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Lefèvre L, Dedieu D, Dahane N, Brezin AP, Sitterlé E, Charlier C, Canouï E. Contribution of aqueous humor beta-D-glucan assay in the diagnosis of endophthalmitis of fungal origin. J Infect 2023; 87:358-360. [PMID: 37516413 DOI: 10.1016/j.jinf.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 07/31/2023]
Affiliation(s)
- Leïla Lefèvre
- Antimicrobial Stewardship Team GH Paris Centre, Cochin Port Royal Hospital, APHP, Paris, France
| | - Daphné Dedieu
- Ophthalmology Department, Hôpital Cochin Port Royal, Paris, France; Université Paris Cité, Paris, France
| | - Naïma Dahane
- Department of Mycology and Parasitology, Hôpital Cochin Port Royal, Université Paris Cité, Paris, France
| | - Antoine P Brezin
- Ophthalmology Department, Hôpital Cochin Port Royal, Paris, France; Université Paris Cité, Paris, France
| | - Emilie Sitterlé
- Mycology-Parasitology Laboratory, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, France
| | - Caroline Charlier
- Antimicrobial Stewardship Team GH Paris Centre, Cochin Port Royal Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; National Reference Center for Listeria, WHO Collaborating Center, Institut Pasteur, Paris, France; Biology of Infection Unit, Inserm U1117, Institut Pasteur, Paris, France
| | - Etienne Canouï
- Antimicrobial Stewardship Team GH Paris Centre, Cochin Port Royal Hospital, APHP, Paris, France.
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Li X, Li Z, Wang M, Fu A, Hao X, Guo X, Gu J, Jin W, Yang A. The diagnostic utility of nanopore targeted sequencing in suspected endophthalmitis. Int Ophthalmol 2023; 43:2653-2668. [PMID: 36941506 PMCID: PMC10371907 DOI: 10.1007/s10792-023-02665-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/19/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE This paper aimed to assess the diagnostic utility of a newly developed gene-based technology-nanopore targeted sequencing (NTS) in suspected endophthalmitis patients. METHODS This retrospective study included 43 patients (44 eyes) with suspected endophthalmitis. NTS was applied along with microbiological culture to detect unknown pathogens in intraocular fluid samples. The diagnostic utility of NTS was mainly evaluated from three aspects, including the positivity rate of bacterial/fungal presence, diagnostic turnaround time and the frequency of change in treatment based on etiology test results. Non-parametric, two-sided Wilcoxon rank sum test, the McNemar's test and the kappa statistic were used for statistical comparisons. RESULTS NTS showed significant advantages over traditional culture in positivity rates and diagnostic time (P < 0.001, kappa = 0.082; Z = -5.805, P < 0. 001). As regards antibiotic strategy, 17 patients (39.53%) and 5 patients (11.63%) underwent medication change following NTS and culture results respectively (P < 0.001, kappa = 0.335). With reasonable use of antibiotic and surgical intervention, most patients responded favorably, judged by significantly improved visual acuity (Z = -4.249, P < 0.001). The mean duration of hospitalization was 8.49 ± 2.45 days (range, 1-16 days). CONCLUSION The high efficiency feature of NTS in pathogen detection renders it a valuable supplementary to traditional culture. Additionally, it has facilitated patients' management for the early and precise diagnosis of endophthalmitis.
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Affiliation(s)
- Xuejie Li
- Eye Center, Renmin Hospital of Wuhan University, Jiefang Road 238#, Wuhan, 430060, Hubei Province, China
| | - Ziyue Li
- Eye Center, Renmin Hospital of Wuhan University, Jiefang Road 238#, Wuhan, 430060, Hubei Province, China
| | - Ming Wang
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, China
| | - Aisi Fu
- Wuhan Dgensee Clinical Laboratory Co, Ltd. Wuhan 430075, Hubei Province, China
| | - Xinlei Hao
- Eye Center, Renmin Hospital of Wuhan University, Jiefang Road 238#, Wuhan, 430060, Hubei Province, China
| | - Xinyang Guo
- Eye Center, Renmin Hospital of Wuhan University, Jiefang Road 238#, Wuhan, 430060, Hubei Province, China
| | - Jiashuang Gu
- Wuhan Dgensee Clinical Laboratory Co, Ltd. Wuhan 430075, Hubei Province, China
| | - Wei Jin
- Eye Center, Renmin Hospital of Wuhan University, Jiefang Road 238#, Wuhan, 430060, Hubei Province, China.
| | - Anhuai Yang
- Eye Center, Renmin Hospital of Wuhan University, Jiefang Road 238#, Wuhan, 430060, Hubei Province, China.
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Dave VP, Sharma S, Dave PJ, Joseph J, Pappuru RR. CLINICAL PRESENTATIONS, DIAGNOSTIC DILEMMA, AND MANAGEMENT OUTCOMES OF CHRONIC POSTOPERATIVE ENDOPHTHALMITIS CAUSED BY STEPHANOASCUS CIFERRII. Retin Cases Brief Rep 2021; 15:269-274. [PMID: 30028787 DOI: 10.1097/icb.0000000000000782] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the diagnosis and management of a series of chronic postoperative endophthalmitis caused by Stephanoascus ciferrii. METHODS This is a retrospective consecutive case series at a tertiary eye care institute. Case records of consecutive cases of chronic postoperative endophthalmitis caused by a novel fungus S. ciferrii were analyzed. The clinical presentations, microbiologic workup including microscopy, culture, antifungal susceptibility and polymerase chain reaction for fungal DNA of clinical samples, and the clinical management were noted. The cases underwent anterior chamber tap, vitreous biopsy, core vitrectomy, and intraocular lens explantation, and the management consisted of a combination of topical and systemic therapy and intravitreal injections of antimicrobial agents. RESULTS The report includes four eyes of four patients. All patients were diagnosed as chronic postcataract surgery endophthalmitis, and they showed variable levels of persistent low-grade intraocular inflammation till the intraocular lens was explanted. S. ciferrii (identified by the Vitek 2 compact system) was grown in culture from one or more of the clinical samples such as vitreous, anterior chamber fluid, capular bag, and intraocular lens. Fungal DNA was detected from vitreous in one case. One isolate tested for antifungal susceptibility was resistant to amphotericin B; however, the patient responded to treatment with the drug. Good clinical outcome was achieved in all patients. CONCLUSION We describe successful treatment of endophthalmitis caused by S. ciferrii. A good response is obtained after pars plana vitrectomy and intraocular lens explantation.
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Affiliation(s)
- Vivek Pravin Dave
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India ; and
| | - Savitri Sharma
- Jhaveri Microbiology Center, Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad, India
| | - Prachi Jhala Dave
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India ; and
| | - Joveeta Joseph
- Jhaveri Microbiology Center, Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad, India
| | - Rajeev Reddy Pappuru
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India ; and
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Bhikoo R, Wang N, Welch S, Polkinghorne P, Niederer R. Factors Associated With Positive Microbial Culture in Patients With Endophthalmitis Based on Clinical Presentation and Multimodal Intraocular Sampling. Asia Pac J Ophthalmol (Phila) 2020; 9:4-8. [PMID: 31990738 PMCID: PMC7004470 DOI: 10.1097/apo.0000000000000263] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/24/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of this study was to identify the factors associated with positive culture sample in patients with endophthalmitis based on clinical presentation and multimodal intraocular sampling. DESIGN Retrospective review. METHODS A total of 259 subjects with a diagnosis of endophthalmitis presented to a tertiary ophthalmic referral center between 2006 and 2018. Patient demographics, presenting clinical findings and the results of aqueous and vitreous sampling were analyzed. RESULTS Mean age was 64.2 (± 22.6) years with 52.9% female. Endophthalmitis followed cataract surgery in 84 eyes (32.4%) and was the most common precipitant; intravitreal injections were the next common cause involving 60 eyes (23.2%). Mean visual acuity on presentation was hand movements with a hypopyon present 134 eyes (52%). In total, 135 cases (52.1%) were culture positive. Aqueous sampling was performed in 112 eyes [culture positive 36 (32.1%)]; vitreous sample in 122 eyes [positive in 56 (45.3%)]. Vitrectomy was performed in 169 eyes with 149 sent for culture [70 (47.0%) positive]. A positive vitrectomy culture was observed in 14 eyes (36.9%) of 38, despite initial treatment with intravitreal antibiotics. Factors associated with positive culture were aqueous tap [odds ratio (OR) 2.06, P = 0.02], vitrectomy (OR 2.86, P = 0.001), and absent red reflex (OR 2.73, P = 0.001). CONCLUSIONS A multimodal approach to intraocular sampling should be considered in those presenting with endophthalmitis, with both aqueous tap and vitrectomy associated with an increased probability of achieving a positive culture.
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Affiliation(s)
- Riyaz Bhikoo
- Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
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dos Santos HNV, Ferracioli-Oda E, Barbosa TS, Otani CSV, Tanaka T, da Silva LDCS, Lopes GDO, Doi A, Hirata CE, Yamamoto JH. Usefulness of aqueous and vitreous humor analysis in infectious uveitis. Clinics (Sao Paulo) 2020; 75:e1498. [PMID: 31994615 PMCID: PMC6970280 DOI: 10.6061/clinics/2020/e1498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/21/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To evaluate the role of intraocular fluid analysis as a diagnostic aid for uveitis. METHODS Twenty-eight samples (27 patients including 3 HIV-infected patients) with active (n=24) or non-active (n=4) uveitis were submitted to aqueous (AH; n=12) or vitreous humor (VH) analysis (n=16). All samples were analyzed by quantitative PCR for herpes simplex virus (HSV), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV) and Toxoplasma gondii. RESULTS The positivity of the PCR in AH was 41.7% (5/12), with 50% (2/4) in immunocompetent and 67% (2/3) in HIV+ patients. The positivity of the PCR in VH was 31.2% (5/16), with 13% (1/8) in immunocompetent and 50% (4/8) in immunosuppressed HIV negative patients. The analysis was a determinant in the diagnostic definition in 58% of HA and 50% of VH. CONCLUSION Even in posterior uveitis, initial AH analysis may be helpful. A careful formulation of possible clinical diagnosis seems to increase the chance of intraocular sample analysis being meaningful.
