Streptococcus pneumoniae endophthalmitis: clinical settings, antibiotic susceptibility, and visual outcomes.

Streptococcus pneumoniae endophthalmitis is clinically more severe, more difficult to treat, and carry a higher risk of vision loss, evisceration, or enucleation. This study is to investigate the clinical settings, antibiotic susceptibility, and visual outcomes of S. pneumoniae endophthalmitis at a tertiary referral center in Taiwan. S. pneumoniae endophthalmitis was diagnosed in 38 eyes of 38 patients. The main clinical features were postcataract endophthalmitis (n = 13, 34%) and endophthalmitis associated with corneal ulcer (n = 12, 32%), trauma (n = 6, 16%), endogenous etiology (n = 4, 11%), trabeculectomy (n = 2, 5%), and pterygium excision-related scleral ulcer (n = 1, 3%). Presenting visual acuity ranged from counting fingers to no light perception. Pars plana vitrectomy with intravitreal antibiotics was performed in 17 eyes (39%) in primary or secondary treatments. S. pneumoniae isolates were susceptible to vancomycin (38/38, 100%), penicillin (37/38, 97%), ceftriaxone (37/38, 97%), cefuroxime (12/15, 80%), levofloxacin (13/15 ,87%), and moxifloxacin (15/17, 88%). Final visual acuity was better than 20/400 in 3 of 38 eyes (8%), 5/200 to hand motions in 3 eyes (8%), and light perception to no light perception in 32 eyes (84%). Ten eyes (26%) underwent evisceration or enucleation. Although S. pneumoniae isolates were susceptible to vancomycin, S. pneumoniae endophthalmitis had a very poor visual prognosis.

Ocular lesions in a domestic feline: a closer look at the fungal pathogen Sporothrix brasiliensis / Lesões oculares em um felino doméstico: um olhar atento ao patógeno fúngico Sporothrix brasiliensis

Sporotrichosis is a dermatozoonosis, caused by dimorphic pathogenic fungi of the genus Sporothrix. Although Sporothrix brasiliensis is the most frequent and pathogenic species identified from the Brazilian sporotrichosis hyperendemic, to the best of our knowledge this is the first report of its molecular diagnosis from a cat with ocular lesions. A 3-month-old female, domestic feline presented an ocular manifestation with granuloma in the lower-left palpebral conjunctiva, in addition to mucocutaneous lesions in varied locations throughout the body. Samples were collected for subsequent cytopathology, fungal culture, serology, and molecular genotyping. Itraconazole was prescribed for the treatment of sporotrichosis and the animal was considered clinically cured at the end of 5 months of treatment and discharged. S. brasiliensis-cat interactions can manifest with a multitude of clinical forms that resemble either infectious or noninfectious diseases. Both the need for meticulous cat physical evaluation by a veterinarian followed by accurate laboratory diagnosis are key Public Health measures in the Brazilian sporotrichosis hyperendemic area.(AU)

A esporotricose é uma dermatozoonose causada por fungos patogênicos dimórficos do gênero Sporothrix. Embora o Sporothrix brasiliensis seja a espécie mais patogênica e prevalente na hiperendemia brasileira de esporotricose, segundo nosso conhecimento este é o primeiro relato de um gato com lesões oculares causadas por esta espécie, via diagnóstico molecular. Um felino doméstico com três meses de idade apresentou manifestação ocular com granuloma em conjuntiva palpebral inferior esquerda, além de lesões mucocutâneas em diferentes áreas do corpo. Amostras foram coletadas para posterior citopatologia, cultura de fungos, sorologia e genotipagem molecular. O itraconazol foi prescrito para o tratamento da esporotricose e o animal foi considerado clinicamente curado ao final de cinco meses de tratamento, recebendo alta. As interações do S. brasiliensis com o gato podem se manifestar com uma infinidade de formas clínicas que se assemelham a doenças infecciosas ou não. A necessidade de avaliação física meticulosa desses animais por um médico veterinário, seguida do diagnóstico laboratorial preciso, são medidas essenciais em saúde pública na área hiperendêmica para a esporotricose no Brasil.(AU)

Fungal keratitis caused by a rare pathogen, Colletotrichum gloeosporioides, in an east coast city of China.

BACKGROUND: To report a case of fungal keratitis caused by Colletotrichum gloeosporioides in an east coast city of China, which are rare pathogens that cause fungal keratitis in humans. METHODS: A 52-year-old man whose right eye was injured by a branch of an apple tree during farm work was referred to our Hospital. He was examined by Slit-lamp and the HRT II-RCM confocal scanning microscope, thus suggesting filamentous. Orneal scrapings were acquired and then inoculated into Sabouraud medium incubated at 28°C and 37°C. In vitro antifungal susceptibility tests were performed following the CLSI M38-A2 for Filamentous Fungi. Surgical intervention was advised because the abscess in the anterior chamber of the right eye was not completely absorbed. RESULTS: The Colletotrichum gloeosporioides isolate was identified by MALDI-TOF mass spectrometry and the BLAST after DNA sequencing of the amplified internal transcribed spacer (ITS) in rRNA. The patient's eye condition is under control and the patient's vision remains at the level of light perception (LP). CONCLUSIONS: We report the rare keratitis caused by C. gloeosporioides in eastern China, which has not been published. Suddenly ocular trauma and old surgical intervention may be the risk factors associated with Colletotrichum keratitis.

