RESUMO
A 40-year-old man presented with recurrent ocular surface masses in his left eye persisting for over a year. Despite undergoing resection of the conjunctival mass and receiving anti-inflammatory treatment at another hospital, the mass reappeared within a week post-surgery. Over the past 6 months, the mass gradually increased in size, accompanied by a decline in vision. Following conjunctival mass excision combined with amniotic membrane transplantation at Beijing Tongren Hospital, Capital Medical University, histopathological examination revealed a fungal infection of the conjunctiva, resulting in a diagnosis of fungal conjunctivitis and conjunctival granuloma in the left eye. The patient received systemic antifungal medications and local therapy, resulting in a stable condition with no recurrence of the mass.
Assuntos
Infecções Oculares Fúngicas , Humanos , Masculino , Adulto , Infecções Oculares Fúngicas/diagnóstico , Túnica Conjuntiva/patologia , Doenças da Túnica Conjuntiva/diagnóstico , Doenças da Túnica Conjuntiva/microbiologia , Recidiva , Conjuntivite/diagnóstico , Conjuntivite/microbiologia , Granuloma/diagnóstico , Antifúngicos/uso terapêuticoRESUMO
INTRODUCTION: Classically, sporotrichosis occurs as a chronic granulomatous lymphocutaneous infection. The extracutaneous form is uncommon and may affect the eye without cutaneous involvement. The most frequent form of ocular sporotrichosis reported in humans is a granulomatous conjunctivitis. There are no previous reports on primary ocular sporotrichosis in cats. PROCEDURES: Three mixed breed cats rescued from shelters were referred by the veterinarian for ophthalmic evaluation with a complaint of conjunctivitis nonresponsive to treatment with no evidence of skin disease or systemic disease. Complete ophthalmic examination, conjunctival cytology, and microbiological analysis were performed. RESULTS: Ophthalmic examinations revealed epiphora, purulent ocular discharge, conjunctival hyperemia, and a mass in the palpebral conjunctiva. Conjunctival cytology revealed segmented and degenerated neutrophils, conjunctival epithelial cells, and an abundant number of round and oval cells compatible with Sporothrix spp. Microbiological culture was performed and confirmed the presence of fungi from the Sporothrix schenckii complex. All animals were treated with oral itraconazole; two animals received topical itraconazole in association with oral treatment. Case 1 was refractory to treatment, and iodate potassium was combined with itraconazole therapy without resolution at the time of this publication. Cases 2 and 3 had complete resolution of conjunctival lesions with four months of oral and topical itraconazole therapy. CONCLUSION: Conjunctival sporotrichosis should be considered as a differential diagnosis of conjunctivitis in cats from endemic regions. Conjunctival cytology is an important tool that can aid early diagnosis.
Assuntos
Doenças do Gato/microbiologia , Doenças da Túnica Conjuntiva/veterinária , Sporothrix , Esporotricose/veterinária , Administração Oral , Animais , Antifúngicos/uso terapêutico , Brasil , Doenças do Gato/tratamento farmacológico , Gatos , Doenças da Túnica Conjuntiva/tratamento farmacológico , Doenças da Túnica Conjuntiva/microbiologia , Feminino , Itraconazol/uso terapêutico , Masculino , Esporotricose/tratamento farmacológico , Esporotricose/microbiologiaRESUMO
PURPOSE: The aim of this study was to investigate microbiological characteristics of prophylactically removed calcified plaques developed after pterygium excision, and to evaluate risk factors for the growth of microorganisms. METHODS: Only exposed calcified plaques developed at the same site of previous pterygium excision were prospectively removed in 15 eyes of 14 patients. Plaques were completely removed, divided into small pieces and evaluated for microbiological identification. Underlying scleral defects were reconstructed using a conjunctival autograft, amniotic membranes and scleral patch grafts according to the size and depth of the defects. Based on the results of microbiologic cultures, eyes were divided into two groups and risk factors for microbial growth were analyzed. RESULTS: At surgery, the mean age of the patients was 71.2 ± 5.8 years and 71.4 % were females. The mean time interval between pterygium excision and calcified plaque removal was 19.3 ± 13.8 years. Six of 15 (40 %) removed plaques showed bacterial growth, and Stenotrophomonas maltophilia was the most frequently isolated microorganism. The size of calcified plaques was the only risk factor for culture-positive results (p = 0.045). Underlying scleral defects were successfully repaired without any serious complication. CONCLUSIONS: Microorganisms can be isolated from calcified plaques developed at the site of previous pterygium excision, and the size of plaques is the only risk factor for culture-positive results. To remove potential source of infection, prophylactic removal of calcified plaques and scleral surface reconstruction should be considered, especially when the plaques are exposed and large.
