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Abstract
This study aims to identify predictive factors associated with surgical intervention and the visual outcome of orbital cellulitis and to evaluate the treatment outcomes.A retrospective study involving 66 patients (68 eyes; 64 unilateral and 2 bilateral) diagnosed with bacterial orbital cellulitis was conducted between November 2005 and May 2019.The mean (± standard deviation) age was 42.1 (± 25.8) years (range: 15 days-86 years). Sinusitis was the most frequent predisposing factor, occurring in 25 patients (37.9%), followed by skin infection in 10 patients (15.2%), and acute dacryocystitis in 9 patients (13.6%). Subperiosteal abscesses were found in 24 eyes and orbital abscesses in 19 eyes. Surgical drainage was performed in 31 eyes. Regarding the abscess volume for surgical drainage, a cut-off of 1514 mm3 showed 71% sensitivity and 80% specificity. There was significant improvement in visual acuity (VA) and decrease in proptosis after treatment (for both, P ≤ .001). Only pre-treatment VA ≤20/200 was a significant predictor for post-treatment VA of 20/50 or worse (adjusted odds ratio: 12.0, P = .003). The presence of a relative afferent pupillary defect was the main predictor of post-treatment VA of 20/200 or worse (adjusted odds ratio: 19.0, P = .003).The most common predisposing factor for orbital cellulitis in this study was sinusitis. VA and proptosis significantly improved after treatment. We found that the abscess volume was strongly predictive of surgical intervention. Pre-treatment poor VA and the presence of relative afferent pupillary defect can predict the worst visual outcome. Hence, early detection of optic nerve dysfunction and prompt treatment could improve the visual prognosis.
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Affiliation(s)
| | | | - Nuttha Sanghan
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Sagar P, Shankar R, Wadhwa V, Singh I, Khurana N. Primary tubercular dacryocystitis - a case report and review of 18 cases from the literature. Orbit 2019; 38:331-334. [PMID: 30142013 DOI: 10.1080/01676830.2018.1513044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 04/11/2018] [Accepted: 08/14/2018] [Indexed: 06/08/2023]
Abstract
Tuberculosis is an airborne communicable disease primarily affecting lungs. Primary tuberculosis of the lacrimal sac is very rare. A 15-year-old girl presented with bilateral epiphora for 8 months. Examination revealed bilateral nasolacrimal duct obstruction. During dacryocystorhinostomy, bone over lacrimal sac was found partially eroded. Lacrimal sac was found filled with caseous white material. Biopsy from the lacrimal sac revealed tubercular granulomas. Patient improved after anti-tubercular therapy. Abbreviations: PCR: polymerase chain reaction; NAAT: nucleic acid amplification test.
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Affiliation(s)
- Poonam Sagar
- a Department of ENT & Head & Neck Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital , Delhi , India
| | - Ravi Shankar
- b Department of Head and Neck Surgery, Tata Memorial Hospital , Mumbai , India
| | - Vikram Wadhwa
- a Department of ENT & Head & Neck Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital , Delhi , India
| | - Ishwar Singh
- a Department of ENT & Head & Neck Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital , Delhi , India
| | - Nita Khurana
- c Department of Pathology, Maulana Azad Medical College & Associated Lok Nayak Hospital , Delhi , India
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Abstract
The aim of the study was to review the distribution, current trends, and microbiological characteristics of bacterial pathogens isolated from dacryocystitis patients in China during the last 15 years.This is a retrospective multiple-center noncomparative case series. The medical records of 15,452 consecutive patients from 7 cities diagnosed as having dacryocystitis between 2002 and 2016 were reviewed. The patients' demographics, microbiological data, and antibiotic sensitivity were reviewed and analyzed.A total of 3344 lacrimal sac content cultures were taken (21.6%) during the study period. A pathogen was identified in 1996 samples (59.7%), with bacterial isolates accounting for 1902 of the positive cultures (95.3%). Gram-positive isolates, gram-negative isolates, and anaerobic bacteria were found in 1218 (61.0%), 607 (30.4%), and 285 (14.3%) samples, respectively. An increase in gram-positive isolates over the study duration was found (P = .003). The predominant isolates were coagulase negative Staphylococci (485, 25.5%), Staphylococcus aureus (186, 9.8%), Pseudomonas aeruginosa (184, 9.7%), and Haemophilus influenzae (152, 9.0%). There was a trend toward increasing resistance to erythromycin from 10.5% during the first 5 years of the study to 20.7% during the last 5 years (P < .001). Antimicrobial susceptibility testing showed that gatifloxacin was the most effective drug against most of gram-positive, gram-negative, and anaerobic bacteria.The microbial culture rate of dacryocystitis in China is low. There was an increase in the percentage of gram-positive bacteria over time. The sensitivity of gram-positive isolates to tested antibiotics is relatively low compared with that of gram-negative isolates. Our data show that the empiric use of fourth-generation fluoroquinolones in refractory dacryocystitis may be justified.
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Affiliation(s)
- Lijuan Chen
- People's Hospital of Putuo District, Shanghai
| | - Tongsheng Fu
- Department of Ophthalmology, People Hospital, Yangzhong
| | - Hao Gu
- Department of Ophthalmology, The Affiliated Hospital of Guizhou Medical University, Guiyang
| | - Ying Jie
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Laboratory Beijing, China
| | - Zhongmou Sun
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Donghong Jiang
- Department of Ophthalmology, The Second People Hospital, Taixing
| | - Jibing Yu
- The Affiliated Hospital of Ningbo University, Ningbo
| | - Xinxing Zhu
- Rudong Hospital of Traditional Chinese Medicine, Rudong
| | - Jianjiang Xu
- Department of Ophthalmology and Visual Science, Eye, and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiaxu Hong
- Department of Ophthalmology, The Affiliated Hospital of Guizhou Medical University, Guiyang
- Department of Ophthalmology and Visual Science, Eye, and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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5
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Abstract
Acute dacryoadenitis with abscess formation has been rarely described. We describe four cases that resolved with incision and drainage. This includes a retrospective case series of four patients with radiologically confirmed lacrimal gland abscesses and a review of the reported cases in the literature. Computed tomography showed characteristic rim enhancing collections with central attenuation in all four cases. All patients presented with ptosis, upper eyelid erythema, and severe pain similar to scleritis. Injection of the conjunctiva and sclera was present in two patients, and a third patient presented with expression of purulent discharge onto the ocular surface upon palpation of the lacrimal gland. All patients were treated with intravenous antibiotics and underwent incision and drainage with subsequent improvement. All were monitored for 24 to 48 hours and discharged on oral antibiotics. There were no complications or recurrences. Lacrimal gland abscess formation is a rare complication of dacryoadenitis, and in our experience these patients respond well to incision and drainage in combination with systemic antibiotics.