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Affiliation(s)
- Helen Nazareth Veloso dos Santos
- Servico de Uveites, Departmento de Oftalmologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Eduardo Ferracioli-Oda
- Servico de Uveites, Departmento de Oftalmologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Thaisa Silveira Barbosa
- Servico de Uveites, Departmento de Oftalmologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Camila Sayuri Vicentini Otani
- Servico de Uveites, Departmento de Oftalmologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Tatiana Tanaka
- Servico de Uveites, Departmento de Oftalmologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Guilherme de Oliveira Lopes
- Secao de Citometria de Fluxo, Divisao do Laboratorio Central DLC, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Andre Doi
- Secao de Biologia Molecular, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Carlos Eduardo Hirata
- Servico de Uveites, Departmento de Oftalmologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Joyce Hisae Yamamoto
- Servico de Uveites, Departmento de Oftalmologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Sobaci G, Tuncer K, Taş A, Ozyurt M, Bayer A, Kutlu U. The Effect of Intraoperative Antibiotics in Irrigating Solutions on Aqueous Humor Contamination and Endophthalmitis after Phacoemulsification Surgery. Eur J Ophthalmol 2018; 13:773-8. [PMID: 14700098 DOI: 10.1177/1120672103013009-1007] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine the efficacy of intraoperative antibiotic use in irrigating solutions on aqueous humor contamination during phacoemulsification surgery and to evaluate the corresponding risk of postoperative endophthalmitis. METHODS 644 eyes of 640 patients who underwent phacoemulsification surgery with foldable intraocular lens (IOL) implantation were included in this study. Preoperative conjunctival smears were taken and eyes were allocated to receive irrigating infusion fluid containing either balanced salt solution (BSS)-only (group 1; 322 eyes) or BSS with antibiotics (vancomycin and gentamycin) during surgery (group 2; 322 eyes). Bacterial contamination rates of aqueous humor samples taken in the beginning and at the end of operation were compared. Predictive factors for the development of postoperative endophthalmitis were determined by clinical and microbiologic analyses. RESULTS The rates of culture-positivity were similar between group 1 and group 2 for both preoperative conjunctival smears and aqueous samples (p > 0.05). Aqueous samples taken at the end of operation were found to be contaminated in 68 (21.1%) eyes in group 1 and 22 (6.8%) eyes in group 2, and the difference was significant (p = 0.0001; OR = 3.65 (2.1-6.0)). Capsular rupture was associated with higher rate of contamination in both groups (p = 0.0001; OR = 7.7 and p = 0.0001; OR = 8.1). Two eyes in the BSS-only group developed postoperative endophthalmitis and these cases had posterior capsular rupture during the surgery and culture-positivity for staphylococcus epidermidis throughout the study. CONCLUSIONS Intraoperative antibiotic irrigation decreases aqueous humor contamination during phacoemulsification. Further studies are warranted to determine the interrelationship between aqueous humor contamination and endophthalmitis in eyes with posterior capsular rupture.
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Affiliation(s)
- G Sobaci
- Department of Ophthalmology, Gülhane Military Medical Academy and Medical School Hospital, Ankara, Turkey.
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Malalana F, Blundell RJ, Pinchbeck GL, Mcgowan CM. The role of Leptospira spp. in horses affected with recurrent uveitis in the UK. Equine Vet J 2017; 49:706-709. [PMID: 28321895 PMCID: PMC5655720 DOI: 10.1111/evj.12683] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 03/14/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Equine recurrent uveitis (ERU) is a common cause of ocular pain and blindness in horses. Leptospira spp. have been commonly implicated in the pathophysiology of ERU in mainland Europe and the USA. No recent studies have been carried out in the UK, but Leptospira is reported not to be a major factor in the aetiology of ERU in the UK. OBJECTIVES To establish the prevalence of Leptospira-associated ERU in the UK and to identify the serovars involved in these cases; to compare serum vs. aqueous humour antibody levels in cases and controls in order to confirm the diagnosis of Leptospira-associated ERU, and to assess the usefulness of serology alone as a confirmatory test for Leptospira-associated ERU in the UK. STUDY DESIGN Case-control study. METHODS Eyes enucleated for clinical reasons in ERU-affected horses were collected. Blood and aqueous humour were obtained to determine antibody levels against a variety of Leptospira serovars and C-values (aqueous humour value/serum value) were calculated. In addition, eyes, blood and aqueous humour were obtained from control cases for comparison. Histopathology was performed in all eyes to confirm uveitis in each case. Differences in seroprevalences between ERU and control cases and between Leptospira- and non-Leptospira-associated ERU cases were calculated. RESULTS A total of 30 ERU and 43 control eyes were analysed. Of the ERU eyes, only two had a C-value of >4 (prevalence of Leptospira-associated uveitis: 6.7%). Serovars hardjo and javanica were detected. There was no difference in seroprevalence between horses with uveitis and control cases (65.5% and 41.9%, respectively; P = 0.11) or between Leptospira- and non-Leptospira-associated uveitis cases (100% and 63.0%, respectively; P = 0.52). MAIN LIMITATIONS The study was limited by low case numbers. Eyes were presented at different stages of disease. The only test used to detect Leptospira was the microscopic agglutination test. CONCLUSIONS Leptospira-associated ERU is uncommon in the UK. Serology alone may not help to definitively diagnose Leptospira-associated uveitis in this country.
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Affiliation(s)
- F. Malalana
- School of Veterinary Science, University of LiverpoolNestonUK
| | - R. J. Blundell
- School of Veterinary Science, University of LiverpoolNestonUK
| | - G. L. Pinchbeck
- Institute of Infection and Global HealthSchool of Veterinary Science, University of LiverpoolNestonUK
| | - C. M. Mcgowan
- Institute of Ageing and Chronic DiseaseSchool of Veterinary Science, University of LiverpoolNestonUK
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Chung CY, Li KKW. The efficacy of latent tuberculosis treatment for immunocompetent uveitis patients with a positive T-SPOT.TB test: 6-year experience in a tuberculosis endemic region. Int Ophthalmol 2017; 38:2273-2282. [PMID: 28948453 DOI: 10.1007/s10792-017-0716-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 09/18/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the efficacy of latent tuberculosis (TB) treatment for immunocompetent uveitis patients with a positive T-SPOT.TB test. METHODS This is a consecutive case series of all T-SPOT.TB positive latent TB patients with presumed tuberculous uveitis managed with anti-tuberculous therapy (ATT) from 1 January 2000 to 31 December 2015. Patients with active TB or other known causes of uveitis, immunocompromised states and those followed up < 12 months were excluded. Descriptive statistics and hypothesis testing were performed, with a significance level of p < 0.05 taken. RESULTS Among the 75 T-SPOT.TB tests performed for uveitis, 14 cases were enrolled. Mycobacterium tuberculosis was isolated in none of the sputum and intraocular samples. Most cases had posterior uveitis (10/14 cases, 71.4%) and/or intermediate uveitis (9/14 cases, 64.3%). Vasculitis was predominantly occlusive. The mean presenting best-corrected visual acuity (BCVA) was 0.18, improving to 0.44 at 6 months (p = 0.03) and 0.40 at 12 months. (p = 0.03). At 1 year, remission of uveitis was achieved in 92.9%, in which none of them recurred at the last follow-up. High-dose systemic steroid was required in 50% of patients. Only 1 patient was steroid dependent at 18 months. The BCVA improvement in patients treated with or without steroid was comparable. CONCLUSION In a TB-endemic region with wide Bacille Calmette-Guerin vaccination coverage, ATT for immunocompetent uveitis patients with latent TB identified from T-SPOT.TB test can improve vision, induce long-term steroid-free remission, and prevent recurrence and systemic reactivation of TB in those who require steroid.
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Affiliation(s)
- Chung Yee Chung
- Department of Ophthalmology, United Christian Hospital, Kowloon, Hong Kong SAR.
- Department of Ophthalmology, Tseung Kwan O Hospital, New Territories, Hong Kong SAR.
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR.
| | - Kenneth K W Li
- Department of Ophthalmology, United Christian Hospital, Kowloon, Hong Kong SAR
- Department of Ophthalmology, Tseung Kwan O Hospital, New Territories, Hong Kong SAR
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
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Doan T, Wilson MR, Crawford ED, Chow ED, Khan LM, Knopp KA, O’Donovan BD, Xia D, Hacker JK, Stewart JM, Gonzales JA, Acharya NR, DeRisi JL. Illuminating uveitis: metagenomic deep sequencing identifies common and rare pathogens. Genome Med 2016; 8:90. [PMID: 27562436 PMCID: PMC4997733 DOI: 10.1186/s13073-016-0344-6] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 08/05/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Ocular infections remain a major cause of blindness and morbidity worldwide. While prognosis is dependent on the timing and accuracy of diagnosis, the etiology remains elusive in ~50 % of presumed infectious uveitis cases. The objective of this study is to determine if unbiased metagenomic deep sequencing (MDS) can accurately detect pathogens in intraocular fluid samples of patients with uveitis. METHODS This is a proof-of-concept study, in which intraocular fluid samples were obtained from five subjects with known diagnoses, and one subject with bilateral chronic uveitis without a known etiology. Samples were subjected to MDS, and results were compared with those from conventional diagnostic tests. Pathogens were identified using a rapid computational pipeline to analyze the non-host sequences obtained from MDS. RESULTS Unbiased MDS of intraocular fluid produced results concordant with known diagnoses in subjects with (n = 4) and without (n = 1) uveitis. Samples positive for Cryptococcus neoformans, Toxoplasma gondii, and herpes simplex virus 1 as tested by a Clinical Laboratory Improvement Amendments-certified laboratory were correctly identified with MDS. Rubella virus was identified in one case of chronic bilateral idiopathic uveitis. The subject's strain was most closely related to a German rubella virus strain isolated in 1992, one year before he developed a fever and rash while living in Germany. The pattern and the number of viral identified mutations present in the patient's strain were consistent with long-term viral replication in the eye. CONCLUSIONS MDS can identify fungi, parasites, and DNA and RNA viruses in minute volumes of intraocular fluid samples. The identification of chronic intraocular rubella virus infection highlights the eye's role as a long-term pathogen reservoir, which has implications for virus eradication and emerging global epidemics.
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Affiliation(s)
- Thuy Doan
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA USA
| | - Michael R. Wilson
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA USA
- Department of Neurology, University of California San Francisco, San Francisco, CA USA
| | - Emily D. Crawford
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA USA
- Howard Hughes Medical Institute, Chevy Chase, MD USA
| | - Eric D. Chow
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA USA
| | - Lillian M. Khan
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA USA
| | - Kristeene A. Knopp
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA USA
| | - Brian D. O’Donovan
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA USA
| | - Dongxiang Xia
- California Department of Public Health, Richmond, CA USA
| | - Jill K. Hacker
- California Department of Public Health, Richmond, CA USA
| | - Jay M. Stewart
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA USA
| | - John A. Gonzales
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA USA
| | - Nisha R. Acharya
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA USA
| | - Joseph L. DeRisi
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA USA
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Kazi H, de Groot-Mijnes JDF, Ten Dam-van Loon NH, Ossewaarde-van Norel J, Oosterheert JJ, de Boer JH. No Value for Routine Serologic Screening for Borrelia burgdorferi in Patients With Uveitis in the Netherlands. Am J Ophthalmol 2016; 166:189-193. [PMID: 27080573 DOI: 10.1016/j.ajo.2016.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 04/01/2016] [Accepted: 04/03/2016] [Indexed: 01/14/2023]
Abstract
PURPOSE To determine whether routine serologic screening for Borrelia burgdorferi and subsequent aqueous or vitreous humor analysis is useful in patients with uveitis. DESIGN Cross-sectional study. METHODS All patients referred to our tertiary uveitis referral clinic in the period of from January 1, 2004 to October 31, 2014, in whom routine serologic screening for Borrelia burgdorferi (IgG as determined by enzyme-linked immunosorbent assay and confirmed by immunoblot) was performed were retrospectively reviewed. In patients with an unclassified uveitis, aqueous and vitreous humor and cerebrospinal fluid were also analyzed. Local antibody production was determined by Goldmann-Witmer coefficient calculation or polymerase chain reaction for B burgdorferi. The seroprevalence of B burgdorferi among patients with uveitis was compared to the general population. RESULTS Borrelia burgdorferi screening was performed in 1126 uveitis patients (44.3% male, mean age 45.9 ± 19.6 years). The seroprevalence of B burgdorferi among uveitis patients was 3.7% (95% confidence interval 2.6%-4.8%) (n = 42) as compared to 5%-10% in the general Dutch population. Of these 42 patients, 14 (1.2% of all uveitis patients) had an unclassified uveitis, 7 of whom underwent aqueous humor (n = 5) or vitreous humor (n = 2) analysis and cerebrospinal fluid analysis (n = 2). None of the patients had local antibody production in either ocular or cerebrospinal fluid. CONCLUSION The prevalence of immunoblot-confirmed B burgdorferi IgG seropositivity in our uveitis patients is only slightly lower as compared to the general Dutch population. Intraocular antibody production and DNA was absent in all tested patients. These findings do not support routine serologic examination for Borrelia in uveitis patients.
