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Huang L, Suhler EB, Rosenberg C, Ta Kim D, Winthrop KL, Doan T, Lin P. Acanthamoeba-associated retinitis successfully treated with intravitreal and systemic antimicrobials. Am J Ophthalmol Case Rep 2023; 32:101902. [PMID: 37663996 PMCID: PMC10474359 DOI: 10.1016/j.ajoc.2023.101902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/03/2023] [Accepted: 07/19/2023] [Indexed: 09/05/2023] Open
Abstract
Purpose To describe a case of unilateral Acanthamoeba-associated retinitis in the absence of concomitant corneal infection in an immunocompetent host without risk factors. Observations A 37-year-old woman presented with unilateral multifocal retinitis with minimal vitritis. Anterior segment was normal. Conventional diagnostics of bacterial, fungal, viral, Toxoplasma and Toxocara etiologies all returned negative. Empiric treatments were unsuccessful, including oral valacyclovir, oral fluconazole, as well as intravitreal injection of vancomycin and ceftazidime. Metagenomic deep sequencing (MDS) identified Acanthamoeba genomic fragments in the vitreous sample. Multiple intravitreal voriconazole injections were performed and achieved partial suppression of lesion growth. Subsequent dual therapy of oral voriconazole and trimethoprim-sulfamethoxazole led to resolution of the lesions and vision improvement without further injections. Conclusions and importance This is an unusual case of unilateral Acanthamoeba-associated retinitis without concomitant corneal infection, diagnosed via unbiased DNA and RNA deep sequencing, with other etiologies ruled out by conventional approaches. Treatment with systemic and intravitreal therapy led to a successful resolution of retinitis and vision improvement. Our case demonstrates the potential of MDS as an unbiased diagnostic tool for rare ocular pathogens and the therapeutic effect of oral voriconazole with trimethoprim-sulfamethoxazole for Acanthamoeba intraocular infection.
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Affiliation(s)
- Lingling Huang
- Casey Eye Institute, Oregon Health & Science University, 515 SW Campus Drive, Portland, OR, USA
| | - Eric B. Suhler
- Casey Eye Institute, Oregon Health & Science University, 515 SW Campus Drive, Portland, OR, USA
- Veterans Affairs Portland Health Care System, 3710 Southwest US Veterans Hospital Road, Portland, OR, USA
| | - Christopher Rosenberg
- Casey Eye Institute, Oregon Health & Science University, 515 SW Campus Drive, Portland, OR, USA
| | - David Ta Kim
- University of British Columbia, 2550 Willow Street, Vancouver, British Columbia, Canada
| | - Kevin L. Winthrop
- Division of Infectious Diseases, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - Thuy Doan
- Francis I. Proctor Foundation, University of California San Francisco, 490 Illinois Street, San Francisco, CA, USA
| | - Phoebe Lin
- Casey Eye Institute, Oregon Health & Science University, 515 SW Campus Drive, Portland, OR, USA
- Cole Eye Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, USA
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Hong D, Wang P, Zhang J, Li K, Ye B, Li G, Zhou J, Tong Z, Ke L, Shi S, Li W. Plasma metagenomic next-generation sequencing of microbial cell-free DNA detects pathogens in patients with suspected infected pancreatic necrosis. BMC Infect Dis 2022; 22:675. [PMID: 35931956 PMCID: PMC9356476 DOI: 10.1186/s12879-022-07662-2] [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: 04/10/2022] [Accepted: 07/30/2022] [Indexed: 11/17/2022] Open
Abstract
Background Infected pancreatic necrosis (IPN) is a life-threatening complication of acute pancreatitis (AP). Timely diagnosis of IPN could facilitate appropriate treatment, but there is a lack of reliable non-invasive screening tests. In this study, we aimed to evaluate the diagnostic value of plasma metagenomic next-generation sequencing (mNGS) based on circulating microbial cell-free DNA in patients with suspected IPN. Methods From October 2020 to October 2021, 44 suspected IPN patients who underwent plasma mNGS were reviewed. Confirmatory diagnosis of IPN within two weeks after the index blood sampling was considered the reference standard. The confirmation of IPN relied on the microbiological results of drains obtained from the necrotic collections. The distribution of the pathogens identified by plasma mNGS was analyzed. Positive percent agreement (PPA) and negative percent agreement (NPA) were evaluated based on the conformity between the overall mNGS