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Affiliation(s)
- Brian Savoie
- a Department of Ophthalmology , Hofstra Northwell School of Medicine , Great Neck , New York , USA
| | - Rand Rodgers
- b Icahn School of Medicine at Mount Sinai , New York , New York , USA
| | - Matthew Gorski
- a Department of Ophthalmology , Hofstra Northwell School of Medicine , Great Neck , New York , USA
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Ramírez Soto MC. Sporotrichosis in the Ocular Adnexa: 21 Cases in an Endemic Area in Peru and Review of the Literature. Am J Ophthalmol 2016; 162:173-179.e3. [PMID: 26585212 DOI: 10.1016/j.ajo.2015.11.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 05/03/2015] [Revised: 11/08/2015] [Accepted: 11/09/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe the clinical and epidemiologic characteristics of sporotrichosis in ocular adnexa and give an insight into factors associated with this condition. DESIGN Retrospective case series and literature review. METHODS We retrospectively reviewed all cases of sporotrichosis in ocular adnexa between 2004 and 2014 in the Santa Teresa Clinic of Abancay, Peru and reviewed all case reports of sporotrichosis in ocular adnexa in the literature. RESULTS We reviewed records of 21 patients with sporotrichosis in ocular adnexa; 12 (57.1%) of them were male and their median age surrounded 9 years. In our series, 19 patients had lesions in the eyelids and 2 in the eyebrows. The lymphocutaneous form occurred in 62% of them. Ten patients (47.6%) were cured with potassium iodide. Among 65 patients with sporotrichosis in ocular adnexa (our 21 patients and 44 from the literature), the average age was 9 years, and 78% were ≤15 years of age; 54% were male. The lesions were more frequent on the eyelids (n = 53 [82%]), followed by the lacrimal gland (n = 5), conjunctiva (n = 4), and eyebrows (n = 3). The lymphocutaneous clinical form (54%) was the most frequent. Fifty patients were cured: 31 of them with potassium iodide, 16 with itraconazole, and 3 with a combination including potassium iodide, itraconazole, and fluconazole. Twenty-nine patients (44.6%) resided in a hyperendemic region, and 5 patients reported contact with cats that had sporotrichosis. CONCLUSIONS Sporotrichosis in ocular adnexa is associated with children ≤15 years of age, and in 82% of these cases the disease is limited to the eyelids.
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Affiliation(s)
- Max Carlos Ramírez Soto
- Unidad de Postgrado, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru.
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Nakajima N, Igarashi T, Yaguchi C, Ueda M. [Ophthalmoplegia without severe painful eyelid swelling in acute dacryoadenitis: a case report]. Rinsho Shinkeigaku 2015; 56:23-26. [PMID: 26616487 DOI: 10.5692/clinicalneurol.cn-000778] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Here, we present a case of right eyelid drooping in a 79-year-old man. Neurological examination revealed ptosis of the right eye without severe painful eyelid swelling and redness. An ocular motility examination of the right eye revealed upward limitation and downward overshoot. The results of routine blood examinations were within normal limits, and no autoantibodies were detected. Orbital magnetic resonance images revealed mild right eyelid swelling and lacrimal gland enlargement, indicating orbital inflammation. The ocular discharge was positive for Staphylococcus hominis by culture and the patient was diagnosed as having acute dacryoadenitis. Treatment with topical and systemic administration of antibiotics rapidly improved symptoms. Ocular infection is not usually suspected in the absence of local severe painful swelling and redness, and painless acute dacryoadenitis presenting as ophthalmoplegia and ptosis may be misdiagnosed. Orbital inflammation may rapidly progress to orbital cellulitis with treatment delay, which may also lead to aggravation of ophthalmic prognosis. Therefore, neurologists should be aware of the possibility of acute dacryoadenitis occurring without the local severe inflammatory findings mimicking neurological diseases, and acute dacryoadenitis should be considered in patients with ophthalmoplegia even in the absence of severe painful eyelid swelling and redness.
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Abstract
The aim of this report is to present a case of a patient with bilateral lacrimal gland abscesses in the course of dacryoadenitis. A 45-year-old female patient with a long history of cocaine abuse presented with bilateral bacterial dacryoadenitis and upper lid inflammation with purulent discharge from a palpebral wound of the right upper lid. The diagnosis was confirmed with microbiology culture and an orbital CT scan, which revealed lacrimal gland abscesses. The patient admitted to vigorous eye scratching, which we believe was the mechanism responsible for the process. The infection resolved on targeted antibiotic therapy. This is the first reported case of bilateral infectious dacryoadenitis produced in a self-inflicted mechanism in a cocaine addict.
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Affiliation(s)
- Marta Latasiewicz
- Department of Ophthalmology, Hospital Clinic de Barcelona , Barcelona , Spain
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10
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Abstract
A 22-year-old female with multiple developmental abnormalities stemming from cardiofaciocutaneous syndrome presented with a recurrent orbital abscess 2 years after orbitotomy with drainage of an abscess of presumed hematogenous-origin. During careful intraoperative examination the abscess was seen to directly extend from the lacrimal sac. Cultures were taken and grew Morganella morganii, a Gram negative rod uncommon in ocular and periocular infections. To the author's knowledge, this microorganism has been reported in only one previous case of orbital abscess and underscores the need for organism identification and antibiotic sensitivity analysis in cases of orbital abscess, particularly those with extension from dacryocystitis.
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Affiliation(s)
- Bryant P Carruth
- Department of Ophthalmology, Division of Ophthalmic Plastic Surgery, Lions Eye Institute, Albany Medical College, Slingerlands, NY 12159, USA.
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Abstract
Dacryocystitis related to Stenotrophomonas maltophilia is rare. We describe a case of Strenotrophomonas maltophilia-related chronic dacryocystitis with associated coagulase-negative Staphylococcus. Following external dacryocystorhinostomy without intraoperative or postoperative antibiotics, her discharge and lacrimal sac fullness resolved.
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Affiliation(s)
- Douglas P Marx
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA.
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Hanada K, Miyokawa N, Sano A, Igarashi S, Yoshida A. [Fungal dacryocystitis with cacosmia after penetrating keratoplasty--taxonomy and identification of pathogenic fungi based on DNA sequence analysis]. Nippon Ganka Gakkai Zasshi 2012; 116:1144-1149. [PMID: 23379204] [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: 06/01/2023]
Abstract
CASE A 76-year-old woman with a history of penetrating keratoplasty had cacosmia associated with dacryocystitis. Two species of yeast-like fungi were isolated from the contents of her lacrimal sac. Each cultured fungus had a unique, distinctive odor. Althogh treated with an oral antifungal agent and washing of the nasolacrimal duct, the cacosmia was not improved. The continuous dacryocystitis with cacosmia was treated by dacryocystectomy. Two yeast-like fungi were again isolated from the contents of the lacrimal sac. Pathological examination confirmed a diagnosis of fungal dacryocystitis based on the fungal hyphae observed on the excised lacrimal sac wall. The cacosmia promptly disappeared. The fungi isolated from the contents of lacrimal sac were identified by DNA sequencing as Wickerhamomyces anamalus (Pichia anomala-Candida pelliculosa) and Galactomyces geotrichum (Geotrichum candidum). CONCLUSION The cause of cacosmia in the present case was fungal dacryocystitis. Antibiotic eye drops and steroid eye drops for the treatment of penetrating keratoplasty can cause atypical fungal presentation in the inconsistently treated lacrimal system and can induce dacryocystitis. Careful usage and consideration is necessary in the long-term use of antibiotics and steroids following corneal transplantation.
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Affiliation(s)
- Kazuomi Hanada
- Department of Medicine and Engineering Combined Research Institute, Asahikawa Medical University, Hokkaido, Japan.
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Kubota T, Hayashi S, Niimi H, Kitajima I. [Trend survey of ocular infections with bacteria at Toyama University Hospital over the past six years--from the standpoint of laboratory examination]. Rinsho Byori 2012; 60:605-611. [PMID: 22973718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Specimens of bacterial ocular infections are frequently received in the clinical laboratory. However, a comprehensive trend survey of ocular infections with bacteria is very rare. Our objective is to understand the current tendency of ocular infections with bacteria in patients at Toyama University Hospital from the standpoint of laboratory examination. We studied 263 cases of ocular infection with bacteria diagnosed at Toyama University Hospital from January 2006 to December 2011. 123 were male and 140 were female, with a mean age of 61.2(0-98) years. Specimens were subjected to direct microscopy and culture. Cultures were positive in 174(66.2%) patients. The most common bacterial isolate was Staphylococcus (28.1%), followed by Corynebacterium (19.3%), Streptococcus (9.3%), and Propionibacterium (8.6%). MRSA accounted for 18.8% of all S. aureus isolates, and has increased in recent years. The number of bacteria detected was larger in March, June, July, August, and October. Age distribution indicated that around 70% of bacterial isolates were detected from patients over 60 years old. The most common specimen of ocular infections with bacteria was eye discharge (detection rate; 87.8%), followed by corneal scraping(41%), aqueous humor (19%), and vitreous body (27%). Nearly 80% of bacterial isolates were detected from patients with keratitis, endophthalmitis, dacryocystitis, and conjunctivitis. As for the disease specific detection rate, endophthalmitis was very low (38.3%). The detection rate by years indicated that the way doctors pick up the specimens greatly affects the detection rate. Based on this survey, we need close cooperation with medical doctors concerning laboratory examination in ocular infection with bacteria, and we must improve the detection sensitivity of specimens from patients with endophthalmitis.
