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Teh JSK, Wilke AE, Overstall SM, Teng JC, Chin R, Couper JM, Lo CA, Waring LJ, Sheffield DA. Prototheca wickerhamii breast implant infection after reconstructive surgery: a new level of complexity. Med Mycol Case Rep 2021; 34:22-26. [PMID: 34584835 PMCID: PMC8455647 DOI: 10.1016/j.mmcr.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/07/2021] [Accepted: 08/11/2021] [Indexed: 11/28/2022] Open
Abstract
We report the first published case of Prototheca wickerhamii breast implant infection. This occurred after mastectomy, chemotherapy, radiotherapy, breast reconstruction, implant revisions and breast seroma aspirations and was preceded by polymicrobial infection. Definitive treatment required implant removal and intravenous liposomal amphotericin B. The management of breast prosthesis infections is discussed.
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Affiliation(s)
- Joanne S K Teh
- Department of Perioperative Medicine, Cabrini Health, 181-183 Wattletree Road, Malvern, Victoria, 3144, Australia.,Department of General Medicine, Monash Health, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Amalie E Wilke
- Department of Infectious Diseases, Cabrini Health, 181-183 Wattletree Road, Malvern, Victoria, 3144, Australia
| | - Simon M Overstall
- Department of Plastic Surgery, Cabrini Health, 181-183 Wattletree Road, Malvern, Victoria, 3144, Australia
| | - Jasmine C Teng
- Department of Microbiology, Melbourne Pathology, 103 Victoria Parade, Collingwood, Victoria, 3066, Australia
| | - Ruth Chin
- Department of Infectious Diseases, Cabrini Health, 181-183 Wattletree Road, Malvern, Victoria, 3144, Australia
| | - Jennifer M Couper
- Department of Microbiology, Cabrini Pathology, Cabrini Health, 181-183 Wattletree Road, Malvern, Victoria, 3144, Australia
| | - Christine A Lo
- Department of Pharmacy, Cabrini Health, 181-183 Wattletree Road, Malvern, Victoria, 3144, Australia
| | - Lynette J Waring
- Department of Microbiology, Melbourne Pathology, 103 Victoria Parade, Collingwood, Victoria, 3066, Australia
| | - David A Sheffield
- Department of Infectious Diseases, Cabrini Health, 181-183 Wattletree Road, Malvern, Victoria, 3144, Australia.,Monash Infectious Diseases, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia
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Practical Guidance for Clinical Microbiology Laboratories: Diagnosis of Ocular Infections. Clin Microbiol Rev 2021; 34:e0007019. [PMID: 34076493 DOI: 10.1128/cmr.00070-19] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The variety and complexity of ocular infections have increased significantly in the last decade since the publication of Cumitech 13B, Laboratory Diagnosis of Ocular Infections (L. D. Gray, P. H. Gilligan, and W. C. Fowler, Cumitech 13B, Laboratory Diagnosis of Ocular Infections, 2010). The purpose of this practical guidance document is to review, for individuals working in clinical microbiology laboratories, current tools used in the laboratory diagnosis of ocular infections. This document begins by describing the complex, delicate anatomy of the eye, which often leads to limitations in specimen quantity, requiring a close working bond between laboratorians and ophthalmologists to ensure high-quality diagnostic care. Descriptions are provided of common ocular infections in developed nations and neglected ocular infections seen in developing nations. Subsequently, preanalytic, analytic, and postanalytic aspects of laboratory diagnosis and antimicrobial susceptibility testing are explored in depth.
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Minato K, Yoshikawa M, Nakanishi H, Hasegawa K. Long Term Follow-Up of Prototheca keratitis: A Case Report. Int Med Case Rep J 2020; 13:503-506. [PMID: 33116941 PMCID: PMC7555245 DOI: 10.2147/imcrj.s268696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/04/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Prototheca spp. are rare human pathogens, and only three cases of Prototheca keratitis have been reported. They were treated with anti-fungal drugs and surgical excision. Two of the three cases were successful, and the case of an immunocompromised patient was not successful. Thus, the best treatment of Prototheca keratitis is still undetermined, and further investigations are needed. The purpose of this report is to present our findings in a case of Prototheca keratitis that was successfully treated with topical medications without surgical excision. METHODS This study was performed in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Hidaka Medical Center, Toyooka Hospital. A written informed consent was obtained from the patient before beginning the medical treatments. CASE REPORT A 75-year-old man with a history of stage 4 prostate carcinoma and bilateral limbal stem cell deficiency had undergone keratoepithelioplasty on his left eye for the deficiency. Postoperatively, a greyish-white epithelial opacity was noted on the central cornea of his left eye, and he had been treated with topical fluorometholone and oral dexamethasone together with a therapeutic contact lens. Corneal smears and contact lens swabs were positive for Prototheca spp. He required a continuous treatment with amphotericin B (AMPH-B) ointment, topical fluconazole (FLCZ), and voriconazole (VRCZ). This treatment protocol was effective, but recurrences developed when his general condition worsened. CONCLUSION Our findings indicate that Prototheca keratitis can be successfully treated but not cured with topical AMPH-B, FLCZ, and VRCZ without surgical treatment. However, recurrences can develop when the general condition of the patient worsens. Thus, continuous monitoring and treatment are necessary in cases of Prototheca keratitis.
