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Iwahashi C, Eguchi H, Hotta F, Uezumi M, Sawa M, Kimura M, Yaguchi T, Kusaka S. Orbital abscess caused by Exophiala dermatitidis following posterior subtenon injection of triamcinolone acetonide: a case report and a review of literature related to Exophiala eye infections. BMC Infect Dis 2020; 20:566. [PMID: 32746887 PMCID: PMC7398408 DOI: 10.1186/s12879-020-05294-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/26/2020] [Indexed: 02/06/2023] Open
Abstract
Background Subtenon injection of triamcinolone acetonide (STTA) has been widely adopted in the clinical setting of ophthalmology and its infectious complications are rare. However, orbital abscess following STTA has been reported in seven cases. Furthermore, although eye infections due to Exophiala species are uncommon, there have been 19 cases to date. E. jeanselmei, E. phaeomuriformis, E. werneckii, and E. dermatitidis have been reported to cause human eye infections; however, to the best of our knowledge, orbital abscess caused by E. dermatitidis has not yet been reported. We describe the first documented case of fungal orbital abscess caused by E. dermatitidis following STTA. We also review the related literature of orbital abscess following STTA, as well as eye infections caused by the four Exophiala species. Case presentation The patient was a 69-year-old Japanese woman with diabetic mellitus. She had a macular oedema in her right eye, which occurred secondary to branch retinal vein occlusion. An orbital abscess caused by E. dermatitidis occurred 4 months after the second STTA for the macular oedema, which was successfully treated by a surgical debridement and systemic administration of voriconazole. Conclusions Our findings in the patient and from our literature survey caution ophthalmologists to the fact that STTA can cause fungal orbital infections, especially in diabetic patients. Furthermore, surgical treatment is one of the most important risk factors.
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Affiliation(s)
- Chiharu Iwahashi
- Department of Ophthalmology, Faculty of Medicine, Kindai University, 377-2, Ohonohigashi, Osakasayama-shi, Osaka, 589-8511, Japan
| | - Hiroshi Eguchi
- Department of Ophthalmology, Faculty of Medicine, Kindai University, 377-2, Ohonohigashi, Osakasayama-shi, Osaka, 589-8511, Japan.
| | - Fumika Hotta
- Department of Ophthalmology, Faculty of Medicine, Kindai University, 377-2, Ohonohigashi, Osakasayama-shi, Osaka, 589-8511, Japan
| | - Mayu Uezumi
- Department of Ophthalmology, Sakai City Medical Center, 1-1-1, Ebaraji-cho, Nishi-ku, Sakai City, Osaka, 593-08304, Japan
| | - Miki Sawa
- Department of Ophthalmology, Sakai City Medical Center, 1-1-1, Ebaraji-cho, Nishi-ku, Sakai City, Osaka, 593-08304, Japan
| | - Masatomo Kimura
- Department of Diagnostic Pathology, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Takashi Yaguchi
- Medical Mycology Research Center Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8673, Japan
| | - Shunji Kusaka
- Department of Ophthalmology, Faculty of Medicine, Kindai University, 377-2, Ohonohigashi, Osakasayama-shi, Osaka, 589-8511, Japan
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Zhong ZY, Sun BB, Shu N, Xie QS, Tang XG, Ling ZL, Wang F, Zhao KJ, Xu P, Zhang M, Li Y, Chen Y, Liu L, Xia LZ, Liu XD. Ciprofloxacin blocked enterohepatic circulation of diclofenac and alleviated NSAID-induced enteropathy in rats partly by inhibiting intestinal β-glucuronidase activity. Acta Pharmacol Sin 2016; 37:1002-12. [PMID: 27180979 DOI: 10.1038/aps.2016.54] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 01/19/2016] [Indexed: 01/27/2023] Open
Abstract
AIM Diclofenac is a non-steroidal anti-inflammatory drug (NSAID), which may cause serious intestinal adverse reactions (enteropathy). In this study we investigated whether co-administration of ciprofloxacin affected the pharmacokinetics of diclofenac and diclofenac-induced enteropathy in rats. METHODS The pharmacokinetics of diclofenac was assessed in rats after receiving diclofenac (10 mg/kg, ig, or 5 mg/kg, iv), with or without ciprofloxacin (20 mg/kg, ig) co-administered. After receiving 6 oral doses or 15 intravenous doses of diclofenac, the rats were sacrificed, and small intestine was removed to examine diclofenac-induced enteropathy. β-Glucuronidase activity in intestinal content, bovine liver and E coli was evaluated. RESULTS Following oral or intravenous administration, the pharmacokinetic profile of diclofenac displayed typical enterohepatic circulation, and co-administration of ciprofloxacin abolished the enterohepatic circulation, resulted in significant reduction in the plasma content of diclofenac. In control rats, β-glucuronidase activity in small intestinal content was region-dependent: proximal intestine<distal intestine<ileal valve. Administration of ciprofloxac caused significant reduction of β-glucuronidase activity in distal small intestine, and particularly in ileal valve. Furthermore, ciprofloxacin (10-2000 μmol/L) dose-dependently inhibited β-glucuronidase activity in distal small intestine content or E coli incubated in vitro, but did not affect that in proximal small intestine content or bovine liver incubated in vitro. After receiving 6 oral doses or 15 intravenous doses of diclofenac, typical enteropathy was developed with severe enteropathy occurred in distal small intestine. Co-administration of ciprofloxacin significantly alleviated diclofenac-induced enteropathy. CONCLUSION Co-administration of ciprofloxacin attenuated enterohepatic circulation of diclofenac and alleviated diclofenac-induced enteropathy in rats, partly via the inhibition of intestinal β-glucuronidase activity.