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Abstract
A previously healthy 23-month-old girl was admitted for the management of an acute unilateral dacryocystitis following accidental contact with dog faeces. No periocular trauma was reported. Microbiological investigation showed a multiresistant strain of Pantoea species to be the responsible pathogen. The infection responded to a course of oral Clindamycin and Ciprofloxacin, in combination with Chloramphenicol eye drops. This is the first report of an acute dacryocystitis sustained by this microorganism.
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Affiliation(s)
- Bruno Zuberbuhler
- Manchester Academic Health Science Centre,Manchester Royal Eye Hospital, Oxford Road, Manchester, UK.
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15
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Abstract
PURPOSE To analyze the clinical and microbiological characteristics and factors associated with the outcome of lacrimal canaliculitis. METHODS Thirty four patients (34 eyes) treated for lacrimal canaliculitis between January 2001 and December 2006 in a tertiary medical centre were retrospectively reviewed. Clinical and microbiological profiles, treatment outcome, and risk factors related to recurrence and concretions formation were evaluated. RESULTS There were 10 males and 24 females with a mean age of 64 years. The average time lapse to diagnosis was 18 months. Lower canaliculus (91%) was most commonly involved. Six patients (18%) had both upper and lower canaliculitis. Culture positive specimens were 21 of 25 (84%), with a mixed infection of 7 (28%). Streptococcus species (28%), Staphylococcus species (20%), and Actinomyces (16%) were the most commonly cultured organisms. Concretions were noted in nine patients (26%). All cultures of concretions were positive. No specific factor was found to be related to concretions formation. Canaliculotomy was performed in 25 patients (74%). Recurrence developed in seven patients (21%), with a mean time to recurrence of 24 months. Multivariate analysis demonstrated that male patients (p=0.038) and presence of concretions (p=0.001) were associated with higher recurrent rate. Both patients with Haemophilus influenzae isolate developed recurrence (100%). CONCLUSION Canaliculitis are often delayed diagnosed and prone to recur or persist. Male gender and concretions are important risk factors for recurrence. Surgical removal of all possible concretions is essential for cure.
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Affiliation(s)
- Shuai-Chun Lin
- Department of Ophthalmology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
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Pornpanich K, Uiprasertkul M, Luemsamran P, Jantharaworamet B, Vangveeravong S. Entomophthoramycosis: a rare fungal orbital infection presenting with dacryocystitis. Orbit 2011; 30:21-23. [PMID: 21281074 DOI: 10.3109/01676830.2010.535640] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 05/30/2023]
Abstract
We report a case of a rare fungal orbital infection in an infant presenting with dacryocystitis. The causative organism was Conidiobolus sp. of the order Entomophthorales. There is no standard treatment for entomophthoramycosis. Our patient responded well to combined antifungal therapy without aggressive surgical débridement.
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Affiliation(s)
- Kanograt Pornpanich
- Department of Ophthalmology, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Gregory ME, Macdonald ECA, Lockington D, Ramaesh K. Recurrent fungal keratitis following penetrating keratoplasty: an unusual source of infection. ACTA ACUST UNITED AC 2010; 128:1490-1. [PMID: 21060054 DOI: 10.1001/archophthalmol.2010.264] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Sun H, Zhao JY, Yan QC, Zhang JS, Chen B, Lin L. [Pathogens distribution and drug sensitivity of infantile dacryocystitis]. Zhonghua Yan Ke Za Zhi 2010; 46:34-37. [PMID: 20388320] [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: 05/29/2023]
Abstract
OBJECTIVE To investigate the pathogens and drug tolerance of infantile dacryocystitis in order to provide evidence for clinical drug use. METHODS 230 cases of infant dacryocystitis (aged from 2 to 10 months, average 90 days) were analyzed for bacterial culture and drug sensitivity tests. These tests were performed following National Guide to Clinical Laboratory Procedures. Based on the results, analyzed the difference of pathogens in different year, the pathogens kind of dacryocystitis, main pathogens of infantile dacryocystitis, average isolation rate of pathogens and sensitive or resistance drug for pathogens. RESULTS Average detecting rate was 87.0% (200 cases). There is no difference for detecting rate in each year. The pathogens were predominantly gram-positive coccus 74.5% (149 cases), coagulase-negative staphylococcus 20.5% (41 cases) and staphylococcus aureus 11.0% (22 cases). Majority of these bacteria were sensitive to tobramycin, ciprofloxacin and levofloxacin. Gram-positive coccus was sensitive to tobramycin and levofloxacin. For gram-negative rod, tobramycin and chloromycetin were most sensitive drug. The sensitivity rates were 96.67% (29 cases). The resistant rates to erythromycin and penicillin were 66.67% (20 cases) and 80.00% (24 cases). CONCLUSION Coagulase-negative staphylococcus was the main pathogen of infantile dacryocystitis.
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Affiliation(s)
- Hong Sun
- Department of Ophthalmology, Shenyang Children's Hospital, Shenyang 110032, China
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Kebede A, Adamu Y, Bejiga A. Bacteriological study of dacryocystitis among patients attending in Menelik II Hospital, Addis Ababa, Ethiopia. Ethiop Med J 2010; 48:29-33. [PMID: 20607995] [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: 05/29/2023]
Abstract
BACKGROUND Dacryocystitis usually results from blockage of the nasolacrimal duct. The treatment of such obstruction is surgery. There is a fivefold risk of soft tissue infection after open lacrimal surgery without systemic antibiotic prophylaxis that represents a significant risk of failure in lacrimal surgery. PURPOSE To determine the current bacteriology of dacryocystitis and their sensitivity to different antibiotics at Menelik II Hospital. METHOD Consecutive patients with dacryocystitis who presented to the department of ophthalmology at Menelik II Hospital between May 2004 and September 2005 were included in the study. Each patient was sent for culture and sensitivity test. Culture and sensitivity tests were obtained from Ethiopian National Health Research Institute (ENHRI), Arsho, Black Lion and Emmanuel Higher clinic laboratories. RESULTS One hundred fourteen patients, 58 (50.9%) males and 56 (49.1%) females, with dacryocystitis were examined The majority of cases, 82 (71.9%), were under 30 years of age. Positive results were obtained from 91 (79.8%) patients. Gram-positive and gram negative organisms were isolated from 57 (62.6%) and 34 (37.4%) samples respectively. The five most common isolates were Streptococcus pneumoniae (23%), Streptococcus pyogens (14.3%), Staphylococcus aureus (12.1%), Streptococcus viridans (9.9%) and Haemophilus influenzae (9.9%). The antibiotics to which the majority of the isolates sensitive to were chloramphenicol (82.4%), gentamycin (79.1%), erythromycin (68.1%) and tetracycline (61.5%). While Streptococcus pneumoniae was sensitive to chloramphenicol in 95.2%. its sensitivity to tetracycline was 100%. Haemophilus influenzae was sensitive to tetracycline and chloramphenicol in 88.9% and 77.8% respectively. CONCLUSION Gram positive organisms were the most common causes of dacryocystitis. Streptococcus pneumoniae and Haemophilus Influenza was the commonest gram positive and gram negative organisms identified respectively. Chloramphenicol and tetracycline were effective against these common organisms and are recommended for the clinical treatment of dacryocystitis.
