Actinomycosis: a differential diagnosis for appendicitis. A case report and review of the literature.

Actinomyces is a genus of gram-positive anaerobic or microaerophilic bacteria that colonize the upper respiratory and gastrointestinal tracts and the female genital tract. These organisms cause disseminated disease in the mouth, the respiratory system, and rarely in the gastrointestinal tract. The diseases produced by Actinomyces species result from the disruption of the barriers that allow the dissemination of the bacteria through the surrounding tissues. The appendix is often a nidus of Actinomyces infection, but a prompt diagnosis cannot be made without the results of histologic examination of the appendix. The treatment of choice for actinomycosis of the appendix is the high-dose parenteral administration of penicillin G for 2 weeks immediately after the diagnosis has been made and continued oral treatment with that agent for at least the next 6 months. We present the case of a 13-year-old adolescent boy with actinomycosis of the appendix that was identified by histologic examination after appendectomy.

Effects of intravitreal moxifloxacin and dexamethasone in experimental Staphylococcus aureus endophthalmitis.

PURPOSE: To evaluate the effects of intravitreal moxifloxacin and moxifloxacin and dexamethasone combination in an experimental rabbit model of Staphylococcus aureus endophthalmitis. METHODS: The right eyes of 24 rabbits weighing 2 to 3 kg were used. Ten thousand colony-forming units (CFU) of S. aureus in 0.1 ml saline solution were inoculated into the vitreous cavity. The eyes were randomly assigned to one of the four groups equally. Twenty-four hours after the inoculation of S. aureus, group 1 received 50 microg moxifloxacin, group 2 received 50 microg moxifloxacin plus 400 microg dexamethasone, and group 3 received 1 mg vancomycin intravitreally. No treatment was given to group 4. Clinical examination scores were recorded. Vitreous aspirates were obtained for microbiological analysis just before sacrifice, and the eyes were enucleated for histopathologic examination. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U tests. RESULTS: In all treatment groups, mean number of CFU and histopathologic score were significantly lower compared with control group (p<0.05), and the difference between treatment groups was not statistically significant (p>0.05). The clinical score was not significantly different between groups (p>0.05). CONCLUSIONS: Intravitreal injection of 50 microg moxifloxacin was effective in the treatment of S. aureus endophthalmitis. Bacteriological, histopathologic, and clinical outcomes after treatment using moxifloxacin, moxifloxacin and dexamethasone combination, and vancomycin were comparable. Intravitreal moxifloxacin may be an option in the treatment of S. aureus endophthalmitis.

Treatment of Staphylococcus epidermidis endophthalmitis with intravitreal moxifloxacin in a rabbit model.

Staphylococcus epidermidis is one of the most common causes of postoperative infectious endophthalmitis, which is a serious complication of ocular surgery and penetrating trauma. Moxifloxacin is a newly developed fluoroquinolone with a potent antimicrobial activity. Corticosteroids are used in endophthalmitis to suppress devastating intraocular inflammatory response. This study was designed to assess the efficacy of intravitreal moxifloxacin alone and in combination with intravitreal dexamethasone. To the best of our knowledge, there is no published report demonstrating the effect of intravitreal moxifloxacin on bacterial endophthalmitis. One eye of each rabbit (n=24) was infected by inoculation of 10(5) colony-forming units (CFU) of S. epidermidis into the vitreus cavity. Rabbits received intravitreal injection of moxifloxacin (50 microg) or a combination of moxifloxacin (50 microg) and dexamethasone (400 microg). No treatment was given to control group. Clinical and histopathological examination scores and microbiological analysis of vitreus aspirates were compared. In the treatment groups, the clinical and histopathological scores and mean CFU were significantly lower than those in the control group (p <0.05) but showed no significant difference between the treatment groups. These results suggest that intravitreal injection of moxifloxacin is effective against S. epidermidis in this experimental rabbit model. Moxifloxacin may be a promising agent in the treatment of bacterial endophthalmitis.