Sutureless wound infection by unusual acid-fast organisms

Nontuberculous mycobacterial endophthalmitis: case series and review of literature

Background

To report three cases of nontuberculous mycobacterial (NTM) endophthalmitis following multiple ocular surgeries and to review previous literature in order to study the clinical profile, treatment modalities, and visual outcomes among patients with NTM endophthalmitis.

Methods

Clinical manifestation and management of patients with NTM endophthalmitis in the Department of Ophthalmology, Faculty of Medicine, Siriraj hospital, Mahidol University, Bangkok, Thailand were described. In addition, a review of previously reported cases and case series from MEDLINE, EMBASE, and CENTRAL was performed. The clinical information and type of NTM from the previous studies and our cases were summarized.

Results

We reported three cases of NTM endophthalmitis caused by M. haemophilum, M. fortuitum and M. abscessus and a summarized review of 112 additional cases previously published. Of 115 patients, there were 101 exogenous endophthalmitis (87.8%) and 14 endogenous endophthalmitis (12.2%). The patients’ age ranged from 13 to 89 years with mean of 60.5 ± 17.7 years with no gender predominance. Exogenous endophthalmitis occurred in both healthy and immunocompromised hosts, mainly caused by cataract surgery (67.3%). In contrast, almost all endogenous endophthalmitis patients were immunocompromised. Among all patients, previous history of tuberculosis infection was identified in 4 cases (3.5%). Rapid growing NTMs were responsible for exogenous endophthalmitis, while endogenous endophthalmitis were commonly caused by slow growers. Treatment regimens consisted of macrolides, fluoroquinolones or aminoglycosides, which were continued for up to 12 months. Initial and final vision were generally worse than 6/60.

Conclusions

NTM endophthalmitis is a serious intraocular infection that leads to irreversible loss of vision. The presentation can mimic a chronic recurrent or persistent intraocular inflammation. History of multiple intraocular surgeries or immune-deficiency in patient with chronic panuveitis should raise the practioner’s suspicion of NTM endophthalmitis. Appropriate diagnosis and treatment are important to optimize visual outcome.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-020-05606-2.

Bilateral Mycobacterium chelonae Keratitis after Phacoemulsification Cataract Surgery

The purpose of this manuscript is to report the case of an 81-year-old patient who presented with bilateral keratitis after phacoemulsification surgery. Cultures came back positive for Mycobacterium chelonae. Despite aggressive topical and systemic antimicrobial treatment, the patient developed a corneal perforation in both eyes, treated with corneal glue in the right eye and corneoscleral patch in the left eye. After two years of follow-up, patient was free of infection in the right eye with visual acuity of 20/200 and the left eye progressed to phthisis bulbi. We present an unusual case of bilateral Mycobacterium chelonae keratitis associated with phacoemulsification cataract surgery. This case represents the importance of making clinicians aware of this devastating infection and highlights the need for better management to improve outcomes.

Nontuberculous Mycobacterial Ocular Infections: A Systematic Review of the Literature

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.

Fungal, Mycobacterial, and Nocardia infections and the eye: an update

Although relatively uncommon, fungi, atypical Mycobacteria, and Nocardia have been isolated from a variety of infections of eye including keratitis, scleritis, canaliculitis, dacryocystitis, endophthalmitis and orbital cellulites. The organisms typically cause a slowly progressive disease. The diseases caused by the organisms can pose both diagnostic and therapeutic challenges. In this manuscript we will describe updates on important aspects of the ocular infections caused by these organisms.

Recalcitrant fungal tunnel infection treated with intrastromal injection of voriconazole

We are reporting a case of recalcitrant fungal tunnel infection treated with intrastromal injection of voriconazole. A 50-year-old woman underwent an uneventful phacoemulsification through a temporal corneal tunnel incision for age-related cataract in her right eye. One month post-surgery, she developed tunnel infection. Microbiological investigations revealed Aspergillus flavus as the offending pathogen. Despite intensive medical treatment, the corneal and anterior chamber infiltrate progressively enlarged. At the end of three and a half weeks, 0.1 ml of 0.05% voriconazole was injected intra-stromally surrounding the central end of the corneal infiltrate. On the subsequent follow-ups, a gradual improvement was noted and slowly it resolved completely. Topical therapy along with a judicious use of intrastromal administration of antifungal drugs may be of immense benefit in such cases prior to embarking on the surgical treatment.