Prolonged Curvularia endophthalmitis due to organism sequestration.

IMPORTANCE: Endophthalmitis caused by Curvularia is a rare condition seen after cataract surgery and trauma. The clinical course has not been described previously. OBJECTIVE: To examine the clinical course of 6 postoperative and trauma-related cases of Curvularia endophthalmitis. DESIGN, SETTING, AND PARTICIPANTS: Retrospective case series. We reviewed the archives of the microbiology laboratory of Bascom Palmer Eye Institute, a tertiary referral hospital, from January 1, 1980, through September 30, 2013, to identify cases of Curvularia endophthalmitis. Data collected included demographic information, the cause of endophthalmitis, presenting features, treatment course, the number of recurrences, the area of organism sequestration, and final visual outcome. EXPOSURES: Trauma and cataract surgery. MAIN OUTCOMES AND MEASURES: Times from the inciting event to presentation of symptoms, diagnosis, and eradication; visual acuity; and identification of the area of sequestration. RESULTS: We identified 6 patients with Curvularia endophthalmitis, including 5 who underwent cataract surgery and 1 after trauma. The diagnosis was established rapidly in the trauma case. In the postoperative cases, the time from the surgery to first symptoms ranged from 2 to 5 months; from the surgery to correct diagnosis, 7 to 24 months; and from the surgery to eradication, 8 to 27 months. Despite aggressive antifungal therapy, eradication of the infection could be achieved only by identification and removal of the nidus of sequestration. The median follow-up was 29.5 months. CONCLUSIONS AND RELEVANCE: In cases of endophthalmitis caused by Curvularia, the diagnosis and treatment are often delayed, especially in postoperative cases. The eradication of the organism requires identification and removal of the nidi of sequestration.

Stachybotrys eucylindrospora isolated from foreign material following a traumatic eye injury.

Stachybotrys eucylindrospora was characterised as a new species in 2007, and we present the first report of this organism isolated from foreign material recovered from a patient. It is probable that isolates of this species have been previously identified as either Stachybotrys chartarum or Stachybotrys cylindrospora.

Conjunctival microbial florae in patients with seriously sulfur mustard induced eye injuries.

INTRODUCTION: Ocular surface disorders and infections in sulfur mustard (SM) exposed patients are of particular clinical importance. The aim of the present study is to detect the conjunctival bacterial florae in patients with seriously SM induced eye injuries. MATERIALS AND METHODS: Conjunctival bacterial florae of 143 seriously eye injured subjects as the study group was detected. The results were compared with 26 normal participants. Both groups were matched in age and sex. The samples were taken by sterile swab from interior fornixes of conjunctiva in both groups and were transported to microbiology laboratory by Stuart's Transport Medium. All samples were inoculated onto Blood agar, Mac Conkey agar and Chocolate agar and isolated microorganisms were identified by biochemical tests. The data were analyzed by SPSS and Man Whitney tests. RESULTS: Nineteen cases (13.39%) and none of the controls (0%) had positive culture results (p = .043). Isolated microorganisms from patients included coagulase-negative staphylococci 10 cases (52.6%), Staphylococcus aureus 5 cases (26.3%), non enterobacteriaceae gram negative bacilli 2 cases (10.5%), Penicillium spp. 2 cases (10.5%), Citrobacter sp. 1 case (5.2%), non-spore forming Gram positive bacillus 1 case (5.2%) and α hemolytic streptococcus 1 case (5.2%). Two patients had mixed microorganisms and other patients had just one microorganism. Most of the S. aureus isolates were sensitive to usual antibiotics. CONCLUSIONS: The results of this study showed that the prevalence rate of conjunctival bacterial isolates in patients with seriously SM induced ocular injuries are higher and potentially more dangerous than normal controls.

Microbial keratitis following vegetative matter injury.

