ABSTRACT
A 59‑year‑old Asian Indian male presented with complaints of left eye blurring of vision associated with on and off episodes eye pain and redness since last 4 months. On examination, his best corrected visual acuity in the right eye was 6/15, N12 and left eye counting finger at 2 m, <N36. Anterior segment examination of the left eye revealed circumciliary congestion, corneal edema, mutton fat pigmented keratic precipitates, and dilated pupil with complicated cataract [Fig. 1a and b]. Intraocular pressure (IOP) in the right eye was 18 and left eye 48 mmHg. On the basis of history and clinical examination, a probable diagnosis of viral anterior granulomatous keratouveitis was made. The patient was started on topical prednisolone, homatropine, and empirical tablet acyclovir. Patient was also advised tablet. Acetazolamide, topical antiglaucoma medications (timolol and brinzolamide) in left eye to control IOP. Anterior chamber tap was done in left eye for real time polymerase chain reaction (RT‑PCR) for herpes simplex virus (HSV). RT‑PCR report was positive for HSV [Fig. 2a and b]. The patient was started with T. valacyclovir 1 g 3 times and tapering dose of topical prednisolone. The patient is on follow‑up and responding well to the treatment.
ABSTRACT
Background & objectives: There are only a few reports available on characterization of Propionibacterium acnes isolated from various ocular clinical specimens. We undertook this study to evaluate the role of P. acnes in ocular infections and biofilm production, and also do the phylogenetic analysis of the bacilli. Methods: One hundred isolates of P. acnes collected prospectively from ocular clinical specimens at a tertiary care eye hospital between January 2010 and December 2011, were studied for their association with various ocular disease conditions. The isolates were also subjected to genotyping and phylogenetic analysis, and were also tested for their ability to produce biofilms. Results: Among preoperative conjunctival swabs, P. acnes was a probably significant pathogen in one case; a possibly significant pathogen in two cases. In other clinical conditions, 13 per cent isolates were probably significant pathogens and 38 per cent as possibly significant pathogens. The analysis of 16S rRNA gene revealed four different phylogenies whereas analysis of recA gene showed two phylogenies confirming that recA gene was more reliable than 16S rRNA with less sequence variation. Results of polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) had 100 per cent concordance with phylogenetic results. No association was seen between P. acnes subtypes and biofilm production. Interpretation & conclusions: RecA gene phylogenetic studies revealed two different phylogenies. RFLP technique was found to be cost-effective with high sensitivity and specificity in phylogenetic analysis. No association between P. acnes subtypes and pathogenetic ability was observed. Biofilm producing isolates showed increased antibiotic resistance compared with non-biofilm producing isolates.