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Soleimani M, Masoumi A, Tabatabaei SA, Zamani MH. Citrobacter keratitis: predisposing factors and clinical characteristics. J Ophthalmic Inflamm Infect 2023; 13:3. [PMID: 36720767 PMCID: PMC9889583 DOI: 10.1186/s12348-022-00322-1] [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: 04/12/2022] [Accepted: 12/11/2022] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To report predisposing factors, clinical presentation, antibiotic sensitivity, and management of Citrobacter-caused infectious keratitis. METHODS We retrospectively reviewed the medical records of culture-proven cases of Citrobacter keratitis in a tertiary referral center for 8 years (from January 2012 to September 2020). Demographic data of the patients, predisposing factors, and presenting signs were extracted. RESULTS Eighteen cases of microbial keratitis due to Citrobacter spp. were identified. The median age of the patients was 66 years (range: 10-89, interquartile range : 59-81). Thirteen patients were male and 5 were female. Multiple predisposing factors were identified in all eyes, including ocular surface disease (n = 8), previous corneal surgery (n = 6), and history of ocular trauma (n = 6). Five patients were diabetic. Corrected distance visual acuity (CDVA) of patients was light perception (LP) in 8 patients, hand motion (HM) in 7, counting fingers (CF) at 1 m in 1, and CF at 2 m in 2 patients. Thirteen eyes exhibited hypopyon. An area of corneal thinning was observed in 7 eyes (38.9%). Endophthalmitis due to infectious keratitis developed in one patient. In vitro susceptibility testing confirmed high sensitivity to ceftazidime and aminoglycosides. Medical management consisted primarily of topical amikacin (20 mg/ml) combined with topical cefazoline (50 mg/ml) (72.2%). Surgical tectonic procedures were carried out in 7 eyes (38.9%). CONCLUSION Citrobacter spp. is a rare cause of bacterial keratitis.Previous keratoplasty and ocular surface problems are important risk factors. The prognosis is not good and surgical tectonic intervention is required in many cases to resolve the corneal infection.
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Affiliation(s)
- Mohammad Soleimani
- grid.411705.60000 0001 0166 0922Ocular Trauma and Emergency Department, Tehran University of Medical Sciences, 1336616351 Tehran, Iran
| | - Ahmad Masoumi
- grid.411705.60000 0001 0166 0922Ocular Trauma and Emergency Department, Tehran University of Medical Sciences, 1336616351 Tehran, Iran
| | - Seyed Ali Tabatabaei
- grid.411705.60000 0001 0166 0922Ocular Trauma and Emergency Department, Tehran University of Medical Sciences, 1336616351 Tehran, Iran
| | - Mohammad Hossein Zamani
- grid.411705.60000 0001 0166 0922Ocular Trauma and Emergency Department, Tehran University of Medical Sciences, 1336616351 Tehran, Iran
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Zapata Cuevas MA, García de Oteyza G, Alvarado-Villacorta R, Quintana Hernández LM, Ordoñez-Ranz G, de Wit Carter G, García-Albisua AM. Pars plana vitrectomy and therapeutic keratoplasty in endophthalmitis and infectious keratitis. Eur J Ophthalmol 2023; 33:207-215. [PMID: 35915984 DOI: 10.1177/11206721221118151] [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: 01/11/2023]
Abstract
PURPOSE To describe the anatomical and functional outcomes of patients with infectious keratitis (IK) and secondary endophthalmitis who underwent penetrating keratoplasty (PK) after pars plana vitrectomy (PPV) assisted by temporary keratoprosthesis (TKP). METHODS An observational retrospective case series was performed. Data were collected from January 2013 to July 2020. Patients over 18 years old with a clinical and microbiological diagnosis of IK, and clinical, ultrasonographic, and or microbiological diagnosis of endophthalmitis were included. Anatomical success was defined as infection resolution with preservation of the ocular globe integrity. No change or improvement of best-corrected visual acuity (VA) at the last follow-up was considered as a functional success. RESULTS A total of 32 eyes of 32 patients were analyzed. The anatomic success was obtained in 87.5% eyes in which the infection was eradicated. The 63% patients maintained or improved their best-corrected VA, 37.5% ended up with hand motion VA. CONCLUSIONS Our results suggest that PPV assisted by TKP followed by PKP can be a good approach for treating patients with endophthalmitis secondary to IK while allowing further visual improvement after an optical PK. Further prospective studies need to be done to evaluate final visual rehabilitation of these patients.