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Affiliation(s)
- Hawkar Kazi
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jolanda D F de Groot-Mijnes
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, Netherlands; Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Netherlands.
| | | | | | - Jan Jelrik Oosterheert
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, Netherlands
| | - Joke H de Boer
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, Netherlands
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Rayess N, Rahimy E, Storey P, Shah CP, Wolfe JD, Chen E, DeCroos FC, Garg SJ, Hsu J. Postinjection Endophthalmitis Rates and Characteristics Following Intravitreal Bevacizumab, Ranibizumab, and Aflibercept. Am J Ophthalmol 2016; 165:88-93. [PMID: 26944277 DOI: 10.1016/j.ajo.2016.02.028] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 02/22/2016] [Accepted: 02/22/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare the incidence and clinical outcomes of endophthalmitis following intravitreal injections of bevacizumab, ranibizumab, and aflibercept. DESIGN Multicenter, retrospective cohort study. METHODS All included patients had received intravitreal injections of bevacizumab, ranibizumab, or aflibercept between January 1, 2009 and September 30, 2013 at 5 retina practices. Billing records were used to identify the total number of anti-vascular endothelial growth factor (VEGF) injections administered. Patients who developed endophthalmitis were ascertained from endophthalmitis logs and billing records. Chart review of these patients was performed to confirm that the endophthalmitis was related to the antecedent anti-VEGF injection. Visual outcomes, causative organisms, and clinical course were also recorded. RESULTS A total of 503 890 anti-VEGF injections were included, from which 183 cases of presumed endophthalmitis were identified. The rate of endophthalmitis for bevacizumab was 0.039% (60/153 812), which was similar to ranibizumab 0.035% (109/309 722; P = .522) and aflibercept 0.035% (14/40 356; P = .693). Similarly, there was no difference in the rates between ranibizumab and aflibercept (P = .960). The culture-positive rate of the vitreous/aqueous tap was 38% for both bevacizumab and ranibizumab and was 43% for aflibercept. Furthermore, visual acuity remained decreased at 3 months follow-up for bevacizumab (P = .005), ranibizumab (P < .001), and aflibercept (P = .07) compared to vision at causative injection. CONCLUSIONS Endophthalmitis following intravitreal bevacizumab, ranibizumab, and aflibercept injection appears to occur at similar rates and have comparable visual outcomes. This study suggests that the choice of anti-VEGF agent should be primarily based on efficacy and patient response rather than concern for risk of infection.
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Affiliation(s)
- Nadim Rayess
- Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania
| | - Ehsan Rahimy
- Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania
| | - Philip Storey
- Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania
| | - Chirag P Shah
- Ophthalmic Consultants of Boston, Boston, Massachusetts
| | - Jeremy D Wolfe
- Associated Retinal Consultants at William Beaumont Hospital, Royal Oak, Michigan
| | - Eric Chen
- Retina Consultants of Houston, Houston, Texas
| | | | - Sunir J Garg
- Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania
| | - Jason Hsu
- Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania.
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Ratra D, Saurabh K, Das D, Nachiappan K, Nagpal A, Rishi E, Bhende P, Sharma T, Gopal L. Endogenous Endophthalmitis: A 10-Year Retrospective Study at a Tertiary Hospital in South India. Asia Pac J Ophthalmol (Phila) 2015; 4:286-92. [PMID: 26181589 DOI: 10.1097/apo.0000000000000120] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of this study was to review the clinical profile including predisposing systemic conditions, microorganisms responsible, clinical presentation, and outcomes of endogenous endophthalmitis (EE) in South India. DESIGN This study is a retrospective, noncomparative case series. METHODS This study presents a retrospective analysis of records of patients with EE in a 10-year period. RESULTS A total of 61 eyes of 58 patients were included in the study. Preceding systemic illness or surgery was noted in 31 patients (53.4%). No predisposing condition was found in 27 patients (46.5%). All eyes had severe diffuse EE. Culture positivity was seen in 34 of 58 patients (58.6%). Gram-positive organisms were isolated in 9 cases (15.5%), and Gram-negative organisms were isolated in 20 cases (34.5%). Pseudomonas aeruginosa (13.8%) was the most common isolate. Eleven eyes (18%) were managed medically with intravenous and intravitreal antibiotics, and 38 eyes (62.3%) also underwent vitrectomy. Eight eyes (13.1%) required repeat vitrectomy, and 12 eyes (19.7%) were eviscerated. The mean follow-up was 16.2 ± 13.9 months. Final visual acuity of 20/200 or better was seen in 29.5% eyes. A favorable outcome was noted in culture-positive patients (P = 0.03) and in patients with no predisposing causes. CONCLUSIONS This study provides information about the clinical and microbiologic profile of EE. Aggressive medical and surgical treatment can result in favorable outcomes.
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Affiliation(s)
- Dhanashree Ratra
- From the Bhagawan Mahavir Department of Vitreoretinal Diseases, Sankara Nethralaya Medical Research Foundation, Chennai, India
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Levinson JD, Giangiacomo AL, Beck AD, Pruett PB, Superak HM, Lynn MJ, Costarides AP. Glaucoma drainage devices: risk of exposure and infection. Am J Ophthalmol 2015; 160:516-521.e2. [PMID: 26032191 PMCID: PMC4543444 DOI: 10.1016/j.ajo.2015.05.025] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/24/2015] [Accepted: 05/26/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To identify risk factors for device exposure and intraocular infection following implantation of a glaucoma drainage device. DESIGN Retrospective case series. METHODS The medical records of adult patients undergoing glaucoma drainage device implantation at an academic medical center between 2000 and 2010 were reviewed. Main outcome measures included device exposure and intraocular infection. RESULTS Seven hundred and sixty-three cases were identified. These included 702 primary implants (ie, the first drainage device implanted into an eye) and 61 sequential implants. Among 702 primary implants, there were 41 cases of exposure (5.8%). None of the potential risk factors were statistically significant. Implant location was found to be a marginally significant risk factor. The exposure rates for inferior and superior implants were 12.8% (5 of 39) and 5.4% (36 of 663), respectively (P = .056). The highest rate of exposure for primary implants occurred in the inferior-nasal quadrant (17.2%, 5 of 29). The rate of exposure for sequential devices was 13.1% (8 of 61), with the highest rate also found in the inferior-nasal quadrant (20%, 5 of 25). Of 49 total exposures, 8 were associated with intraocular infection (16.3%). Exposures over inferior implants were more likely to be associated with infection than exposures over superior implants (41.7% vs 8.1%; P = .0151). CONCLUSION Implant location approached, but did not reach, statistical significance as a risk factor for exposure. Exposures over inferior implants place patients at a higher risk of infection than superior exposures. More studies are needed to identify modifiable risk factors for device exposure.
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Affiliation(s)
| | | | - Allen D Beck
- Department of Ophthalmology, Emory University, Atlanta, Georgia
| | - Paul B Pruett
- Department of Ophthalmology, Emory University, Atlanta, Georgia
| | - Hillary M Superak
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | - Michael J Lynn
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
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Sadaka A, Palmer K, Suzuki T, Gilmore MS. In vitro and in vivo models of Staphylococcus aureus endophthalmitis implicate specific nutrients in ocular infection. PLoS One 2014; 9:e110872. [PMID: 25340474 PMCID: PMC4207797 DOI: 10.1371/journal.pone.0110872] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 09/18/2014] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To define global transcriptional responses of Staphylococcus aureus and its codY mutant (CodY is a transcription regulator of virulence and metabolic genes in response to branched-chain amino acids) when growing in bovine aqueous (AH) and vitreous humor (VH) in vitro, and to investigate the impact of codY deletion on S. aureus virulence in a novel murine anterior chamber (AC) infection model. METHODS For the in vitro model, differential transcriptomic gene expression of S. aureus and its codY mutant grown in chemically defined medium (CDM), AH, and VH was analyzed. Furthermore, the strains were inoculated into the AC of mice. Changes in bacterial growth, electroretinography and inflammation scores were monitored. RESULTS Bovine AH and VH provide sufficient nutrition for S. aureus growth in vitro. Transcriptome analysis identified 72 unique open reading frames differentially regulated ≥10-fold between CDM, AH, and VH. In the AC model, we found comparable growth of the codY mutant and wild type strains in vivo. Average inflammation scores and retinal function were significantly worse for codY mutant-infected eyes at 24 h post-infection. CONCLUSION Our in vitro bovine AH and VH models identified likely nutrient sources for S. aureus in the ocular milieu. The in vivo model suggests that control of branched-chain amino acid availability has therapeutic potential in limiting S. aureus endophthalmitis severity.
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Affiliation(s)
- Ama Sadaka
- Departments of Ophthalmology, and Microbiology and Molecular Genetics, Harvard Medical School, Boston, Massachusetts, United States of America
- The Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States of America
- Harvard Microbial Sciences Initiative, Cambridge, Massachusetts, United States of America
| | - Kelli Palmer
- Departments of Ophthalmology, and Microbiology and Molecular Genetics, Harvard Medical School, Boston, Massachusetts, United States of America
- The Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States of America
- Harvard Microbial Sciences Initiative, Cambridge, Massachusetts, United States of America
| | - Takashi Suzuki
- Departments of Ophthalmology, and Microbiology and Molecular Genetics, Harvard Medical School, Boston, Massachusetts, United States of America
- The Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States of America
- Harvard Microbial Sciences Initiative, Cambridge, Massachusetts, United States of America
| | - Michael S. Gilmore
- Departments of Ophthalmology, and Microbiology and Molecular Genetics, Harvard Medical School, Boston, Massachusetts, United States of America
- The Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States of America
- Harvard Microbial Sciences Initiative, Cambridge, Massachusetts, United States of America
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Brillat-Zaratzian E, Bron A, Aptel F, Romanet JP, Cornut PL, Vandenesch F, Boisset S, Maurin M, Chiquet C. FRIENDS Group: clinical and microbiological characteristics of post-filtering surgery endophthalmitis. Graefes Arch Clin Exp Ophthalmol 2013; 252:101-7. [PMID: 24248809 DOI: 10.1007/s00417-013-2503-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 10/03/2013] [Accepted: 10/14/2013] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To study the clinical and microbiological characteristics as well as the prognostic factors for post-filtering surgery endophthalmitis. METHODS Twenty-three eyes were included in the study in four tertiary centres between 2004 and 2010. The clinical and microbiological data were collected prospectively (minimum follow-up, 6 months). Microbiological diagnosis was based on conventional cultures and panbacterial PCR (16SrDNA amplification and sequencing). RESULTS The onset of endophthalmitis was early (<6 weeks) in 22 % of the cases and delayed in 78 %. Elevated intraocular pressure and hypopyon were more frequent in delayed than in early presentations (p = 0.04). By combining the results of culture and panbacterial PCR, a bacterial species could be identified in 73.9 % of the cases, including 56.5 % of commensal species of the digestive tract such as Moraxella spp., oropharyngeal streptococci and Enterococcus faecalis. Good final visual acuity (VA ≥ 20/40) was correlated with initial VA greater than light perception (p = 0.05). Poor final VA (≤20/400) was correlated with a higher virulence of the infecting bacterial species (p = 0.006), and was noted in all patients with early-onset endophthalmitis. CONCLUSION Acute early- or delayed-onset post-filtering surgery endophthalmitis is frequently caused by bacteria of the digestive tract (e.g., Streptococcus and Enterococcus spp.). The combination of conventional cultures and panbacterial PCR allowed us to identify the causative microorganism in three-quarters of the cases, i.e., 21 % more cases than through culture alone. Despite adequate antibiotic and surgical treatment, the anatomical and visual prognosis remains poor.
