RESUMO
PURPOSE: To determine the cause of bilateral retrobulbar optic neuritis followed by progressive outer retinal necrosis in a patient with human immunodeficiency virus (HIV). METHODS: Extensive ophthalmologic, neurologic, infectious disease, rheumatologic, and radiologic examinations were performed. RESULTS: Cerebrospinal fluid samples taken after the onset of bilateral retrobulbar optic neuritis and before the development of clinical progressive outer retinal necrosis disclosed varicella-zoster virus from polymerase chain reaction and viral culture. CONCLUSION: Ophthalmologists and neurologists should consider varicella-zoster virus optic neuritis as a potential precursor of progressive outer retinal necrosis and as a cause of retrobulbar optic neuritis in patients infected with HIV.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/etiologia , Infecções Oculares Virais , Herpes Zoster Oftálmico/etiologia , Neurite Óptica/etiologia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/patologia , Adulto , Antivirais/uso terapêutico , Líquido Cefalorraquidiano/virologia , DNA Viral/análise , Infecções Oculares Virais/tratamento farmacológico , Infecções Oculares Virais/etiologia , Infecções Oculares Virais/patologia , Feminino , Herpes Zoster Oftálmico/tratamento farmacológico , Herpes Zoster Oftálmico/patologia , Herpesvirus Humano 3/genética , Herpesvirus Humano 3/isolamento & purificação , Humanos , Imageamento por Ressonância Magnética , Neurite Óptica/tratamento farmacológico , Neurite Óptica/patologia , Órbita , Reação em Cadeia da Polimerase , Síndrome de Necrose Retiniana Aguda/etiologiaRESUMO
PURPOSE: Streptococcal gangrene, also termed streptococcal necrotizing fasciitis, is resurgent but remains exceedingly rare. Ophthalmologists and dermatologists must be aware of streptococcal gangrene, as eyelids are the most commonly affected area of the head and neck. METHODS: We studied two cases of streptococcal gangrene of the orbit with clinical manifestations indistinguishable from common nonnecrotizing orbital cellulitis. RESULTS: Infection progressed with dramatic rapidity to produce eyelid necrosis, respiratory failure, sepsis, and severe permanent visual loss caused by ophthalmic artery occlusions. Histopathologic analysis disclosed vascular thrombosis, necrosis, acute inflammation, and the presence of gram-positive cocci. Cultures grew heavy group A beta hemolytic Streptococcus. The first patient was infected with M type 1 carrying exotoxins A and B. The second patient was also infected with Streptococcus carrying exotoxin A. CONCLUSION: Early diagnosis of this life-threatening infection is of paramount importance because survival may depend on early surgical debridement.
Assuntos
Celulite (Flegmão)/diagnóstico , Doenças Palpebrais/diagnóstico , Fasciite Necrosante/diagnóstico , Doenças Orbitárias/diagnóstico , Idoso , Antibacterianos/uso terapêutico , Desbridamento , Diagnóstico Diferencial , Doenças Palpebrais/patologia , Doenças Palpebrais/terapia , Fasciite Necrosante/patologia , Fasciite Necrosante/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Orbitárias/patologia , Doenças Orbitárias/terapia , Tomografia Computadorizada por Raios XRESUMO
Amifloxacin and two of its metabolites, N-desmethyl amifloxacin and amifloxacin N-oxide, were evaluated by a microdilution MIC susceptibility test against 500 clinical isolates and compared with ciprofloxacin, lomefloxacin, norfloxacin, aztreonam, and imipenem. Of the Staphylococcus species isolates, 208 were methicillin resistant; the MICs for 78 of the isolates of the family Enterobacteriaceae were greater than or equal to 64 micrograms of cefazolin, ampicillin, piperacillin, and mezlocillin per ml. Based on our results, amifloxacin had activity equivalent to those of norfloxacin and lomefloxacin but was less active than ciprofloxacin. The N-oxide metabolite was the least active; however, for the majority of gram-negative bacteria, N-desmethyl amifloxacin was as active as amifloxacin.