Francisella tularensis Infection Causing Parinaud Oculoglandular Syndrome.

BACKGROUND Parinaud oculoglandular syndrome is a unilateral granulomatous palpebral conjunctivitis associated with preauricular, submandibular, and cervical lymphadenopathies. Several infectious diseases can cause Parinaud oculoglandular syndrome, usually with a conjunctival entry. The most common underlying pathology is cat scratch disease, followed by the oculoglandular form of tularemia. Diagnosis is usually a serious challenge as these infections are themselves rare. On the other hand, Parinaud oculoglandular syndrome may be a rare manifestation of more common disorders (eg, tuberculosis, syphilis, mumps, herpes simplex and Epstein-Barr virus, adenovirus, Rickettsia, Sporothrix, Chlamydia infections). CASE REPORT We present the case of a 66-year-old man with granulomatous conjunctivitis and ipsilateral preauricular, submandibular, and upper cervical lymphadenopathies following a superficial corneal injury. Although the systematic amoxicillin/clavulanic acid and metronidazole antibiotic therapy started immediately at admission, the suppuration of the lymph nodes required surgical drainage. Based on his anamnesis (sheep breeding; a twig scratching his eye 2 days before the initial attendance) and symptoms, a zoonosis, namely the oculoglandular form of tularemia, was suspected, empiric ciprofloxacin therapy was administered, and the patient recovered without sequelae. The Francisella tularensis infection was eventually confirmed by microagglutination serologic assay. CONCLUSIONS If Parinaud oculoglandular syndrome is diagnosed and cat scratch fever as the most common etiology is not likely, other zoonoses, especially the oculoglandular form of tularemia, should be suspected. Serology is the most common laboratory method of diagnosing tularemia. Empiric fluoroquinolone (ciprofloxacin) or aminoglycoside (gentamicin or streptomycin) antibiotic therapy should be started immediately at the slightest suspicion of oculoglandular tularemia.

Actividad antimicrobiana de extractos de plantas frente a Staphylococcus aislados de pacientes con conjuntivitis bacteriana / Antimicrobial Activity of Plant Extracts against Isolated Staphylococcus Infection in Patients with Bacterial Conjunctivitis / Atividade antimicrobiana de extratos vegetais contra Staphylococcus isolados de pacientes com conjuntivite bacteriana

Staphylococcus aureus y Staphylococcus epidermidis son los principales agentes etiológicos de las conjuntivitis bacterianas, que al tratarse con antibióticos de manera empírica, incrementan la resistencia antimicrobiana después de exposiciones repetidas. Se están buscando alternativas naturales para el tratamiento de infecciones bacterianas autolimitadas de la conjuntiva. Objetivo: determinar la actividad antimicrobiana de ocho extractos de las plantas frente a bacterias aisladas de pacientes con conjuntivitis bacterianas. Materiales y métodos: se tomaron muestras de 15 pacientes con conjuntivitis bacterianas. Se cultivaron en agar sangre y chocolate durante 24 h a 37 °C y se identificaron mediante el sistema automatizado vitek y pruebas de susceptibilidad antimicrobiana por el método de Kirby-Bauer. A cada aislamiento identificado con el género Staphylococcus se le evaluó su susceptibilidad frente a siete extractos: Ocimum basilicum, Sambucus nigra L., Delphinium elatum, Calendula officinalis, Bixa ore-llana (parte aérea y fruto independiente), Clinopodium brownei y Laurus nobilis, con un uso tradicional reportado para el tratamiento de infecciones oculares. Resultados: las bacterias aisladas con más frecuencia fueron S. epidermidis, S. hominis y S. aureus, las cuales presentaron resistencia antimicrobiana a oxacilina, tetraciclinas y eritromicina. Todos los aislamientos fueron inhibidos por los extractos de O. basilicum (cmi: >0.9 mg/mL) y L. nobilis (cmi: hasta 15 mg/mL). Conclusión: los extractos de C. officinalis y D. elatum tuvieron actividad antimicrobiana solo frente a los aislados con mayor sensibilidad antimi-crobiana. Los extractos etanólicos de O. basilicum y L. nobilis pueden ser una alternativa de tratamiento de las infecciones de la conjuntiva.