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Affiliation(s)
- María Alejandra Zapata Cuevas
- Cornea and Refractive Surgery Department, 42588Asociación Para Evitar la Ceguera en México I.A.P, Ciudad de México, México
| | | | - Rosa Alvarado-Villacorta
- Cornea and Refractive Surgery Department, 42588Asociación Para Evitar la Ceguera en México I.A.P, Ciudad de México, México
| | - Luis Manuel Quintana Hernández
- Cornea and Refractive Surgery Department, 42588Asociación Para Evitar la Ceguera en México I.A.P, Ciudad de México, México
| | - Gabriela Ordoñez-Ranz
- Cornea and Refractive Surgery Department, 42588Asociación Para Evitar la Ceguera en México I.A.P, Ciudad de México, México
| | - Guillermo de Wit Carter
- Cornea and Refractive Surgery Department, 42588Asociación Para Evitar la Ceguera en México I.A.P, Ciudad de México, México
| | - Ana Mercedes García-Albisua
- Cornea and Refractive Surgery Department, 42588Asociación Para Evitar la Ceguera en México I.A.P, Ciudad de México, México
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Innate immunity dysregulation in aging eye and therapeutic interventions. Ageing Res Rev 2022; 82:101768. [PMID: 36280210 DOI: 10.1016/j.arr.2022.101768] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/29/2022] [Accepted: 10/20/2022] [Indexed: 01/31/2023]
Abstract
The prevalence of eye diseases increases considerably with age, resulting in significant vision impairment. Although the pathobiology of age-related eye diseases has been studied extensively, the contribution of immune-related changes due to aging remains elusive. In the eye, tissue-resident cells and infiltrating immune cells regulate innate responses during injury or infection. But due to aging, these cells lose their protective functions and acquire pathological phenotypes. Thus, dysregulated ocular innate immunity in the elderly increases the susceptibility and severity of eye diseases. Herein, we emphasize the impact of aging on the ocular innate immune system in the pathogenesis of infectious and non-infectious eye diseases. We discuss the role of age-related alterations in cellular metabolism, epigenetics, and cellular senescence as mechanisms underlying altered innate immune functions. Finally, we describe approaches to restore protective innate immune functions in the aging eye. Overall, the review summarizes our current understanding of innate immune functions in eye diseases and their dysregulation during aging.
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Campolo A, Pifer R, Shannon P, Crary M. Microbial Adherence to Contact Lenses and Pseudomonas aeruginosa as a Model Organism for Microbial Keratitis. Pathogens 2022; 11:1383. [PMID: 36422634 PMCID: PMC9695309 DOI: 10.3390/pathogens11111383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/11/2022] [Accepted: 11/17/2022] [Indexed: 08/27/2023] Open
Abstract
Microbial keratitis (MK), the infection of the cornea, is a devastating disease and the fifth leading cause of blindness and visual impairment around the world. The overwhelming majority of MK cases are linked to contact lens wear combined with factors which promote infection such as corneal abrasion, an immunocompromised state, improper contact lens use, or failing to routinely disinfect lenses after wear. Contact lens-related MK involves the adherence of microorganisms to the contact lens. Therefore, this review discusses the information currently available regarding the disease pathophysiology, the common types of microorganisms causing MK, physical and organic mechanisms of adhesion, material properties which are involved in adhesion, and current antimicrobial strategies. This review also concludes that Pseudomonas aeruginosa is a model organism for the investigation of contact lens microbial adherence due to its prevalence in MK cases, its extremely robust adhesion, antimicrobial-resistant properties, and the severity of the disease it causes.
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Combined Therapeutic Penetrating Keratoplasty and Pars Plana Vitrectomy for the Treatment of Infectious Keratitis Endophthalmitis: Mexican Endophthalmitis Study Group Protocol 4. Cornea 2022:00003226-990000000-00110. [PMID: 36441843 DOI: 10.1097/ico.0000000000003114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to assess the role of combined surgical treatment of therapeutic penetrating keratoplasty and pars plana vitrectomy in the anatomical and functional outcome of infectious keratitis endophthalmitis. METHODS This study reviewed the medical records of 4 participating centers in the United States and Mexico. This study included patients with a clinical diagnosis of infectious keratitis endophthalmitis who had been treated with an early therapeutic penetrating keratoplasty and pars plana vitrectomy as the main treatment for endophthalmitis. From each medical record, the study retrieved demographic data, relevant medical and drug history, baseline clinical manifestation of endophthalmitis, best-corrected visual acuity, and the need for enucleation/evisceration for the control of the infection or any other reason through the follow-up. RESULTS The study included 48 patients (50.15 ± 20.6 years). The mean follow-up time was 13 ± 0.5 months. The mean best-corrected visual acuity at baseline was 2.1 ± 0.25 logarithm of the minimum angle of resolution. At month 12 was 2.09 ± 0.61 logarithm of the minimum angle of resolution ( P = 0.9). The overall prevalence of enucleation/evisceration was 8.3% (95% confidence interval: 2.32%-19.98%). The prevalence of a vision of no-light perception was 20.8% (95% confidence interval: 2.32%-19.98%). CONCLUSIONS Combined surgery for severe cases of infectious keratitis endophthalmitis eradicates the infection in most cases, while significantly improving the overall outcomes.
