin University, Changchun, P.R. China
| | - Xueman Lv
- Department of Ophthalmology, China-Japan Union Hospital of Jilin University, Changchun, P.R. China
| | - Li Yang
- Ophthalmologic Center of the Second Hospital, Jilin University, Changchun, P.R. China
| | - Feng Bai
- Ophthalmologic Center of the Second Hospital, Jilin University, Changchun, P.R. China
| | - Xiaoli Liu
- Ophthalmologic Center of the Second Hospital, Jilin University, Changchun, P.R. China
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Cunha LPD, Juncal V, Carvalhaes CG, Leão SC, Chimara E, Freitas D. Nocardial scleritis: A case report and a suggested algorithm for disease management based on a literature review. Am J Ophthalmol Case Rep 2018; 10:1-5. [PMID: 29780901 PMCID: PMC5956651 DOI: 10.1016/j.ajoc.2018.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 11/02/2017] [Accepted: 01/08/2018] [Indexed: 01/10/2023] Open
Abstract
Purpose To report a case of nocardial scleritis and to propose a logical treatment algorithm based on a literature review. Observations It is important to suspect a nocardial infection when evaluating anterior unilateral scleritis accompanied by multiple purulent or necrotic abscesses, especially in male patients with a history of chronic ocular pain and redness, trauma inflicted by organic materials, or recent ophthalmic surgery. A microbiological investigation is essential. In positive cases, a direct smear reveals weakly acid-fast organisms or Gram-positive, thin, beading and branching filaments. Also, the organism (usually) grows on blood agar and Lowenstein-Jensen plates. An infection can generally be fully resolved by debridement of necrotic areas and application of topical amikacin drops accompanied by systemic sulfamethoxazole-trimethoprim. Conclusions and significance Together with the case report described, we review data on a total of 43 eyes with nocardial scleritis. Our proposed algorithm may afford a useful understanding of this sight-threatening disease, facilitating easier and faster diagnosis and management.
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Affiliation(s)
- Laura Pires da Cunha
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Universidade Federal de São Paulo, Hospital São Paulo. 821, Botucatu Street, São Paulo, SP, Brazil
| | - Verena Juncal
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Universidade Federal de São Paulo, Hospital São Paulo. 821, Botucatu Street, São Paulo, SP, Brazil
| | - Cecília Godoy Carvalhaes
- Department of Microbiology, Immunology and Parasitology, Escola Paulista de Medicina, Universidade Federal de São Paulo. 715, Napoleão de Barros Street, São Paulo, SP, Brazil
| | - Sylvia Cardoso Leão
- Department of Microbiology, Immunology and Parasitology, Escola Paulista de Medicina, Universidade Federal de São Paulo. 862, Botucatu Street, São Paulo, SP, Brazil
| | - Erica Chimara
- Tuberculosis and Mycobacteriosis Service, Instituto Adolfo Lutz. 355, Dr Arnaldo Avenue, São Paulo, SP, Brazil
| | - Denise Freitas
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Universidade Federal de São Paulo, Hospital São Paulo. 821, Botucatu Street, São Paulo, SP, Brazil
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Gonzalez A, Jennings E, Vaziri S, Yachnis AT, Kubal A. Second report of a Nocardia beijingensis infection in the United States: nodular scleritis with in vitro imipenem resistance. Digit J Ophthalmol 2016; 22:62-66. [PMID: 28924404 DOI: 10.5693/djo.02.2016.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe the case of a 52-year-old woman with scleritis caused by an imipenem-resistant strain of Nocardia beijingensis. The patient presented with pain, redness, and nodules on the sclera of 8 weeks' duration. A Gram stain from a nodule on the superonasal aspect of the globe was initially negative. After empiric treatment for an autoimmune etiology, cytopathology confirmed filamentous bacteria. A presumptive diagnosis of Nocardia scleritis was made, and medical management was based on a literature review on treatments for Nocardia infections. Cultures returned confirming Nocardia beijingensis. Antibiotic sensitivity testing confirmed the correct initial management. The patient's scleritis resolved with a good visual outcome.
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Affiliation(s)
| | - Eric Jennings
- Department of Ophthalmology, University of Florida, Gainesville
| | - Sasha Vaziri
- College of Medicine, University of Florida, Gainesville
| | | | - Anup Kubal
- Department of Ophthalmology, University of Florida, Gainesville
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Pradhan ZS, Jacob P. Infectious scleritis: clinical spectrum and management outcomes in India. Indian J Ophthalmol 2014; 61:590-3. [PMID: 24212312 PMCID: PMC3853459 DOI: 10.4103/0301-4738.121085] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In this retrospective case series, we studied the predisposing factors, causative organisms, clinical spectrum, and outcomes of 12 cases of culture-proven infectious scleritis. Nine of 12 patients had a history of preceding trauma (surgical or accidental). Past surgical history included small-incision cataract surgery (4), pterygium surgery (1), and trabeculectomy (1). Six patients had multifocal scleral abscesses due to Pseudomonas, Klebsiella, or Nocardia. Only 2 patients retained useful vision (>6/18). A poor visual acuity at presentation usually resulted in a worse visual outcome (P = 0.005). Four eyes developed phthisis. The addition of surgical intervention did not result in a significantly better visual outcome than medical management alone (P = 0.209), but resulted in a higher globe preservation rate (P = 0.045). Therefore, we concluded that infection must be ruled out in cases of scleritis with preceding history of trauma, and aggressive surgical intervention improves the anatomical outcome but does not change the visual outcome.