Staphylococcus aureus and Staphylococcus epidermidis are the primary etiological agents of bacterial conjunctivitis which are empirically treated with antibiotics. This results in an increase in antimicrobial resistance due to repeated exposure. Currently, natural treatment alternatives are being sought for self-limited bacterial infections of the conjunctiva. Objective: To determine the antimicrobial activity of eight extracts from Colombian plants against bacteria isolated from patients with bacterial conjunctivitis. Materials and methods: Samples were taken from 15 patients with bacterial conjunctivitis which were grown on blood and chocolate agar for 24 h at 37 °C. These samples were identified by the vitek automated system and antimicrobial susceptibility tests by the Kirby Bauer method. Each isolate identified with the genus Staphylococcus was evaluated for susceptibility to the following eight plant extracts of seven plant: Ocimum basilicum (basil), Sambucus nigra L. (elderberry), Delphinium elatum(belladonna), Calendula officinalis (marigold), Bixa orellana (annatto) (aerial part and independent fruit), Clinopodium brownei (pennyroyal), and Laurus nobilis (laurel), with traditional use previously reported for treating eye infections. Results: The most frequently isolated bacteria were S. epidermidis, S. hominis, and S. aureus, which exhibited antimicrobial resistance mainly to oxacillin, tetracyclines, and erythromycin. All isolates were inhibited by O. basilicum extracts (mic > 0.9 mg/mL) and L. nobilis (mic < 15 mg/mL). Conclusion: The extracts of C. officinalis y D. elatum showed antimicrobial activity only against isolates with higher antimicrobial sensitivity. Ethanolic extracts of O. basilicum y L. nobilis can be used as an alternative treatment for infections of the anterior segment of the eye.

Staphylococcus aureus e Staphylococcus epidermidis são os principais agentes etiológicos da conjuntivite bacteriana, estes são tratados empiricamente com antibióticos, causando aumento da resistência antimicrobiana após repetidas exposições aos mesmos. Atualmente, estão sendo estudadas alternativas naturais para o tratamento de infecções bacterianas autolimitadas da conjuntiva. Objetivo: determinar a atividade antimicrobiana de oito extratos de sete vegetais contra bactérias isoladas de pacientes com conjuntivite bacteriana. Materiais e métodos: foram retiradas amostras de 15 pacientes com conjuntivite bacteriana. As amostras foram cultivadas em ágar sangue e ágar chocolate por 24 horas a 37°C e os isolados foram identificados pelo sistema automatizado vitek, além de testes de susce-tibilidade antimicrobiana pelo método Kirby Bauer. Cada isolado identificado como sendo pertencente ao gênero Staphylococcus foi avaliado quanto à suscetibilidade a oito extratos vegetais: Ocimum basili-cum (manjericão), Sambucus nigra L. (sabugueiro), Delphinium elatum (belladona), Calendula officinalis(calêndula), Bixa orellana (urucum; parte aérea e fruto independente), Clinopodium brownei (poejo) e Laurus nobilis (louro), anteriormente relatados como uso tradicional para o tratamento de infecções ocu-lares. Resultados: as bactérias mais frequentemente isoladas foram S. epidermidis, S. hominis e S. aureus, que apresentaram resistência antimicrobiana principalmente à oxacilina, tetraciclinas e eritromicina. Todos os isolados foram inibidos por extratos de O. basilicum (cim: >0,9 mg/mL) e L. nobilis (cim: até 15 mg/mL). Conclusão: os extratos de C. officinalis e D. elatum apresentaram atividade antimicrobiana apenas contra os isolados com maior sensibilidade antimicrobiana. Os extratos etanólicos de O. basilicum e L. nobilis podem ser uma alternativa de tratamento para infecções conjuntivais.

Safety of topical ophthalmic antibiotics in pregnant women with hordeola, chalazia, blepharitis, or bacterial conjunctivitis: propensity score analyses.