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Affiliation(s)
- Kazumi Minato
- Department of Ophthalmology, Eye Center, Hidaka Medical Center, Toyooka Hospital, Toyooka City, Hyogo669-5392, Japan
| | - Munemitsu Yoshikawa
- Department of Ophthalmology, Eye Center, Hidaka Medical Center, Toyooka Hospital, Toyooka City, Hyogo669-5392, Japan
| | - Hideo Nakanishi
- Department of Ophthalmology, Eye Center, Hidaka Medical Center, Toyooka Hospital, Toyooka City, Hyogo669-5392, Japan
| | - Kaori Hasegawa
- Department of Microbiology, Toyooka Hospital, Toyooka City, Hyogo668-0065, Japan
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Moyal L, Adam R, Boumendil J, Meney J, Rodallec T, Akesbi J, Nordmann JP. [Boston Keratoprosthesis with temporal aponeurosis graft: A solution when there seems to be no more]. J Fr Ophtalmol 2018; 41:830-835. [PMID: 30343989 DOI: 10.1016/j.jfo.2018.01.010] [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: 12/12/2017] [Accepted: 01/30/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To report cases of patients with severe bilateral corneal blindness and recurrent refractory perforation to keratoplasty and conventional treatment, for whom Boston keratoprosthesis (KP) was a satisfactory alternative when combined with a temporalis aponeurosis graft. DESCRIPTION OF CASES The first patient had progressive Lyell syndrome with spontaneous corneal perforation. The second had a severe graft vs. host reaction with a persistent Seidel-positive descemetocele. Despite repeated penetrating keratoplasties, amniotic membrane (AM) transplantations, and buccal mucosal (BM) grafts, they both experienced recurrent corneal perforation. The only solution thus appeared to be Boston Type I KP surgery. One month postoperatively, the first patient had to receive a temporalis aponeurosis (TA) graft, due to thinning of the recipient graft. Six months postoperatively, his visual acuity (VA) was 1/10 without correction, and the corneal status had been stabilized. The second patient underwent KP and TA graft concurrently. Six months after surgery, VA was 2/10 uncorrected, and the local inflammation had been stabilized. OBSERVATION Boston type I keratoprostheses constitute an alternative in cases of severe bilateral corneal blindness with perforation refractory to conventional treatment and surgery, with satisfactory visual results. DISCUSSION Patients with preoperative severe ocular surface disease are at greater risk of postoperative keratolysis. For our patients with a higher risk, TA graft prevented corneal melt. TA seems to be more effective than AM or BM in preventing corneal thinning or melt. CONCLUSION We would recommend performing a TA graft in combination with Boston KP surgery concurrently as first line treatment in eyes with severe ocular surface inflammation.
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Affiliation(s)
- L Moyal
- Service d'ophtalmologie II, centre hospitalier national des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France.