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Affiliation(s)
- Zia Sultan Pradhan
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
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Rush RB. Contact lens-associated nocardial necrotizing scleritis. KOREAN JOURNAL OF OPHTHALMOLOGY 2013; 27:291-3. [PMID: 23908577 PMCID: PMC3730073 DOI: 10.3341/kjo.2013.27.4.291] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 10/31/2011] [Indexed: 11/25/2022] Open
Abstract
A 52 year-old, contact lens-wearing man presented with progressive right eye pain and redness for one month. He had been evaluated and treated for necrotizing scleritis by multiple eye care specialists prior to presentation. He underwent a complete systemic work-up for both autoimmune and infectious causes of scleritis, including a culture. The culture revealed heavy growth of Nocardia asteroides complexes. The patient was treated with topical amikacin and oral Bactrim. Following several weeks of antibiotic treatment, the patient's infection resolved completely, and his visual acuity returned to baseline status. Nocardia is a rare but potentially devastating cause of necrotizing scleritis that may affect contact lens wearers without an associated keratitis. Prompt recognition and early treatment with appropriate antimicrobial agents are critical to achieve a favorable outcome.
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Affiliation(s)
- Ryan B Rush
- Southwest Retina Specialists, Amarillo, TX 79106, USA.
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Biswas J, Aparna A, Radha A, Vaijayanthi K, Bagyalakshmi R. Tuberculous Scleritis in a Patient with Rheumatoid Arthritis. Ocul Immunol Inflamm 2011; 20:49-52. [DOI: 10.3109/09273948.2011.628195] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Nocardia scleritis-clinical presentation and management: a report of three cases and review of literature. J Ophthalmic Inflamm Infect 2011; 2:7-11. [PMID: 21984396 PMCID: PMC3303001 DOI: 10.1007/s12348-011-0043-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Accepted: 09/22/2011] [Indexed: 12/03/2022] Open
Abstract
Aim This study aims to describe the clinical features and management of Nocardia scleritis. Methods The authors retrospectively reviewed medical charts of three patients with microbiologically proven Nocardia scleritis and reviewed literature. Results All the patients presented with areas of well-demarcated, circumscribed abscess. No specific clinical feature could be attributed to the causative organism. Nocardia was identified by smear and culture from the scleral exudates. The medical management was based on the antibiotic sensitivity. Surgical exploration of the suppurated area along with the healthy margins was done on all patients. Two patients required multiple explorations. All three patients resolved with a good visual and tectonic outcome. The literature review also suggests a good outcome with prolonged medical management though the preferred antibiotic has changed over the years. Conclusion Though the prevalence of a disease like Nocardia scleritis is low, the results suggest that specific diagnosis and appropriate management can lead to a good outcome.
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Maruo H, Shiraishi A, Hara Y, Maruo Y, Ohashi Y. Necrotizing Nocardial Scleritis Successfully Treated with Surgical Debridement and Topical Polyvinyl Alcohol Iodine and Antibiotics. J Ocul Pharmacol Ther 2011; 27:415-8. [DOI: 10.1089/jop.2011.0043] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Atsushi Shiraishi
- Department of Ophthalmology and Regenerative Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
- Department of Cell Growth and Tumor Regulation, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yuko Hara
- Department of Ophthalmology, Ehime University Graduate School of Medicine, Ehime, Japan
| | | | - Yuichi Ohashi
- Department of Ophthalmology, Ehime University Graduate School of Medicine, Ehime, Japan
- Department of Infectious Diseases, Ehime University Graduate School of Medicine, Ehime, Japan
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DeCroos FC, Garg P, Reddy AK, Sharma A, Krishnaiah S, Mungale M, Mruthyunjaya P. Optimizing Diagnosis and Management of Nocardia Keratitis, Scleritis, and Endophthalmitis: 11-Year Microbial and Clinical Overview. Ophthalmology 2011; 118:1193-200. [DOI: 10.1016/j.ophtha.2010.10.037] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 10/21/2010] [Accepted: 10/25/2010] [Indexed: 10/18/2022] Open
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Jain V, Garg P, Sharma S. Microbial scleritis—experience from a developing country. Eye (Lond) 2008; 23:255-61. [DOI: 10.1038/sj.eye.6703099] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Das S, Saunders M, Cheng AC, Whiting M. Nodular non-necrotising anterior scleritis due to Nocardia nova infection. Eye (Lond) 2006; 21:276-8. [PMID: 16878113 DOI: 10.1038/sj.eye.6702524] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Abstract
Scleritis is typically a severe painful inflammatory process centered in the sclera that may involve the cornea, adjacent episclera, and underlying uvea; it poses a significant threat to vision. Careful clinical history taking, detailed ocular examination, appropriate investigation for ocular disease with or without underlying systemic disease, and timely intervention with the use of immunosuppressant drugs when necessary, has improved the long-term outcome for patients with this disease.
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Affiliation(s)
- Narciss Okhravi
- Department of Clinical Ophthalmology, Institute of Ophthalmology, Moorfields Eye Hospital, City Road, London EC1V 2PD, United Kingdom
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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.
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Affiliation(s)
- M S Sridhar
- Cornea Center, L.V. Prasad Eye Institute, Hyderabad, India
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