OBJECTIVE: To investigate the association between exposure to topical ophthalmic antibiotics during pregnancy and adverse neonatal outcomes. METHODS: In this retrospective cohort study, we identified pregnant women with hordeola, chalazia, blepharitis, or bacterial conjunctivitis from 2005 to 2018 using the Japanese Medical Data Centre Claims Database. From the eligible women, we extracted women who were dispensed no topical antibiotics during the first trimester (non-antibiotic group), women who were dispensed topical fluoroquinolones alone at least once (fluoroquinolone alone group), and women who were dispensed any single type of antibiotic (single-antibiotic group). We compared the frequency of congenital anomalies (CA), preterm birth (PB), low birth weight (LBW), and the composite outcome of these three between the fluoroquinolone and non-antibiotic groups and between the single-antibiotic and non-antibiotic groups, using propensity score adjustment. RESULTS: A total of 891 eligible women were identified. In the fluoroquinolone (n = 409) and non-antibiotic (n = 309) groups, CA occurred in 6.8% and 6.8%, PB in 2.4% and 3.2%, LBW in 2.9% and 3.2%, and the composite outcome in 10.5% and 11.3%, respectively. Analysis using propensity score adjustment showed no significant difference between the groups in the frequency of CA (adjusted odds ratio, 1.15; 95% confidence interval, 0.61-2.18), PB (0.80; 0.30-2.17), LBW (1.08; 0.45-2.63), or the composite outcome (1.12; 0.67-1.87). Comparison of the single-antibiotic and non-antibiotic groups showed similar results. CONCLUSIONS: Topical ophthalmic antibiotics for hordeola, chalazia, blepharitis, or bacterial conjunctivitis during the first trimester were not associated with increased adverse neonatal outcomes.

Nanocristais de besifloxacino para o tratamento de conjuntivite bacteriana: preparação, caracterização físico-química e toxicidade / Besifloxacin nanocrystals for treating bacterial conjunctivitis: preparation, physicochemical characterization, and toxicity

A conjuntivite bacteriana tem significante impacto na Saúde Pública. Essa infecção representa mais de um terço das doenças oculares relatadas em âmbito global. É uma doença altamente contagiosa causada por variedade de bactérias aeróbias e anaeróbias. Diferentes antibióticos empregados no tratamento dessa doença têm apresentado elevada incidência de resistência bacteriana. Dentre os antibióticos de última geração, destaca-se o besifloxacino, antibiótico de quarta geração da classe das fluoroquinolonas, indicado exclusivamente para uso oftálmico tópico. Entretanto, esse fármaco possui baixa solubilidade em água, diminuindo sua biodisponibilidade. Tendo em vista superar esse desafio, foi proposta abordagem nanotecnológica para o desenvolvimento de nanocristais desse fármaco. A preparação de nanocristais de besifloxacino empregando moagem via úmida em escala reduzida foi promissora empregando tensoativo Povacoat®. O Diâmetro hidrodinâmico médio (DHM) da partícula foi de aproximadamente 550 nm, com índice de polidispersão (IP) menor que 0,2. Esse resultado permitiu aumentar a solubilidade de saturação em aproximadamente duas vezes em relação a matéria-prima, possibilitando aumentar a velocidade de dissolução desse fármaco e melhorar sua biodisponibilidade e segurança. Além disso, foi validado o método para quantificação do besifloxacino por CLAE, apresentando especificidade, linearidade no intervalo de 20 a 80µg/mL (r= 0,9996), precisão por repetibilidade (DPR= 1,20%, 0,84% e 0,39%), precisão intermediária (DPR= 0,94%) e exatidão 99,03%. Estudo de estabilidade acelerado (90 dias) na condição 40°C±2°C/75%UR±5%UR e estudo de estabilidade de acompanhamento (150 dias) na condição: 25°C ± 2°C / 60% UR ± 5% UR evidenciaram a estabilidade do teor no período avaliado. Ainda, a nanossuspensão de besifloxacino 0,6% m/m (nanocristais) na dose máxima (500 mg/kg) e o estabilizante Povacoat® (750 mg/kg) não apresentaram toxicidade em larvas de G. mellonella. A concentração inibitória mínima (CIM) para a formulação inovadora foi de 0,0960 µg/mL e 1,60 µg/mL frente a Staphylococcus aureus e Pseudomonas aeruginosa, respectivamente, confirmando eficácia in vitro

