Ocular infection by a psychrophile: Pseudomonas fluorescens

Accurate identification of infectious pathogens is essential for appropriate management of ocular infections. Routine laboratory protocols typically support bacterial growth at 37°C. We report a case, wherein we serendipitously isolated Pseudomonas fluorescens – an organism that prefers lower temperatures for optimal growth (psychrophilic) in the environment – from eviscerated contents of an eye with total corneal melt. This case highlights the need for being vigilant for organisms with different temperature sensitivities in culture media than that found in routine protocols.

Conjunctiva Granuloma, a Rare Presentation of Ocular Leptospirosis Presenting as Conjunctiva Granuloma: Case Series

Diagnosis of ocular leptospirosis is challenging and requires a high index of suspicion of previous leptospiral infection and good laboratory support. This case series focuses on two young females with unilateral conjunctiva granuloma. To the best of our knowledge, these are the first two cases of ocular leptospirosis with conjunctiva granuloma. The definitive diagnosis of ocular leptospirosis was based on laboratory studies in which conjunctival biopsies in these two cases showed positive leptospira DNA. Retrospectively, the history was suggestive as both patients had exposure to leptospira organism. In conclusion, a diagnosis of ocular leptospirosis requires a high clinical suspicion index supported by mandatory laboratory investigations.

Correlation between clinical signs of feline conjunctivitis and molecular detection of felid herpesvirus-1, feline calicivirus, chlamydophila felis and mycoplasma felis in cats from shelters in Rio de Janeiro / Correlação entre sinais clínicos da conjuntivite felina e a detecção molecular de felid herpesvirus-1, feline calicivirus, chlamydophila felis e mycoplasma felis em gatos de abrigos no Rio de Janeiro

Objectives: To perform molecular diagnosis of microbial agents (FHV-1, FCV, Mycoplasma felis, and Chlamydophila felis) in kittens with conjunctivitis and correlate the clinical signs with clinical severity. Material and Methods: A total of 108 conjunctival swab were collected from kittens without (G1; n = 40) and with (G2; n = 68) clinical signs of conjunctivitis. Animals from G2 group were scored from 1 (mild) to 4 (severe) according to the severity of conjunctivitis. All samples were submitted to PCR and RT-PCR. Results: FHV-1 was detected in 62/108 (57.4%) of samples, FCV in 40/108 (37.0%), M. felis in 11/108 (10.2%) and C. felis in 26/108 (24.1%). Mixed infections were detected in 39/108 (36.1%). In G1, 28/40 (70.0%) were positive for one or more agents, in G2, 58/68 (85.3%) were positive (P = 0.03). In 1, single infections by FHV-1were found in 21/40 (52.5%) samples, FCV in 2/40 (5.0%), C. felis in 1/40 (2.5%), and no pathogens were detected in 12/40 (30%) of samples, while mixed infections accounted for 29/40 (72.5%) of the cases. In G2, single FHV-1 infections were found in 31/68 (45.6%) samples, FCV in 10/68 (14.7 %), M. felis in 2/68 (3.0%) and C. felis also in 2/68 (3.0%), and no pathogens were detected in 10/68 (14.7%) samples, while mixed infections accounted for 36/68 (52.0%) of the cases. They were categorized as grade 1, 20/68 (29.4%), grade 2, 14/68 (20.6%), grade 3, 21/68 (30.9%) and grade 4, 13/68 (19.1%). The presence of FHV-1 and FCV is equally distributed among the four categories. More severe clinical signs, scores 3 and 4, are related to coinfections by C. felis and M. felis. Conclusions: FHV-1, FCV, C. felis and M. felis were identified in feline conjunctivitis. Co-infections are related to more severe cases of conjunctivitis.Molecular diagnosis is helpful to detect asymptomatic carriers and is a rapid and accurate method to determine the pathogen of feline conjunctivitis.(AU)