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Affiliation(s)
- Aster Kebede
- Addis Ababa Medical Faculty, Department Ophthalmology, Addis Ababa, Ethiopia
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Nikol'skaia GM, Beloglazov VG, At'kova EL, Abdurakhmanov GA, Sidorova MV. [Morphological characteristics of actinomycotic dacryocanaliculitis]. Vestn Oftalmol 2009; 125:40-42. [PMID: 19916334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The paper presents the results of pathohistological studies of the contents of the lacrimal canaliculi and the fragments of their walls, obtained at canaliculotomy in 25 patients. This permitted 14 cases of actinomycotic dacryocanaliculitis to be identified as drusens of the ray fungus Actinomyces israelii had been found. The reactive structural changes found in the wall of the lacrimal canaliculi due to the presence of fungal infection and foreign bodies in their lumen are described. A morphological study is shown to be effective in revealing the actinomycotic etiology of dacryocanaliculitis.
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Halawa A, Yacoub G, Al Hassan M, Byrd RP, Roy TM. Dacryocystitis: an unusual form of Mucorales infection. J Ky Med Assoc 2008; 106:520-524. [PMID: 19058477] [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
Mucormycosis is an acute fungal infection in humans that is often fulminant and potentially fatal. It occurs most frequently in immunocompromised individuals. We report a diabetic patient who presented in ketoacidosis with lacrimal sac infection from this organism. To the best of our knowledge, this is only the second patient with dacryocystitis caused by this fungus described in the medical literature. Our patient is unique in that she had no evidence of concurrent sinus involvement. Surgical debridement and antifungal therapy were combined to ensure a successful outcome.
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Affiliation(s)
- Ahmad Halawa
- James H. Quillen Veterans Affairs Medical Center, Mountain Home, TN 37684-4000, USA
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Mandal R, Banerjee AR, Biswas MC, Mondal A, Kundu PK, Sasmal NK. Clinicobacteriological study of chronic dacryocystitis in adults. J Indian Med Assoc 2008; 106:296-298. [PMID: 18839635] [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: 05/26/2023]
Abstract
Chronic dacryocystitis is the inflammation of lacrimal sac, frequently caused by bacteria. Obstruction of nasolacrimal duct converts the lacrimal sac a reservoir of infection. It is a constant threat to cornea and orbital soft tissue. Moreover, it causes social embarrassment due to chronic watering from the eye. This study was conducted to find out the current clinicobacteriological profile of chronic dacryocystitis in adults. A total of 56 adult patients were selected from ophthalmology OPD. Detail history and clinical examinations were carried out. All patients underwent either dacryocystorhinostomy or dacryocystectomy. A part of the sac was collected for culture and sensitivity. This study revealed that chronic dacryocystitis is more common in females and left eye is more frequently involved than right eye. It is common among lower socioeconomic strata with habit of pond-bathing. Some form of nasal pathology like hypertrophied inferior turbinate, deviated nasal septum, nasal polyp and allergic rhinitis werefound in 19.6% of the patients. Complications of chronic dacryocystitis like conjunctivitis, corneal ulcer, acute on chronic dacryocystitis, lacrimal abscess and fistula were seen in 25.0% of these patients; 53.6% of the culture samples were positive for bacterial growth. Gram-positive organisms were most common isolate. Unlike other studies, Staphylococcus aureus (40.0%) was found to be most common Gram-positive organism, followed by Staphylococcus epidermidis (10.0%) and Steptococcus pneumoniae (10.0%). Among the Gram-negative organisms, Pseudomonas aeruginosa (16.6%) was the most common, followed by Klebsiella pneumoniae (6.6%) and Haemophilus influenzae (6.6%). Antibiotic sensitivity tests were done. Most of the organisms were resistant to penicillin. Chloramphenicol was effective against most of the Gram-positive organisms. Aminoglycosides, tobramycin in particular, was effective against Staphylococcus epidermidis. Fluoroquinolones, namely ciprofloxacin and ofloxacin were effective against Pseudomonas aeruginosa and Klebsiella pneumoniae.
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Mills DM, Bodman MG, Meyer DR, Morton AD. The microbiologic spectrum of dacryocystitis: a national study of acute versus chronic infection. Ophthalmic Plast Reconstr Surg 2007; 23:302-6. [PMID: 17667103 DOI: 10.1097/iop.0b013e318070d237] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [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: 11/25/2022]
Abstract
PURPOSE To examine the microbiologic spectrum of dacryocystitis, specifically characterizing differences between acute and chronic infection. METHODS National multicenter prospective study of the microbiologic spectrum of acute and chronic dacryocystitis based on culture results reported between March 2005 and March 2006. Chi-square analysis was used to compare differences between groups. RESULTS Eighty-nine patients from 16 centers were included: 21 (23.6%) patients had acute infection and 68 (76.4%) had chronic infection. Of all 89 patients, there were 80 total culture isolates with 55 (68.8%) Gram-positive isolates, 23 (28.7%) Gram-negative isolates, and 2 (2.5%) Mycobacterium isolates. In the acute group, 18/23 (78.3%) were Gram-positive and 5/23 (21.7%) were Gram-negative. In the chronic group, 37/57 (64.9%) were Gram-positive, 18/57 (31.6%) were Gram-negative, and 2/57 (3.5%) were Mycobacterium isolates. The proportions of Gram-positive and Gram-negative organisms between groups revealed no statistically significant difference (p > 0.20). The frequency of methicillin-resistant Staphylococcus aureus (MRSA) in the acute group, 4/23 (17.4%), was greater than the chronic group, 1/57 (1.8%) (p < or = 0.01). CONCLUSIONS Gram-positive organisms were much more common than Gram-negative organisms overall, and the proportions did not differ significantly between the groups. Staphylococcus was the most common isolate in both groups, but there was a greater frequency of methicillin-resistant Staphylococcus aureus (MRSA) isolates in the acute group. The results of this study have important implications for the treatment of dacryocystitis.
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Affiliation(s)
- David M Mills
- Ophthalmic Plastic Surgery, Lions Eye Institute, Albany Medical Center, Albany, New York 12159, USA
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Freidlin J, Acharya N, Lietman TM, Cevallos V, Whitcher JP, Margolis TP. Spectrum of eye disease caused by methicillin-resistant Staphylococcus aureus. Am J Ophthalmol 2007; 144:313-5. [PMID: 17659970 DOI: 10.1016/j.ajo.2007.03.032] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [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: 01/31/2007] [Revised: 03/15/2007] [Accepted: 03/21/2007] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare the clinical features and antibiotic susceptibility of ocular methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA). DESIGN Cross-sectional study. METHODS The Proctor clinical laboratory database was reviewed to identify all ocular isolates of S. aureus collected between July 1, 1998 and July 31, 2006. RESULTS Of 915 S. aureus isolates, there were 88 MRSA isolates in 41 different patients. The proportion MRSA increased from 4.1% in 1998 to 1999 to 16.7% in 2005 to 2006. A total of 78.0% of patients with MRSA had blepharoconjunctivitis, 2.4% had cellulitis, 2.4% had dacryocystitis, 14.6% had keratitis, and 2.4% had endophthalmitis. The diagnoses associated with MSSA were not statistically different. A total of 63.6% of MRSA isolates were sensitive to bacitracin, 100% to vancomycin, 14.8% to ciprofloxacin, 14.8% to erythromycin, 97.7% to sulfisoxazole, and 93.2% to tetracycline. CONCLUSIONS MRSA has become a more common ocular pathogen but, as with MSSA, causes mild disease. MRSA should be treated with vancomycin.
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Affiliation(s)
- Julie Freidlin
- F I Proctor Foundation, University of California, San Francisco, CA 94143, USA.
