Infectious conjunctivitis caused by Pseudomonas a eruginosa in infected and extrused scleral buckles.

Extrusion of the scleral buckle is one of the complications patients may encounter undergoing the surgical treatment for retinal detachment. We present two cases of persistent Pseudomonas a eruginosa-related conjunctivitis which infected the silicone explant after retinal surgery. One of them is a 73-year-old Caucasian female patient with hyperaemia, intense pain and mucopurulent discharge. After the conjunctival swabs detected a P. aeruginosa infection, she started both topical and systemic treatment without any results; for this reason we opted for the buckle removal always under systemic therapy. The second case is an 84-year-old Caucasian female patient with fever, periorbital oedema, chronic ocular pain, hyperaemia and purulent discharge. P. aeruginosa has also been detected in this case. No improvement with topical and systemic treatment, so this convinced us to remove patient's buckles and to continue systemic therapy. Both cases had the complete resolution after surgery. It is important to quickly recognise exposed scleral buckles because they can be a source of infections and a rare but threatening cause of endophthalmitis.

The ΦCPG1 chlamydiaphage can infect Chlamydia trachomatis and significantly reduce its infectivity.

Recent years have seen a significant increase in rates of persistent, antibiotic-resistant infection of Chlamydia trachomatis (CT) infections, representing an increasingly serious public health threat. At present there are no effective vaccines or antibodies available to treat CT, prompting the need for novel treatment strategies. One potential solution to this issue is the use of ΦCPG1, a chlamydia-specific lytic phage which has over 90% nucleotide sequence identity with other chlamydiaphages. Previous work has shown the Vp1 capsid protein of ΦCPG1 to exhibit broad inhibitory activity against all CT serotypes, inhibiting CT-mediated host cell toxicity. Patients with CT infections exhibit circulating antibodies against this Vp1 protein, suggesting that this or similar phages may be present in vivo in the context of CT infections, even though no phages have been specifically detected to date. Given these previous findings, we hypothesized that the ΦCPG1 chlamydiaphage may be able to infect CT, thereby inhibiting its growth and proliferation. To test this, we generated a recombinant pGFP-ΦCPG1 phage which we used to explore its effects on CT and chlamydia conjunctivitis of guinea pigs (GPIC). We found that pGFP insertion did not alter the packaging or infectivity of ΦCPG1, and that this recombinant phage was readily able to infect CT and GPIC and inhibit CT and GPIC in a dose-dependent fashion. This inhibition was most pronounced during the mid and late stages of the CT infection, disrupting the reticular body (RB) to EB transition, leading to the formation of enlarged RBs. These results indicate that ΦCPG1 is able to infect CT, highlighting this phage as a novel potential therapeutic agent for treating chlamydia infections. In addition, by engineering pGFP to express ΦCPG1, we have produced an valuable experimental tool useful for future studies of drug resistance, pathogenicity, and vaccine research aimed at improving CT treatment.

[Right treatment of red eyes - prescription of topical antibiotics for infectious conjunctivitis is still common in Sweden]. / Rekommendationer följs inte vid okomplicerad konjunktivit - Tillståndet behandlas ofta med topikala antibiotika i strid mot aktuell kunskap.

Conjunctivitis is one of the most common ophthalmologic conditions in general medical practice. In most cases, it is self-limiting and do not require topical antibiotic therapy. In a retrospective, observational cohort study during 2013-2017 in a region in Sweden conjunctivitis was diagnosed in 32 000 cases in primary care. Antibiotics were prescribed in 66% of undefined and in 83% of purulent conjunctivitis. Fusidic acid was the most common medication with 81% followed by chloramphenicol with 17%. Although unnecessary, the treatment is probably harmless. Toxicity is uncommon and the cost is low. Increased consciousness of this issue may however decrease resistance to antibiotics and support evidence-based medical practice.

Bacterial Conjunctivitis in Childhood: Etiology, Clinical Manifestations, Diagnosis, and Management.

