Vertical transmission of bacterial eye infections, Angola, 2011-2012

To determine transmission rates for neonatal conjunctivitis causative microorganisms in Angola, we analyzed 312 endocervical and 255 conjunctival samples from mothers and newborns, respectively, during 2011–2012. Transmission rates were 50% for Chlamydia trachomatis and Neisseria gonorrhoeae and 10.5% for Mycoplasma genitalium. Possible pathogenic effects of M. genitalium in children’s eyes are unknown.

Frequency of positive donor rim cultures after penetrating keratoplasty using hypothermic and organ-cultured donor corneas

PURPOSE

To compare the frequency of positive rim cultures after penetrating keratoplasty using corneas preserved by hypothermic and organ culture storage. To evaluate the influence of standard procurement techniques on the frequency of microbial donor rim contamination.

METHODS

Six hundred four donor corneas stored at 31 degrees C and 214 at 4 degrees C were studied. Microbiology studies were carried out during organ culture storage, and corneas with positive medium cultures were discarded. Frequency of postoperative positive rim cultures was related to the type of corneal storage and procurement technique used.

RESULTS

Thirty-nine (6.4%) corneas with positive medium cultures were discarded during organ culture. Microbiology reports of 628 donor rims cultures from 671 (94%) consecutive transplants were reviewed. Positive rim cultures resulted in 24 (3.8%) cases. None of the patients developed endophthalmitis. The frequency of postoperative positive rim cultures was greater after hypothermic than organ culture storage, being 9.8% and 1.3%, respectively (chi(2) = 24.9; P < 0.001). With organ culture storage, the frequency of positive rim cultures was 1.3% and 1.4% after enucleation and in situ corneal excision, respectively (chi(2) = 0.03; P = 0.638). After hypothermic storage, positive rim cultures were found in 8% of the corneas procured using enucleation and 12% of the corneas excised in situ (chi(2) = 0.829; P = 0.254).

CONCLUSIONS

Organ culture storage allows one to recognize and discard corneas with microbial contamination during storage. This method significantly reduces the frequency of postoperative positive rim cultures compared with hypothermic storage. Procurement methods do not influence the percentage of positive rim cultures.

Multivariate analysis of childhood microbial keratitis in South India

INTRODUCTION

Corneal infection is the most common cause of profound ocular morbidity leading to blindness worldwide. Corneal infection in children is difficult to diagnose and treat, as they are unwilling and sometimes unable to cooperate during active management. This study analyses the prevalence, microbiology, demography, therapeutic and visual outcome of infectious microbial keratitis in the paediatric age group seen at a tertiary eye care hospital in south India.

MATERIALS AND METHODS

A retrospective review of all cases presenting with keratitis to the ocular microbiology and cornea service at Aravind Eye Hospital, Coimbatore, from February 1997 to January 2004, was done to screen the patients for microbial keratitis. Their records were further analysed for clinical and microbiological details. Cases with culture-proven non-viral keratitis in children <or=15 years were included in the study. Full ophthalmic examination was performed for all cases.

RESULTS

Of the 310 patients who attended the cornea clinic, 97 (31.2%) patients were confirmed to be positive for microbial keratitis. 54.6% of cases were male. The most common predisposing cause of ulceration was trauma (69%) with organic matter. Pure bacterial cultures were obtained from 64 (65.9%) eyes, whereas pure fungal cultures were obtained from 37 (38.1%) eyes. Four (4.1%) eyes showed mixed growth.

CONCLUSION

The most commonly isolated organism was Pseudomonas aeruginosa. The most common predisposing cause of infectious microbial keratitis was corneal trauma. Early stage of diagnosis and formulation of an uncompromising management protocol can prevent profound visual morbidity.

Microbial keratitis in ITU staff: an occupational hazard?

Microbial keratitis is a potentially blinding corneal infection; the infection may progress rapidly if untreated and result in corneal perforation. The breakdown of the innate ocular defences is known to predispose to corneal infection. We present three cases of microbial keratitis in intensive therapy unit (ITU) staff each of whom had compromised corneal immunity. Anaesthetists and nurses regularly perform high-risk procedures, such as tracheal suctioning, which have been known to cause ocular infections by aerosol inoculation. We suggest that although the absolute risk of infection is low, susceptible individuals may be at increased risk of corneal infection from exposure to potentially pathogenic organisms in such environments. We stress the need for ITU staff, particularly those who wear contact lenses, to wear eye protection when performing procedures likely to cause infected aerosols.