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Abstract
AIMS To compare the bacterial aetiology and their in vitroantibacterial susceptibilities of acute and chronic dacryocystitis. METHODS A retrospective analysis of patients with clinically diagnosed acute and chronic dacryocystitis who underwent microbiological evaluation presenting between January 2000 and December 2005 was carried out. Mucopurulent discharge through punctum, pus from burst abscess, incision drainage, and lacrimal sac content were taken and subjected to microbiological evaluation. RESULTS A total of 1891 patients of dacryocystitis were evaluated and subjected to microbiological evaluation, of which 566 (29.9%) had acute dacryocystitis and 1325 (70.1%) had chronic dacryocystitis. Of 1891 eyes, 1518 (80.3%) had pure bacterial growth and the remaining 373 (19.7%) had no growth. The percentage of culture-positivity was found to be higher in chronic dacryocystitis (90%) than in acute dacryocystitis (57.4%) (P<0.0001). A total of 1612 bacterial isolates were recovered from 325 acute and 1193 chronic dacryocystitis; in 1424 (93.8%) eyes, single bacterial species was isolated, and in the remaining 94 (6.2%) eyes, two bacterial species were isolated. The predominant bacterial pathogen isolated from acute dacryocystitis was Staphylococcus aureus(22.3%) followed by Pseudomonas aeruginosa(21.1%) and from chronic dacryocystitis was coagulase-negative staphylococci (CoNS) (44.2%), S. aureus(10.8%), and Streptococcus pneumoniae(10%). The highest percentage of bacterial isolates were susceptible to gatifloxacin (96.5%), ofloxacin (94.8%), and amikacin (91.1%). The percentage of resistance of bacterial isolates recovered from chronic dacryocystitis to gentamicin (45.7%), tobramycin (50.8%), norfloxacin (50.7%), and ciprofloxacin (30.4%) were found to be higher than that of bacterial isolates from acute infection to gentamicin (24.6%), tobramycin (35%), norfloxacin (36.5%), and ciprofloxacin (19.9%). CONCLUSION The proportions of S. aureusand Pseudomonasspp are higher in causing acute dacryocystitis, while the proportion of CoNS is higher in chronic dacryocystitis. The percentages of antibacterial resistant isolates were higher among bacterial species from chronic dacryocystitis.
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Affiliation(s)
- M J Bharathi
- Department of Microbiology, Microbiology Research Centre, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India.
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Pastor-Pascual F, España-Gregori E, Aviñó-Martínez J, Gallego-Pinazo R. [Dacryocystitis caused by Candida lusitaniae]. Arch Soc Esp Oftalmol 2007; 82:365-7. [PMID: 17573647 DOI: 10.4321/s0365-66912007000600009] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
CASE REPORT We report the case of a 60-year-old woman with recurrent dacryocystitis of the right lacrimal sac. She did not recover after medical treatment, nor after dacryocystorhinostomy with canalicular intubation. She also had dacryocystitis on the left side. The material that was obtained during surgery was grown in a culture medium and Candida Lusitaniae was identified as the responsible organism. All symptoms disappeared after topical treatment with amphotericin B and dacryocystorhinostomy. DISCUSSION Dacryocystitis caused by Candida Lusitaniae is very rare. We should always consider whether Candida Lusitaniae is responsible for the primary infection or is the agent resulting from a superadded infection caused by previous antibiotic therapy.
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Affiliation(s)
- F Pastor-Pascual
- Servicio de Oftalmología, Hospital Universitario La Fe, Valencia, España.
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Starska K, Lukomski M, Starska-Dawidowskda D. Rozległy ropień przedprzegrodowy jako późne powikłanie pourazowe oczodołowe – przegląd piśmiennictwa i opis przypadku. Otolaryngol Pol 2007; 61:331-4. [PMID: 17847793 DOI: 10.1016/s0030-6657(07)70438-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Preseptal orbital cellulitis and orbital abscess are rare post-traumatic late orbital complications. Authors reported a case of anterior orbital abscess following craniofacial trauma in a 47-year-old men. Diagnostic procedures, therapeutic intervention were presented and literature reviewed.
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Affiliation(s)
- Katarzyna Starska
- Katedra Otolaryngologii, Klinika Laryngologii Onkologicznej Uniwersytetu Medycznego w Lodzi
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Kodsi S. Community-acquired methicillin-resistant Staphylococcus aureus in association with chronic dacryocystitis secondary to congenital nasolacrimal duct obstruction. J AAPOS 2006; 10:583-4. [PMID: 17189157 DOI: 10.1016/j.jaapos.2006.08.020] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Accepted: 08/28/2006] [Indexed: 11/18/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as an important pathogen responsible for serious ocular and systemic disease. MRSA has been reported to occur in dacryocystitis in the adult population. This is the first case report of community-acquired MRSA in the pediatric population in association with chronic dacryocystitis secondary to congenital nasolacrimal duct obstruction in an infant.
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Affiliation(s)
- Sylvia Kodsi
- Department of Ophthalmology, North Shore University-Long Island Jewish Department of Ophthalmology, Great Neck, New York 11021, USA.
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Badhu BP, Karki BS, Khanal B, Dulal S, Das H. Microbiological Patterns of Chronic Dacryocystitis⁎. Ophthalmology 2006; 113:2377.e1-2. [PMID: 17157151 DOI: 10.1016/j.ophtha.2006.07.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2006] [Accepted: 07/21/2006] [Indexed: 11/23/2022] Open
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Westbrook BJ, Scurry WC, Hudak DT, McGinn J, Stack BC. Recurrent bilateral dacryocystoceles in Wegener's granulomatosis: a rhinologic perspective. Am J Otolaryngol 2006; 27:409-12. [PMID: 17084226 DOI: 10.1016/j.amjoto.2006.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 12/16/2005] [Indexed: 11/26/2022]
Abstract
Wegener's granulomatosis (WG) is a rare, idiopathic, systemic vasculitis of small vessels that manifests in multiple organ systems. Otorhinolaryngic manifestations of this disease include recurrent sinusitis and relapsing polychondritis. Periocular involvement is also a well-documented location of Wegener's disease. We present the case of a 13-year-old girl with severe WG who developed multiple recurrent orbital infections. She underwent multiple incision and drainage surgeries of each orbit and multiple courses of intravenous antibiotics. The patient persistently reaccumulated purulence in her nasolacrimal duct system and was referred to an oculoplastic surgeon for evaluation of these recurrent infections. The diagnosis of dacryocystitis as a complication of WG was made. This unique case represents a patient with severe WG developing bilateral dacryocystitis requiring bilateral dacryocystorhinostomies.
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Affiliation(s)
- Benjamin James Westbrook
- Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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31
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Abstract
In recent years, candida species other than Candida albicans have emerged as causes of human candidiasis, particularly in HIV-infected and other immunocompromised people. C. dubliniensis, a recently described species closely related to C. albicans, first isolated from patients with AIDS in Dublin, has been implicated as an agent of oral candidiasis in HIV-positive people. However, it has also been recovered from HIV-negative people, with clinical signs of oral candidiasis and from the genital tract of some women with vaginitis. The first case of bilateral chronic fungal dacryocystitis caused by C. dubliniensis is described in an HIV-negative woman.
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Affiliation(s)
- E Obi
- Department of Ophthalmology, Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, Wales, UK.