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Infectious keratitis caused by Klebsiella spp.: predisposing factors, presentation, and management. Int Ophthalmol 2022; 43:1169-1173. [PMID: 36114910 DOI: 10.1007/s10792-022-02515-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/11/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To study predisposing factors, clinical presentation and management strategies for Klebsiella keratitis. METHODS A retrospective case review was performed on clinical records of culture-proven Klebsiella keratitis cases in a tertiary referral center over an 8-year period (from 2012 to 2020). RESULTS Thirty eight episodes of culture-proven Klebsiella keratitis were identified in 37 patients. The mean age of the patients was 62.9 years (range, 24-101). Multiple predisposing factors were identified in 33 eyes including history of previous keratoplasty (n = 11) history of ocular trauma (n = 7), preexisting ocular surface disease (n = 7) and diabetes (n = 6). Corrected distance visual acuity (CDVA) at presentation was light perception (LP) in 16 patients, hand motion (HM) in 12, counting fingers (CF) at 50 cm in 5, CF at 1 m in 1, CF at 2 m in 2. One patient had a CDVA of 3/10. On initial examination Hypopyon was detected in 21 eyes. Descemet's membrane folds were present in 1 eye. Corneal thinning was identified in 20 eyes and perforation occurred in 4 patients. Corneal ulcer progressed to endophthalmitis in one patient. Microbiologic sensitivity testing showed that 89.5% isolates were sensitive to amikacin (34/38),88.9%sensitive to ceftazidime (32/36),94.4% were sensitive to gentamicin (34/36),97.2% sensitive to ciprofloxacin (35/36), and 100% to levofloxacin (26/26).Ultimately, one or more surgical procedures was needed in 21 patients. CONCLUSION Previous keratoplasty, history of ocular trauma, ocular surface disease and systemic disease such as diabetes are major risk factors for Klebsiella keratitis. In most of the patients, surgical and tectonic procedures were necessary to control the infection.
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Endophthalmitis Caused by Pseudomonas aeruginosa: Clinical Characteristics, Outcomes, and Antibiotics Sensitivities. J Ophthalmol 2022; 2022:1265556. [PMID: 36157680 PMCID: PMC9492326 DOI: 10.1155/2022/1265556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/26/2022] [Accepted: 09/03/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose The aim of this study is to report the clinical characteristics, visual outcomes, and antibiotic susceptibilities of patients with Pseudomonas aeruginosa endophthalmitis. Methods The medical records of patients with culture-proven Pseudomonas aeruginosa endophthalmitis treated from June 2013 to December 2019 were reviewed. Results This study included 36 eyes of 36 patients. The clinical settings included ocular trauma (15/36), corneal ulcer (9/36), postoperative endophthalmitis (5/36), endogenous (3/36), and unknown (4/36). Sixteen patients underwent evisceration, 13 patients underwent pars plana vitrectomy (PPV), 2 patients were treated with only intravitreal antibiotics, and 5 patients did not undergo surgery. Only one patient achieved a visual acuity of 20/400, and the others had all counting fingers or below. The cultured Pseudomonas aeruginosa was 100% sensitive to gentamicin, tobramycin, amikacin, ciprofloxacin, and levofloxacin and, approximately 95% sensitive to meropenem, imipenem, and aztreonam. Conclusion The visual outcomes of Pseudomonas aeruginosa endophthalmitis were very poor, and the evisceration rate remained high. Pseudomonas aeruginosa has good susceptibility to gentamicin, tobramycin, amikacin, ciprofloxacin, and levofloxacin.
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Liu Q, Wan L, Zhou J, Huang Y. Ten-Year Analysis of Pathogenic Factors and Etiological Characteristics of Endophthalmitis from a Tertiary Eye Center in North China. Infect Drug Resist 2022; 15:3005-3012. [PMID: 35711516 PMCID: PMC9196666 DOI: 10.2147/idr.s367222] [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: 03/24/2022] [Accepted: 06/04/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe the etiology and spectrum of isolated pathogens in endophthalmitis over 10 years from an ophthalmic hospital in North China and report their antimicrobial susceptibilities. Patients and Methods The data covered the patients with endophthalmitis treated at Qingdao Eye Hospital from January 2011 to December 2020. Patients’ medical history, pathogenic factors, bacterial and fungal culture results of intraocular specimens, and in vitro drug sensitivity test results were assessed. Results A total of 524 cases were counted in this study. Exogenous endophthalmitis was the main component, accounting for 94.66%, of which 49.62% of eyes had a history of ophthalmic trauma, intraocular surgery in 26.72% and suppurative keratitis in 17.37%. By comparison, endogenous endophthalmitis was found in only 5.34% of eyes. Among the 292 strains of pathogenic organisms obtained by co-culture, gram-positive bacteria accounted for 64.04%, with Staphylococcus epidermidis as the predominant pathogen (29.45%). Gram-positive cocci were identified in 76.77% of eyes with traumatic endophthalmitis, while 53.70% of keratitis-associated endophthalmitis was caused by fungi. The high susceptibility of bacteria to vancomycin (77.78%~98.33%) supported its continued use as empirical treatment. Among the fluoroquinolones, gram-positive cocci showed a higher susceptibility to gatifloxacin (94.83%), while there was a significant decrease to levofloxacin (51.67%). Gram-negative bacteria were less sensitive to cephalosporins (45.95%~66.67%) than fluoroquinolones (68.42%~78.05%) and aminoglycosides (75.00%~78.05%). Fungal susceptibilities to voriconazole and amphotericin B were 90.16% and 70.31% respectively. More than half of the 11 antibiotics were observed to exhibit a trend of reduced susceptibility. Conclusion Ophthalmic trauma was the primary pathogenic factor of endophthalmitis. Gram-positive cocci were the most common pathogens of traumatic and postoperative endophthalmitis, while suppurative keratitis-associated endophthalmitis often resulted from fungal pathogens. Levofloxacin as the preferred antibiotic in the perioperative period and cephalosporin as the first-line drug for the treatment of empiric endophthalmitis need to be vigilant.
