Keratitis with Kocuria palustris and Rothia mucilaginosa in Vitamin A Deficiency.

PURPOSE: To present a case of unusual corneal infection early in the course of peripheral ulcerative keratitis in a patient with severe vitamin A deficiency. METHOD: Single observational case report in urban USA. CASE PRESENTATION: An alcoholic patient with pancreatitis, chronic diarrhea, and vitamin A deficiency presented with a marginal corneal ulcer from which two bacteria of the family Micrococcaceae were cultured and identified by genome sequence analysis, namely Kocuria palustris and Rothia mucilaginosa. Soon after, severe bilateral peripheral ulcerative keratitis developed, later accompanied by eyelid cellulitis of one lid. These conditions improved with antibiotics, treatment of the underlying gastrointestinal conditions, and treatment of the vitamin deficiency. CONCLUSION: Susceptibility to keratitis with unusual bacteria of the Micrococcaceae family can occur in the setting of alcoholism-related gastrointestinal disease with severe vitamin A deficiency. To our knowledge, K. palustris is a species not previously identified in any human disease, and the Kocuria genus has not previously been reported as a participant in eye infection. Documented cases of R. mucilaginosa in ocular disease are rare. These unusual infections heralded the onset of severe marginal corneal melts.

Should antibody to hepatitis B core antigen be tested in routine screening of donor corneas for transplant?

PURPOSE: A review of the literature on transfusion-transmitted infectious diseases shows that antibody to hepatitis B core antigen (anti-HBc) is not presently viewed as helpful for hepatitis C or hepatitis non-ABC screening of blood donors. Its utility as a screen for hepatitis B or human immunodeficiency virus-1 (HIV-1) is controversial among experts. METHODS: We compare relevant aspects of the screening of blood donations and the screening of cornea transplant donors to assess implications for the screening of donor corneas. CONCLUSION: We conclude that there is not sufficient evidence to warrant introducing anti-HBc as a routine screening test for cornea donors.

The impact on tissue utilization of screening donor corneas by specular microscopy at the University of Texas Southwestern Medical Center.

To determine how frequently specular microscopy results affect the outcome of eye-bank judgments on the transplantability of donor corneas, 1,011 consecutive donor records from a 3-year period at the Transplant Services Center of the University of Texas Southwestern Medical Center at Dallas were analyzed. Specular microscopy cell counts from each decade of donor age were determined, and it was found that there were no cell counts < 2,000 mm2 for any donor age < 40. Above age 40, the percentage of cell counts < 2,000 per mm2 rose from 3.9% for donors in their forties of 6% for donors in their seventies. For donors between 40 and 69 years, specular microscopy was used to rule out unacceptable tissue in an additional 3.3% of a prescreened pool of corneas evaluated by current Eye Bank Association of America standards. While corneas from donors over age 69 were initially presumed to be unacceptable for transplant at this eye bank, routine specular microscopic examination helped to clear for transplant of 31 corneas from donors of this age group.

Retinoic acid inhibits formation of mesenchyme from lens epithelium in collagen gels.

PURPOSE: To examine the possibility that retinoic acid (RA), a stabilizer of the epithelial phenotype, would inhibit formation of mesenchymal cells from avian lens epithelium in three-dimensional collagen. METHODS: Lens epithelia from 11-day-old chick embryos were cultured for 6 days in collagen gels in the presence of RA. The number of mesenchymal cells emigrating into the gels was quantitatively compared with control cultures to which RA was not added. RESULTS: It was found that few fibroblast-like cells form at the highest dose used (10(-5) M RA) and outgrowth approaches control levels at lower doses of RA. The mesenchymal cells that form after RA treatment are not ultrastructurally different from those of controls. Many have well-developed rough endoplasmic reticulum and undoubtedly produce the collagen fibrils that accumulate around the cells. Others, although spindle-shaped, still exhibit lenslike cytoplasm. New basement membrane is deposited on the former free surface of RA-treated lens epithelium, but is not present at the former free surface of control epithelium. CONCLUSIONS: It is possible that RA inhibition of lens transformation to fibroblast-like cells is at least partly due to the ability of RA to stimulate production of basement membrane components by epithelia. More studies of RA action on epithelial-mesenchymal transformation in collagen gels may reveal additional mechanisms. It is also suggested that mesenchymal genes similar to those activated in lens epithelium by suspension in collagen may turn on in pathologic transformations (ie, in anterior capsular cataract, fibroblast-like cells arise from lens epithelium.