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32
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Usha K, Smitha S, Shah N, Lalitha P, Kelkar R. Spectrum and the susceptibilities of microbial isolates in cases of congenital nasolacrimal duct obstruction. J AAPOS 2006; 10:469-72. [PMID: 17070485 DOI: 10.1016/j.jaapos.2006.04.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Accepted: 04/24/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine the microbial profile of congenital nasolacrimal duct obstruction (CNLDO) and the appropriate antimicrobial agents based on the sensitivity pattern of the isolated microorganisms. METHODS Two hundred thirty-eight eyes of 187 young children in the age group of 0-5 years with CNLDO were included in the study. A group of 40 children (80 eyes) who had attended the hospital for other ocular disorders was considered a control. Material obtained from the lacrimal sac was cultured, and infectious agents were isolated. Susceptibility testing was done by Kirby-Bauer disk diffusion method for 7 different antibiotics. Fisher's exact test was used to look for statistical associations between the age group, the type of discharge, and the type of microorganisms isolated. RESULTS Of the 238 samples with a clinical diagnosis of CNLDO, 197 (83%) yielded a positive culture. There was no growth in 41 samples (17%). Altogether, there were 217 isolates. One hundred twenty-four (57%) isolates were Gram-positive bacteria, the most frequent isolate being Streptococcus pneumoniae. Gram-negative bacteria accounted for 93 (43%) of the isolates, the most frequent isolate being Haemophilus influenza. There was one fungal isolate (0.5%) of Candida tropicalis. Gram-positive bacteria were sensitive to chloramphenicol, vancomycin, and ofloxacin and Gram-negative bacteria to ofloxacin and ciprofloxacin. CONCLUSIONS Chronic dacryocystitis caused by CNLDO is associated with an almost-equal proportion of Gram-positive and Gram-negative bacteria. Ofloxacin topical drops can be used in the treatment of cases with CNLDO.
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Affiliation(s)
- Kim Usha
- Department of Orbit and Oculoplasty, Aravind Eye Hospital & PG Institute of Ophthalmology, Madurai, India.
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33
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Leung DYL, Kwong YYY, Ma CH, Wong WM, Lam DSC. Canaliculitis associated with a combined infection of Lactococcus lactis cremoris and Eikenella corrodens. Jpn J Ophthalmol 2006; 50:284-5. [PMID: 16767387 DOI: 10.1007/s10384-005-0318-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2005] [Accepted: 09/12/2005] [Indexed: 10/24/2022]
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Oznur AK, Ozer S, Benzonana NA. [Antibiotic resistance in Streptococcus pneumoniae strains isolated from sterile body sites]. MIKROBIYOL BUL 2006; 40:179-84. [PMID: 17001846] [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: 05/12/2023]
Abstract
Antibiotic resistance in Streptococcus pneumoniae has become an important issue in the last years. Penicillin resistance rates vary among countries and among different regions in countries. It is important to know penicillin resistance rates among isolates, in planning empirical antimicrobial therapy in pneumococcal infections. In this study, the antibiotic resistance rates of S. pneumoniae strains isolated from sterile body sites were investigated with both E-test and disc diffusion methods for penicillin, erythromycin, levofloxacin, and with only disc diffusion method for chloramphenicol, ceftriaxone, vancomycin, rifampin, trimethoprim-sulfamethoxazole (TMP-SMX), clindamycin, and tetracycline. A total of 165 strains were included into the study of which 52 were isolated from blood, 46 from cerebrospinal fluids, 25 from pleural fluids, 24 from dacryocystitis materials, 13 from tympanocentesis materials, 3 from joint fluids and 2 from wound specimens. Intermediate resistance to penicilin was 18.8%, while the resistance rates to TMP-SMX, tetracycline, chloramphenicol, erythromycin and levofloxacin were detected as 21.2%, 10.9%, 9.7%, 5.4% and 0.6%, respectively. None of the isolates were highly resistant to penicillin, nor resistant to vancomycin, ceftriaxone and rifampin. In conclusion, penicillin is still the first line therapeutic agent for pneumococcal infections except for severe infections such as meningitis, in our region.
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Affiliation(s)
- A K Oznur
- Dr. Lütfi Kirdar Kartal Eğitim ve Araştirma Hastanesi, infeksiyon Hastaliklari ve Klinik Mikrobiyoloji Kliniği, Istanbul
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Islam MN, Kundu PK, Biswas MC, Shaw C, Chakroborty M, Biswas S. Bacteriological profile in chronic dacryocystitis. J Indian Med Assoc 2006; 104:398, 400. [PMID: 17240814] [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
A study was conducted to see the bacteriological profile in 172 cases of chronic dacryocystitis attending eye outpatients department of Midnapore Medical College and Hospital and NRS Medical College and Hospital, Kolkata. The patients underwent clinical examination of the eyes and lacrimal system, with particular attention to drainage system. The culture and sensitivity test was done from the material, which regurgitated through the punctum following pressure on sac. Out of 172 cases, 66(38.4%) were found with epiphora, 44 cases (25.9%) of epiphora with mass, 8 cases (4.6%) with epiphora mass with cellulitis and in 54 (31.4%) with chronic conjunctivitis. Bactriologically, 142 patients (82.5%) were revealed with pure culture, mixed culture in 18 cases (10.5%) and no growth of organism in 12 cases (7.0%). Staphylococcus aureus was found primary pathogen in disease process. Candida albicans were seen in 4 cases (2.3%).
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Affiliation(s)
- Md Nazarul Islam
- Department of Ophthalmology, Midnapore Medical College and Hospital, Paschim Medinipore
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Koreishi AF, Schechter BA, Karp CL. Ocular infections caused by Providencia rettgeri. Ophthalmology 2006; 113:1463-6. [PMID: 16797710 DOI: 10.1016/j.ophtha.2006.03.047] [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: 09/16/2005] [Revised: 03/01/2006] [Accepted: 03/02/2006] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To report a series of patients with ocular infections caused by the rarely described gram-negative bacterium, Providencia rettgeri. DESIGN Retrospective case series. PARTICIPANTS Five patients with ocular infections who grew P. rettgeri after culture (2 keratitis, 1 dacryocystitis, 1 conjunctivitis, 1 conjunctivitis/endophthalmitis). METHODS Microbiology culture results positive for P. rettgeri were cross-referenced to identify the patients with ocular infections. Medical records of these patients were carefully reviewed. MAIN OUTCOME MEASURES Descriptive analysis of each patient's history, potential risk factors, and clinical outcome. RESULTS Five eyes in 2 institutions were found to be culture positive for the gram-negative bacterium P. rettgeri. The organism may cause keratitis, dacryocystitis, conjunctivitis, and endophthalmitis. Possible risk factors include a compromised ocular surface and coexisting medical morbidity, including urinary tract infections, recent hospitalizations, and an immunocompromised state. Culture and sensitivity profiles should guide treatment; resistant strains are being identified. CONCLUSIONS Infections caused by P. rettgeri, although rare, are responsible for ocular morbidity. This report describes patient attributes, risk factors, and outcomes that will be helpful to ophthalmologists treating ocular infections. P. rettgeri should be acknowledged as a source of ocular infection.
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Affiliation(s)
- Aaleya F Koreishi
- Cornea and External Disease, Bascom Palmer Eye Institute, Miami, Florida 33136, USA
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Abstract
A case of chronic Actinomyces canaliculitis with associated pyogenic granuloma formation and bloody tears is described. Although Actinomyces is a well-known cause of canaliculitis, the authors are not aware that it has been reported in association with pyogenic granulomas.
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Abstract
The authors report a case of unilateral chronic epiphora resistant to prolonged topical antibiotic treatment in a 62-year-old woman. Culture yielded some colonies of Actinomyces species. A dacryocystorhinostomy was found to be ineffective. Canaliculotomy with removal of cast resolved the chronic canaliculitis. Histological examination confirmed the diagnosis of solid cast of Actinomyces.
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Affiliation(s)
- L Levecq
- Service d'Ophtalmologie, Université Catholique de Louvain, Cliniques Universitaires de Mont-Godinne, Yvoir, Belgique.