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Affiliation(s)
- Qing Liu
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, People's Republic of China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, People's Republic of China
| | - Lei Wan
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, People's Republic of China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, People's Republic of China
| | - Jinyan Zhou
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, People's Republic of China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, People's Republic of China
| | - Yusen Huang
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, People's Republic of China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, People's Republic of China
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González-Dibildox LA, Oyervidez-Alvarado JA, Vazquez-Romo KA, Ramos-Betancourt N, Hernandez-Quintela E, Beltran F, Garza-Leon M. Polymicrobial Keratitis: Risk Factors, Clinical Characteristics, Bacterial Profile, and Antimicrobial Resistance. Eye Contact Lens 2021; 47:465-470. [PMID: 33625061 DOI: 10.1097/icl.0000000000000777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe clinical characteristics, complications, and the most prevalent microorganisms causing polymicrobial keratitis and their antibiotic sensitivities. METHODS A cross-sectional study including a consecutive analysis of patient's records with a diagnosis of bacterial keratitis with a positive culture and antibiogram report were included. Patients were grouped into those having monomicrobial and polymicrobial infection. Features studied included demographic and clinical characteristics, risk factors, Gram stain, cultures, and antibiotic sensitivity. RESULTS We included 656 patients; in 31.5% more than one microorganism was found. Seven hundred and twenty-three gram-positive bacteria were isolated, and 336 (46.5%) had polymicrobial keratitis. One hundred sixty-one gram-negative bacteria were isolated, and 99 (61.5%) from polymicrobial keratitis. Fourteen (0.60%) patients presented ring infiltrate, and 10 (71.42%) of those patients had polymicrobial keratitis (X2 10.654, P=0.001). Multivariate analysis showed that patients with history of contact lens use (odds ratio [OR] of 1.78, P=0.042), coexistent autoimmune disease (OR 4.64, P=0.03), irregular edges of the infiltrate (OR 2.06, P=0.005), and ring infiltrate (OR 6.034, P=0.005) have a higher risk for developing polymicrobial infection. In the polymicrobial group, gram-positive and gram-negative organisms showed a high sensitivity to Netilmicin. CONCLUSIONS We found a high incidence of polymicrobial keratitis. Our results suggest that it should be suspected in patients with a history of contact lens use, coexistent autoimmune disease, infiltrates with indistinct edges, and ring infiltrates. Sensitivities to moxifloxacin are lower than those reported in previous studies, but sensitivity to Netilmicin is higher.
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Affiliation(s)
- Laura A González-Dibildox
- Cornea and Refractive Surgery Department (L.A.G.-D., J.A.O.-A., K.A.V.-R., N.R.-B., E.H.-Q., F.B.), Asociación para Evitar La Ceguera en México IAP, Hospital Dr. Luis Sánchez Bulnes, Mexico City, Mexico; and Clinical Science Department (M.G.-L.), Science of Health Division, University of Monterrey, Monterrey, México
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Mo S, Durrani AF, Safiullah Z, Kowalski RP, Jhanji V. Proteus mirabilis Keratitis: Risk Factors, Clinical Features, Treatment Outcomes, and Microbiological Characteristics. Cornea 2021; 40:704-709. [PMID: 32833846 DOI: 10.1097/ico.0000000000002469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/14/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To characterize the risk factors, clinical presentations, management choices, and outcomes of Proteus mirabilis keratitis. METHODS In this retrospective study, 26 culture-proven cases of P. mirabilis infections were diagnosed and treated between 1998 and 2019 at the University of Pittsburgh Medical Center. Medical records were available for 14 keratitis cases and were reviewed for demographic information, ocular risk factors, and treatment outcomes. RESULTS Sixteen eyes of 14 patients were included in the study. The average age was 47.8 ± 19.3 years, with a median follow-up time of 6 months. The most common ocular risk factors were poor ocular surface and contact lens use in 57.1% and 42.9% of cases, respectively. Eleven of the 14 patients (78.6%) had positive corneal cultures, and 13 of the 14 patients (92.9%) had positive conjunctiva or eyelid cultures. All isolates were susceptible to ciprofloxacin, ofloxacin, moxifloxacin, gatifloxacin, and cefazolin. Surgical intervention was required in 4 patients (28.6%). Average LogMAR visual acuity was 1.3 ± 1.0 at presentation and 0.9 6 ± 1.0 at the most recent follow-up visit. CONCLUSIONS Proteus mirabilis is an uncommon cause of microbial keratitis. Patients with poor ocular surface and those who use contact lens are at increased risk for developing this cause of keratitis. Empiric treatment with fortified antibiotics or fluoroquinolones seemed to provide effective coverage for P. mirabilis.