The purpose of the present study was to analyze the microbiological profile of cases of keratitis following trauma with vegetative matter in a tertiary care center. A retrospective review of the medical records of 49 patients with keratitis following vegetative matter injury over a 3-month period was performed. All patients underwent corneal scraping for smears and inoculation onto various culture media. The microbiological profile was based on the smear and culture reports. For patients who were culture-negative, outcome after standard empirical antibacterial therapy as per hospital protocol was analyzed. Thirteen patients with corneal ulcers had fungal etiology, eight had bacterial etiology, and two had protozoal etiology, while 13 patients were polymicrobial and 13 were culture-negative. Polymicrobial infections were mainly bacterial (eight cases), and the remaining five cases had coexistent fungal and bacterial etiology. The treatment was directed to the specific organism and patients improved with medical or surgical therapy. Only a third of culture-negative cases showed fungal etiology on biopsy or histopathology after keratoplasty while a third showed improvement with therapy. Corneal infections following vegetative matter trauma show a varied etiological profile; however, bacterial and polymicrobial infections are more prevalent. Empirical anti-fungal therapy, as commonly practiced, must be avoided in cases with vegetative matter injury.

Burkholderia cepacia endophthalmitis: clinico-microbiologic profile and outcomes.

BACKGROUND: To report the clinical presentations, antibiotic sensitivities, and outcomes of Burkholderia cepacia endophthalmitis. METHODS: Retrospective, consecutive, noncomparative, interventional case series. We reviewed case records of culture-proven B. cepacia endophthalmitis from the endophthalmitis registry between January 2003 and December 2008. Data collected included the cause of endophthalmitis, time of presentation, presenting visual acuity, initial surgical procedures performed, clinical response, secondary interventions, antibiotic sensitivity of the organism, and final visual acuity. RESULTS: Burkholderia cepacia was the causative agent in 14 (1.8%) of the 744 culture-positive cases. Endophthalmitis occurred after cataract surgery in nine, penetrating keratoplasty in one, and trauma in four patients. Acute- and delayed-onset postoperative endophthalmitis presentation was noted in eight and two patients, respectively. Susceptibility of isolates to ceftazidime and ciprofloxacin was 78.6%. Of the isolates, 50% were sensitive to amikacin. Secondary interventions were carried out in 12 eyes. Final best-corrected visual acuity was 20/200 or better in 6 (41.66%) of 14 eyes. CONCLUSION: Burkholderia cepacia can present as posttraumatic, acute-onset and delayed-onset postoperative endophthalmitis. Oral ciprofloxacin and intravitreal ceftazidime may be administered while awaiting the sensitivity reports. Recurrence and/or persistence of infection are not uncommon. Like other gram-negative organisms causing endophthalmitis, it is also associated with poor visual outcomes.

Clinical and microbiological characteristics of fungal keratitis in the United States, 2001-2007: a multicenter study.

OBJECTIVE: To study the epidemiology, clinical observations, and microbiologic characteristics of fungal keratitis at tertiary eye care centers in the United States. DESIGN: Retrospective multicenter case series. PARTICIPANTS: Fungal keratitis cases presenting to participating tertiary eye care centers. METHODS: Charts were reviewed for all fungal keratitis cases confirmed by culture, histology, or confocal microscopy between January 1, 2001, and December 31, 2007, at 11 tertiary clinical sites in the United States. MAIN OUTCOME MEASURES: Frequency of potential predisposing factors and associations between these factors and fungal species. RESULTS: A total of 733 cases of fungal keratitis were identified. Most cases were confirmed by culture from corneal scraping (n = 693) or biopsies (n = 19); 16 cases were diagnosed by microscopic examination of corneal scraping alone; and 5 cases were diagnosed by confocal microscopy alone. Some 268 of 733 cases (37%) were associated with refractive contact lens wear, 180 of 733 cases (25%) were associated with ocular trauma, and 209 of 733 cases (29%) were associated with ocular surface disease. No predisposing factor was identified in 76 cases (10%). Filamentous fungi were identified in 141 of 180 ocular trauma cases (78%) and in 231 of 268 refractive contact lens-associated cases (86%). Yeast was the causative organism in 111 of 209 cases (53%) associated with ocular surface disease. Yeast accounted for few cases of fungal keratitis associated with refractive contact-lens wear (20 cases), therapeutic contact-lens wear (11 cases), or ocular trauma (21 cases). Surgical intervention was undertaken in 26% of cases and was most frequently performed for fungal keratitis associated with ocular surface disease (44%). Surgical intervention was more likely in cases associated with filamentous fungi (P = 0.03). Among contact lens wearers, delay in diagnosis of 2 or more weeks increased the likelihood of surgery (age-adjusted odds ratio = 2.2; 95% confidence interval, 1.2-4.2). CONCLUSIONS: Trauma, contact lens wear, and ocular surface disease predispose patients to developing fungal keratitis. Filamentous fungi are most frequently the causative organism for fungal keratitis associated with trauma or contact lens wear, whereas yeast is most frequently the causative organism in patients with ocular surface disease. Delay in diagnosis increases the likelihood of surgical intervention for contact lens-associated fungal keratitis.

Polymerase chain reaction in pediatric post-traumatic fungal endophthalmitis among Egyptian children.