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Asheim J, Spickler E. CT demonstration of dacryolithiasis complicated by dacryocystitis. AJNR Am J Neuroradiol 2005; 26:2640-1. [PMID: 16286415 PMCID: PMC7976188] [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: 05/05/2023]
Abstract
Cross-sectional imaging has demonstrated an increasing role in the evaluation of the orbits and the periorbital structures. The case presented in this article demonstrates the rare finding of a dacryolith by CT. To our knowledge, little has been reported on cross-sectional imaging characteristics of this entity in the recent radiologic literature. We demonstrated that CT can be a useful tool in diagnosing both dacryolithiasis and dacryocystitis. Obtaining an early diagnosis of dacryolithiasis is optimal to avoid potential complications, particularly because treatment is often curative.
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Affiliation(s)
- Jason Asheim
- Department of Radiology, Henry Ford Hospital, Detroit, MI 48202, USA
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Abstract
PURPOSE To describe the occurrence of community-onset methicillin-resistant Staphylococcus aureus (MRSA) infections of the lacrimal system and their treatment. METHODS This cases series consisted of data obtained from seven clinical cases of acute or subacute MRSA dacryocystitis, with or without concurrent conjunctivitis, occurring in nonhospitalized individuals presenting between December 2001 and July 2003. Clinical presentations, microbial culture results, treatment modalities, and outcomes were retrospectively reviewed. RESULTS Three patients were successfully treated with antibiotics and lacrimal surgery with no recurrence of symptoms after surgery for 6 months or longer. Four patients had temporary relief of symptoms with antibiotic therapy, but surgery was not performed for non-ophthalmologic reasons, and recurrence occurred. CONCLUSIONS The treatment of MRSA dacryocystitis can be challenging. Microbiologic cultures should be performed in all patients with dacryocystitis that is unresponsive to conventional first-line antibiotic treatment and in patients at risk for acquisition of MRSA. Appropriate antibiotic therapy in combination with dacryocystorhinostomy appears to be the optimal treatment.
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Affiliation(s)
- Brett S Kotlus
- Department of Ophthalmology, Long Island Jewish Medical Center-Albert Einstein College of Medicine, New Hyde Park, New York, New York 11042, USA
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Abstract
AIMS To investigate the microbiology of specimens from patients with chronic dacryocystitis. METHODS A total of 100 samples were obtained from the contents of the lacrimal duct in 91 consecutive patients with chronic dacryocystitis, including nine bilateral cases. These samples were cultured for aerobic and anaerobic bacteria and fungi with a routine microbiological technique. Positive cultured isolates were identified. RESULTS A total of 180 strains were isolated from the 85 bacterial samples, including 150 strains of aerobic bacteria and 30 strains of anaerobic bacteria. Fungi were found in eight samples and actinomyces in three samples. The bacterial species that were most frequently found were Staphylococcus species, representing 34.5% of all strains, followed by Corynebacterium diphtheroides (15.5%). The sensitivity tests revealed that levo-ofloxacin and amikacin were the most effective antibiotics. CONCLUSIONS Gram positive cocci was the predominant pathogen of chronic dacryocystitis. Levo-ofloxacin and amikacin had the best effect in vitro.
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Affiliation(s)
- Xuguang Sun
- Department of Eye Microbiology, Beijing Institute of Ophthalmology, China.
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Abstract
PURPOSE To examine the current spectrum of bacterial isolates in cases of chronic dacryocystitis and dacryoabcess and to determine their antibiotic sensitivities. MATERIALS AND METHODS We carried out a prospective study in which 39 patients who presented to the outpatient clinic with chronic purulent dacryocystitis or acute dacryoabscess had cultures taken. All patients were antibiotic-free for at least one week prior to culturing. RESULTS The 39 positive cultures grew 41 bacterial isolates, as two patients grew two species of bacteria. Sixteen isolates (39%) were Gram positive and 25 (61%) were Gram negative. The most common isolates were Pseudomonas (22%), Staphylococcus aureus (13%), Enterobacter (10%), Citrobacter (10%), Streptococcus pneumoniae, Escherichia coli, and Enterococcus (7%). Uncommon Gram-negative bacteria were also cultured: Alcaligenes in 2 cases (5%) and one case of Stenotrophomonas maltophilia (2.5%). No anaerobic bacteria were isolated. Gram-negative isolates were sensitive to ceftazidime in 95%, ciprofloxacin in 86% and cefuroxime in 50%, with a sensitivity of less than 30% to cefalexin and ampicillin in those tested. All Pseudomonas isolates (100%) were sensitive to ceftazidime, 86% were sensitive to ciprofloxacin, while only 20% were sensitive to ampicillin and 14% to cefalexin. Alcaligenes was resistant to all antibiotics tested with the exception of ceftazidime. CONCLUSION This study demonstrates a significant change in bacterial flora and antibiotic treatment requirements of purulent dacryocystitis from previously published data. A higher incidence of Gram-negative organisms, particularly Pseudomonas, with resistance to commonly used antibiotics was found. The emergence of rarer, highly resistant, Gram-negative microorganisms may also indicate a trend in lacrimal sac infections. These findings suggest that the antibiotic treatment protocol before and after lacrimal surgery should be reconsidered in this subgroup of patients.
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Affiliation(s)
- Daniel Briscoe
- Department of Ophthalmology, Sapir Medical Center, Kfar Saba, Israel.
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Sainju R, Franzco AAA, Shrestha MK, Ruit S. Microbiology of dacryocystitis among adults population in southern Australia. Nepal Med Coll J 2005; 7:18-20. [PMID: 16295714] [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: 05/05/2023]
Abstract
Retrospective study on microbiology of dacryocystitis cases in adults was carried out at the Royal Victorian Eye and Ear Hospital (RVEEH). Sixty-four consecutive cases seen between March 2000 and June 2003 were included. Seventy-nine organisms were isolated from the sixty-six samples (1.2/specimen). Aerobic or facultative bacteria were recovered in 76 (96.2), fungi from two specimens (2.5%). And anaerobic bacteria from only one specimen (1.3%). Staphylococcus aureus (27), was most common followed by Pseudomonas aeruginosa (6), Proteus mirabilis (4), Hemophilus parainfluenza (4) and H. influenza (4). Fifty-four samples showed single organism while 12 samples showed multiple organisms. Overall, Gram-positive organisms were predominating (54.4%) over Gram negative (41.8%) organisms. The current bacteriology of lacrimal duct obstruction in the population served by the RVEEH should be taken into account while selecting first line antimicrobial treatment for dacryocystitis and in prophylaxis in lacrimal drainage surgery.
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Affiliation(s)
- Rohit Sainju
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
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Abstract
PURPOSE To determine the current bacteriology of adult chronic dacryocystitis in a tertiary eye care center and compare it with previously reported studies. METHODS Clinical and microbiological records of patients with diagnosis of chronic dacryocystitis between January 1999 and March 2002 were reviewed for age, sex, lacrimal sac side involved, and culture results. Patients younger than 16 years of age and patients who were receiving any systemic or topical antibiotics were excluded from the study. RESULTS One hundred eighty-eight adult patients with an average age of 50.5 years (range, 16 to 91 years), who had a diagnosis of chronic dacryocystitis, were identified. The study was predominated by female subjects (65.4%). Of the cultures from the nasolacrimal sac, 183 (97.3%) were positive for bacteria, with an average of 2.3 (1 to 6) microorganisms. More than 2 microorganisms were present in 66.1% of the cultures, whereas a single microorganism was recovered from 33.9% of the cultures. The majority of microorganisms in our study were Gram-positive bacteria, representing 53.7% of the overall microorganisms cultured with a predominance of Staphylococcus species. Gram-negative bacteria were recovered from 26.0% of the specimens with predominance of Haemophilus influenzae. Anaerobic microorganisms were present in 19.1% of the samples. The most frequently isolated anaerobic microorganisms were Propionibacterium acne and Peptostreptococcus species. CONCLUSIONS Several bacterial species may be involved in the pathogenesis of chronic dacryocystitis in adults, and the majority of patients harbor multiple microorganisms in their nasolacrimal sacs. The high rate of microorganism-positive lacrimal sac cultures suggests that adult patients should be treated for their infection before any intraocular surgery because of the potential risk of infection.