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Affiliation(s)
- Shelley Mo
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Asad F Durrani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI; and
| | - Zaid Safiullah
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Regis P Kowalski
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA
- The Charles T. Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA
- The Charles T. Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, PA
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Dhirachaikulpanich D, Soraprajum K, Boonsopon S, Pinitpuwadol W, Lourthai P, Punyayingyong N, Tesavibul N, Choopong P. Epidemiology of keratitis/scleritis-related endophthalmitis in a university hospital in Thailand. Sci Rep 2021; 11:11217. [PMID: 34045630 PMCID: PMC8160326 DOI: 10.1038/s41598-021-90815-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/18/2021] [Indexed: 12/29/2022] Open
Abstract
To demonstrate the demographics, associated factors, clinical presentations, microbiology, management, visual outcome and complications of keratitis/scleritis-related endophthalmitis (KSE). A retrospective chart of all endophthalmitis patients diagnosed between September 2001 and August 2011 was reviewed. Only endophthalmitis cases with previous corneal or scleral infection were included in the study. The patients were followed until losing vision or eyeball, becoming phthisis, or the end of 2018. Eighty-seven patients with KSE were identified, all unilateral. The mean age was 56.4 ± 21.4 years. There was a slight male predilection (55 patients, 63.2%). The mean follow-up time was 50 ± 149 weeks. The causative pathogens were identified in 35 patients (40.2%), with the highest frequency being bacteria. The most common bacterium was Pseudomonas aeruginosa (n = 13), and the most common fungus was Aspergillus sp. (n = 5). Fifteen patients achieved (17.2%) final visual acuity (VA) of hand motion or better after treatment. Eyeball removal was performed in 61 (70.1%) patients. From multivariate analysis, the only prognostic factor for poor final VA (worse than hand motion, HM) was poor VA (worse than HM) at the initial visit (relative risk 1.97, 95% confidence interval 1.15–3.36, p = 0.013). KSE is uncommon but has a devastating outcome. We found that the patient’s initial VA was the only predictor for their final vision. P. aeruginosa was the most common identifiable organism in this study. However, several fungal infections were recognised. These findings should raise awareness for treatment of KSE in the tropics.
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Affiliation(s)
- Dhanach Dhirachaikulpanich
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Prannok, Bangkok-noi, Bangkok, 10700, Thailand
| | - Kunravitch Soraprajum
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Prannok, Bangkok-noi, Bangkok, 10700, Thailand
| | - Sutasinee Boonsopon
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Prannok, Bangkok-noi, Bangkok, 10700, Thailand
| | - Warinyupa Pinitpuwadol
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Prannok, Bangkok-noi, Bangkok, 10700, Thailand
| | | | | | - Nattaporn Tesavibul
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Prannok, Bangkok-noi, Bangkok, 10700, Thailand
| | - Pitipol Choopong
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Prannok, Bangkok-noi, Bangkok, 10700, Thailand.
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Dago TR, Woldemichael DK, Daba FB. Medical History, Clinical Features, Treatment Outcome and Its Predictors Among Infectious Keratitis Patients in Jimma University Medical Center, Southwest Ethiopia: Prospective Observational Study. Clin Ophthalmol 2021; 15:1223-1237. [PMID: 33790530 PMCID: PMC7997589 DOI: 10.2147/opth.s291880] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/22/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Infectious keratitis is a major global cause of visual impairment and irreversible blindness among the corneal diseases. Its diagnosis and management remain getting challenge. The clinical and visual outcome remains poor in developing countries. The aim of this study was to determine treatment outcome and its predictors among patients with infectious keratitis. METHODS Prospective observational study was conducted among adult patients diagnosed with infectious keratitis at the Ophthalmology Department in Jimma University Medical Center from April 1 to September 30, 2019. The primary outcome indicator was response of the ulcer to empirical treatment. Ulcers that did not heal and required surgery had a poor outcome. Variables with a p-value of <0.25 were entered into a multivariate logistic regression model to determine the independent predictors of poor treatment outcome and variables with a p-value of <0.05 were considered statistically significant. RESULTS The research involved 131 adult patients. Eighty-seven (66.4%) were males. The mean age was 39.38 (±18.9) years. Eighty-three (63.4%) patients had poor treatment outcome. Mean length of hospital stay was 17.38 (±12.563) days. Poor visual outcome was observed among 71 (54.2%) participants. Evisceration was done for seven (5.3%) patients. Independent predictors of poor treatment outcome include perforation at admission (AOR=6.1, 95%CI: 1.5-25.1), presence of comorbidity (AOR=7.7, 95%CI: 2.16-27.3), poor adherence (AOR=5.3, 95%CI: 1.8-25.9), traditional medicine use (AOR=6.7, 95%CI: 1.8-25.4), ulcer depth >1/3 (AOR=7.6, 95%CI: 2.48-48.23) and farm workers (AOR=3.59, 95%CI: 1.09-11.77). Major complications occurred after admissions were perforation (14.5%), followed by endophthalmitis (7.63%) and corneal opacity (6.87%). CONCLUSION AND RECOMMENDATION Our study found high poor treatment outcomes and high poor visual outcomes. Presence of comorbidity, perforation at admission, traditional medicine use, working on a farm, poor adherence, and ulcer depth were the predictors of poor treatment outcome. This high poor outcome requires a nationwide interventional study and urgent intervention that may reach rural communities.