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Cornut PL, Youssef EB, Bron A, Thuret G, Gain P, Burillon C, Romanet JP, Vandenesch F, Maurin M, Creuzot-Garcher C, Chiquet C. A multicentre prospective study of post-traumatic endophthalmitis. Acta Ophthalmol 2013; 91:475-82. [PMID: 22313810 DOI: 10.1111/j.1755-3768.2011.02349.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Study the clinical and microbiological characteristics and the prognostic factors of post-traumatic endophthalmitis. METHODS Seventeen eyes were included between 2004 and 2010, with clinical and microbiological data collected prospectively. Conventional cultures and panbacterial PCR were performed on aqueous and vitreous samples. RESULTS Clinical signs of endophthalmitis were observed soon after trauma (1.5 ± 2.5 days). Laceration with an intraocular foreign body (IOFB) was noted in 53% of the patients. At admission, all patients had aqueous humour (71%) and/or vitreous (53%) samples. Fifteen patients (88%) underwent a pars plana vitrectomy. Bacteria were identified in 77% of the cases: Staphylococcus epidermidis (n = 5), Streptococcus (n = 4), Bacillus (n = 2), Pseudomonas stuzeri (n = 1), and Streptococcus salivarius and Gemella haemolysans (multibacterial infection, n = 1). Progression toward phthisis was observed in 35% of the cases; 41% of the patients recuperated visual acuity (VA) ≥20/40. A good final visual prognosis (≥20/40) was significantly associated with initial VA better than light perception (0% versus 70%, p = 0.01) and absence of pupillary fibrin membrane (80% versus 20%, p = 0.05). There was no correlation between visual prognosis and age, the type of laceration (corneal or scleral) or presence of an IOFB. We found a statistical trend toward an association between bacterial virulence and poor final VA. CONCLUSION This series showed that better final VA outcomes were associated with initial VA better than light perception, S. epidermidis or culture-negative cases and absence of retinal detachment during the clinical course.
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Affiliation(s)
- Pierre-Loïc Cornut
- Department of Ophthalmology, Hôpital Edouard Herriot, Hospices Civils de Lyon, University Hospital, Université Lyon I, Lyon, France
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Carron A, Samudio M, Laspina F, Fariña N, Sanabria RR, Cibils D, Ramirez L, Carron J, Mino de Kaspar H. [Efficacy of topical 0.3% ciprofloxacin application in reducing the conjunctival biota of patients undergoing cataract extraction]. ACTA ACUST UNITED AC 2013; 88:345-51. [PMID: 23988041 DOI: 10.1016/j.oftal.2013.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 12/29/2012] [Accepted: 01/08/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the efficacy of topical 0.3% ciprofloxacin in reducing conjunctival biota in patients undergoing cataract surgery. PATIENTS AND METHODS Experimental, prospective, randomized, controlled and single-blind study. Forty-six eyes of 46 patients were randomized into 2 groups, the study group (n=23) received topical 0.3% ciprofloxacin one day before surgery for six times, and on the day of the surgery one drop every 15minutes starting one hour before surgery until 3 doses were completed. The control group (n=23) did not receive any antibiotics. For both groups for the surgical field 10% povidone-iodine was applied. Samples from the conjunctiva were taken at four different times and then cultured on solid media (chocolate agar, blood agar) and enrichment broth (thioglycolate). The aqueous humor samples were also cultured in thioglycolate. The presence of bacteria was identified quantitatively and qualitatively, and the frequency of contamination was measured by considering the presence of bacteria in liquid and solid culture media. The number of colony forming units (CFU) was counted in the solid culture medium. RESULTS Positive cultures were obtained in 82.6% and 78.2% of the patients in the study and control groups, respectively, before the administration of 0.3% ciprofloxacin. The administration of 0.3% ciprofloxacin significantly reduced the CFU compared to the control group (P<.05). Immediately after the use of povidone-iodine, the proportion of patients with a positive culture decreased to 21.7% in the study group, and 8.7% in the control group. At the end of the surgery, this percentage was 26% and 30.4%, respectively. The most common isolated pathogen was negative-coagulase Staphylococcus (66.7%). CONCLUSION The administration of 0.3% ciprofloxacin reduces conjunctival bacterial load in the preoperative period. However, it was unable to eradicate the bacteria completely. The administration of povidone-iodine reduced conjunctival biota in 50%-70% of patients undergoing cataract surgery.
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Affiliation(s)
- A Carron
- National University of Asunción, Asunción, Paraguay
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Hooper CY, Lightman SL, Pacheco P, Tam PMK, Khan A, Taylor SRJ. Adjunctive antibiotics in the treatment of acute bacterial endophthalmitis following cataract surgery. Acta Ophthalmol 2012; 90:e572-3. [PMID: 22429465 DOI: 10.1111/j.1755-3768.2011.02365.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ogawa M, Sugita S, Watanabe K, Shimizu N, Mochizuki M. Novel diagnosis of fungal endophthalmitis by broad-range real-time PCR detection of fungal 28S ribosomal DNA. Graefes Arch Clin Exp Ophthalmol 2012; 250:1877-83. [PMID: 22527320 DOI: 10.1007/s00417-012-2015-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 03/21/2012] [Accepted: 03/22/2012] [Indexed: 11/25/2022] Open
Abstract
AIM To detect the fungal genome in the ocular fluids of patients with fungal endophthalmitis by using a novel broad-range polymerase chain reaction (PCR) system. METHODS After informed consent was obtained, ocular fluid samples (aqueous humor or vitreous fluids) were collected from 497 patients (76 patients with infectious endophthalmitis including clinically suspected bacterial and fungal endophthalmitis and 421 patients with infectious or non-infectious uveitis). Forty ocular samples from non-infectious patients without ocular inflammation were collected as controls. Fungal ribosomal DNA (28 S rDNA) was measured by a quantitative real-time PCR assay. RESULTS Fungal 28 S rDNA of the major fungal species, such as Candida, Aspergillus, and Cryptococcus, were detected by novel broad-range real-time PCR examination (>10(1) copies/ml). Fungal 28 S rDNA was detected in the ocular fluids of 11 patients with endophthalmitis or uveitis (11/497, 2.2%). All 11 positive samples were detected in the infectious endophthalmitis patients (11/76, 14.5%). These PCR-positive ocular fluids had high copy numbers of fungal 28 S rDNA (range, 1.7 × 10(3) to 7.9 × 10(6) copies/ml), which indicated the presence of fungal infection. Of the 11 patients who were PCR positive, further examinations led to a diagnosis of fungal endophthalmitis in ten patients. The fungal 28 S rDNA was detected in one non-infectious case (a false-positive case). In addition, there were two PCR false-negative cases that were clinically suspected of having fungal endophthalmitis. CONCLUSIONS This novel quantitative broad-range PCR of fungal 28 S rDNA is a useful tool for diagnosing endophthalmitis related to fungal infections.
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Affiliation(s)
- Manabu Ogawa
- Department of Ophthalmology & Visual Science, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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van Rooij J, Boks AL, Sprenger A, Ossewaarde JM, van Meurs JC. The concentration of povidone-iodine for preoperative disinfection: relation to endophthalmitis incidence. Am J Ophthalmol 2011; 152:321; author reply 321-2. [PMID: 21784195 DOI: 10.1016/j.ajo.2011.03.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 03/11/2011] [Accepted: 03/14/2011] [Indexed: 11/30/2022]
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Shah CP, Garg SJ, Vander JF, Brown GC, Kaiser RS, Haller JA. Outcomes and risk factors associated with endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents. Ophthalmology 2011; 118:2028-34. [PMID: 21705087 DOI: 10.1016/j.ophtha.2011.02.034] [Citation(s) in RCA: 164] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 02/16/2011] [Accepted: 02/17/2011] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To describe outcomes of and risk factors for endophthalmitis after intravitreal anti-vascular endothelial growth factor (VEGF) injection. DESIGN Single-center, consecutive, case series and retrospective case-control study. PARTICIPANTS Between January 1, 2009, and May 31, 2010, 16 vitreoretinal surgeons administered a total of 27 736 injections. During this period, 23 cases of presumed infectious endophthalmitis occurred. Each surgeon used his own preferred injection technique. INTERVENTION Vitreous or aqueous tap, or both, with intravitreal antibiotic injection and subsequent topical antibiotic and steroid drops. MAIN OUTCOME MEASURES Visual acuity, bladed lid speculum use, conjunctival displacement, hemisphere of injection, bevacizumab versus ranibizumab, and infectious organism. RESULTS Seven of 23 cases had positive culture results; 3 grew coagulase-negative Staphylococcus. All cases had pain and vitritis on average 3.4 days (range, 1-6 days) after injection, with no difference between culture-positive and culture-negative groups. Eighteen (78%) of 23 cases had a hypopyon. Fifteen of 23 cases returned to baseline vision (±2 lines) within 3 months. Neither lid speculum use (0.10% vs. 0.066% in the no-use group; P = 0.27), conjunctival displacement (0.11% vs. 0.076% in the no-displacement group; P = 0.43), hemisphere of injection (0.11% superior vs. 0.079% inferior; P = 0.56), or bevacizumab versus ranibizumab (0.11% vs. 0.066%; P = 0.21) affected risk. Analysis of only culture-positive results yielded similar results. There was no statistically significant difference between the proportion of culture-negative cases after bevacizumab injection (83%) versus ranibizumab injection (55%; P = 0.13). CONCLUSIONS Most patients in whom presumed infectious endophthalmitis develop after anti-VEGF injection regained baseline vision after treatment. Bladed lid speculum use, conjunctival displacement, hemisphere of injection, and type of anti-VEGF agent did not affect risk. No difference in culture-negative endophthalmitis rates was detected after bevacizumab versus ranibizumab injection. Neither the presence of pain, vitritis, decreased vision, hypopyon, nor the interval between injection and development of symptoms differentiate culture-positive from culture-negative cases. Because a subgroup of patients had poor outcomes, a low threshold for vitreous tap with intravitreal antibiotic injection may be warranted. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Chirag P Shah
- Ophthalmic Consultants of Boston, Boston, Massachusetts, USA
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Abstract
PURPOSE To describe ocular involvement and response to treatment in a patient with human immunodeficiency virus (HIV) infection with severe progressive disseminated histoplasmosis (PDH). METHODS We report a 35-year-old HIV-infected patient seen in our clinics over a period of 4 years. During antiretroviral treatment (ART), the HIV load became undetectable at 3 months; however, CD4 T-cell count increased slowly and rose to 100 cells/microl. Histoplasma capsulatum was cultured from skin pustules, cerebrospinal fluid (CF) and aqueous humour. RESULTS The patient developed central nervous system (CNS) involvement 2 months and panuveitis in both eyes 4 months after the initiation of ART. With intravenous liposomal amphotericin B followed by oral voricanozole, the chorioretinal lesions of the right eye (RE) became inactivated and magnetic resonance imaging (MRI) lesions of CNS disappeared. Relapse of the inflammation in the anterior segment of the left eye (LE) resulted in a total closure of the chamber angle and severe glaucoma. Despite medical therapy, two cyclophotocoagulations, total vitrectomy and repeated intravitreal amphotericin B injections, LE became blind. Histoplasma capsulatum was cultured from the aqueous humour after antifungal therapy of 16 months' duration. CONCLUSION PDH with intraocular and CNS manifestations was probably manifested by an enhanced immune response against a previous subclinical disseminated infection. It seems difficult to eradicate H. capsulatum from the anterior segment of the eye in an immunocompromised patient.