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Enzymatic Activity and Susceptibility to Antifungal Agents of Brazilian Environmental Isolates of Hortaea werneckii. Mycopathologia 2015; 180:345-52. [DOI: 10.1007/s11046-015-9920-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/30/2015] [Indexed: 10/23/2022]
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Quintero-Estades JA, Walter S, Valenzuela F, Amescua G. Delayed-onset postoperative endophthalmitis secondary to Exophiala. BMJ Case Rep 2015; 2015:bcr-2014-208680. [PMID: 25691581 DOI: 10.1136/bcr-2014-208680] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Exophiala is a genus of slow-growing, melanin-producing, saprophytic fungi most commonly found in soil, faeces and decaying plant matter. It is an unusual fungal pathogen capable of causing a variety of ophthalmic manifestations, including keratitis, scleritis and endophthalmitis. In this report, we present a rare case of delayed-onset postoperative endophthalmitis confined to the anterior segment, secondary to Exophiala species. Previous reported cases of delayed-onset postoperative endophthalmitis have been treated medically, with suboptimal outcomes. Our experience supports the use of anterior segment surgery to clear the nidus of disease combined with intravitreal voriconazole to prevent recurrence of the infection.
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Affiliation(s)
| | - Scott Walter
- Bascom Palmer Eye Institute, Miami, Florida, USA
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Chowdhary A, Meis J, Guarro J, de Hoog G, Kathuria S, Arendrup M, Arikan-Akdagli S, Akova M, Boekhout T, Caira M, Guinea J, Chakrabarti A, Dannaoui E, van Diepeningen A, Freiberger T, Groll A, Hope W, Johnson E, Lackner M, Lagrou K, Lanternier F, Lass-Flörl C, Lortholary O, Meletiadis J, Muñoz P, Pagano L, Petrikkos G, Richardson M, Roilides E, Skiada A, Tortorano A, Ullmann A, Verweij P, Cornely O, Cuenca-Estrella M. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of systemic phaeohyphomycosis: diseases caused by black fungi. Clin Microbiol Infect 2014; 20 Suppl 3:47-75. [DOI: 10.1111/1469-0691.12515] [Citation(s) in RCA: 216] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 12/13/2013] [Accepted: 12/16/2013] [Indexed: 11/28/2022]
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Ng KP, Soo-Hoo TS, Na SL, Tay ST, Hamimah H, Lim PC, Chong PP, Seow HF, Chavez AJ, Messer SA. The mycological and molecular study of Hortaea werneckii isolated from blood and splenic abscess. Mycopathologia 2005; 159:495-500. [PMID: 15983734 DOI: 10.1007/s11046-005-1154-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2004] [Accepted: 01/06/2005] [Indexed: 10/25/2022]
Abstract
Hortaea werneckii is an environmental dematiaceous fungus found in the halophilic environment. It causes tinea nigra. We report the isolation of H. werneckii from blood and splenic abscess of two patients with acute myelomonocytic leukaemia. H. werneckii grew at room temperature but not at 37 degrees C, it was identified by biochemical tests, growth characteristics and the presence of conspicuous collarette intercalary on dividing yeast cells. The use of specific oligonucleotide primer Hor-F (5'-TGGACACCTTCA TAACTCTTG-3') and Hor-R (5'-TCACAACGCTTAGAGACGG-3') confirmed the two isolates were H. werneckii. The sequence for 281 nucleotide of HW299 and HW403 were 99% identical but differed only in one nucleotide. In vitro anti-fungal susceptibility testing showed that the isolates were resistant to amphotericin B and flucytosine.
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Affiliation(s)
- K P Ng
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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Abstract
Black moulds are a heterogeneous group of darkly pigmented (dematiaceous) fungi, widely distributed in the environment, that occasionally cause infection in humans. The clinical spectrum of infection includes mycetomas, chromoblastomycosis, sinusitis, and superficial, cutaneous, subcutaneous and systemic phaeohyphomycosis. During the last 2 years, there have been reports of infection caused by black moulds in previously healthy individuals and in immunocompromised patients, including an outbreak of fungemia in hospitalized patients. Molecular analysis of strains obtained from patients and from the environment has suggested a common nosocomial source. In addition, data on antifungal susceptibility tests have become available. Surgical excision and antifungal therapy (usually itraconazole) remain the standard treatment for these infections.
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Affiliation(s)
- F Silveira
- Department of Internal Medicine, Jackson Memorial Hospital, University of Miami, Miami, Florida, USA
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