Assuntos
Bactérias/isolamento & purificação , Calcinose/microbiologia , Doenças da Túnica Conjuntiva/microbiologia , Infecções Oculares Bacterianas/microbiologia , Complicações Pós-Operatórias , Pterígio/cirurgia , Doenças da Esclera/microbiologia , Idoso , Técnicas Bacteriológicas , Calcinose/cirurgia , Doenças da Túnica Conjuntiva/cirurgia , Infecções Oculares Bacterianas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Oftalmológicos , Estudos Prospectivos , Fatores de Risco , Doenças da Esclera/cirurgiaRESUMO
Rothia mucilaginosa is a gram-positive coagulase-negative coccus of the family Micrococcaceae. Although R. mucilaginosa forms part of the oropharyngeal microflora, it has only recently been isolated in ocular infections. We report a case of a 41-year-old man who developed late-onset bleb-related endophthalmitis (BRE). He had undergone glaucoma surgery 21 years earlier and had a thin-walled cystic bleb prior to the development of endophthalmitis in his right eye. He immediately received intravitreal injections of ceftazidime and vancomycin, topical levofloxacin and cefmenoxime, and intravenous cefozopran. Culture of the aqueous humor specimen identified R. mucilaginosa by 16S rRNA sequence analysis. To our knowledge, this is the first report of late-onset BRE caused by R. mucilaginosa. Our case indicates that R. mucilaginosa can be a cause of late-onset BRE, and that molecular analysis is an accurate method to identify R. mucilaginosa.
Assuntos
Infecções por Actinomycetales/diagnóstico , Doenças da Túnica Conjuntiva/diagnóstico , Endoftalmite/diagnóstico , Micrococcaceae/genética , Trabeculectomia/efeitos adversos , Adulto , Vesícula/etiologia , Vesícula/microbiologia , Doenças da Túnica Conjuntiva/microbiologia , Endoftalmite/microbiologia , Genes de RNAr , Glaucoma/complicações , Humanos , Masculino , Micrococcaceae/isolamento & purificação , Análise de Sequência de RNA/métodosAssuntos
Doenças da Túnica Conjuntiva/diagnóstico , Doenças da Córnea/diagnóstico , Infecções Oculares/diagnóstico , Sequenciamento de Nucleotídeos em Larga Escala , Metagenoma , Doenças da Esclera/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Bactérias/genética , Doenças da Túnica Conjuntiva/microbiologia , Doenças da Túnica Conjuntiva/parasitologia , Doenças da Córnea/microbiologia , Doenças da Córnea/parasitologia , Infecções Oculares/microbiologia , Infecções Oculares/parasitologia , Feminino , Fungos/genética , Humanos , Masculino , Pessoa de Meia-Idade , Parasitos/genética , Reação em Cadeia da Polimerase , Estudos Retrospectivos , Doenças da Esclera/microbiologia , Doenças da Esclera/parasitologiaRESUMO
There are several pigmented nonneoplastic lesions that can clinically simulate melanocytic tumors. The authors report an unusual conjunctival epithelial inclusion cyst that contained luminal bacterial colonies, hemorrhage, and epithelial debris. Clinical appearance convincingly simulated a melanoma. The clinical and histopathologic features of this lesion are discussed.