Bacterial conjunctivitis greatly impacts the population's health, presenting more than a third of eye diseases reported worldwide. It is an infection caused by various aerobic and anaerobic bacteria and is highly contagious. Therefore, it presents a high incidence of bacterial resistance to the antibiotics commonly used for treatment. Among the most recent antibiotics, besifloxacin is a fourth-generation fluoroquinolone antibiotic indicated exclusively for topical ophthalmic use. Due to its importance in treating bacterial conjunctivitis and its low solubility in the water, a nanotechnological approach was proposed to develop besifloxacin nanocrystals. The preparation of besifloxacin nanocrystals using small-scale wet milling was promising using Povacoat® surfactant. The particle's average hydrodynamic diameter (DHM) was approximately 550 nm, with a polydispersity index (IP) of less than 0.2. This result increased the saturation solubility approximately two times concerning the raw material, making it possible to increase the dissolution rate of this drug and improve its bioavailability and safety. In addition, the method for quantification of besifloxacin by HPLC was validated, presenting specificity, linearity in the range of 20 to 80µg/mL (r= 0.9996), precision by repeatability (DPR= 1.20%, 0.84% and 0.39%), intermediate precision (DPR= 0.94%) and accuracy 99.03%. Accelerated stability study (90 days) at 40°C±2°C/75%RH±5%RH condition and follow-up stability study (150 days) at 25°C ± 2°C / 60% RH ± condition 5% RH showed the stability of content in the evaluated period. Furthermore, the 0.6% besifloxacin nanosuspension (nanocrystals) at the maximum dose (500 mg/kg) and the Povacoat® stabilizer (750 mg/kg) did not show toxicity in G. mellonella larvae. The minimum inhibitory concentration (MIC) to innovative formulation was 0.0960 µg/mL and e 1.60 µg/mL against Staphylococcus aureus and Pseudomonas aeruginosa, respectively, confirming in vitro efficacy

Mucositis sin rash inducida por Mycoplasma pneumoniae, primer reporte de caso en Perú / Rashless mucositis induced by Mycoplasma pneumoniae. First case reported in Peru

Introducción: Mycoplasma pneumoniae es una bacteria de distribución mundial que comúnmente ocasiona infecciones respiratorias en forma de traqueobronquitis y neumonía atípica, recientemente se ha descrito como etiología de una enfermedad denominada Mycoplasma-induced rash and mucositis. Caso clínico: Varón de 11 años, procedente del departamento de Tacna en Perú que se presentó con cuatro días de enfermedad caracterizado por fiebre, tos, disnea, conjuntivitis bilateral purulenta y lesiones erosivas muy dolorosas en mucosa yugal, lengua y labios, recibió tratamiento antibiótico, antiviral y antifúngico, evolucionando favorablemente. Se confirmó infección por Mycoplasma pneumoniae mediante serología IgM por ELISA. De nuestro conocimiento, este es el primer caso de Mucositis sin rash inducido por Mycoplasma pneumoniae reportado en Perú, el reconocimiento temprano de este síndrome permitirá un tratamiento más específico, evitando la restricción de fármacos apropiados(AU)

Introduction: Mycoplasma pneumoniae is a bacterium of worldwide distribution which commonly causes respiratory infections such as tracheobronchitis and atypical pneumonia. It has recently been described as etiology of a disease called Mycoplasma pneumoniae-induced rash and mucositis. Objective: Present the first known report of Mycoplasma pneumoniae-associated mucositis in Peru, diagnosed by compatible clinical picture and confirmed by serology. Clinical case: A male 11-year-old patient from the Tacna Region in Peru presented with a clinical state of four days' evolution characterized by fever, coughing, dyspnea, bilateral purulent conjunctivitis and very painful erosive lesions on the jugal mucosa, tongue and lips. The patient received antibiotic, antiviral and antifungal treatment, to which he responded favorably. Mycoplasma pneumoniae infection was confirmed by IgM ELISA serology. Conclusions: Early recognition of this syndrome will lead to a more specific treatment, avoiding the restriction of appropriate drugs(AU)

Potencial antimicrobiano de extractos de plantas medicinales y sus mezclas frente a bacterias asociadas con conjuntivitis / Antimicrobial potential of plant extracts and their mixtures against bacteria associated with conjunctivitis

Resumen Introducción. La conjuntivitis bacteriana es una de las infecciones oculares con mayor tasa de consulta oftálmica, siendo el género Staphylococcus el agente etiológico que presenta mayor resistencia a los antibióticos. Objetivo. Determinar el potencial antimicrobiano de extractos de plantas medicinales y sus mezclas frente a bacterias asociadas con conjuntivitis. Métodos. A partir de plantas como Belladona, Caléndula, Albahaca, Achiote y Romerillo se prepararon los extractos etanólicos y se evaluó su potencial antibacteriano frente a S. aureus y S. epidermidis, mediante las técnicas de difusión en disco y dilución en tubo. El efecto de las mezclas se determinó para el extracto con mejor actividad y el antibiótico con mayor halo de inhibición a través de la técnica de tablero. Resultados. Se encontró que el extracto con mayor potencial para S. aureus fue el de achiote (hojas) con un halo de inhibición de 13 mm y CMIs de 15 mg/mL, mientras que para S. epidermidis fueron los de hojas y frutos de achiote con halos de 16,6 y 9,6 mm y CMIs de 15 y 30 mg/mL respectivamente. En relación con las combinaciones, el extracto de achiote y ciprofloxacina mostró un efecto de sinergia parcial para S. aureus con una CFI de 0,83 y un efecto aditivo para S. epidermidis con una CFI de 1,84. Conclusiones. Este trabajo se constituye en la base de futuras investigaciones orientadas hacia el desarrollo de bioproductos de uso ocular que puedan ser considerados como alternativa en el tratamiento de infecciones causadas por Staphylococcus.