O objetivo deste estudo foi realizar diagnóstico molecular de agentes microbiológicos (FHV-1, FCV, Mycoplasma felis e Chlamydophila felis) em gatos filhotes e associar a presença dos patógenos à gravidade dos sinais clínicos de conjuntivite. Foram coletadas um total de 108 amostras de suabe conjuntival de filhotes felinos assintomáticos (G1; n = 40) e sintomáticos (G2; n = 68). Animais do G2 foram categorizados de 1 (leve) até 4 (grave), de acordo com o quadro clínico de conjuntivite. As 108 amostras foram submetidas à PCR e RT-PCR. O FHV-1 foi detectado em 57,4% das amostras, o FCV em 37%, o M. felis em 10,2% e o C. felis em 24,1%. Coinfecções, por sua vez, foram detectadas em 36,1%. No G1, 70% das amostras foram positivas para um ou mais patógenos. No G2, 85,3% apresentavam infecções (P = 0,03). No G1, monoinfecções por FHV-1 foram diagnosticadas em 52,5% das amostras, por FCV em 5%, por C. felis em 2,5%, e em 30% das amostras analisadas nenhum dos patógenos estudados foi encontrado. Coinfecções, por sua vez, estavam presentes em 72,5% das amostras. No G2, monoinfecções por FHV-1 foram encontradas em 45,6% das amostras, por FCV em 14,7 %, por M. felis em 3% e por C. felis também em 3%. Nenhum dos patógenos estudados foi encontrado em 14,7% das amostras analisadas. Coinfecções, responsáveis por 52% dos casos, foram categorizados como Grau 1 (29,4%), Grau 2 (20,6%), Grau 3 (30,9%) e Grau 4 (19,1%). A presença de FHV-1 e FCV está igualmente distribuída entre as quatro categorias. Os sinais clínicos mais graves (graus 3 e 4) estão relacionados a coinfecções por C. felis e M. felis. Os agentes microbiológicos FHV-1, FCV, C. felis e M. felis foram encontrados em animais com conjuntivite. Coinfecções estão relacionadas aos casos mais graves. Por fim, concluiu-se que o diagnóstico molecular, além de detectar portadores assintomáticos, é um método rápido e acurado para o diagnóstico do patógeno causador da conjuntivite felina.(AU)

Infectious scleritis: Clinical spectrum and management outcomes in India.

culture‑proven infectious scleritis. Nine of 12 patients had a history of preceding trauma (surgical or accidental). Past surgical history included small‑incision cataract surgery (4), pterygium surgery (1), and trabeculectomy (1). Six patients had multifocal scleral abscesses due to Pseudomonas, Klebsiella, or Nocardia. Only 2 patients retained useful vision (>6/18). A poor visual acuity at presentation usually resulted in a worse visual outcome (P = 0.005). Four eyes developed phthisis. The addition of surgical intervention did not result in a significantly better visual outcome than medical management alone (P = 0.209), but resulted in a higher globe preservation rate (P = 0.045). Therefore, we concluded that infection must be ruled out in cases of scleritis with preceding history of trauma, and aggressive surgical intervention improves the anatomical outcome but does not change the visual outcome.

Etiology and antibacterial susceptibility pattern of community-acquired bacterial ocular infections in a tertiary eye care hospital in south India.