Assuntos
Doenças da Túnica Conjuntiva/diagnóstico , Cistos/diagnóstico , Células Epiteliais/patologia , Bactérias Gram-Positivas/isolamento & purificação , Infecções por Bactérias Gram-Positivas/diagnóstico , Melanoma/diagnóstico , Idoso de 80 Anos ou mais , Biópsia , Doenças da Túnica Conjuntiva/microbiologia , Doenças da Túnica Conjuntiva/cirurgia , Cistos/microbiologia , Cistos/cirurgia , Diagnóstico Diferencial , Feminino , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/cirurgia , Humanos , Melanoma/cirurgiaRESUMO
Actinomycosis is a rare cause of a caruncular mass previously unreported in large clinicohistopathologic studies. A 25-year-old man presented with an enlarged and irritated left caruncle and an otherwise normal ocular examination. After the patient failed to respond to conservative medical management, an excision biopsy revealed an underlying diagnosis of actinomycotic granule of the caruncle. The patient's symptoms resolved, and after 6 months of follow up there was no evidence of recurrence. Actinomycosis is a slowly progressive, chronic infection with a nonspecific clinical presentation. Diagnosis is therefore difficult and is generally made on the basis of histopathology. This case demonstrates that actinomycosis can present as a caruncular mass.
Assuntos
Actinomicose/microbiologia , Doenças da Túnica Conjuntiva/microbiologia , Infecções Oculares Bacterianas/microbiologia , Doenças Palpebrais/microbiologia , Actinomyces/isolamento & purificação , Actinomicose/diagnóstico , Actinomicose/cirurgia , Adulto , Doenças da Túnica Conjuntiva/diagnóstico , Doenças da Túnica Conjuntiva/cirurgia , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/cirurgia , Doenças Palpebrais/diagnóstico , Doenças Palpebrais/cirurgia , Humanos , MasculinoAssuntos
Doenças da Túnica Conjuntiva/diagnóstico , Doenças da Córnea/diagnóstico , Técnicas de Diagnóstico Oftalmológico , Infecções Oculares/diagnóstico , Doenças da Túnica Conjuntiva/microbiologia , Doenças da Córnea/microbiologia , Diagnóstico Diferencial , Infecções Oculares/microbiologia , HumanosRESUMO
Ehrlichia canis is a major tick-borne bacterial pathogen of dogs. Quantitative real-time PCR was evaluated for the detection of E. canis in naturally (NI) and experimentally infected (EI) dogs. DNA was extracted from blood, spleen and conjunctival swabs of experimentally infected dogs pre- and post-infection (PI), and during doxycycline therapy, and from blood and conjunctivas of naturally infected dogs. The primers and probe were designed to amplify a 93bp fragment of the single copy E. canis 16S rRNA gene with the TaqMan system. All EI dogs were positive for E. canis DNA by 7d PI and developed clinical ehrlichiosis by 9-12d PI. A rapid increase in ehrlichial DNA in EI dogs correlated with the appearance of severe clinical signs of disease. The mean spleen and blood DNA copies significantly increased by more than 10-folds from 7d PI to 10 and 12d PI (p<0.05). E. canis DNA was undetectable in the blood by day 9 post-treatment. Although the spleen was more frequently positive than blood (15/15 specimens vs. 13/15), no significant differences were found between the mean ehrlichial DNA copies in the spleen and blood on each day of examination. In 12 naturally infected dogs, the mean blood DNA copies was similar to the number found in EI 7d PI, but significantly lower than the means of 10 and 12d PI (p<0.0001). Although the conjunctivas of all EI dogs were positive by 12d PI, only 3/5 (60%) NI dogs were positive also by conjunctival PCR. In conclusion, the kinetics of E. canis during acute experimental infection with complete pathogen clearance following doxycyline treatment was demonstrated for the first time by real-time PCR. The value of real-time PCR was shown in NI dogs as well as in EI dogs with spleen and blood sampling more sensitive than non-invasive conjunctival PCR.