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Affiliation(s)
- Tolcha Regasa Dago
- School of Pharmacy, College of Medicine and Health Science, Mizan Tepi University, Mizan-Aman, Ethiopia
| | | | - Fekede Bekele Daba
- School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
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Sim HE, Kang MJ, Kim JS, Hwang JH. Effect of Intravitreal Antibiotic Injections on Culture-Negative Keratitis-Induced Endophthalmitis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2020. [DOI: 10.1097/ipc.0000000000000899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Uppuluri A, Zarbin MA, Bhagat N. Risk Factors for Post–Open-Globe Injury Endophthalmitis. JOURNAL OF VITREORETINAL DISEASES 2020; 4:353-359. [PMID: 37008290 PMCID: PMC9979028 DOI: 10.1177/2474126420932322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: The objective of our project is to use the National Inpatient Sample Database to identify risk factors for endophthalmitis in cases of open-globe injury (OGI). Methods: This is a cross-sectional observational study of 48 627 cases of OGI from the National Inpatient Sample Database. We performed regression analysis using IBM SPSS Statistics 23. Codes from the International Classification of Disease, Ninth Revision were used to identify ocular findings and conditions. Variables with P values less than .05 on univariate analysis were included in the multivariable regression model; Bonferroni correction was applied to these results. Results: Of the 48 627 cases of OGI, 37 440 (77.0%) occurred in the adult group (21 years and older). Overall, 1018 (2.1%) cases developed posttraumatic endophthalmitis, with 74.5% cases in the adult group. Endophthalmitis developed in 293 (4.5%) eyes with an intraocular foreign body (IOFB). Results of binary logistic regression showed the clinical findings of traumatic cataracts, hypopyon, vitreous inflammation, corneal ulcers, or IOFBs were associated with an increased risk of developing endophthalmitis after OGI. Conversely, orbital fractures, rupture-type injuries, and intraocular tissue prolapse were associated with a decreased likelihood of being diagnosed with endophthalmitis. Conclusions: Endophthalmitis developed in 2.4% of pediatric OGIs and 2.0% of adult OGIs. Traumatic cataract, hypopyon, vitreous inflammation, corneal ulcer, keratitis, retinal detachment, IOFB, and diabetes increased the risk of post-open-globe endophthalmitis.
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Affiliation(s)
| | - Marco A. Zarbin
- Rutgers New Jersey Medical School, Newark, NJ, USA
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Neelakshi Bhagat
- Rutgers New Jersey Medical School, Newark, NJ, USA
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
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Viruni N, Zhang AY, Wang X, Handa JT, Liu TYA. Quantitative Ocular Ultrasound Findings in Microbial Keratitis-Associated Endophthalmitis. Ophthalmol Retina 2020; 4:560-567. [PMID: 32147489 DOI: 10.1016/j.oret.2020.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 12/23/2019] [Accepted: 01/06/2020] [Indexed: 06/10/2023]
Abstract
PURPOSE To assess how ocular ultrasound findings correlate with clinical parameters of patients with infectious keratitis and concern for endophthalmitis and to evaluate the usefulness of ultrasound in managing these patients. DESIGN Retrospective study. PARTICIPANTS Seventy-three eyes of 73 patients with microbial keratitis who underwent ultrasound to evaluate for endophthalmitis were included. METHODS Ultrasound images were graded in a masked fashion independently by 2 retina specialists. The degree of vitreous opacities, defined as the largest area within the vitreous cavity occupied by opacities on any single image, were categorized as less than 10%, 10% to less than 50%, 50% to 90%, and more than 90%. The diagnosis of endophthalmitis was defined as severe intraocular inflammation that necessitated obtaining an intraocular culture sample and injection of intravitreal antimicrobials. The demographic and clinical characteristics of this patient cohort were compared. MAIN OUTCOME MEASURES Vitreous opacities measured quantitatively on ocular ultrasound. RESULTS The incidence of endophthalmitis in our patients with microbial keratitis who underwent ultrasound was 20.5%. Corneal and intraocular cultures showed positive results in 66.7% and 26.7% of endophthalmitis patients, respectively. A 4-fold increase in the likelihood of treatment for endophthalmitis was observed with increasing vitreous opacity severity (odds ratio, 3.97; confidence interval, 1.9-8.5; P < 0.0001). Endophthalmitis was associated with 50% or more vitreous opacities (P < 0.001), older age (P < 0.001), pseudophakia (P = 0.001), and hypopyon height (P < 0.001). Eye pain, eyelid edema, poor presenting visual acuity, larger corneal ulcer diameter, and causative organisms were not associated with endophthalmitis. CONCLUSIONS Patients with more severe vitreous opacities on ultrasound were more likely to be treated for endophthalmitis. Patients with microbial keratitis, who were older and pseudophakic, were prone to have more severe vitreous opacities.
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Affiliation(s)
- Narine Viruni
- Wilmer Eye Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Alice Y Zhang
- Wilmer Eye Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Xueyang Wang
- Wilmer Eye Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - James T Handa
- Wilmer Eye Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - T Y Alvin Liu
- Wilmer Eye Institute, The Johns Hopkins Hospital, Baltimore, Maryland.