PURPOSE: The aim of this study was to evaluate the effectiveness of polymerase chain reaction (PCR) in accurate and rapid diagnosis of fungal endophthalmitis in comparison with conventional Gram stain and culture in pediatric fungal endophthalmitis. PATIENTS AND METHODS: This study included 26 cases with endophthalmitis. Age was less than 16 years old, and all were males with history of ocular trauma and with clinical picture suggestive of fungal endophthalmitis. A prospective nonrandomized study was done. For all cases pars plana vitrectomy was done and sample of vitreous wash was collected from the vitrectomy cassette and was sent for laboratory diagnosis. At the end of surgery, intravitreal injection of 1.0 mg/0.1 mL vancomycin was given. PCR, culture sensitivity and ultrasound were done for all cases. Follow-up of cases by visual acuity, full ophthalmological examination, ultrasound, PCR, and other laboratory investigation. The schedule for follow-up was daily for 1 week, weekly for 1 month, and monthly for 1 year than all data collected and analysed. RESULTS: The ages ranged from 7 to 16 years old. All cases were males. Seventeen cases had central corneal ulcer, 5 of them with penetration full thickness, and 9 cases had peripheral corneal ulcer, 2 of them with penetration. Ophthalmological examination revealed a marked drop of vision ranging from HM to PL in the affected eye. Although Gram stain gave negative results in 20 cases (was positive in only 6 cases), KOH wet mount preparation revealed septate hyphae in only 4 cases, and culture on blood agar was negative in all samples, suggestive of Aspergillus niger and showing Candida albicans colonies in 8 samples. PCR assay was positive for the universal as well as for the Aspergillus-specific primers, but it was negative for Candida-specific primer in 4 samples. No recurrence of infection was noticed for the following 1 year The mean follow-up period was 10.3 months (range, 5-24 months), but with trivial improvement in visual acuity. The sensitivity of PCR assay was found to be highly significant, p < .0001, much superior to that of microscopy and culture in detecting fungal endophthalmitis. CONCLUSION: PCR assay was found to be a highly sensitive and specific test that allows rapid and accurate diagnosis of pediatric fungal endophthalmitis. PCR was found to give a much more sensitive and more rapid result than Gram stain and culture technique with comparable high specificity. Thus, we recommend the use of conventional methods as culture and stained smears as they are useful if positive, inexpensive, and available in all laboratories. This is in addition to PCR assay, which must be added to the protocol of management of cases of pediatric fungal endophthalmitis.

Post-traumatic fungal keratitis caused by Carpoligna sp.

PURPOSE: To report the first case of fungal keratitis caused by presumed Carpoligna species. METHODS: A 37-year-old gardener sustained a full-thickness, stellate corneal laceration while cutting wood outdoors with a circular saw. Two months after surgical repair, he developed a severe infectious keratitis with descemetocoele at the apex of the original stellate laceration. RESULTS: Culture results confirmed fungal elements without evidence of bacteria. Oral and topical voriconazole were initiated. Due to compliance and cost issues, voriconazole was replaced with natamycin 5% prior to discharge from hospital. The patient improved and healed without perforation. The patient was left with a central stromal scar. DNA extraction from the fungal colony allowed PCR amplification of the 28s ribosomal RNA region of the fungus that led to the diagnosis of Carpoligna pleurothecii. Corticosteroids were never used during the patient's treatment. CONCLUSION: This is the first reported case of infectious keratitis caused by presumed Carpoligna species. The treatment for Carpoligna pleurothecii keratitis includes voriconazole, natamycin, and possibly amphotericin B.

Successful treatment of multiple subdural empyemata caused by Mycoplasma hominis in a newborn.

We report a case of neonatal subdural empyema caused by Mycoplasma hominis. The infant sustained severe birth-related eye injury and subsequently developed multiple subdural empyemata. This report illustrates the clinical presentation of this unusual infection and the crucial role of neurosurgical intervention and specific antimicrobial therapy for its successful management.

Posttraumatic cellulitis and ulcerative conjunctivitis caused by Yersinia enterocolitica O:8.

A 55-year-old white man presented with orbital cellulitis and suspicion of an intraorbital foreign body after ocular trauma. He underwent orbital exploration, but no intraorbital foreign bodies were identified. Intraoperative orbital and conjunctival cultures grew Yersinia enterocolitica O:8. The patient's signs and symptoms resolved with intravenous antibiotic treatment after this exploratory orbitotomy. This is the first case, to our knowledge, of human orbital cellulitis caused by Y. enterocolitica O:8. The single visible interpalpebral conjunctival ulceration was suspected to be an entry wound by the patient's primary physician, the emergency room physician, and the orbital surgeon prior to surgical investigation, at which time all the other ulcerations were identified. Therefore, the physical manifestations of this rare but important infection are presented because they may mislead clinicians in suspecting an intraorbital foreign body.