Assuntos
Doenças da Túnica Conjuntiva/veterinária , Doenças do Cão/microbiologia , Doxiciclina/farmacologia , Ehrlichia canis/isolamento & purificação , Ehrlichiose/veterinária , Animais , Antibacterianos/farmacologia , Anticorpos Antibacterianos/sangue , Doenças da Túnica Conjuntiva/tratamento farmacológico , Doenças da Túnica Conjuntiva/microbiologia , DNA Bacteriano/química , DNA Bacteriano/genética , Doenças do Cão/tratamento farmacológico , Cães , Doxiciclina/uso terapêutico , Ehrlichia canis/genética , Ehrlichiose/tratamento farmacológico , Ehrlichiose/microbiologia , Ensaio de Imunoadsorção Enzimática/veterinária , Estudos Longitudinais , Reação em Cadeia da Polimerase/veterinária , Baço/microbiologiaRESUMO
OBJECTIVE: To describe a case of a conjunctivo-corneal mass in a cat associated with acid-fast bacilli. METHODS: A 2-year-old female black European Short-Hair cat, living outdoors in a suburban environment in Italy, was referred for evaluation of a nodular, vascularized mass of 2 weeks duration. The mass involved the dorsal bulbar conjunctiva at the temporal canthus of OS and invaded the sclera and cornea. Routine ophthalmic and systemic examination, serologic testing, cytology and histology of the mass were performed. Mycobacterium specific polymerase chain reaction (PCR) of variable regions 1, 2 and 3 of the 16S ribosomal RNA (rRNA) gene was also performed. RESULTS: Neutrophils, lymphocytes, macrophages and giant cells with intracytoplasmic acid-fast bacilli were seen on cytological examination. The histological examination confirmed the presence of a granulomatous lesion with acid-fast bacilli within macrophages. Bacteriological culture of the material from the lesion was negative for Mycobacterium spp. Mycobacterium 16S rRNA gene specific PCR was positive. A diagnosis of feline leprosy was made. The owners refused any treatment, and 1 year later the lesion was still present. CONCLUSIONS: Veterinary ophthalmologists should be aware of conjunctivo-corneal leproma as an unusual symptom of leprosy.
Assuntos
Doenças do Gato/microbiologia , Doenças da Túnica Conjuntiva/microbiologia , Doenças da Túnica Conjuntiva/veterinária , Doenças da Córnea/veterinária , Granuloma/veterinária , Hanseníase Virchowiana/veterinária , Animais , Doenças do Gato/patologia , Gatos , Doenças da Túnica Conjuntiva/patologia , Doenças da Córnea/microbiologia , Doenças da Córnea/patologia , Feminino , Granuloma/microbiologia , Granuloma/patologia , Itália/epidemiologia , Hanseníase Virchowiana/patologiaRESUMO
Background: Trachoma, a neglected tropical disease, is the leading infectious cause of blindness and visual impairment worldwide. Host responses to ocular chlamydial infection resulting in chronic inflammation and expansion of non-chlamydial bacteria are hypothesized risk factors for development of active trachoma and conjunctival scarring. Methods: Ocular swabs from trachoma endemic populations in The Gambia were selected from archived samples for 16S sequencing and host conjunctival gene expression. We recruited children with active trachoma and adults with conjunctival scarring, alongside corresponding matched controls. Findings: In children, active trachoma was not associated with significant changes in the ocular microbiome. Haemophilus enrichment was associated with antimicrobial responses but not linked to active trachoma. Adults with scarring trachoma had a reduced ocular bacterial diversity compared to controls, with increased relative abundance of Corynebacterium. Increased abundance of Corynebacterium in scarring disease was associated with innate immune responses to the microbiota, dominated by altered mucin expression and increased matrix adhesion. Interpretation: In the absence of current Chlamydia trachomatis infection, changes in the ocular microbiome associate with differential expression of antimicrobial and inflammatory genes that impair epithelial cell health. In scarring trachoma, expansion of non-pathogenic bacteria such as Corynebacterium and innate responses are coincident, warranting further investigation of this relationship. Comparisons between active and scarring trachoma supported the relative absence of type-2 interferon responses in scarring, whilst highlighting a common suppression of re-epithelialization with altered epithelial and bacterial adhesion, likely contributing to development of scarring pathology.