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Affiliation(s)
- Imtiaz A Chaudhry
- Oculoplastic and Orbit Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.
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Abstract
INTRODUCTION Primary chronic canaliculitis is an uncommon disease, which is often misdiagnosed and insufficiently treated. We present two cases of canaliculitis caused by two different organisms, Actinomycetes spp. and Arcanobacterium haemolyticum. To the best of our knowledge, canaliculitis due to Arcanobacterium haemolyticum has not been reported before. PATIENTS AND METHODS The two cases described in this series show typical clinical features of canaliculitis with an inflamed upper canaliculus, not responsive to topical antibiotics. Appropriate treatment was delayed as they were initially treated for conjunctivitis. Both patients were treated with a canaliculotomy, with curettage and subsequent treatment with topical and systemic penicillin. The contents were sent for microbiological examination. RESULTS There was complete resolution following treatment. Actinomyces spp. was grown from one patient as expected. However, in the second patient, Arcanobacterium haemolyticum was isolated. Although this organism was not expected, the patient did respond to similar, conventional treatment. DISCUSSION Actinomyces spp. is a cast-forming Gram-positive anaerobe. They are difficult to isolate and identify and can cause infections of hollow spaces with formation of canaliculiths. Arcanobacterium (Corynebacterium) haemolyticum closely resembles Actinomyces (Corynebacterium) pyogenes. Ocular infections reported with this organism include orbital cellulitis and subperiosteal abscesses. The difficulty encountered in the isolation and identification of these organisms is discussed and the need for thorough curettage in the treatment of persistent or recurrent canaliculitis is emphasised. CONCLUSION Chronic canaliculitis should be considered in any patient who presents with chronic or recurrent conjunctivitis. Definitive cure will not be affected until all concretions are removed, either at surgery or by mechanical expression.
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Affiliation(s)
- Deepali Varma
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
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Abstract
OBJECTIVE To examine the current spectrum of bacterial isolates in cases of chronic dacryocystitis and dacryoabcess and to determine their antibiotic sensitivities. MATERIALS AND METHODS We carried out a prospective study in which 39 patients who presented to the outpatient clinic with chronic purulent dacryocystitis or acute dacryoabscess had cultures taken. All patients were antibiotic-free for at least one week prior to culturing. RESULTS The 39 positive cultures grew 41 bacterial isolates, as two patients grew two species of bacteria; 16 isolates (39%) were Gram-positive and 25 (61%) were Gram-negative. The most common isolates were Pseudomonas (22%), Staphylococcus aureus (13%), Enterobacter (10%), Citrobacter (10%), Streptococcus pneumoniae, E. coli, and Enterococcus (7%). Uncommon Gram-negative bacteria were also cultured: Alcaligenes in two cases (5%), and one case of Stenotrophomonas maltophilia (2.5%). No anaerobic bacteria were isolated. Gram-negative isolates were sensitive to ceftazidime in 95%, ciproxin in 86%, and cefuroxime in 50% of cases, with sensitivity of less than 30% to cephalexin and ampicillin in those tested. All Pseudomonas isolates (100%) were sensitive to ceftazidine, 86% were sensitive to ciprofloxacin, with only 20% being sensitive to ampicillin and 14% to cephalexin. Alcaligenes was resistant to all antibiotics tested with the exception of ceftazidine. CONCLUSION This study demonstrates a significant change in bacterial flora and antibiotic treatment requirements of purulent dacryocystitis from previously published data. A higher incidence of Gram-negative organisms, particularly Pseudomonas, with resistance to commonly used antibiotics was found. The emergence of rarer highly resistant Gram-negative microorganisms may also indicate a trend in lacrimal sac infections. These findings suggest that the antibiotic treatment protocol before and after lacrimal surgery should be reconsidered in this subgroup of patients.
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Affiliation(s)
- Daniel Briscoe
- Department of Ophthalmology, Sapir Medical Center, Kfar Saba, Israel.
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Sodhi PK. Early and late assessment of internal drainage of chronic dacryocystitis. Ophthalmologica 2004; 218:288; author reply 289. [PMID: 15258421 DOI: 10.1159/000078623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2003] [Accepted: 06/11/2003] [Indexed: 11/19/2022]
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Briscoe D, Edelstein E, Zacharopoulos I, Keness Y, Kilman A, Zur F, Assia EI. Actinomyces canaliculitis: diagnosis of a masquerading disease. Graefes Arch Clin Exp Ophthalmol 2004; 242:682-6. [PMID: 15221305 DOI: 10.1007/s00417-004-0871-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [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: 11/13/2003] [Revised: 01/07/2004] [Accepted: 01/08/2004] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND To review the diagnosis and management of seven cases of Actinomyces canaliculitis. METHODS Culture of discharge was performed in six of seven patients with Actinomyces canaliculitis using a PD Plus/F blood culture bottle. All patients were treated by canaliculotomy with curettage of dacryoliths, followed by treatment with systemic penicillin and Sulphacetamide drops over a period of 3-6 months. Part of the curetted concretions was fixed on a glass slide and part was sent to the laboratory for culture. RESULTS Four patients were women and three men with age ranging between 43 and 90 years. The average time lapse between onset of symptoms until diagnosis was 3 years. All cases presented with epiphora, chronic conjunctivitis, palpably thickened canaliculus, and yellow punctal discharge. Diagnosis was achieved by culture of discharge in three of six cases, culture of concretions in three of five cases, and staining of dacryoliths in all seven cases. Follow-up ranged between 12 and 48 months. The canaliculitis resolved completely and all patients have patent canalicula. CONCLUSIONS Actinomyces canaliculitis presents with epiphora, chronic purulent conjunctivitis, a palpably thickened canaliculus, and yellow punctual discharge. In suspect cases canuliculotomy and curettage should be performed, although canalicular reconstruction is generally unnecessary. Culture of discharge and concretions using PD Plus/F blood culture medium gave improved results over accepted norms. Fixation of smeared concretions on a slide in alcohol is simple and is diagnostic of the disease. We recommend long-term systemic penicillin treatment in Actinomyces canaliculitis.
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Affiliation(s)
- Daniel Briscoe
- Department of Ophthalmology, Sapir Medical Center, Kfar Saba, and Sackler Faculty of Medicine, Tel Aviv University, Israel.
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Eloy P, Brandt H, Nollevaux MC, Levecq L, Collet S, Rombaux P, Bertrand B. Solid cast-forming actinomycotic canaliculitis: case report. Rhinology 2004; 42:103-6. [PMID: 15224638] [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: 04/30/2023]
Abstract
Solid-cast forming actinomycotic canaliculitis is an uncommon cause of unilateral chronic red eye resistant to conventional topical medical therapy. The authors report the history of a 62-year old woman who was complaining of mucopurulent discharge from the right lower canaliculus for a period of 12 months. Culture yielded a few colonies of Actinomyces. Magnetic resonance imaging showed a dilation of the right lower canaliculus. The signal was hypointense and heterogeneous on both T1 and T2 weighted sequences. Surgery enabled removal of several solid yellowish casts and resulted in resolution of the disease. Histopathologic examination confirmed the presence of dense, basophilic conglomerates of filamentous organisms. Because rhinologists have more and more opportunities to perform surgery of the lachrymal pathway they need to be informed about this clinical entity.
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Affiliation(s)
- Philippe Eloy
- ENT & HNS Department, University Hospital of Mont-Godinne, Catholic University of Leuven, Yvoir, Belgium.
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