results and culture results of IPN drains. In addition, the clinical outcomes were compared between mNGS positive and negative patients. Results Across all the study samples, thirteen species of bacteria and five species of fungi were detected by mNGS. The positivity rate of plasma mNGS was 54.55% (24/44). Of the 24 mNGS positive cases, twenty (83.33%, 95% CI, 68.42–98.24%) were consistent with the culture results of IPN drains. The PPA and NPA of plasma mNGS for IPN were 80.0% (20/25; 95% CI, 64.32–95.68%) and 89.47% (17/19; 95% CI, 75.67–100%), respectively. Compared with the mNGS negative group, patients in the positive group had more new-onset septic shock [12 (50.0%) vs. 4 (20.0%), p = 0.039]. Conclusion IPN relevant pathogens can be identified by plasma mNGS, potentially facilitating appropriate treatment. The clinical application of mNGS in this cohort appears feasible. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07662-2.
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Affiliation(s)
- Donghuang Hong
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Critical Care Medicine, Fujian Provincial Hospital, No.134 East Street, Fuzhou, 350001, Fujian, China
| | - Peng Wang
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China
| | - Jingzhu Zhang
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China
| | - Kaiwei Li
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China
| | - Bo Ye
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China
| | - Gang Li
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China
| | - Jing Zhou
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China
| | - Zhihui Tong
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China
| | - Lu Ke
- Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China.,National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
| | - Songjing Shi
- Department of Critical Care Medicine, Fujian Provincial Hospital, No.134 East Street, Fuzhou, 350001, Fujian, China.
| | - Weiqin Li
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China. .,Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China. .,National Institute of Healthcare Data Science, Nanjing University, Nanjing, China.
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Chen MJ, Huang R, Liang RB, Pan YC, Shu HY, Liao XL, Xu SH, Ying P, Kang M, Zhang LJ, Ge QM, Shao Y. Abnormal Intrinsic Functional Hubs in Corneal Ulcer: Evidence from a Voxel-Wise Degree Centrality Analysis. J Clin Med 2022; 11:jcm11061478. [PMID: 35329804 PMCID: PMC8949159 DOI: 10.3390/jcm11061478] [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: 01/06/2022] [Revised: 02/08/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Numerous anterior neuroimaging researches have revealed that corneal ulcers (CU) are related to changes in cerebral anatomic structure and functional area. Nonetheless, functional characteristics of the brain's network organization still show no definite research results. The study was designed to confirm CU-associated spatial centrality distribution functional network of the whole cerebrum and explore the mechanism through which the larvaceous changed the intrinsic functional hubs. MATERIAL AND METHODS In this study, 40 patients with CU and 40 normal controls (matched in sex, age, and education level) were enrolled in this study to undergo resting-state functional magnetic resonance imaging (fMRI) scans. The differences between the groups were determined by measuring the voxel-wise degree centrality (DC) throughout the whole cerebrum. For the purpose of assessing the correlation between abnormal DC value and clinical variables, the Linear correlation analysis was used. RESULTS Compared with normal controls (NCs), CU patients revealed high DC values in the frontal lobe, precuneus, inferior parietal lobule, posterior cingulate, occipital lobe, and temporal lobe in the brain functional connectivity maps throughout the brain. The intergroup differences also had high similarity on account of different thresholds. In addition, DC values were positively related to the duration of CU in the left middle frontal gyrus. CONCLUSIONS The experimental results revealed that patients with CU showed spatially unnatural intrinsic functional hubs whether DC values increased or decreased. This brings us to a new level of comprehending the functional features of CU and may offer useful information to make us obtain a clear understanding of the dysfunction of CU.
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