Ocular syphilis acquired through oral sex in two HIV-infected patients

Two cases of ocular syphilis are described in HIV-infected individuals after unprotected oral sex. The primary syphilitic lesion remained unnoticed and lues was therefore only diagnosed after visual symptoms developed.

[Anthrax--an old disease becomes topical: cutaneous anthrax and the eye]

BACKGROUND

Anthrax disease and its eye manifestations were rare in the last 100 years, but the threat of terrorist actions has revived its topicality.

MATERIALS AND METHODS

After an introductory historical review, the pathogenesis of this disease with regard to the virulence of Bacillus anthracis is reported. On the basis of photos displaying the course of the disease, the symptoms particularly of the cutaneous form of this disease as well as the diagnostic possibilities are described.

RESULTS AND CONCLUSIONS

The current status of therapy and research for more effective treatment is discussed, with particular emphasis on the development of new substances with antitoxin properties and better vaccines. Bacillus anthracis is once again an actual threat, and therefore it is necessary for doctors to familiarize themselves with the current knowledge of this infection.

Prospective evaluation of external ocular microbial growth and aqueous humor contamination during cataract surgery

PURPOSE

To analyze the route of aqueous humor contamination leading to the development of postoperative endophthalmitis.

SETTING

Department of Ophthalmology, University of Helsinki, Finland.

METHODS

Forty-nine eyes of 49 patients (31 having phacoemulsification and 18 extracapsular cataract extraction [ECCE]) participated in the study. Four bacterial cultures were taken: preoperative conjunctival swab, lid margin culture, intraoperative lacrimal lake sample, and immediate postoperative anterior chamber fluid sample.

RESULTS

Preoperative lid margin cultures were positive in 59.2% of eyes, conjunctival cultures in 69.4%, and lacrimal lake cultures in 24.9%. Four aqueous humor samples (8.2%) showed bacterial growth in the anterior chamber aspirate: 3 in the phacoemulsification and 1 in the ECCE group. The bacteria isolated in this study, Staphylococcus epidermidis and Propionibacterium acnes (2 positive isolates each) were sensitive to the preoperative topical antibiotics used. No aqueous humor sample or any from other locations showed gram-negative microbe growth. The most frequently recovered microbes in all samples collected from the 3 other sources were S epidermidis and other coagulase-negative staphylococcus species, followed by P acnes and other propionibacterium species. Staphylococcus aureus, and diptheroids.

CONCLUSION

The ocular surface significantly contributed to the transmission of microbes into the eye during cataract surgery. These microbes could not be eradicated by topical preoperative antibiotics. However, no patient developed postoperative endophthalmitis. Natural defense mechanisms appear to fend off a minor inoculum with these microbes of relatively low pathogenicity.

Serologic testing of cornea donors

PURPOSE

To review the current requirements and rationale for serologic testing of cornea donors and to provide guidelines for dealing with results of nonrequired tests.

METHODS

Eye Bank Association of America (EBAA) and Food and Drug Administration (FDA) regulations are examined with respect to current knowledge of the risk of donor-to-host transmission of systemic infectious diseases via corneal transplantation.

RESULTS

Negative screening tests are required for human immunodeficiency virus (HIV) 1 and 2, hepatitis B surface antigen (HBsAg), and hepatitis C virus (HCV) before release of tissue for transplantation. Other tests reported by organ-procurement organizations commonly include hepatitis B core antibody (anti-HBc), syphilis, cytomegalovirus (CMV), and human T-lymphotropic virus (HTLV) I and II. No systemic infectious-disease transmission from donor corneas supplied by EBAA-member eye banks has occurred in the last 12 years, a period during which >400,000 corneas were provided for transplantation.

CONCLUSION

EBAA donor-screening requirements, including serologic testing, have resulted in an excellent safety record. Requirements for serologic testing should continue to be regularly reviewed as new information becomes available.

Bacterial keratitis in the critically ill

BACKGROUND

In the 4 year period (1988-91 there were nine cases of bacterial keratitis in five critically ill patients on an intensive care unit ('unit A'), all except one due to Pseudomonas aeruginosa. Many of these patients had serious ocular complications requiring surgery and all surviving patients were left with significant visual deficits. One further case of keratitis due to P aeruginosa occurred on unit A in April 1993. The problem of keratitis in ventilated patients is not unique to this unit as a further four cases in three patients from additional units in this area have been treated.

METHODS

Predisposing factors in unit A were established through subsequent investigations. It was found, in particular, that all the ocular infections were preceded by colonisation of the respiratory tract with the pathogenic organism. Recommendations concerning eye care and tracheal suctioning were adopted by unit A in 1991.

