In-vitro susceptibility testing by agar dilution method to determine the minimum inhibitory concentrations of amphotericin B, fluconazole and ketoconazole against ocular fungal isolates.

PURPOSE: To standardize in-vitro antifungal susceptibility testing by agar dilution method to find out the minimum inhibitory concentration (MIC) of amphotericin B, fluconazole and ketoconazole on ocular fungal isolates. METHODS: A total of 180 ocular fungal isolates (130 filamentous fungi and 50 yeasts) were included. The antifungal drugs such as amphotericin B (0.0625-8 microg/mL), fluconazole (0.2-819.6 microg/mL) and ketoconazole (0.025-6.4 microg/mL) were incorporated in doubling dilutions in the yeast nitrogen base medium. The MIC was determined as the lowest concentration of the antifungal drug preventing growth of macroscopically visible colonies on drug containing plates when there was visible growth on the drug-free control plates. RESULTS: All 50 ocular isolates of yeast were susceptible to amphotericin B, while two (4%) and five (10%) strains were resistant to fluconazole and ketoconazole respectively. Of the 130 filamentous fungi tested, six (4.6%) were resistant to amphotericin B, 49 (37.7%) and 10 (7.6%) were resistant to fluconazole and ketoconazole respectively. Percentile 50 (MIC 50) and Percentile 90 (MIC 90) for all the three antifungal agents were calculated. Aspergillus niger, Aspergillus terreus and Candida krusei were found to be resistant to fluconazole and ketoconazole. CONCLUSION: This technique was found to be reliable, cost effective and easy to perform with consistent results.

Ocular complications in incident relapsed borderline lepromatous and lepromatous leprosy patients in south India.

PURPOSE: To determine the magnitude of ocular complications that present in incident cases of relapsed borderline lepromatous (BL) and lepromatous leprosy (LL) patients. METHOD: From 1991 to 1997, all new BL and LL patients who had relapsed from an earlier disease, detected by active case finding in the geographically defined area of Gudiyattam taluk, were invited for ocular examination after their leprosy status was confirmed clinically and histopathologically. RESULTS: Sixty relapsed lepromatous patients, 45 male and 15 females, were examined. Fifty-two patients had relapsed after receiving only dapsone mono-therapy, 4 after receiving paucibacillary multi-drug therapy (PB-MDT) preceded by dapsone mono-therapy and 4 after only PB-MDT. Three (5%) patients had lagophthalmos, 1 (1.6%) patients each had ectropion and trichiasis, 32 (53%) patients had impaired corneal sensation in both eyes, 2 (3.3%) patients each had corneal opacity (associated with reduced vision), corneal nerve beading, punctate keratitis, keratic precipitates, and iris atrophy, 4 (6.6%) patients had cataract associated with decreased vision, 1 (1.6%) patient had blocked naso-lacrimal duct and 13 (21.7%) patients had pterygium. Seven (12%) patients had a visual acuity of 6/18 or less, 4 (6.7%) patients had 6/60 or less and one patients had vision below 3/60. General ocular complications rather than leprosy-related ocular complications were responsible for reduced vision. Lagophthalmos was associated with increased duration of the disease (P = 0.009), Grade II deformity (P = 0.001), punctate keratitis (P < 0.001) and cataract (P < 0.001). Beaded corneal nerves were associated with lepromatous leprosy (P < 0.001) and high mycobacterial infection (P = 0.05). Patients whose initial disease was categorised as BL and LL had greater impairment of vision (P = 0.037), more iris atrophy (P = 0.013), increased keratic precipitates (P = 0.013) and more corneal nerve beading (P = 0.013), when compared with the group comprising Tuberculoid-tuberculoid (TT), Borderline-tuberculoid (BT) and Intermediate (IND). CONCLUSION: This first report on ocular complications in relapsed lepromatous patients demonstrates that general and leprosy-related ocular complications occur in these patients. However, they are not in excess of those reported in other leprosy groups. Borderline and lepromatous leprosy patients tend to have had more ocular complications than patients with tuberculoid leprosy.

Endofitalmites: uma rotina para diagnóstico e tratamento / Endophtalmitis: a guideline to diagnosis and treatment

Os autores propöem uma rotina para diagnóstico clínico-etiológico e tratamento das Endoftalmites, a ser realizado de maneira rápida e simples, sem intervençäo cirúrgica e sem o uso de antibióticos sistêmicos

Isolamento e identificaçäo de actinomiceto de paciente com lesäo intra-ocular / Isolation and identification of actnomycete from a patient with a intra-ocular lesion

O material de uma lesäo intra-ocular de paciente do Hospital das Clínicas da Universidade Federal de Minas Gerais foi cultivado em ágar-sangue. Após o isolamento, o microorganismo foi cultivado em vários outros meios. Depois de quatro dias de incubaçäo em ágar Sabouraud, houve crescimento de colônias de cor branca, que se tornaram alaranjadas após oito dias. Os esfregaçäos das culturas revelaram formas cocóides, bacilares e alguns filamentos Gram-positivos. Entre os substratos testados, tirosina, xantina, gelatina e uréia, somente o último foi hidrolisado pela bactéria. O microorganismo foi identificado como Nocardia asteroides

Relato de um caso de endoftalmite endógena por Proteus rettgeri em neonato / Report of a case of indogenous endophthalmitis by Proteus rettgeri in a newborn infant

Descreve-se um caso clínico caracterizado por megaloglobo associado a leucocoria em um recém nato cujo diagnóstico final foi o de endoftalmite endógena causada por Proteus rettgeri e cuja hipótese diagnóstica inicial fora de glaucoma congênito e em seguida retinoblastoma. Os diversos diagnósticos diferenciais säo também discutidos