Abstract Introduction. Bacterial conjunctivitis is one of the ocular infections with the highest rate of ophthalmic consultation, being the Staphylococcus genus the etiological agent that presents the greatest resistance to antibiotics. Objective. To determine the antimicrobial potential of medicinal plant extracts and their mixtures against bacteria associated with conjunctivitis. Methods. From plants such as Belladonna, Calendula, Basil, Achiote and Romerillo, ethanolic extracts were prepared and their antibacterial potential against S. aureus and S. epidermidis was evaluated by means of disk diffusion and tube dilution techniques. The effect of the mixtures was determined for the extract with the best activity and the antibiotic with the highest inhibition halo through the board technique. Results. It was found that the extract with the highest potential for S. aureus was that of annatto (leaves) with an inhibition halo of 13 mm and MICs of 15 mg / mL, while for S. epidermidis it was those of annatto leaves and fruits with halos of 16.6 and 9.6 mm and MICs of 15 and 30 mg / mL respectively. In relation to the combinations, the annatto extract and ciprofloxacin showed a partial synergistic effect for S. aureus with a CFI of 0.83 and an additive effect for S. epidermidis with a CFI of 1.84. Conclusions. This work constitutes the basis for future research aimed at the development of bioproducts for ocular use that can be considered as an alternative in the treatment of infections caused by Staphylococcus.

Retrospective Review of Mycobacterial Conjunctivitis in Cockatiels (Nymphicus hollandicus).

The etiologic disease organism responsible for causing mycobacteriosis in avian species is an acid-fast gram-positive bacterium. This bacterium causes granulomatous disease in various internal organs, but in cockatiels (Nymphicus hollandicus) it has been commonly identified within the conjunctival tissues. Twenty-six cases of mycobacterial conjunctivitis in cockatiels were diagnosed through histopathologic assessment of diseased tissue samples, Fite acid-fast staining, and polymerase chain reaction in this retrospective study. Clinicians who saw these cases were contacted, and information was obtained regarding recommended treatment protocols prescribed for the patients, the Mycobacterium species identified, and case outcomes. All patients in this retrospective study had a biopsy performed on the affected conjunctival tissue, and because of the small size of the patients, this excisional biopsy removed the affected tissue in its entirety or significantly debulked the lesion. Of the 26 cases, 10 were lost to follow-up, 4 were euthanatized, 7 died, and 5 were alive at the time this information was submitted for publication.

Infectious conjunctivitis caused by Pseudomonas a eruginosa in infected and extrused scleral buckles.

Extrusion of the scleral buckle is one of the complications patients may encounter undergoing the surgical treatment for retinal detachment. We present two cases of persistent Pseudomonas a eruginosa-related conjunctivitis which infected the silicone explant after retinal surgery. One of them is a 73-year-old Caucasian female patient with hyperaemia, intense pain and mucopurulent discharge. After the conjunctival swabs detected a P. aeruginosa infection, she started both topical and systemic treatment without any results; for this reason we opted for the buckle removal always under systemic therapy. The second case is an 84-year-old Caucasian female patient with fever, periorbital oedema, chronic ocular pain, hyperaemia and purulent discharge. P. aeruginosa has also been detected in this case. No improvement with topical and systemic treatment, so this convinced us to remove patient's buckles and to continue systemic therapy. Both cases had the complete resolution after surgery. It is important to quickly recognise exposed scleral buckles because they can be a source of infections and a rare but threatening cause of endophthalmitis.

Topical Povidone-Iodine for Treatment of Giant Fornix Syndrome.