Aims: To identify the etiology, incidence and prevalence of ocular bacterial infections, and to assess the in vitro susceptibility of these ocular bacterial isolates to commonly used antibiotics. Materials and Methods: Retrospective analysis of consecutive samples submitted for microbiological evaluation from patients who were clinically diagnosed with ocular infections and were treated at a tertiary eye care referral center in South India between January 2002 and December 2007. Results: A total of 4417 ocular samples was submitted for microbiological evaluation, of which 2599 (58.8%) had bacterial growth, 456 (10.3%) had fungal growth, 15 (0.34%) had acanthamoebic growth, 14 (0.32%) had mixed microbial growth and the remaining 1333 (30.2%) had negative growth. The rate of culture-positivity was found to be 88% (P < 0.001) in eyelids’ infection, 70% in conjunctival, 69% in lacrimal apparatus, 67.4% in corneal, 51.6% in intraocular tissues, 42.9% in orbital and 39.2% in scleral infections. The most common bacterial species isolated were Staphylococcus aureus (26.69%) followed by Streptococcus pneumoniae (22.14%). Sta. aureus was more prevalent more in eyelid infections (51.22%; P = 0.001) coagulase-negative staphylococci in endophthalmitis (53.1%; P = 0.001), Str. pneumoniae in lacrimal apparatus and corneal infections (64.19%; P = 0.001), Corynebacterium species in blepharitis and conjunctivitis (71%; P = 0.001), Pseudomonas aeruginosa in keratitis and dacryocystitis (66.5%; P = 0.001), Haemophilus species in dacryocystitis and conjunctivitis (66.7%; P = 0.001), Moraxella lacunata in blepharitis (54.17%; P = 0.001) and Moraxella catarrhalis in dacryocystitis (63.83%; P = 0.001). The largest number of gram-positive isolates was susceptible to moxifloxacin (98.7%) and vancomycin (97.9%), and gram-negative isolates to amikacin (93.5%) and gatifloxacin (92.7%). Conclusions: Gram-positive cocci were the most frequent bacteria isolated from ocular infections and were sensitive to moxifloxacin and vancomycin, while gram-negative isolates were more sensitive to amikacin and gatifloxacin.

Molecular epidemiology of adenovirus conjunctivitis in Rio de Janeiro, Brazil, between 2004 and 2007 / Epidemiologia molecular de adenovírus associados à conjuntivite no Rio de Janeiro, Brasil, no periodo de 2004 a 2007

Viral conjunctivitis is a common, highly contagious disease often caused by adenovirus. We investigate the frequency of adenoviral conjunctivitis in the population of Rio de Janeiro, Brazil, between March 2004 and May 2007 and identified the predominant serotype circulating among this population. Seventy-five ocular swabs were collected from 66 patients with clinical presentation of conjunctivitis. The specimens were analyzed for detection of adenovirus (AdV) by polymerase chain reaction (PCR). The PCR products were further analyzed for virus typing by sequence analysis and/or heteroduplex mobility assay (HMA). Forty-five samples (60%) were positive for AdV of which 21 samples were typed as AdV19 (46.7%), 7 AdV8 (15.5%), 3 AdV31 (6.7%), and one each AdV1, AdV2, AdV3, AdV4 and AdV6. For nine samples the serotype was not determined. AdV19 was the predominant serotype circulating in Rio de Janeiro during the studied period.

A conjuntivite viral é doença ocular comum, altamente contagiosa, frequentemente causada por adenovírus. Neste estudo, investigamos a frequência de conjuntivite por adenovírus na população do Rio de Janeiro, Brasil, entre março de 2004 e maio de 2007, e identificamos o sorotipo predominante circulando nesta população. Setenta e cinco swabs de secreção ocular foram coletados de 66 pacientes com conjuntivite. As amostras foram analisadas para detecção de adenovírus (AdV) por reação em cadeia da polimerase (PCR). Os produtos da PCR foram caracterizados por sequenciamento e/ou ensaio de mobilidade do heteroduplex (Heteroduplex Mobility Assay - HMA) para identificação do sorotipo viral. Quarenta e cinco (60%) amostras foram positivas para AdV das quais 21 foram identificadas como pertencentes ao sorotipo AdV19 (46,7%), sete AdV8 (15,5%), três AdV31 (6,7%), e uma de cada: AdV1, AdV2, AdV3, AdV4 e AdV6. Para nove amostras o sorotipo não pode ser identificado. O AdV 19 foi o sorotipo predominante circulando no Rio de Janeiro durante o período estudado.

Epidemiology of Ocular Infection Due to Bacteria and Fungus – A Prospective Study.