Assuntos
Túnica Conjuntiva/microbiologia , Células Epiteliais/microbiologia , Microbiota , Tracoma/imunologia , Tracoma/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bactérias/classificação , Bactérias/efeitos dos fármacos , Bactérias/genética , Estudos de Casos e Controles , Criança , Pré-Escolar , Chlamydia trachomatis , Cicatriz/genética , Doenças da Túnica Conjuntiva/imunologia , Doenças da Túnica Conjuntiva/microbiologia , Feminino , Gâmbia , Expressão Gênica , Interações entre Hospedeiro e Microrganismos/efeitos dos fármacos , Interações entre Hospedeiro e Microrganismos/genética , Interações entre Hospedeiro e Microrganismos/imunologia , Humanos , Imunidade Inata , Lactente , Interferon gama , Masculino , Microbiota/efeitos dos fármacos , Microbiota/genética , Microbiota/imunologia , Pessoa de Meia-Idade , Tracoma/tratamento farmacológico , Tracoma/genética , Adulto JovemRESUMO
PURPOSE: To investigate the clinical features and risk factors of atypical mycobacterial infection in anophthalmic sockets with porous orbital implant exposure. DESIGN: Case-control study. METHODS: The medical records of all patients who had undergone surgical correction of porous orbital implant exposure were consecutively reviewed, and the patients were stratified as those with atypical mycobacterial infection (AM infection group) and others (non-AM group). RESULTS: Five and 21 patients were included in the AM infection and non-AM groups, respectively. All patients of the AM infection group had a peg or motility coupling post (MCP) and showed implant exposure around it. Following up on implant exposure, 2 patients abruptly presented with severe conjunctival injection and new lesions such as erythematous nodules or eyelid masses. They underwent immediate orbital implant exchange and atypical mycobacterial infection was diagnosed. Three patients who were not suspected of having infection underwent surgery for orbital implant exposure. Results revealed erythematous eyelid nodule or recurrent exposure shortly after surgery and patients were diagnosed with atypical mycobacterial infection. In the non-AM group, 7 (33.3%) patients underwent insertion of a peg or MCP. Statistical analysis showed that the insertion of a peg or MCP was the only risk factor showing a significant difference between the 2 groups. CONCLUSIONS: The most important underlying risk factor for atypical mycobacterial infection in the anophthalmic socket is thought to be peg- or MCP-related exposure of the porous orbital implant. Surgical removal of the infected orbital implant and long-term antibiotic medication are needed for treatment.