RESULTS

In the subsequent 4 years (1991-5), the frequency of isolation of pseudomonas from the respiratory tract per patient treated in unit A remained relatively high at 3.8% (153/4032). However, the conjunctival pseudomonas isolation rate has decreased significantly (p < 0.001) from 0.8% (19/2430) to 0.05% (2/4032).

CONCLUSIONS

Ventilated patients may be at risk from inoculation of pathogens into the eyes. The principal risk factor for bacterial keratitis in this series was corneal exposure secondary to conjunctival chemosis or lid damage. The adoption of simple preventative measures on unit A had a significant impact on the incidence of eye infections due to pseudomonas, despite the high proportion of patients whose respiratory tracts were colonised with the same organism. There is a need for additional research into the most effective method of eye care for ventilated patients in order to reduce the frequency of this avoidable condition.

Ocular lyme disease

Lyme disease is reported from all over the United States. Transmitted by deer ticks, mosquitoes, and deer flies, it affects numerous organ systems. All age groups are vulnerable to this disease and must be educated about early signs and symptoms to speed diagnosis and appropriate treatment.

OptiSol corneal storage medium and transmission of Treponema pallidum

This study was conducted to provide experimental information on the probability of syphilis transmission resulting from corneal transplantation. To determine the effects of commonly employed corneal storage conditions on the survival and infectivity of Treponema pallidum, T. pallidum subsp. pallidum (Nichols) was inoculated into OptiSol storage medium or a T. pallidum survival medium at a concentration of 10(6)/ml and incubated in cornea viewing chambers for 24 h at 4 degrees C. When inoculated intradermally into rabbits (0.1 ml per site), none of the 10 sites developed lesions from suspensions incubated in OptiSol in the presence or absence of 100 microgram/ml gentamicin; T. pallidum incubated in the survival medium yielded lesions at one of 10 sites, whereas freshly extracted organisms produced lesions at all 10 sites. In another set of experiments, the infectivity of corneal tissue from rabbits inoculated intratesticularly with 2 x 10(7) T. pallidum 10 days earlier was determined. Corneas from five T. pallidum-infected rabbits were excised, extracted, and tested for infectivity either immediately after removal or after 24-h storage in OptiSol. Recipient rabbits developed lesions at five of 50 intradermal sites when the corneas were neither stored in OptiSol nor rinsed before extraction. Corneas from 10 donor rabbits that were rinsed with phosphate-buffered saline to remove blood and aqueous humor before extraction did not yield lesions at any of 200 sites in the recipient animals. The results of this study indicate that retention of T. pallidum infectivity is poor under typical corneal storage conditions and that rabbit corneal tissue contains few, if any, infectious T. pallidum organisms under the experimental conditions employed.

Ocular cat scratch disease

Cat scratch disease (CSD) is infectious and can cause a multitude of systemic diseases in addition to ocular CSD. Rochalimaea henselae has been identified as the causative agent for ophthalmic manifestations of cat scratch disease. A noninvasive method of making a positive diagnosis of ocular CSD was recently developed.

Chlamydial ocular infection: efficacy of partner notification by patient referral

Records on 254 patients with chlamydial ocular infection observed over a period of 67 months at the Moorfield's Eye Hospital were reviewed retrospectively in relation to sexual partners in the 6 months prior to diagnosis. Contactable partners were given an appointment through index patients to attend our clinic. Those unable to attend were issued contact slips, as used by the sexually transmitted disease (STD) clinics in the United Kingdom, to attend elsewhere: 175/328 (53%) of all partners were seen in our clinic: 161/218 (74%) of current regular partners compared to only 7/57 (12%) of ex-regular and 7/53 (13%) of casual partners. However, of those given appointments 175/201 (87%) attended: 161/179 (90%) of current regular, 7/14 (50%) of ex-regular and 7/8 (88%) of casual partners. Seventy of 328 (21%) of all partners were issued contact slips, of whom 47/70 (67%) were reported to have attended elsewhere. No contact slips were returned by other clinics, indicating a failure in the contact slip system. Thirty-five of 53 (66%) of casual, 22/57 (39%) of ex-regular and none of the current regular partners were untraceable. One hundred and five of 196 (54%) female partners were examined, of whom 59/105 (56%) had chlamydial genital infection, 45/105 (43%) had other genital infections and 35/105 (33%) had multiple genital infections. Seventy of 132 (53%) male partners were examined, of whom 58/70 (83%) had chlamydial or non-specific urethritis, 5/70 (7%) had other genital infections and 4/70 (6%) had multiple genital infections. Partner notification is important to interrupt chlamydia transmission.(ABSTRACT TRUNCATED AT 250 WORDS)