A total number of 400 cases of eye infection were studied. Among them, 250 were conjunctivitis (59.2%),120 were keratitis (53.34%) 15 were endophthalmitis (26.67%) and 15 were suffering from other infections (40%). The corneal scrapping, conjunctival swab and biopsy material ( endophthalmitis cases) was collected asceptically. The material was examined using 10% Potassium hydroxide, Gram staining and Giemsa staining. The specimens were cultured on sheeps’ blood agar, chocolate agar and sabourauds’ dextrose agar. In the bacterial cause of eye infection Staphylococcus aureus (19.13%) was the most commonly isolated organism and other pathogens isolated were Streptococcus pneumoniae (10.93%), Streptococcus pyogens (0.55%), Pseudomonas aeruginosa (4.92%), Klebsiella species(2.74%), Escherichia colli (1.10%) and Proteus mirabilis (0.55%). Among the opportunistic pathogens, Staphylococcus epidermidis, (19.13%) were the most common isolate followed by Acinetobacter species(2.74%). Alkaligenes faecalis (1.10%), Staphylococcus saprophyticus (0.55%), Staphylococcus cohnii (0.55%), Staphylococcus haemolyticus (0.55%). In the endopthalmitis patients only Pseudomonas aeruginosa (20%) and Staphylococcus epidermidis (6.67%) were isolated. In the fungal keratitis, the total fungal isolates were 32.50%. Among them Aspergillus species (56.42%) was the most common fungus isolated followed by Curvurlaria (17.95%), Cladosporium (7.70%), Candida species (5.13%), Fusarium (5.13%), Alternaria (5.13%), Penicillium (2.57%). Fungal infection is a life threatening condition, which needs early diagnosis and treatment to save the patients’ eye. Staphylococcus aureus and Staphylococcus epidermidis are still the most common isolates among the known and opportunistic pathogens in ocular infection. Pseudomonas is the most common cause of endophthalmitis. Aspergillus remains most common cause for fungal keratitis.

Perfil microbiologico de pacientes con patologia infecciosa del segmento anterior / Patient microbiological profile with infectious pathology of the previous segment

En esta investigación fueron evaluados 286 pacientes con patología infecciosa del segmento anterior y mediante estudio microbiológico se identificaron las bacterias asociadas con la infección. En 286 cultivos bacteriológicos realizados se obtuvieron 177 aislamientos, encontrándose un 73.45 por ciento de flora gran positiva siendo las especies más frecuentes S. Epidermidis 48.46 por ciento, S. Aureus (35.38 por ciento), S.Pneumoniae (4.61 por ciento) y Corynebacterium SP. (2.31 por ciento). El 26.55 por ciento correspondía a bacilos gran negativos de los cuales el 74.47 por ciento son enterobacterias y el 25.53 por ciento microorganismos no fermentados. El mayor porcentaje de aislamientos fue realizado en pacientes con conjuntivitis bacteriana, blefaritis bacteriana, conjuntivitis inespecífica y blefaritis inespecífica.

286 patients with infectious pathology in previous segment were studied and through a microbiological study the bacteria associated with the infection were identified. From the 286 bacteriological samples, 177 were isolated, and from these 73.45 percent of Gram positive flora being the most frequent species S. epidermidis (48.46 percent), S. aureus (35.38 percent), S. pneumonia (4.61 percent)and Corynebacterium sp. (2.31 percent). The 26.55 percent corresponded to Gram negative bacilli of which the 74.47 percent are enterobacterias and the 25.53 percent were non fermented microorganisms. The highest percentages of isolations were conducted in patient with bacterial conjunctivitis, bacterial blepharitis, unspecific conjunctivitis and unspecific blepharitis.Key words: ocular infection, Gram positives and Gram negatives bacterial, bacteriological isolations, S. epidermidis, S. aureus, S. pneumonia, Corynebacterium sp.

Ocular manifestations of systemic tuberculosis: Report of 3 cases

Tuberculosis is a chronic infectious disease caused by mycobacteria species, which can affect any organ of the body including the eye. Primary ocular tuberculosis is very rare condition and likely to be caused by introduction of bacilli through epithelial injury. Post primary infections (or secondary infection) due to direct hematogenous spread or contiguous spread from an adjacent structure are more common presentations of ocular tuberculosis. The authors experienced 3 cases of ocular tuberculosis associated with systemic infection. One case was a scleral involvement of miliary tuberculosis and the others were choroidal tuberculoma from systemic tuberculosis.