BACKGROUND: Bacterial conjunctivitis is a common reason for children to be seen in pediatric practices. A correct diagnosis is important so that appropriate treatment can be instituted. OBJECTIVE: To provide an update on the evaluation, diagnosis, and treatment of bacterial conjunctivitis in children. METHODS: A PubMed search was completed in Clinical Queries using the key term "bacterial conjunctivitis". Patents were searched using the key term "bacterial conjunctivitis" from www.freepatentsonline.com and www.google.com/patents. RESULTS: In the neonatal period, bacterial conjunctivitis is rare and the most common cause of organism is Staphylococcus aureus, followed by Chlamydia trachomatis. In infants and older children, bacterial conjunctivitis is most often caused by Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. Clinically, bacterial conjunctivitis is characterized by a purulent eye discharge, or sticky eyes on awakening, a foreign body sensation and conjunctival injection (pink eye). The diagnosis is made clinically. Cultures are unnecessary. Some authors suggest a watchful observation approach as most cases of bacterial conjunctivitis are self-limited. A Cochrane review suggests the use of antibiotic eye drops is associated with modestly improved rates of clinical and microbiological remission as compared to the use of placebo. Various investigators have also disclosed patents for the treatment of conjunctivitis. CONCLUSION: The present consensus supports the use of topical antibiotics for bacterial conjunctivitis. Topical antibiotics shorten the course of the disease, reduce discomfort, prevent person-to-person transmission and reduce the rate of reinfection.

Efficacy of Bdellovibrio bacteriovorus 109J for the treatment of dairy calves with experimentally induced infectious bovine keratoconjunctivitis.

OBJECTIVE To determine the efficacy of Bdellovibrio bacteriovorus 109J for the treatment of calves with experimentally induced infectious bovine keratoconjunctivitis (IBK). ANIMALS 12 healthy dairy calves. PROCEDURES For each calf, a grid keratotomy was performed on both eyes immediately before inoculation with Moraxella bovis hemolytic strain Epp63-300 (n = 11 calves) or nonhemolytic strain 12040577 (1 calf). For each calf inoculated with M bovis Epp63-300, the eyes were randomly assigned to receive an artificial tear solution with (treatment group) or without (control group) lyophilized B bacteriovorus 109J. Six doses of the assigned treatment (0.2 mL/eye, topically, q 48 h) were administered to each eye. On nontreatment days, eyes were assessed and corneal swab specimens and tear samples were collected for bacterial culture. Calves were euthanized 12 days after M bovis inoculation. The eyes were harvested for gross and histologic evaluation and bacterial culture. RESULTS The calf inoculated with M bovis 12040577 did not develop corneal ulcers. Of the 22 eyes inoculated with M bovis Epp63-300, 18 developed corneal ulcers consistent with IBK within 48 hours after inoculation; 4 of those eyes developed secondary corneal ulcers that were not consistent with IBK. Corneal ulcer size and severity and the time required for ulcer healing did not differ between the treatment and control groups. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that B bacteriovorus 109J was not effective for the treatment of IBK; however, the experimental model used produced lesions that did not completely mimic naturally occurring IBK.

Allergic rhinoconjunctivitis and differential diagnosis of the red eye.

Red eye is a common presentation in clinical practice with conjunctivitis being the most common cause of red eye. Most commonly, conjunctivitis is infective (bacterial and viral) or allergic in origin although other forms of conjunctivitis including toxic and irritative conjunctivitis and conjunctivitis related to systemic conditions or dry eye are prevalent enough to warrant consideration in diagnosis. This article aims to provide a guide for generalists and allergists in the differential diagnosis of conjunctivitis allowing the inclusion of eye treatment into their current practice. With a discussion of important aspects to include in the patient history as well as a systematic guide to examination of the eye for generalists and allergists, this article provides a "plan of action" in the examination protocol for red eye patients. A differential diagnosis table and flowchart are provided as a useful chair-side reference for practitioners. With a particular focus on the more prevalent types of conjunctivitis, typical features, signs, and symptoms of each type are detailed. A general discussion of prognosis and treatment options and conditions that require ophthalmologic referral is included.