Assuntos
Infecções Oculares Bacterianas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Doenças Orbitárias/diagnóstico , Implantes Orbitários , Falha de Prótese , Infecções Relacionadas à Prótese/diagnóstico , Adulto , Idoso , Estudos de Casos e Controles , Doenças da Túnica Conjuntiva/diagnóstico , Doenças da Túnica Conjuntiva/microbiologia , Durapatita , Enucleação Ocular , Evisceração do Olho , Infecções Oculares Bacterianas/microbiologia , Doenças Palpebrais/diagnóstico , Doenças Palpebrais/microbiologia , Feminino , Humanos , Masculino , Infecções por Mycobacterium não Tuberculosas/microbiologia , Doenças Orbitárias/microbiologia , Polietileno , Porosidade , Infecções Relacionadas à Prótese/microbiologia , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios XRESUMO
We report the first case of invasive ophthalmologic infection by Acrophialophora sp. that was successfully treated using voriconazole (VRCZ). Acrophialophora spp., which has been reported to be an opportunistic pathogen, is a rare thermotolerant soil fungus, but its pathogenicity remains unclear. A 77-year-old man had neutropenia and prostate carcinoma and was receiving hemodialysis. His right eye had been infected for 2 days. His conjunctiva was congested, and it partially formed an abscess. Liposomal amphotericin B (L-AMB) was administered following systemic itraconazole. However, the treatment was changed from L-AMB to systemic VRCZ and VRCZ eye drops because his eye symptoms worsened. Subsequently, his symptoms stabilized and his vision was maintained. Acrophialophora sp. was identified by analyzing regions of internal transcribed spacer and domain 1 and 2 of the ribosomal RNA gene. He completed the 7-week systemic VRCZ course. The mean minimum inhibitory concentration of VRCZ for Acrophialophora spp. has been reported to be the lowest among various antifungal agents, and our results indicated the efficacy of VRCZ treatment for Acrophialophora sp. infection. Our results suggest that invasive Acrophialophora sp. infection may require long-term therapy. Further analysis of the clinical spectrum of Acrophialophora spp. infection and adequate treatment methods are required in the future.
Assuntos
Ascomicetos/isolamento & purificação , Doenças da Túnica Conjuntiva/diagnóstico , Infecções Oculares Fúngicas/diagnóstico , Hospedeiro Imunocomprometido , Úlcera/diagnóstico , Uveíte/diagnóstico , Adolescente , Adulto , Idoso , Anfotericina B/administração & dosagem , Anfotericina B/farmacologia , Antifúngicos/administração & dosagem , Antifúngicos/farmacologia , Ascomicetos/classificação , Ascomicetos/genética , Criança , Pré-Escolar , Análise por Conglomerados , Doenças da Túnica Conjuntiva/complicações , Doenças da Túnica Conjuntiva/microbiologia , Doenças da Túnica Conjuntiva/patologia , DNA Fúngico/química , DNA Fúngico/genética , DNA Espaçador Ribossômico/química , DNA Espaçador Ribossômico/genética , Infecções Oculares Fúngicas/microbiologia , Infecções Oculares Fúngicas/patologia , Feminino , Humanos , Itraconazol/administração & dosagem , Itraconazol/farmacologia , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Filogenia , RNA Ribossômico/genética , Análise de Sequência de DNA , Resultado do Tratamento , Úlcera/complicações , Úlcera/microbiologia , Úlcera/patologia , Uveíte/complicações , Uveíte/microbiologia , Uveíte/patologia , Voriconazol/administração & dosagem , Voriconazol/farmacologiaRESUMO
PURPOSE: To report a case of Mycobacterium hemophilum of the eye. METHODS: Case report with pathologic correlation. A 55-year-old Malaysian man with a 3-year history of graft-versus-host disease presented with dry eye and keratopathy. RESULTS: The diagnosis was not initially evident, despite biopsy specimens of the conjunctiva. Definitive diagnosis was made after dermatology consultation suggested a histoid variant of lepromatous leprosy, prompting Ziehl-Neelsen staining of the initial and subsequent conjunctival biopsies with subsequent polymerase chain reaction testing. Anti-M. hemophilum treatment resulted in prompt resolution of ocular signs. CONCLUSIONS: Mycobacterium hemophilum is a rare condition, affecting mainly immunocompromised patients. Although filamentary keratopathy has been described as common manifestations of leprosy, to date, no ocular manifestations of M. hemophilum have been described. Conjoint management with infectious disease and clinical microbiology is imperative to ensure accurate diagnosis and appropriate early intervention. The effect of systemic immunosuppression is relevant in such patients.