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Abstract
A 36-year-old woman with no prior medical history presented with a unilateral decrease in vision and iridocyclitis to our hospital. External examination demonstrated multifocal, firm, elevated, non-tender skin nodules on the patient's face and left hand. In addition, slit-lamp biomicroscopy revealed gray, cheesy-appearing nodules on the iris surface of the affected eye. Anterior chamber paracentesis and pars plana vitrectomy did not reveal further information. Skin nodule biopsy, however, demonstrated multiple fragmented organisms within histiocytes, consistent with leprosy. The iridocyclitis resolved after treatment with dapsone, corticosteroids, and rifampin and her vision returned to 20/20.
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Jirásková N, Rozsíval P, Pozlerová J, Ludvíková M. [Microbiological examination of the aqueous humor after implantation of the intraocular lens CORNEAL]. Cesk Slov Oftalmol 2008; 64:185-187. [PMID: 18988471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE To compare the results of the microbiological examination of aqueous humor after implantation of the intraocular lens (IOL) CORNEAL using either injector or forceps. MATERIALS AND METHODS In this prospective randomized clinical study 46 eyes (43 patients) were implanted with the hydrophylic acrylic IOL CORNEAL ACR6D SE. Injector was used in 23 eyes and folding and implantation forceps in 23 eyes. After delivery of the IOL in the capsular bag, viscoelastic material was removed using bimanual I/A and the specimen for microbiological examination was obtained. The anterior chamber was filled with balanced salt solution, intracameral antibiotics were injected and the stroma alongside the primary incision and the side port incisions were lightly irrigated to form a fairly secure seal. RESULTS The results of primary cultivation were negative in all specimen. Only threetimes sporadic colonies of Staphylococcus plasmacoag. neg. were isolated from the liquid medium after reincubation, that were described by microbiologist as very probably contamination of the sample. At two from these three cases forceps were used for implantation, once injector. Anaerobic and mycologic examinations of all samples were negative. There was no evidence of postoperative inflammation in any case. CONCLUSION Both implantation techniques proved to be safe with no significant differences comparing the microbiological examination and postoperative outcome.
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Affiliation(s)
- N Jirásková
- Ocní klinika Lékarské fakulty Univerzity Karlovy a Fakultní nemocnice, Hradec Králové.
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Nubourgh I, Vandergheynst F, Lefebvre P, Lemy A, Dumarey N, Decaux G. An atypical case of Whipple's disease: case report and review of the literature. Acta Clin Belg 2008; 63:107-11. [PMID: 18575052 DOI: 10.1179/acb.2008.63.2.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We report the case of a 57-year-old man, presenting with bilateral panuveitis, bilateral sacroiliitis, intermittent pyrexia and a pulmonary nodule. The patient had been under immunosuppressive treatment for 2 years for Behçet's disease. However, he did not fulfill the diagnostic criteria of Behçet's disease. Blood analysis showed a very high C reactive protein (CRP at 34 mg/dl). In view of severe intra-ocular inflammation, the anterior chamber was punctured. Polymerase chain reaction (PCR) on the aqueous humour and on the blood revealed the presence of Tropheryma whippelii DNA, an agent responsible for Whipple's disease. The patient was treated with ceftriaxone followed by trimethoprim-sulfamethoxazol for 1 year with good clinical and biological evolution. This case illustrates the difficulty to diagnose an atypical Whipple's disease. In cases of uveitis with atypical signs and/or not responding to the treatment, the internist must consider to perform an analysis of the ocular fluids.
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Affiliation(s)
- I Nubourgh
- Department of General Internal Medicine, Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium.
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Matos K, Muccioli C, Belfort Junior R, Rizzo LV. Correlation between clinical diagnosis and PCR analysis of serum, aqueous, and vitreous samples in patients with inflammatory eye disease. Arq Bras Oftalmol 2008; 70:109-14. [PMID: 17505729 DOI: 10.1590/s0004-27492007000100020] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2005] [Accepted: 07/25/2006] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To study the applicability (sensitivity, specificity) of polymerase chain reaction (PCR) tests in the detection of cytomegalovirus (CMV), herpes virus (HSV) and varicella zoster (VZV), Epstein-Barr virus (EBV), Mycobacterium sp and Toxoplasma gondii in the diagnosis of patients with or without AIDS, with presumably infectious uveitis, using serum, aqueous humor and vitreous humor samples. METHODS Twenty individuals with uveitis of presumed infectious origin were evaluated. Sixteen of them had AIDS, four were immunocompetent individuals. We also evaluated 4 normal controls who underwent vitrectomy surgery. Clinical evaluation of the patients was performed together by three clinicians. PCR evaluations of the serum, aqueous, and vitreous humor were performed in a masked fashion by the laboratory staff. RESULTS Twelve patients had a clinical diagnosis of CMV retinitis. Of these 6 (50%) had a positive PCR for CMV in the vitreous, three (25%) had a positive PCR for CMV in the serum, and none were positive in the aqueous. Five patients had a clinical diagnosis of acute retinal necrosis (ARN). Three (60%) of these had positive PCR for HSV/VZV in the vitreous. One of these patients had a positive PCR reaction for both EBV and HSV/VZV in the vitreous samples. One patient with cutaneous herpes zoster had a positive PCR reaction for HSV/VZV in the serum. Four patients had a presumed diagnosis of ocular toxoplasmosis, one patient (25%) had a positive PCR for Toxoplasma gondii in the serum, 3 (75%) had positive results in the aqueous, and 2 (50%) had positive results in the vitreous. One patient with presumed ocular tuberculosis had a positive PCR reaction both in the serum and in the vitreous samples. Finally, none of the four control individuals revealed any positive PCR reaction. CONCLUSION PCR is an auxiliary diagnostic procedure that should be evaluated together with ophthalmological aspects of the patient.
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Affiliation(s)
- Kimble Matos
- Setor de Uveite e AIDS, Universidade Federal de São Paulo, Rua Pintassilgo 480, São Paulo, SP, CEP 04514-032, Brazil.
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Westeneng AC, Rothova A, de Boer JH, de Groot-Mijnes JDF. Infectious uveitis in immunocompromised patients and the diagnostic value of polymerase chain reaction and Goldmann-Witmer coefficient in aqueous analysis. Am J Ophthalmol 2007; 144:781-5. [PMID: 17707328 DOI: 10.1016/j.ajo.2007.06.034] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2007] [Revised: 06/24/2007] [Accepted: 06/26/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE To establish the causes of uveitis in immunocompromised patients and to determine the contribution of polymerase chain reaction (PCR) and Goldmann-Witmer coefficient (GWC) analysis of aqueous humor in patients with an infectious etiology. DESIGN Retrospective case series of 56 consecutive immunocompromised patients with uveitis. METHODS All patients underwent full ophthalmologic examination and laboratory blood analysis for uveitis. Aqueous humor analyses were performed using PCR and GWC for cytomegalovirus (CMV), herpes simplex virus (HSV), varicella zoster virus (VZV), and Toxoplasma gondii. RESULTS Of 56 immunocompromised patients, 43 (77%), all posterior and panuveitis, had intraocular infections. Twenty-one (49%) had CMV, three (7%) had VZV, 11 (26%) had T. gondii, six (14%) had Treponema pallidum, and one (2%) each had Aspergillus and Candida. In AIDS patients, CMV was the most common cause. A strong correlation between AIDS and ocular syphilis was also observed (P = .007). In nonAIDS immunocompromised patients, T. gondii was most frequently detected. Twenty-seven patients were examined by both PCR and GWC; five (18.5%) were positive by both assays, 15 (55.5%) were positive by PCR alone and seven (26%) by GWC alone. Viral infections were detected by PCR in 16 of 17 (94%) cases; T. gondii in four of 10 (40%) patients. Using GWC, a viral infection was diagnosed in three of 17 (18%) and T. gondii in nine of 10 (90%) cases. CONCLUSIONS In immunocompromised patients, PCR is superior in diagnosing viral infections. Analysis of intraocular antibody production played a decisive role in the diagnosis of ocular toxoplasmosis.
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Bagyalakshmi R, Therese KL, Madhavan HN. Application of semi-nested polymerase chain reaction targeting internal transcribed spacer region for rapid detection of panfungal genome directly from ocular specimens. Indian J Ophthalmol 2007; 55:261-5. [PMID: 17595473 DOI: 10.4103/0301-4738.33037] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The incidence of fungal endophthalmitis has dramatically increased in recent years and rapid detection of fungi using nucleic acid-based amplification techniques is helpful in management. AIM To evaluate semi-nested polymerase chain reaction (PCR) targeting internal transcribed spacer (ITS) region for detection of panfungal genome in ocular specimens. STATISTICAL ANALYSIS USED Z test for two proportion. MATERIALS AND METHODS Standardization of PCR targeting ITS primers was carried out by determining analytical sensitivity and specificity. The sensitivity and specificity of PCR was determined by serial tenfold dilutions of C. albicans (ATCC 24433) DNA and DNA extracts of laboratory isolates of Aspergillus fumigatus, Fusarium lichenicola (4), other fungal and closely related bacterial strains and also human DNA. Semi-nested PCR was applied onto a total of 168 ocular specimens with clinically suspected fungal etiology during 2003-2005. RESULTS AND CONCLUSIONS PCR was specific and sensitive to detect 1fg of fungal DNA with ITS primers. PCR detected fungal genome in 90 (53.57%) in comparison with the conventional technique, positive in 34 (20.23%) by smear examination and in 42 (25%) by culture. The increase in clinical sensitivity by 28.57% using PCR was found to be statistically significant { P < 0.001 using Z test for two proportion}. The accuracy of the test was found to be 70.85%. PCR proved to be a rapid diagnostic technique for detection of panfungal genome directly from clinical specimens.