Over a 2-year period, a 68-year-old woman suffered multiple recurrences of left giant fornix syndrome during the repeated tailing of intensive topical steroids and antibiotics; she had also undergone surgery to reduce the left upper fornix. After a further recurrence during tailing of topical therapy for bilateral disease, treatment with 4 times daily preservative-free povidone-iodine 5% eyedrops was started-with a marked improvement of symptoms and signs within a week. The patient is maintained, symptom-free, on once-daily povidone-iodine drops and dexamethasone 0.1% drops. The dramatic improvement on topical povidone-iodine therapy might suggest that, as an initial therapy, this might be more effective than the previously-recommended regime of hourly potent topical steroids and antibiotics.

Effects of topical azithromycin, moxifloxacin, and povidone iodine on conjunctival bacterial flora in patients undergoing intravitreal injection / Os efeitos da azitromicina tópica, moxifloxacina e iodopovidona na flora bacteriana conjuntival em injeções intravítreas

ABSTRACT Purpose: To compare effects of 5% topical povidone iodine with prophylactic topical azithromycin and moxifloxacin on bacterial flora in patients undergoing intravitreal injection. Methods: A total of 132 patients were randomly assigned to receive treatment with azithromycin or moxifloxacin, or no treatment (control group). In total, 528 specimens were obtained at the time of admission, 4 days before intravitreal injection, 4 days after intravitreal injection, and 8 days after intravitreal injection. Samples were immediately sent to the microbiology laboratory for incubation. Results: The microorganism observed most frequently was coagulasenegative Staphylococcus (23.8%). When the results of samples obtained on Day 4 before injection were assessed, growth of coagulase-negative Staphylococcus was significantly lower in the moxifloxacin group, compared with controls (p=0.049). Acinetobacter baumannii continued to grow after administration of azithromycin (p=0.033). When the results of four days after intravitreal injection were evaluated, growth of coagulase-ne gative Staphylococcus was higher in controls, compared with patients who received azithromycin or moxifloxacin (p=0.004). Eradication rate was significantly higher in the moxifloxacin group than in the control group (p=0.001). Samples obtained on Day 8 after intravitreal injection showed similar levels of bacterial growth in all groups (p=0.217). Conclusion: Moxifloxacin was more effective than 5% povidone iodine in controlling the growth of conjunctival bacterial flora. Use of moxifloxacin in combination with 5% povidone iodine resulted in a synergistic effect.

RESUMO Objetivo: Comparar os efeitos de iodopovidona tópico a 5% com azitromicina e moxifloxacina profiláticas sobre a flora bacteriana em pacientes submetidos à injeção intravítrea. Métodos: Um total de 132 pacientes foram aleatoriamente designados para receber tratamento com azitromicina ou moxifloxacina ou nenhum tratamento (grupo controle). No total, 528 amostras foram obtidas no momento na admissão, 4 dias antes da injeção intravítrea, 4 dias após a injeção intravítrea e 8 dias após a injeção intravítrea. As amostras foram imediatamente enviadas para o laboratório de microbiologia para incubação. Resultados: O microorganismo mais frequentemente observado foi o Staphylococcus coagulase-negativo (23,8%). Quando os resultados das amostras obtidas no dia 4 antes da injeção foram avaliados, o crescimento do Staphylococcus coagulase-negativo foi significativamente menor no grupo mo xifloxacina, em comparação com os controles (p=0,049). Acinetobacter baumannii continuou a crescer após a administração de azitromicina (p=0,033). Quando os resultados de 4 dias após a injeção intravítrea foram avaliados, o crescimento do Staphylococcus coagulase-negativo foi maior no controle, em comparação com pacientes que receberam azitromicina ou moxifloxacina (p=0,004). A taxa de erradicação também foi significativamente maior no grupo moxifloxacina do que no grupo controle (p=0,001). As amostras obtidas no dia 8 após injeção intravítrea mostraram níveis semelhantes de crescimento bacteriano em todos os grupos (p=0,217). Conclusão: A moxifloxacina foi mais eficaz do que 5% de iodopovidona no controle do crescimento da flora bacteriana conjuntival. O uso de moxifloxacina em combinação com 5% de iodopovidona resultou em um efeito sinérgico.

Lentes de contato provocando conjuntivite por Ralstonia Pichettii / Contact lenses causing conjunctivity by Ralstonia Pichettii

Resumo O presente relato apresenta o caso de conjuntivite causada por Ralstonia pichettii em paciente imunocompetente usuária de lente de contato. A bactéria isolada da solução utilizada para desinfecção das lentes R. pichettii não pertente a microbiota humana mas infecta pacientes imunodeprimidos e está presente em soluções aquosas. Não há padronização de sensibilidade para esta bactéria e poucos antibióticos foram testados para bactérias não fermentadoras da glicose. Devido ao reduzido perfil de sensibilidade aos antimicrobianos demonstrado pela R. pichettii, torna-se importante a identificação correta deste agente etiológico em quadros de conjuntivite e ceratites. Este relato de caso ilustra que R. Pickettii é um patógeno mais importante do que se pensava anteriormente.