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Makrynioti D, Zagoriti Z, Koutsojannis C, Morgan PB, Lagoumintzis G. Ocular conditions and dry eye due to traditional and new forms of smoking: A review. Cont Lens Anterior Eye 2020; 43:277-284. [PMID: 32111452 DOI: 10.1016/j.clae.2020.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 01/24/2020] [Accepted: 02/16/2020] [Indexed: 12/26/2022]
Abstract
Addiction to cigarette smoking has high prevalence rates recorded worldwide. Smoking has been linked to several life-threatening systemic conditions such as cancer, heart attack and stroke, in addition to a range of ocular pathologies. In recent years, electronic cigarettes (EC) have emerged as alternatives to smoking. ECs are nicotine delivery devices which produce an aerosol by heating, rather than combusting, a liquid which contains nicotine, flavours and preservatives. This review focuses on the association of traditional and new forms of smoking with dry eye disease, contact lens wear and four other common ocular diseases: cataract, age-related macular degeneration, glaucoma and Graves' ophthalmopathy. It is concluded that smoking and vaping appear as a risk factor for the aforementioned ocular conditions. An evidence-based, clear link between cigarette smoking, or EC vaping and ocular problems is yet to be discovered.
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Affiliation(s)
- Dimitra Makrynioti
- School of Health Rehabilitation Sciences, University of Patras, Psaron 6, GR 25100, Aιgio, Greece.
| | - Zoi Zagoriti
- Department of Pharmacy, Laboratory of Molecular Biology and Immunology, University of Patras, University Campus, GR26504, Patras, Greece.
| | - Constantinos Koutsojannis
- Department of Physiotherapy, Laboratory of Health Physics and Computational Intelligence, School of Health Rehabilitation Sciences, University of Patras, Psaron 6, GR 25100, Aιgio, Greece.
| | - Philip B Morgan
- Eurolens Research, Division of Pharmacy and Optometry, The University of Manchester, Carys Bannister Building, Dover Street, Manchester, M13 9PL, United Kingdom.
| | - George Lagoumintzis
- School of Health Rehabilitation Sciences, University of Patras, Psaron 6, GR 25100, Aιgio, Greece; Department of Pharmacy, Laboratory of Molecular Biology and Immunology, University of Patras, University Campus, GR26504, Patras, Greece.
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Lin L, Mei F, Liao J, Yang Y, Duan F, Lin X. Nine-Year Analysis of Isolated Pathogens and Antibiotic Susceptibilities of Infectious Endophthalmitis from a Large Referral Eye Center in Southern China. Infect Drug Resist 2020; 13:493-500. [PMID: 32104019 PMCID: PMC7025819 DOI: 10.2147/idr.s235954] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 02/02/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose To analyze the pathogen spectrum of isolated pathogens and antibiotic susceptibility trends of infectious endophthalmitis over 9 years from a large referral eye center in southern China. Methods Data from all inpatients who were clinically diagnosed with infectious endophthalmitis and underwent microbiological evaluation at the Zhongshan Ophthalmic Center from January 2010 to December 2018 were collected retrospectively and analyzed according to different clinical etiologies. Results A total of 816 cases were collected in the study. Open-globe injuries had caused 473 (57.97%) cases, 70 (8.58%) cases presented endophthalmitis after infectious keratitis, 156 (19.12%) cases were postoperative, and endogenous causes accounted for 117 (14.34%) cases. Among the 309 culture-positive cases, the predominant pathogen for both postoperative and posttraumatic endophthalmitis was gram-positive cocci (59.52% and 49.72%, respectively). Regarding keratitis-related endophthalmitis, the main pathogens were filamentous fungi (57.58%) and gram-negative bacilli (30.30%). The pathogens of endogenous endophthalmitis were almost evenly distributed among gram-positive cocci, gram-negative bacilli, and fungi. Eighty-five (10.42%) cases underwent evisceration/enucleation, including 42 cases secondary to keratitis-related endophthalmitis. The incidence of evisceration/enucleation was much higher in keratitis-related endophthalmitis than the total endophthalmitis population (χ2 =123.61, P<0.001). Overall bacteria showed high susceptibility to fluoroquinolones (75.36–100.00%). Gram-positive cocci showed much higher sensitivity to cephalosporins compared to gram-negative bacilli (85.11–92.59% vs 25.42–35.72%). For the five first-line antibiotics analyzed for time trend of susceptibility, four exhibited a significant decrease of susceptibility from 2010–2014 to 2015–2018. Conclusion Between 2010 and 2018, posttraumatic endophthalmitis was the most common form of the treated endophthalmitis in Zhongshan Ophthalmic Center. The causative pathogens varied according to different clinical settings. Even though the overall antibiotic susceptibilities were fairly high, we observed a substantial decrease of susceptibility for most first-line antibiotics.