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Affiliation(s)
- R Bagyalakshmi
- Larsen and Toubro Microbiology Research Centre, Vision Research Foundation, No.18, College Road, Sankara Nethralaya, Chennai - 600 006, India
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Chiquet C, Lina G, Benito Y, Cornut PL, Etienne J, Romanet JP, Denis P, Vandenesch F. Polymerase chain reaction identification in aqueous humor of patients with postoperative endophthalmitis. J Cataract Refract Surg 2007; 33:635-41. [PMID: 17397736 DOI: 10.1016/j.jcrs.2006.12.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Accepted: 12/01/2006] [Indexed: 11/22/2022]
Abstract
PURPOSE To identify bacterial agents in the aqueous humor of patients with postoperative endophthalmitis using eubacterial polymerase chain reaction (PCR) and conventional culture. SETTING University Hospital of Lyon E. Herriot, Lyon, France. METHODS Broad-range eubacterial PCR amplification followed by direct sequencing was used to identify microbial pathogens in ocular samples from 30 patients with acute or delayed-onset endophthalmitis, mainly after cataract surgery. Ocular samples included aqueous humor collected before the first intravitreal injection of antibiotics and vitreous samples collected at the time of the therapeutic pars plana vitrectomy. RESULTS Cultures were positive in 32% of cases and PCR in 61% of cases with aqueous humor samples. When associated, culture and PCR of aqueous humor samples allowed for a microbiological diagnosis in 71% of cases. Microorganisms cultured by conventional techniques matched those identified by PCR. When applied on vitreous pretreated with intravitreal antibiotics, PCR increased the identification rate from 18% to 62%. CONCLUSIONS Polymerase chain reaction assay of initial aqueous humor samples contributed to the diagnosis of endophthalmitis in 30% of cases. Previous use of intravitreal antibiotics did not seem to affect the ability to PCR-amplify DNA in the short term. Polymerase chain reaction-based technology was a useful adjunct to conventional culture because when used with aqueous humor samples only, the association of both techniques allowed for a microbiological diagnosis in 71% of cases of postoperative acute and delayed-onset endophthalmitis.
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Affiliation(s)
- Christophe Chiquet
- Department of Ophthalmology, Hôpital Edouard Herriot, Université Lyon, France.
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Harper T, Miller D, Flynn HW. In Vitro Efficacy and Pharmacodynamic Indices for Antibiotics against Coagulase-Negative Staphylococcus Endophthalmitis Isolates. Ophthalmology 2007; 114:871-5. [PMID: 17383732 DOI: 10.1016/j.ophtha.2007.01.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2006] [Revised: 12/24/2006] [Accepted: 01/02/2007] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To compare pharmacodynamic indices and minimal inhibitory concentrations for vancomycin, gatifloxacin, moxifloxacin, linezolid, and combined quinupristin and dalfopristin for historic and current human coagulase-negative staphylococcus (CoNS) endophthalmitis isolates. DESIGN Experimental study. PARTICIPANTS Fifty-nine CoNS endophthalmitis isolates retrieved from patients at the Bascom Palmer Eye Institute from 1993 through 2006. METHODS Coagulase-negative staphylococcal endophthalmitis isolates were recovered from the microbiology specimen bank, rehydrated, and processed for susceptibility testing using standard microbiological protocols. E tests were used to determine and compare mean inhibitory concentration for 50% of isolates (MIC50) and mean inhibitory concentration for 90% of isolates (MIC90) values. Peak concentration (C(max)) was defined as the maximum attainable aqueous concentration using topical or oral therapy, or both. The MIC50 and MIC90 values for each antibiotic are the minimum concentrations that inhibit 50% and 90% of CoNS endophthalmitis isolates, respectively. Significance was determined by the McNemar test. Pharmacodynamic indices (C(max)/MIC) were calculated using determined MIC values and published intraocular drug concentrations for topical and oral dosing. The pharmacodynamic index was defined as the achievable aqueous humor concentration of an antibiotic divided by the concentration of the antibiotic required to inhibit a specified percentage of microbiologic isolates. MAIN OUTCOME MEASURES Pharmacodynamic indices for new and conventional antibiotics. RESULTS General in vitro susceptibility patterns in descending order were vancomycin (100%), linezolid (100%), quinupristin and dalfopristin (98%), moxifloxacin (48%), and gatifloxacin (47%). The corresponding MIC50 and MIC90 values were vancomycin, 2 microg/ml and 3 microg/ml, respectively; linezolid, 1 microg/ml and 4 microg/ml; quinupristin and dalfopristin, 0.25 microg/ml and 0.5 microg/ml; moxifloxacin, 0.75 microg/ml and > or =32 microg/ml; and gatifloxacin, 2 microg/ml and > or =32 microg/ml. Pharmacokinetic indices (C(max)/MIC90) for topical dosing were all <1. There was a significant difference in the percent of isolates susceptible to combined quinupristin and dalfopristin, vancomycin, and linezolid compared with moxifloxacin and gatifloxacin. There was no statistical significance in CoNS susceptibility between the tested fluoroquinolones. CONCLUSIONS Vancomycin, linezolid, and combined quinupristin and dalfopristin were more effective in vitro than fluoroquinolones against CoNS in the current study. Reported aqueous concentrations of the antibiotics used in this study failed to provide adequate coverage for 90% of the CoNS endophthalmitis isolates.
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Affiliation(s)
- Tom Harper
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA.
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Fonollosa A, Segura A, Giralt J, Garcia-Arumi J. Tuberculous uveitis after treatment with etanercept. Graefes Arch Clin Exp Ophthalmol 2007; 245:1397-9. [PMID: 17364199 DOI: 10.1007/s00417-007-0549-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Revised: 01/20/2007] [Accepted: 01/26/2007] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Etanercept is a tumor necrosis factor (TNF) inhibitor that has been licensed in the United States for the treatment of adult and juvenile rheumatoid arthritis as well as psoriatic arthritis. Reactivation of tuberculosis is a complication of its use. We report the first case of tuberculous uveitis due to etanercept. METHODS We performed a clinical chart review. CASE A 58-year-old Caucasian woman was referred to our hospital for chronic unilateral granulomatous panuveitis of the right eye (RE). She was on etanercept and methotrexate for rheumatoid arthritis. Since the patient was immunosuppressed with etanercept and since the uveitis was granulomatous we considered tuberculosis as a possible etiology. An aqueous humor tap was performed and sent for polymerase chain reaction analyses of Herpes simplex, Herpes zoster, and Mycobacterium tuberculosis (MT). This last test was positive. Another aqueous humor sample was taken and sent for microscopic examination of sputum for acid-fast bacilli and culture, both of which were positive for MT. A diagnosis of tuberculous uveitis was established; the patient was treated with rifampin, isoniazid pyrazinamide, and ethambutol and etanercept was stopped. Four months later there were no cells in the anterior chamber and the vitreous was clear. DISCUSSION To our knowledge this is the first reported case of tuberculous uveitis following treatment with etanercept. This etiology has to be considered in patients taking this drug who present with intraocular inflammation.
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Affiliation(s)
- S Rathinam
- Department of Uvea, Aravind Eye Hospital, Madurai, India.
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Chhabra S, Kunimoto DY, Kazi L, Regillo CD, Ho AC, Belmont J, Maguire J, Vander J, Brown GC. Endophthalmitis after open globe injury: microbiologic spectrum and susceptibilities of isolates. Am J Ophthalmol 2006; 142:852-4. [PMID: 17056367 DOI: 10.1016/j.ajo.2006.05.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2006] [Revised: 05/08/2006] [Accepted: 05/11/2006] [Indexed: 02/08/2023]
Abstract
PURPOSE To present the microbiologic spectrum and susceptibilities of isolates in posttraumatic endophthalmitis, and to provide a review of the literature. DESIGN Retrospective consecutive case series. METHODS A review of 1182 consecutive open globe injuries was performed, identifying 10 patients with culture-proven endophthalmitis. RESULTS Thirteen organisms were isolated from 10 eyes with posttraumatic endophthalmitis. Isolated organisms included Streptococcus species (46.2%), coagulase-negative Staphylococcus (23.1%), and Bacillus cereus (15.4%). All organisms tested were susceptible to vancomycin and tobramycin. The most commonly isolated organisms from an aggregate posttraumatic endophthalmitis pool of 372 cases obtained by literature-based meta-analysis were coagulase-negative Staphylococcus (21.5%) and Bacillus cereus (18.5%). CONCLUSION We report a high prevalence of gram-positive pathogens and a notable prevalence of Bacillus cereus in posttraumatic endophthalmitis. Susceptibility results suggest that posttraumatic endophthalmitis isolates are generally susceptible to vancomycin and tobramycin.
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Affiliation(s)
- Sachin Chhabra
- Wills Eye Retina Service, Philadelphia, Pennsylvania 19107, USA.
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Thiel MA, Zinkernagel AS, Burhenne J, Kaufmann C, Haefeli WE. Voriconazole concentration in human aqueous humor and plasma during topical or combined topical and systemic administration for fungal keratitis. Antimicrob Agents Chemother 2006; 51:239-44. [PMID: 17060517 PMCID: PMC1797668 DOI: 10.1128/aac.00762-06] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Voriconazole (VRC) is an antifungal drug that effectively treats keratitis caused by yeasts and molds when administered orally. We retrospectively evaluated clinical outcomes and plasma and aqueous humor drug concentrations in five patients with fungal keratitis and one patient with posttraumatic endophthalmitis who were treated with VRC. VRC was administered either topically (1% eye drops every hour) or orally (400 mg twice a day). Plasma and aqueous humor samples from affected eyes were taken 12 h after oral administration or 1 h after eye drop application. The drug concentration was measured by liquid chromatography with UV or mass spectrometric detection. All six patients responded well to VRC treatment. The VRC concentration ranged from 2.93 to 3.40 mg/liter in the aqueous humor and from 3.20 to 4.20 mg/liter in the plasma after combined oral and topical treatment. Topical administration alone resulted in highly variable trough VRC concentrations of 0.61 to 3.30 mg/liter in the aqueous humor. VRC concentrations were above the MIC for Candida albicans Aspergillus fumigatus and clinical improvement was seen in all four patients with C. albicans and A. fumigatus keratitis. Combined orally and topically administered VRC resulted in aqueous humor drug concentrations of > or =2.93 mg/liter, which is above the VRC MIC for most fungi. Topical VRC treatment resulted in an aqueous humor drug concentration >0.61 mg/liter, which is above the MIC for most Candida species. The results from this small series of patients suggest that both topical and combined systemic and topical VRC therapy can be effective in treating fungal keratitis. Furthermore, the data provide preliminary support for initiation of VRC treatment with a combined topical and systemic administration until the causative fungus and its MIC are identified.
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Affiliation(s)
- Michael A Thiel
- Division of Pediatric Infectious Diseases, UCSD School of Medicine, Cellular and Molecular Medicine East, Room 1088, 9500 Gilman Drive, Mail Code 0687, La Jolla, CA 92093-0687, USA.