Abstract The present report reports a case of conjunctivitis caused by Ralstonia pichettii in an immunocompetent patient wearing a contact lens. The bacterium isolated from the solution used to disinfect R. pichettii does not belong to the human microbiota but infects immunodepressed patients and is present in aqueous solutions. There is no standardization of sensitivity for this bacterium and few antibiotics have been tested for non-fermenting glucose bacteria. Due to the reduced antimicrobial sensitivity profile demonstrated by R. pichettii, it is important to correctly identify this etiologic agent in conjunctivitis and keratitis. This case report illustrates that R. Pickettii is a more important pathogen than previously thought.

Eficacia de la azitromicina versus tobramicina. Uso tópico en niños con conjuntivitis bacteriana. Revisión sistemática y meta-análisis / Efficacy of azithromycin versus tobramycin in topical formulation in children with bacterial conjunctivitis. A systematic review and meta-analysis

Introducción. La conjuntivitis bacteriana aguda (CBA) es una patología frecuente en niños. El uso de antibióticos tópicos acelera la recuperación, reduce recidivas y previene complicaciones. Un tratamiento abreviado, con menor número de aplicaciones diarias podría mejorar la adherencia al mismo. Actualmente, se proponen intervenciones con esquemas terapéuticos con estas características. Objetivo. Evaluar la eficacia del uso de azitromicina en esquemas breves, comparada con tobramicina para el tratamiento de CBA en niños. Materiales y métodos. Se realizó la búsqueda bibliográfica en MEDLINE, Cochrane Library y LILACS, considerando la evidencia disponible hasta mayo de 2019. Se incluyeron ensayos clínicos controlados aleatorizados (ECCAs) y ensayos clínicos controlados (ECCs). Resultados. Incluimos 3 ECCAs con 557 participantes. La mayoría de los dominios investigados fueron de bajo e incierto riesgo de sesgo. Comparado con el tratamiento estándar ­tobramicina­, la azitromicina podría incrementar la cura clínica al tercer día (3 estudios, 557 participantes: RR 1.36 IC95% 0.92 a 2.01; I2 54%; con baja certeza de evidencia) y al finalizar el tratamiento (3 estudios, 557 participantes: RR 1.03 IC95% 0.91 a 1.17; I2 50%; con baja certeza de evidencia). En ambos tratamientos los IC incluyen beneficio, pero también cierto grado de daño. La azitromicina podría reducir levemente la cura bacteriológica al finalizar el tratamiento (3 estudios, 556 participantes: RR 0.97 IC95% 0.91 a 1.03; I2 14%; moderada certeza de evidencia) comparado con la tobramicina. El IC es impreciso, debido a a que cruza la línea de nulidad. Conclusión de los autores. Basados fundamentalmente en resultados con baja a moderada calidad de evidencia, la azitromicina podría incrementar la cura clínica y reducir la cura bacteriológica en niños con CBA comparada con la tobramicina; sin embargo, los IC 95% indican también ausencia de beneficio. No se describen eventos adversos. Serán necesarios nuevos ECCAs para reducir la imprecisión observada en los resultados, y acceder al efecto de la azitromicina

Introduction. Acute bacterial conjunctivitis is a frequent pathology in children. The use of topical antibiotics accelerates recovery, reduces recurrences and prevents complications. A short treatment course with less instillation could improve treatment compliance. Nowadays, short term treatments are proposed. Objective. To assess the efficacy of topical azithromycin in short term regimen, compared with topical tobramycin in children with CBA. Materials and methods. A literature search was performed in MEDLINE, Cochrane and LILACs, including literature published until May 2019. Controlled and randomized clinical trials (RCTs) were included. Results. We included three RCTs with 557 participants. Overall, most domains were assessed as being at low or unclear risk of bias. Compared to the standard treatment (tobramycin), azithromycin may increase the clinical cure on third day (3 studies, 557 participants: RR 1.36 95% CI 0.92 to 2.01; I2 54%; low certainty of evidence) and at the end of treatment (3 studies, 557 participants: RR 1.03 95% CI 0.91 to 1.17; I2 50%; low certainty of evidence). However, in both results the CIs included benefit and harm. Azithromycin probably slightly reduce the bacteriological cure at the end of treatment (3 studies, 556 participants: RR 0.97 95% CI 0.91 to 1.03; I2 14%; moderate certainty of evidence). Conclusion. Based mainly on low quality of evidence identified, azithromycin treatment may increase the clinical cure, and probably reduce the bacteriological cure; however, the 95% CIs indicates lack of benefit too. None of the papers analyzed reported serious adverse effects in the participants. Given these results and considering that the regimen of azithromycin could have other benefits such as better adherence to treatment, we consider that azithromycin should be included as the antibiotic of choice for the treatment of acute bacterial conjunctivitis. Further adequate-powered RCTs are needed to reduce the imprecision of the results and allowing us to access the true effect of short treatment of azithromycin