Assuntos
Doenças da Túnica Conjuntiva/microbiologia , Doenças da Córnea/microbiologia , Infecções Oculares Bacterianas/microbiologia , Hospedeiro Imunocomprometido , Infecções por Mycobacterium/microbiologia , Mycobacterium haemophilum/isolamento & purificação , Doenças da Túnica Conjuntiva/diagnóstico , Doenças da Túnica Conjuntiva/tratamento farmacológico , Doenças da Córnea/diagnóstico , Doenças da Córnea/tratamento farmacológico , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/tratamento farmacológico , Doença Enxerto-Hospedeiro/tratamento farmacológico , Doença Enxerto-Hospedeiro/imunologia , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium/diagnóstico , Infecções por Mycobacterium/tratamento farmacológicoRESUMO
Presumed subconjunctival abscess has been reported as a rare postoperative complication of strabismus surgery.(1-2) We report the case of a child who initially was diagnosed with subconjuctival abscess after strabismus surgery for whom histopathology demonstrated an infected epithelial inclusion cyst. We suggest that previous reports of presumed subconjunctival abscess after strabismus surgery also may have been caused by a similar mechanism.
Assuntos
Abscesso/diagnóstico , Doenças da Túnica Conjuntiva/diagnóstico , Cistos/diagnóstico , Infecções Oculares Bacterianas/diagnóstico , Complicações Pós-Operatórias , Infecções Estafilocócicas/diagnóstico , Estrabismo/cirurgia , Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Pré-Escolar , Ácido Clavulânico/uso terapêutico , Doenças da Túnica Conjuntiva/tratamento farmacológico , Doenças da Túnica Conjuntiva/microbiologia , Cistos/tratamento farmacológico , Cistos/microbiologia , Diagnóstico Diferencial , Quimioterapia Combinada , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções Oculares Bacterianas/microbiologia , Feminino , Humanos , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificaçãoRESUMO
A 60-year-old woman returned from visiting a cousin in Texas. For the past 6 weeks, she had not been feeling well and had lost almost 30 lb. She had frequent night sweats, although she did not recall having taken her temperature. Upon evaluation in the emergency department, results of physical examination were notable for cachexia and poor dentition. She was noted to have pyuria, and therapy was initiated for a urinary tract infection. Results of blood cultures performed the same day were positive for gram-positive cocci, and vancomycin therapy was initiated. She developed difficulty in seeing to her, left and a computed tomographic scan of the brain was performed; results were interpreted as negative. A transesophageal echocardiogram showed a 3-cm mass attached the posterior leaflet of the mitral valve. Initial interpretation was of an atrial myxoma. One of the authors was asked to consult on the case and noted bilateral conjunctival hemorrhages (Figure 1). Subsequently, the blood culture isolate was identified as Streptococcus mitis. Magnetic resonance imaging confirmed multiple cerebral infarcts consistent with embolic origin. The patient underwent emergent cardiac surgery, and her mitral valve was replaced with a bioprosthetic valve. She successfully completed a 4-week course of antibiotic therapy for her endocarditis.
Assuntos
Doenças da Túnica Conjuntiva/microbiologia , Endocardite Bacteriana/microbiologia , Dermatopatias/microbiologia , Infecções Estreptocócicas/complicações , Streptococcus mitis , Doenças da Túnica Conjuntiva/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Dermatopatias/diagnóstico , Infecções Estreptocócicas/diagnósticoRESUMO
Conjunctival ulceration accompanied with secretion and pain was observed in a 30-year-old male, 3 days after a perforating corneal trauma. Cultures of conjunctival ulcer samples grew Fonsecaea pedrosoi, a major causative agent of chromoblastomycosis that is typically transmitted during trauma. The conjunctival ulcer was successfully treated with amphotericin B, itraconazole, and fluconazole. This case report summarizes the diagnosis and treatment of a conjunctival ulcer due to F. pedrosoi, which is a rare complication of contaminated ocular trauma. To the best of our knowledge, this is the first reported case of F. pedrosoi causing acute conjunctival ulceration in the literature.