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Bagyalakshmi R, Therese KL, Madhavan HN. Nucleotide polymorphisms associated with Internal Transcribed Spacer (ITS) regions of ocular isolates of Aspergillus flavus. J Microbiol Methods 2006; 68:1-10. [PMID: 16959342 DOI: 10.1016/j.mimet.2006.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2006] [Accepted: 05/31/2006] [Indexed: 11/18/2022]
Abstract
PURPOSE To analyse the genetic similarity among ocular isolates of Aspergillus flavus by Polymerase chain reaction based Restriction Fragment Length Polymorphism (PCR-RFLP) and DNA sequencing. MATERIALS AND METHODS Seven ocular isolates of A. flavus from 5 patients (3 from paient 1, and four isolates from patients no. 2, 3, 4, and 5 respectively) consisting of 2 Aqueous Humor (AH), 2 Vitreous fluid (VF), 1 eviscerated material, 1 corneal button were included in the study. The three specimens from 1 were one each of AH, VF and corneal button. The fungal isolates were amplified using primers targeting ITS region and the amplicons were subjected to PCR-RFLP using Hae-III enzyme and DNA sequencing to analyse the genetic similarity. RESULTS A. flavus isolates yielded a specific product of 595 bp after amplification. All the seven A. flavus isolates showed similar pattern of digestion with Hae-III . However, DNA sequencing of ITS amplicons revealed 97.7% genetic similarity and 2.3% dissimilarity with nucleotide polymorphisms -- single, double and multiple pertaining to inversion, substitution, insertion and deletion in comparison with that of standard strain of A. flavus ATCC 16883 [Accession Number ]. A. flavus isolated from AH, VF and corneal button from the same patient showed similar nucleotide polymorphisms as against other isolates which exhibited distinct polymorphisms. This pattern of nucleotide polymorphisms in A. flavus isolates is novel and first time reported in literature to the best of our knowledge. CONCLUSION DNA sequencing proves to be a useful molecular tool in screening for nucleotide polymorphisms among fungal isolates.
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Affiliation(s)
- R Bagyalakshmi
- Larsen and Toubro Microbiology Research Centre, Vision Research Foundation, No. 18, College road, Sankara Nethralaya, Chennai-600006, India
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Totsuka N, Koide R. [The effect of preoperative topical antibiotics in cataract surgery]. Nippon Ganka Gakkai Zasshi 2006; 110:504-10. [PMID: 16884070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
PURPOSE We studied whether topical antibiotics prevent endophthalmitis after cataract surgery. METHODS Cefmenoxime hydrochloride (CMX) or artificial tears (AT) were randomly instilled 72 hours before surgery. Conjunctival swab samples were taken before the instillation of eye drops (1) and after the instillation of eye drops (2). Aqueous humor (3) was cultured intraoperatively. RESULTS Positive cultures were found in the CMX group of eyes in 76.3% of (1) samples, 58.1% of (2) samples, and 6.0% of (3) samples. In the AT group of eyes, positive cultures were found in 78.6% of (1) samples, 63.8% of (2) samples, and 2.9% of (3) samples. CMX was not effective. In the CMX group of eyes, Staphylococcus epidermidis was found in 59 eyes of group (1), 5 eyes of group (2), and 0 eyes of group (3). In the AT group of eyes, S. epidermidis was found in 70 eyes of group (1), 26 eyes of group (2), and 1 eye of group (3). In the cases where S. epidermidis was decreased by CMX topical use Propionibacterium acnes was increased. CONCLUSIONS There is a possibility that preoperative topical use of CMX can reduce S. epidermidis. On the other hand, it might increase P. acnes. Considering these results and the fact that there was no difference in effectiveness in the aqueous humor cultures, preoperative CMX topical use may not prevent postoperative endophthalmitis except for endophthalmitis due to S. epidermidis.
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Parmar P, Salman A, Kaliamurthy J, Prasanth DA, Thomas PA, Jesudasan CAN. Anterior chamber contamination during phacoemulsification and manual small-incision cataract surgery. Am J Ophthalmol 2006; 141:1160-1. [PMID: 16765701 DOI: 10.1016/j.ajo.2006.01.046] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2005] [Revised: 01/06/2006] [Accepted: 01/12/2006] [Indexed: 11/13/2022]
Abstract
PURPOSE To compare the per-operative contamination of anterior chamber among eyes undergoing manual small-incision cataract surgery (MSICS) and phacoemulsification (PE). DESIGN Prospective, randomized, interventional clinical trial. METHODS In this study conducted at a tertiary-care center in southern India, 150 eyes undergoing cataract surgery were randomly allocated to undergo MSICS (group A, 75 eyes) and PE (group B, 75 eyes). Aqueous samples were taken before and at the end of surgery. Collected material was subjected to standard microbiological analysis. No preoperative antibiotics were used, but povidone-iodine 5% drops were instilled before surgery. Main outcome measures studied were the incidence of positive cultures in aqueous samples obtained from eyes in both groups. RESULTS The incidence of anterior chamber contamination in the MSICS group (4%) did not significantly differ from the PE group (2.7%; P = .65). CONCLUSIONS Incidence of anterior chamber contamination is similar among eyes undergoing MSICS and PE.
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Affiliation(s)
- Pragya Parmar
- Institute of Ophthalmology, Joseph Eye Hospital, Tamil Nadu, India
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Soriano F, Pérez-Trallero E, Pallarés R, Meseguer MA, Fleites A, Gené A, González A, Liñares J, Esteban J, Baquero F, Valdés E, Muñoz-Almagro C. Streptococcus pneumoniae endophthalmitis: a study of 36 cases with special reference to antibiotic resistance and treatment options. Clin Microbiol Infect 2006; 12:519-26. [PMID: 16700699 DOI: 10.1111/j.1469-0691.2006.01418.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patients (n = 36) diagnosed with pneumococcal endophthalmitis from six Spanish hospitals between 1986 and 2004 were studied retrospectively. The diagnosis was based on clinical findings, ophthalmological examination, and isolation of Streptococcus pneumoniae from vitreous and/or aqueous humours of 19 patients (definite diagnosis), and from other ocular specimens of 17 patients (probable diagnosis). The mean (+/- SD) age was 69.3 (+/- 16.5) years (range 1.5-89 years), and 20 (55.5%) patients were male. The origin of endophthalmitis was considered exogenous for 34 (94.5%) patients. The most common predisposing factors were previous ocular surgery (n = 25, 69.4%), ocular trauma (n = 5, 13.9%), and close-to-eye radiotherapy (n = 3, 8.3%). Eleven (30.5%) patients underwent evisceration as the first therapeutic measure (primary evisceration), and evisceration was performed after antibiotic treatment failure (secondary evisceration) for six (16.7%) patients. Primary evisceration was performed more commonly (63.6%) during 1998-2004, while secondary evisceration was only performed during 1986-1997. Eighteen (50%) patients received intra-vitreous antibiotics (mainly vancomycin), and 31 (86.1%) patients were given systemic antibiotic therapy. The most frequent pneumococcal serogroups isolated were 6, 19, 9, 15 and 23. Pulsed-field gel electrophoresis analysis of 23 isolates revealed that four belonged to the international clones Spain(23F)-1, Spain(6B)-2, Spain(9V)-3 and Sweden(15A)-25. Non-susceptibility rates (i.e., intermediately-resistant and resistant) were: co-trimoxazole, 44.8%; penicillin, 33.3%; tetracycline, 31.0%; erythromycin, 21.9%; chloramphenicol, 17.9%; rifampicin, 7.4%; cefotaxime, 5.9%; and levofloxacin, 0%. Although uncommon, pneumococcal endophthalmitis is a medical emergency because of the often aggressive clinical course, poor visual outcome and need for evisceration in a large proportion of patients.
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Affiliation(s)
- F Soriano
- Fundación Jiménez Díaz-UTE, Madrid, Spain.
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Vasseneix C, Bodaghi B, Muraine M, Favennec L, Brasseur G. Intérêt des prélèvements intraoculaires dans le diagnostic étiologique des uvéites présumées infectieuses. J Fr Ophtalmol 2006; 29:398-403. [PMID: 16885806 DOI: 10.1016/s0181-5512(06)77698-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To study the etiologic distribution of patients with presumed infectious uveitis who underwent ocular fluid analysis. PATIENTS AND METHODS We retrospectively analyzed vitreous and or aqueous humor samples of patients with presumed infectious uveitis, referred to the department of Ophthalmology of the University Hospital of Rouen, France, between January 1997 and June 2004. We excluded patients with postsurgical or endogenous endophthalmitis. We noted clinical features and intraocular sample analysis methods for each pathogen. RESULTS The study included 42 patients, 24 men and 18 women, aged between 6 and 79 years (mean, 39.5 years). Uveitis was unilateral in 88% of cases and bilateral in 12%. Posterior uveitis was predominant (52%), followed by panuveitis (24%), anterior (14%), and intermediate uveitis (10%). Aqueous humor and vitreous analysis confirmed etiological diagnosis for 13 of 41 patients (31%) and three of six cases (50%), respectively. Inflammation was controlled or stabilized in all cases. The most pejorative visual outcome was observed for candidiasis and viral retinitis. Positivity of intraocular samples was variable, depending on the suspected pathogen, with results similar to those reported in other studies. DISCUSSION Atypical features in potential infectious uveitis justify ocular paracentesis or vitrectomy, which are more efficient since molecular biological tools have become available. Sensitivity of aqueous humor analysis is high for posterior uveitis and suspicion of viral retinitis. New molecular variants applied to ocular samples will improve the etiological diagnosis of infectious uveitis, particularly for pathogens that are difficult to culture, such as fungi and bacteria.
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Affiliation(s)
- C Vasseneix
- Service d'Ophtalmologie, CHU Charles Nicolle, Rouen.
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Lai JY, Chen KH, Lin YC, Hsu WM, Lee SM. Propionibacterium acnes DNA from an explanted intraocular lens detected by polymerase chain reaction in a case of chronic pseudophakic endophthalmitis. J Cataract Refract Surg 2006; 32:522-5. [PMID: 16631069 DOI: 10.1016/j.jcrs.2005.12.071] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Accepted: 07/11/2005] [Indexed: 11/28/2022]
Abstract
We report a case of Propionibacterium acnes DNA from the explanted intraocular lens (IOL) a 76-year-old man with delayed-onset chronic endophthalmitis. The detection was by polymerase chain reaction (PCR). Slitlamp microscopic examination showed cells and flare in the anterior chamber, keratic precipitates on the endothelium, and multiple white plaques on both surfaces of the IOL. Propionibacterium acnes DNA was found in both the aqueous humor and the explanted IOL by PCR. Scanning electron microscopy showed diphtheroid particles, a coating of biofilm-like deposits, as well as scattered crystals on the surface of the explanted IOL and supported the possibility of P acne colonies on the IOL.
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Affiliation(s)
- Jui-Yang Lai
- Department of Chemical Engineering, National Tsing Hua University, Hsinchu, Taiwan, China
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Suzuki T, Uno T, Kawamura Y, Joko T, Ohashi Y. Postoperative low-grade endophthalmitis caused by biofilm-producing coccus bacteria attached to posterior surface of intraocular lens. J Cataract Refract Surg 2006; 31:2019-20. [PMID: 16338578 DOI: 10.1016/j.jcrs.2005.02.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2005] [Indexed: 12/17/2022]
Abstract
We report a case of low-grade inflammation that developed in the anterior segment after cataract extraction with intraocular lens (IOL) implantation. The 57-year-old patient complained of blurred vision 2 weeks after phacoemulsification and IOL implantation in the right eye. Slitlamp biomicroscopy showed many nonpigmented keratoprecipitates. After antibiotic therapy failed, the IOL was removed and aqueous collected. Scanning electron microscopy of the IOL demonstrated many biofilm-producing cocci with slime on the IOL, and aqueous smears showed gram-positive cocci. Two weeks after removal of the IOL, the inflammation disappeared.