Mycobacterium genavense Infection in a Domestic Ferret (Mustela putorius furo).

Mycobacterium genavense infection was diagnosed in an adult ferret with ptosis of the left eye, a proliferative lesion of the conjunctiva of the nictitating membrane, conjunctival swelling, and tumefaction of the periorbital tissues with a watery ocular discharge and the presence of a retrobulbar mass. The diagnosis was based on characteristic cytology of the retrobulbar mass and left mandibular lymph node that revealed granulomatous inflammation. Ziehl-Neelsen staining showed the presence of positive acid-fast bacilli in the cytoplasm of the macrophages. The diagnosis was confirmed by sequence analysis of the 16S rRNA gene amplified by using a multiplex polymerase chain reaction from a fresh lymph node biopsy. Therapy with marbofloxacin, rifampicin, and clarithromycin was recommended for 6 months and after this period, the veterinarian who was treating the ferret reported the disappearance of clinical signs. Six months after the end of the antibiotic treatment, the symptoms described previously reoccurred. Confirmatory laboratory tests were not performed but a recurrence of M genavense infection was suspected and the veterinarian, in agreement with the owner, euthanized the ferret.

Corynebacterium macginleyi-associated Blebitis: A Case Report.

PURPOSE: The purpose of this study was to report a rare case of posttrabeculectomy bleb-related infection associated with Corynebaterium macginleyi, a rare conjunctival pathogen. METHODS: Case description including clinical imaging and microbiology data, and literature review of Corynebacterium macginleyi-related infections. RESULTS: A 60-year-old glaucomatous female patient presented with a bleb-related infection 6 years after trabeculectomy in her right eye, suggestive of blebitis. No bleb-related endophthalmitis was reported. CONCLUSIONS: C. macginleyi is a rare conjunctival pathogen that can cause conjunctivitis and, rarely, bleb-related infections.

Contact lenses with dual drug delivery for the treatment of bacterial conjunctivitis.

Currently, bacterial conjunctivitis is treated by frequent administration of antibiotic eye drop solutions, which is tedious and patient noncompliant. Contact lenses could be ideal medical devices to sustain the release of ophthalmic drugs, but the incorporation of the latter can alter the optical and physical properties of the lenses. In addition, many contact lens users have reported the pink eye syndrome, making them unsuitable as ocular medical devices. In the present study, we have designed a novel type of lenses containing semi-circular rings loaded with moxifloxacin HCl (a broad spectrum antibiotic) and hyaluronic acid (a comfort agent), respectively, in order to treat bacterial conjunctivitis without altering the critical lens properties. The drug loaded rings were implanted separately within the periphery of the contact lenses using the modified cast moulding technology. The atomic force microscopy report showed an average roughness of 22.27 nm for the implant lens, which was significantly lower in comparison to the marketed Freshlook® (116.27 nm) contact lens. The major amount of moxifloxacin HCl was leached (68.16-74.55%) during the monomer extraction and wet sterilization (autoclave) steps; hence the lenses were terminally sterilized by radiation and packaged under dry condition (dehydrated). The in vitro release data showed release for moxifloxacin HCl and hyaluronic acid up to 96 h. The in vivo drug release studies showed significant improvement [>MIC for Staphylococcus aureus] in the drug residence time in comparison to the eye drop therapy. The in vivo efficacy study in the staphylococcus aureus induced conjunctivitis showed equivalent healing effect with the single implant contact lens in comparison to the frequent high dose eye drop therapy. The study demonstrated the successful application of the implantation technology to co-deliver moxifloxacin HCl and hyaluronic acid from the contact lenses for the extended period of time to treat conjunctivitis.