[Gonococcal conjunctivitis complicated by perforating corneal abscess in an adult]. / Conjonctivite à gonocoque compliquée d'abcès cornéen perforant chez un adulte.

We present a case of bilateral purulent conjunctivitis complicated by ocular perforation of the right eye secondary to fulminant corneal melt in a 29-year-old man. He developed urethritis after a sexual contact with a prostitute 3 weeks previously. Microbiological analyses of conjunctival and urinary cultures were positive for Neisseria gonorrhoeae resistant to penicillins, tetracyclines, and fluoroquinolones. Progression was favorable with a 15-day course of high doses of parenterally administered antibiotics associating imipenem and fosfomycin. Keratoplasty was done after 3 months. This observation is a good example of the problems raised by gonococcal conjunctivitis in adults. Extremely rare in developed countries, it remains widely unrecognized by ophthalmologists. It is a sexually transmitted disease usually resulting from autoinoculation from an infected genital site. The risk of marginal purulent corneal melt, which can lead to fulminant perforation, warrants prompt microbiological analysis and early parenteral antibiotic treatment.

Bacterial conjunctivitis in children: antibiotic eye drops only if eye washing is ineffective.

(1) Acute infectious conjunctivitis in children is often due to bacterial infection. (2) Systematic use of local antibiotic therapy may not be needed. A systematic review and two recent trials conducted in the primary care setting provide interesting results. (3) The results of several trials, and specifically of a study of children (excluding neonates) with uncomplicated conjunctivitis in primary healthcare, show that about 50% of patients recover within four days without antibiotic therapy. Antibiotic therapy seems to hasten recovery by less than half a day. (4) A trial involving adults and children at least one year of age compared immediate antibiotic eye drop therapy versus antibiotic eye drops given only when symptoms persisted for three days. A control group received no antibiotic treatment. Immediate antibiotic therapy hastened recovery by slightly more than half a day in comparison with delayed treatment. (5) In practice, when a child presents with conjunctivitis, it is reasonable to wait and see how the symptoms evolve before prescribing local antibiotics.

[The risks of anti-infectious drugs]. / Les risques des anti-infectieux.

The main risk of anti-infectious drugs is the selection of resistant microorganisms that might be a threat for the human community. It requires a justified prescription of every antibiotic and antiseptic product, including the topicals such as eye drops. The risk of toxicity is less important because it is well known, it is obvious when it occurs, and because it is an individual and nontransmissible risk.

Dacryocystitis caused by community-onset methicillin-resistant Staphylococcus aureus.

PURPOSE: To describe the occurrence of community-onset methicillin-resistant Staphylococcus aureus (MRSA) infections of the lacrimal system and their treatment. METHODS: This cases series consisted of data obtained from seven clinical cases of acute or subacute MRSA dacryocystitis, with or without concurrent conjunctivitis, occurring in nonhospitalized individuals presenting between December 2001 and July 2003. Clinical presentations, microbial culture results, treatment modalities, and outcomes were retrospectively reviewed. RESULTS: Three patients were successfully treated with antibiotics and lacrimal surgery with no recurrence of symptoms after surgery for 6 months or longer. Four patients had temporary relief of symptoms with antibiotic therapy, but surgery was not performed for non-ophthalmologic reasons, and recurrence occurred. CONCLUSIONS: The treatment of MRSA dacryocystitis can be challenging. Microbiologic cultures should be performed in all patients with dacryocystitis that is unresponsive to conventional first-line antibiotic treatment and in patients at risk for acquisition of MRSA. Appropriate antibiotic therapy in combination with dacryocystorhinostomy appears to be the optimal treatment.