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Affiliation(s)
- Takashi Suzuki
- Department of Ophthalmology (Suzuki, Uno, Joko, Ohashi), Ehime University School of Medicine, Ehime, Japan.
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Gerkowicz M, Pietraś-Trzpiel M, Kozioł-Montewka M, Kosior-Jarecka E, Latalska M, Paluch-Oleś J. [Application of polymerase chain reaction method (PCR) in diagnosis of endophthalmitis]. Klin Oczna 2006; 108:319-22. [PMID: 17290833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE The goal of this study is to determine the usefulness of the PCR method in the diagnosis of endophthalmitis. MATERIALS AND METHODS 30 clinical specimens 18 AH and 12 VF were obtained from 20 eyes with the clinical diagnosis of endophthalmitis. These included: 14 cases after cataract surgery, 1 case post trabeculectomy, 2 cases after penetrating traumas, and 3 cases after endogenous endophthalmitis. The same samples were analysed using 2 different methods: 1. conventional microbiological techniques (microscopy and diagnostic culture) and 2. PCR directed at 16S rDNA using universal primers. RESULTS In the aqueous humor the causative pathogen was identified in one case (5.2%) by using diagnostic culture compared with seven cases (39%) by using PCR methods. In the vitreous samples the pathogen was identified in one case (9%) by using conventional method compared with five cases (50%) by using PCR. Microscopic preparation was difficult to evaluate in all samples. CONCLUSIONS PCR performed on aqueous humor and vitreous fluid is a reliable tool for diagnosis of causative organism particularly in smear and culture negative specimens. By using universal primers we are able to detect the presence of pathogen in case of endophthalmitis and than potentially by using DNA probe hybridization to determine the species of the bacteria. The discrimination between infection or non-infection endophthalmitis plays the main role in a succesful therapy.
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Therese KL, Jayanthi U, Madhavan HN. Application of nested polymerase chain reaction (nPCR) using MPB 64 gene primers to detect Mycobacterium tuberculosis DNA in clinical specimens from extrapulmonary tuberculosis patients. Indian J Med Res 2005; 122:165-70. [PMID: 16177475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND & OBJECTIVE The conventional culture technique for diagnosis of extrapulmonary tuberculosis is time consuming. In order to find a sensitive and rapid technique nested polymerase chain reaction (nPCR) targeting the conserved MPB 64 gene of Mycobacterium tuberculosis was evaluated for detection of M. tuberculosis DNA directly from clinical specimens of extrapulmonary origin. METHODS A total of 400 clinical specimens from clinically suspected cases of extrapulmonary tuberculosis and 30 control specimens of nontuberculous aetiology were processed by smear and culture and by nPCR technique for detection of M. tuberculosis. The specimens were divided into 3 groups, (group I--280 specimens [104 peritoneal fluid (PF), 120 cerebrospinal fluid (CSF), 44 lymph node biopsies 3 pericardial fluid and 9 other biopsy specimens], group II--120 aqueous humour (AH) from idiopathic granulomatous uveitis cases, and group III--30 control specimens (10 CSF and 20AH). RESULTS The conventional culture was positive only in 16 of 400 specimens. The overall positivity of nPCR was 35.2 per cent (141/400). Among the 280 specimens from extrapulmonary lesions (group I), 15 were bacteriologically positive, while 115 of 265 bacteriologically negative specimens (43.4%) were positive by nPCR. All the 30 control specimens were negative by nPCR. INTERPRETATION & CONCLUSION The nPCR using MPB64 gene primers might be a rapid and reliable diagnostic technique for detection of M. tuberculosis genome in clinically suspected extrapulmonary tuberculosis specimens, as compared to the conventional techniques.
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Affiliation(s)
- K Lily Therese
- L&T Microbiology Research Centre, Vision Research Foundation, Chennai 600 006, India.
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Ng JQ, Morlet N, Pearman JW, Constable IJ, McAllister IL, Kennedy CJ, Isaacs T, Semmens JB. Management and Outcomes of Postoperative Endophthalmitis since the Endophthalmitis Vitrectomy Study. Ophthalmology 2005; 112:1199-206. [PMID: 15921759 DOI: 10.1016/j.ophtha.2005.01.050] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2004] [Accepted: 01/31/2005] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To examine if changes in the diagnosis and management of postoperative endophthalmitis have occurred since 1995, and to identify factors that might predict final visual outcome. DESIGN Retrospective, population-based, noncomparative, consecutive case series. PARTICIPANTS Patients with clinically diagnosed endophthalmitis after cataract surgery and lens-related surgery in Western Australia from 1980 to 2000. METHODS Endophthalmitis cases were identified using record linkage and cross-referencing with the surgical logbooks of vitreoretinal surgeons before validation by medical record review. MAIN OUTCOME MEASURES Microbiological data (microorganisms isolated and antibiotic susceptibilities), diagnostic interventions, surgical procedures, therapeutic interventions, and visual acuity (VA). RESULTS During the 21-year period, 213 episodes of endophthalmitis occurred after cataract surgery. Since 1995, both anterior chamber sampling and vitreous sampling have increased significantly. The overall use of vitrectomy has also increased, but we did not observe a difference according to presenting VA. Intravitreal antibiotic use increased significantly, whereas the use of both subconjunctival and IV antibiotics decreased. In one third of patients, the VA at least 6 months after admission for endophthalmitis was worse than 6/18. This was associated with treatment that did not include the use of oral antibiotics (odds ratio [OR], 3.86; 95% confidence interval [CI], 1.21-12.39; P = 0.02), growth from intraocular samples of organisms other than coagulase-negative staphylococci (OR, 9.84; 95% CI, 2.84-34.09; P<0.001), and a discharge VA worse than 6/18 (OR, 6.10; 95% CI, 1.63-22.89; P = 0.01). CONCLUSIONS Although we observed noticeable changes in the diagnosis and management of endophthalmitis since 1995, visual outcomes have not improved and remain poor. Our finding that treatment with oral antibiotics may be associated with a better visual outcome warrants further investigation.
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Affiliation(s)
- Jonathon Q Ng
- School of Population Health, The University of Western Australia, Crawley, Australia
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Ozdek SC, Onaran Z, Gürelik G, Konuk O, Tekinşen A, Hasanreisoğlu B. Bilateral endophthalmitis after simultaneous bilateral cataract surgery. J Cataract Refract Surg 2005; 31:1261-2. [PMID: 16039514 DOI: 10.1016/j.jcrs.2005.04.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Otasevic L, Walduck A, Meyer TF, Aebischer T, Hartmann C, Orlic N, Pleyer U. Helicobacter pylori infection in anterior uveitis. Infection 2005; 33:82-5. [PMID: 15827876 DOI: 10.1007/s15010-005-4068-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2004] [Accepted: 09/27/2004] [Indexed: 11/24/2022]
Abstract
BACKGROUND Despite intensive research, the etiology of acute anterior uveitis (AAU) remains poorly defined. Infection with gram-negative bacteria such as Yersinia, Salmonella, Shigella, and Chlamydia have already been suggested as a possible trigger event for AAU. Helicobacter pylori is also a gram-negative bacterium, shares the lipopolysaccharides, but did not attract the attention of many ophthalmologists until recently. Having in mind the relatively high incidence of H. pylori infection in the population, we propose that H. pylori may also be a trigger factor for AAU. PATIENTS AND METHODS The presence of anti-H. pylori antibodies in matching serum and aqueous humor samples of 15 idiopathic AAU patients was determined using a commercial Western blot assay. Control serum and aqueous humor were obtained from five patients undergoing cataract surgery. RESULTS Six out of 15 AAU patients (40%) were serum-positive for H. pylori, and half of these (n = 3) also had anti-H. pylori antibodies in the aqueous humor. All five aqueous humor and sera controls tested negative for H. pylori infection. CONCLUSION These are the first results demonstrating anti-H. pylori antibodies in the aqueous humor of AAU patients. Further studies are needed to demonstrate whether this antibody is indeed locally produced. Our data may provide first evidence for a causative link between H. pylori infection and AAU.
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Affiliation(s)
- L Otasevic
- Dept. of Ophthalmology, Charité, Humboldt University, Berlin, Germany
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Haripriya A, Lalitha P, Mathen M, Prajna NV, Kim R, Shukla D, Natchiar G, Srinivasan M. Nocardia endophthalmitis after cataract surgery: clinicomicrobiological study. Am J Ophthalmol 2005; 139:837-46. [PMID: 15860289 DOI: 10.1016/j.ajo.2004.12.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE To analyze the clinical presentation, microbiological profile, and treatment outcome in cases of nocardial endophthalmitis after cataract surgery. DESIGN Retrospective, observational case series. METHODS setting: Tertiary referral hospital. patients: Retrospective analysis of 24 cases of culture-proven exogenous nocardial endophthalmitis following cataract surgery between January 2000 and December 2003. main outcome measures: Visual acuity and anatomic outcome. RESULTS Visual outcome was poor in most patients, with 79% (19/24) of patients obtaining a final visual acuity of hand motions or worse and 46% (11/24) of patients with no light perception. Initial presenting visual acuity was strongly associated with final visual outcome (P = .0026). There was a statistically significant trend favoring better visual outcome in patients who presented early after the onset of symptoms (P = .01). The majority of the eyes (23/24) had an early onset with predominantly anterior segment involvement. Wound infection was noted in 46% (11/24) of the patients at presentation. Clinical features included scleral abscess, cotton ball exudates in the anterior chamber, fluffy exudates on the corneal endothelium, nodular exudates on the iris, and hypopyon. Among the specimens cultured, the highest positivity was seen with the anterior chamber aspirate (15/16 = 93.75%), which was significantly higher than the vitreous aspirate cultured (1/22 = 4.54%) (P = .001). CONCLUSION Nocardia endophthalmitis after cataract surgery is an aggressive disease with poor visual prognosis. Early diagnosis and treatment with good visual acuity at presentation may be associated with better visual outcome.
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Affiliation(s)
- Aravind Haripriya
- Centre for Advancement in Cataract Services, Aravind Eye Care System, Aravind Eye Care Hospital and Postgraduate Institute of Ophthalmology, 1 Anna Nagar, 625 020 Madurai, Tamil Nadu, India
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Abstract
Uneventful phacoemulsification with implantation of a foldable, acrylic posterior chamber intraocular lens was performed in the right eye of a 73-year-old white man. Postoperatively, the patient developed a chronic, low-grade intraocular inflammation. Cultures from the aqueous specimen grew Actinomyces neuii, an unusual gram-positive bacillus. The low-grade intraocular inflammation persisted with intensive topical steroid-antibiotic medication and systemic antibiotics. A diagnostic, 3-port, pars plana vitrectomy was performed, and aqueous aspirate specimens were sent for culture and sensitivity and to look for abnormal cells. Intracameral antibiotics were not injected. The specimens were sterile to culture, and chronic inflammatory cells were reported on the vitreous specimen. On examination 6 months later, inflammation had not recurred and the best corrected visual acuity was 6/18.
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