ABSTRACT
Emericella nidulans is a species that has only rarely been implicated in human disease after cataract surgery. Here, we report the first postoperative case in the literature, as far as we know. The patient was a 50-year-old patient presented with mild anterior uveitis one week after cataract surgery, and hypopion developed over the next two days. First microbiological evaluation and the results of direct microscopy and cultures of the anterior chamber and vitreous samples were found to be negative. Despite vigorous topical and intravitreal (vancomycin and amikacin) therapy, the endophthalmitis did not improve. Anterior chamber paracentesis, vitreous tap and finally complete vitrectomy with removal of the capsular bag including the intraocular lens (IOL) were performed. The anterior chamber, vitreous fluid samples and IOL were submitted to the microbiology laboratory: the culture yielded E. nidulans growth. Ocular inflammation resolved and vision improved on intravenous, subconjunctival and long-term oral voriconazole treatment. E. nidulans can be an important cause of ocular fungal infections including endophthalmitis, and voriconazole seems to be effective for the treatment of E. nidulans endophthalmitis.
Subject(s)
Cataract Extraction/adverse effects , Emericella/isolation & purification , Endophthalmitis/microbiology , Eye Infections, Fungal/diagnosis , Postoperative Complications/microbiology , Antifungal Agents/therapeutic use , Aspergillosis/diagnosis , Aspergillosis/drug therapy , Aspergillosis/microbiology , Aspergillus nidulans/isolation & purification , Emericella/growth & development , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Eye Infections, Fungal/drug therapy , Eye Infections, Fungal/microbiology , Female , Humans , Middle Aged , Postoperative Complications/drug therapy , Voriconazole/therapeutic useABSTRACT
Start-up and operation of single-stage nitritation-anammox sequencing batch reactors (SBRs) for completely autotrophic nitrogen removal can be challenging and far from trivial. In this study, a step-wise procedure is developed based on stoichiometric analysis of the process performance from nitrogen species measurements to systematically guide start-up and normal operation efforts (instead of trial and error). The procedure is successfully applied to laboratory-scale SBRs for start-up and maintained operation over an 8-month period. This analysis can serve as a strong decision-making tool to take appropriate actions with respect to reactor operation to accelerate start-up or ensure high-rate N removal via the nitritation-anammox pathway.