Assuntos
Ascomicetos/patogenicidade , Cromoblastomicose/microbiologia , Doenças da Túnica Conjuntiva/microbiologia , Perfuração da Córnea/microbiologia , Úlcera da Córnea/microbiologia , Adulto , Antifúngicos/uso terapêutico , Ascomicetos/isolamento & purificação , Cromoblastomicose/terapia , Doenças da Túnica Conjuntiva/terapia , Córnea/microbiologia , Perfuração da Córnea/complicações , Perfuração da Córnea/terapia , Úlcera da Córnea/terapia , Humanos , Masculino , Resultado do TratamentoRESUMO
A 59-year-old female patient, previously healthy, immunocompetent, presented left bulbar conjunctiva lesions and nodular-ulcerated lesions on the arms and cervical region, besides left cervical and retroauricular lymphadenopathy. She had previous contact with domestic cats that excoriated her face. The diagnosis was conclusive of disseminated sporotrichosis through clinical and epidemiological history and cultures of skin and ocular secretions. It evolved with good response to oral antifungal therapy.
Assuntos
Doenças da Túnica Conjuntiva/imunologia , Doenças da Túnica Conjuntiva/microbiologia , Imunocompetência , Esporotricose/imunologia , Esporotricose/microbiologia , Animais , Gatos , Túnica Conjuntiva/metabolismo , Túnica Conjuntiva/microbiologia , Doenças da Túnica Conjuntiva/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Pele/microbiologia , Pele/patologia , Esporotricose/patologia , Ferimentos e Lesões/microbiologiaRESUMO
PURPOSE: Timely identification of a bacterial agent and its corresponding antibiotic sensitivity pattern is paramount in the management of infective corneal ulcers. Isolating the microbiological agents can take time; during this time, the initial therapy used is a chosen form of broad-spectrum antibiotics. There are no specific features of bacterial corneal ulcers that aid in identification of the involved pathogen with certainty. A clinical "marker" would undoubtedly be useful in the management of corneal ulcers. METHODS: Early clinical photographs and clinical notes of 62 cases with confirmed infective corneal ulcers were examined by a masked reviewer. RESULTS: Conjunctival chemosis was observed in 14 out of 16 cases of Pseudomonas aeruginosa-related corneal ulcers, as compared with 6 out of 46 cases caused by other organisms. The association between conjunctival chemosis and Pseudomonas aeruginosa is statistically significant, with P value <0.000001 and odds ratio 42.0 (7.2-470) using the Fisher exact test. CONCLUSIONS: Our findings suggest that conjunctival chemosis could be a useful marker to predict the presence of Pseudomonas aeruginosa in bacterial corneal ulcers.
Assuntos
Doenças da Túnica Conjuntiva/diagnóstico , Úlcera da Córnea/diagnóstico , Edema/diagnóstico , Infecções Oculares Bacterianas/diagnóstico , Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa/isolamento & purificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças da Túnica Conjuntiva/microbiologia , Úlcera da Córnea/microbiologia , Edema/microbiologia , Infecções Oculares Bacterianas/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Pseudomonas/microbiologiaRESUMO
PurposePhaeohyphomycosis are melanin-containing fungi that rarely infect the eye. We describe three cases of ocular infection with some unusual clinical features.MethodsSeries of three case reports describing three different presentations of phaeohyphomycosis of the eye, their histopathology, and management.ResultsCase 1 mimicked an inflamed conjunctival naevus and was excised on this basis, revealing a conjunctival retention cyst containing pigmented fungal hyphae. Case 2 showed a wooden foreign body incidentally associated with pigmented fungal hyphae, which required treatment with topical antifungal therapy. Case 3 clinically was thought to be a perforated uveal melanoma and comprised an extensive plaque of pigmented fungal hyphae over ulcerated cornea.ConclusionThe pigmented melanin containing hyphae of phaeohyphomycosis mimicked melanocytic lesions in two cases and was an incidental finding in the context of a surface foreign body.