| | - R Adam
- Service d'ophtalmologie II, centre hospitalier national des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - J Boumendil
- Service d'ophtalmologie IV, centre hospitalier national des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - J Meney
- Service d'ophtalmologie IV, centre hospitalier national des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - T Rodallec
- Service d'ophtalmologie II, centre hospitalier national des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - J Akesbi
- Service d'ophtalmologie II, centre hospitalier national des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - J-P Nordmann
- Service d'ophtalmologie II, centre hospitalier national des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
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Olteanu C, Shear NH, Chew HF, Hashimoto R, Alhusayen R, Whyte-Croasdaile S, Finkelstein Y, Burnett M, Ziv M, Sade S, Jeschke MG, Dodiuk-Gad RP. Severe Physical Complications among Survivors of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Drug Saf 2018; 41:277-284. [PMID: 29052094 DOI: 10.1007/s40264-017-0608-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Few studies have reported the physical complications among Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) survivors. OBJECTIVE The aim of this study was to comprehensively characterize the physical complications among SJS/TEN survivors and to learn about patients' perspectives of surviving SJS/TEN. METHODS SJS/TEN survivors older than 18 years of age were assessed by different methods: a medical interview; a questionnaire assessing patients' perspectives; thorough skin, oral mucous membrane, and ophthalmic examinations; and a retrospective assessment of medical records. RESULTS Our cohort consisted of 17 patients with a mean time of 51.6 ± 74.7 months (median 9, range 1-228) following SJS/TEN. The most common physical complications identified in the medical examination were post-inflammatory skin changes (77%), cutaneous scars (46%), dry eyes (44%), symblepharon, and chronic ocular surface inflammation (33% each). Novel physical sequelae included chronic fatigue (76%) and pruritus (53%). We also found a novel association between the number of mucous membranes affected in the acute phase of SJS/TEN and hair loss during the 6 months following hospital discharge; hair loss was reported in 88% of the group of patients who had three or more mucous membranes affected versus 29% of patients who had less than three mucous membranes involved (p = 0.0406). Following hospital discharge due to SJS/TEN, 59% of patients were followed by a dermatologist, although 88% had dermatological complications; 6% were followed by an ophthalmologist, even though 67% had ophthalmological complications; and 6% of female survivors were followed by a gynecologist, even though 27% had gynecological complications. CONCLUSION Survivors of SJS/TEN suffer from severe physical complications impacting their health and lives that are mostly under recognized and not sufficiently treated by medical professionals.
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Affiliation(s)
- Cristina Olteanu
- Division of Dermatology, Department of Medicine, University of Alberta, 8-112 Clinical Sciences Building, Edmonton, AB, T6G 2G3, Canada
| | - Neil H Shear
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Suite MI-700, Toronto, ON, M4N 3M5, Canada. .,Division of Clinical Pharmacology and Toxicology, Department of Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
| | - Hall F Chew
- Department of Ophthalmology and Vision Sciences, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Rena Hashimoto
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Suite MI-700, Toronto, ON, M4N 3M5, Canada
| | - Raed Alhusayen
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Suite MI-700, Toronto, ON, M4N 3M5, Canada
| | | | - Yaron Finkelstein
- Paediatric Emergency Medicine, Clinical Pharmacology and Toxicology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Marjorie Burnett
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Michael Ziv
- Dermatology Department, Emek Medical Center, Bruce Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel
| | - Shachar Sade
- Department of Pathology, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Marc G Jeschke
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Roni P Dodiuk-Gad
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Suite MI-700, Toronto, ON, M4N 3M5, Canada.,Dermatology Department, Emek Medical Center, Bruce Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel
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Narayanan N, Vaidehi D, Dhanurekha L, Therese KL, Rajagopal R, Natarajan R, Lakshmipathy M. Unusual ulcerative keratitis caused by Prototheca wickerhamii in a diabetic patient. Indian J Ophthalmol 2018; 66:311-314. [PMID: 29380790 PMCID: PMC5819127 DOI: 10.4103/ijo.ijo_644_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The purpose of the study was to report a case of ulcerative keratitis caused by an unusual algae Prototheca wickerhamii in a diabetic patient. This study design was a case report. A 46-year-old male, who was a known diabetic for 3 years, had an injury to the left cornea with the sparks of fire from wielding at work that developed into an ulcerative keratitis over a period of next 3 months as the patient was not on any medication. Corneal scraping culture report and Vitek 2 system investigation result confirmed it to be a P. wickerhamii infection. The patient was started on intensive topical 1% voriconazole and 5% natamycin for 1 month and with no improvement subsequently underwent penetrating keratoplasty. No recurrence of infection postoperatively was noted. This opportunistic algae rarely known to cause human eye infections is so far reported in either patients with severe systemic immunosuppression causing posterior segment eye involvement or as postcorneal surgery infections. We report an ulcerative keratitis by P. wickerhamii in a diabetic patient post corneal trauma with no prior ocular surgery.
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Affiliation(s)
- Niveditha Narayanan
- Department of Cornea and Refractive Surgery, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - D Vaidehi
- Department of Cornea and Refractive Surgery, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - L Dhanurekha
- Department of Cornea and Refractive Surgery, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - K Lily Therese
- Department of Cornea and Refractive Surgery, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Rama Rajagopal
- Department of Cornea and Refractive Surgery, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Radhika Natarajan
- Department of Cornea and Refractive Surgery, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Meena Lakshmipathy
- Department of Cornea and Refractive Surgery, Sankara Nethralaya, Chennai, Tamil Nadu, India
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