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Affiliation(s)
- Lixia Lin
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Feng Mei
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jingyu Liao
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Yao Yang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Fang Duan
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xiaofeng Lin
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
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Xu MW, Liu HM, Tan G, Su T, Xiang CQ, Wu W, Li B, Lin Q, Xu XW, Min YL, Liu WF, Gao GP, Shao Y. Altered Regional Homogeneity in Patients With Corneal Ulcer: A Resting-State Functional MRI Study. Front Neurosci 2019; 13:743. [PMID: 31396034 PMCID: PMC6664059 DOI: 10.3389/fnins.2019.00743] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 07/05/2019] [Indexed: 12/30/2022] Open
Abstract
Objective To investigate the potential regional homogeneity (ReHo) brain activity changes in patients with corneal ulcer (CU) and their possible relationship with clinical symptoms. Materials and Methods Forty patients with CU (26 men and 14 women), and 40 healthy controls (HCs) (26 men and 14 women) closely matched in age, sex, and weight underwent resting-state functional MRI scans, respectively. The ReHo method was applied to evaluate synchronous neural activity changes. Receiver operating characteristic curve (ROC curve) was used to show high test-retest stability and high degree of sensitivity and specificity. We utilized the correlation analysis to calculate the relationship between the average ReHo signal values in different brain areas and the clinical symptoms in CU patients. Results Compared with the HCs, CU patients had significantly increased ReHo values in right cerebellum posterior lobe, left cerebellum posterior lobe, left inferior temporal gyrus, right lingual gyrus, left middle frontal gyrus, left angular gyrus, left cingulate gyrus, right angular gyrus and bilateral superior frontal gyrus, and decreased ReHo values in right anterior cingulate and left precentral gyrus. ROC curve analysis of each brain regions showed the accuracy of AUC was perfect except the right cerebellum posterior lobe. Nevertheless, there was no clear evidence of prominent relevance between the average ReHo values in brain areas and the clinical symptoms. Conclusion Corneal ulcer caused dysfunctional adaption in different brain areas, which including relatively increased values and decreased values. This finding may help us take a further step in exploring the underlying pathologic mechanisms of CU.
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Affiliation(s)
- Man-Wei Xu
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, China
| | - Hui-Min Liu
- Department of Ophthalmology, University of South China, Hengyang, China
| | - Gang Tan
- Department of Ophthalmology, University of South China, Hengyang, China
| | - Ting Su
- Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, China
| | - Chu-Qi Xiang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, China
| | - Wei Wu
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, China
| | - Biao Li
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, China
| | - Qi Lin
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, China
| | - Xiao-Wei Xu
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, China
| | - You-Lan Min
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, China
| | - Wen-Feng Liu
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, China
| | - Gui-Ping Gao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, China
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, China
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Lazarte C, Paladino L, Mollo L, Katra R, Isabel BM, Puia SA. Cervicofacial Infections Caused by Staphylococcus aureus. Ann Maxillofac Surg 2019; 9:459-464. [PMID: 31909036 PMCID: PMC6933971 DOI: 10.4103/ams.ams_226_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Staphylococcus aureus (S. aureus) is an opportunistic pathogen that causes a wide range of diseases. Dissemination of perioral infections is a common problem in the field of oral and maxillofacial surgery. The aim of the study was to evaluate S. aureus carriage in the oral cavity and its dissemination to different cervicofacial regions. Clinical case 1 is a patient with a systemic history of type I diabetes which led to foot amputation one year previou sly, who presented alteration of ocular motility and the culture showed Grampositive cocci compatible with S. aureus. The patient was discharged after eight days of antibiotic therapy and drainage. Clinical case 2 was a young female without any comorbidities who had never been hospitalized before or even exposed to the hospital environment. The presence of lesions compatible with necrotizing fasciitis (NF) in the lower lip mucosal region, rapid evolution of the infection to deep planes, and evolution of the clinical picture alerted health-care providers to the need for prompt care. Clinical case 3 was an immunosuppressed patient with cellulitis which is a bacterial infection of the skin and soft tissues that occurs when the physical barrier of the skin and soft tissues, the immune system, and/or the circulatory system are affected. S. aureus is an opportunistic pathogen which causes a wide range of diseases. It inhabits the oral cavity, from where it can spread to distant cervicofacial regions. This is why it is important for health-care professionals to be aware of this niche in case of dissemination in order to provide prompt diagnosis and appropriate treatment.
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Affiliation(s)
- Carlos Lazarte
- Chair of Surgery and Traumatology Bucomaxilofacial I, Faculty of Dentistry, University of Buenos Aires, Andress: Marcelo Torcuato de Alvear 2142. Buenos Aires, Argentina
| | - Leonel Paladino
- Chair of Surgery and Traumatology Bucomaxilofacial I, Faculty of Dentistry, University of Buenos Aires, Andress: Marcelo Torcuato de Alvear 2142. Buenos Aires, Argentina
| | - Luciana Mollo
- Chair of Surgery and Traumatology Bucomaxilofacial I, Faculty of Dentistry, University of Buenos Aires, Andress: Marcelo Torcuato de Alvear 2142. Buenos Aires, Argentina
| | - Romina Katra
- Chair of Surgery and Traumatology Bucomaxilofacial I, Faculty of Dentistry, University of Buenos Aires, Andress: Marcelo Torcuato de Alvear 2142. Buenos Aires, Argentina
| | - Brusca María Isabel
- Chair of Surgery and Traumatology Bucomaxilofacial I, Faculty of Dentistry, University of Buenos Aires, Andress: Marcelo Torcuato de Alvear 2142. Buenos Aires, Argentina
| | - Sebastian Ariel Puia
- Chair of Surgery and Traumatology Bucomaxilofacial I, Faculty of Dentistry, University of Buenos Aires, Andress: Marcelo Torcuato de Alvear 2142. Buenos Aires, Argentina
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Commentary. Ann Emerg Med 2019; 73:28. [DOI: 10.1016/j.annemergmed.2018.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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