ABSTRACT
A 42-year-old woman presented with fever, left ear pain, restricted mouth opening, difficulty in swallowing and inability to open her left eyelid for a period of 10 days. She was treated with antibiotics for the same at a local medical facility; however, a sudden decrease in her left eye vision prompted her to visit our tertiary centre. Her history was insignificant except for having multiple left ear syringing for an insect removal 10 days before onset of her current symptoms. On examination, she had ptosis of the left eye with chemosis, dilated pupil with only perception of light and restricted ocular mobility. Oral examination revealed trismus and bulge in the left peritonsillar region. Left ear examination revealed a large central perforation with mucopurulent discharge. CT of the neck with contrast demonstrated a collection in the left peritonsillar space with left internal carotid artery thrombosis. MRI of the brain with gadolinium revealed left cavernous sinus thrombosis with acute infarcts in the left frontal lobe. An emergency incision and drainage of the left peritonsillar abscess was performed. Culture grew broad aseptate fungal hyphae. Despite starting on antifungal therapy, she succumbed to her illness.
Subject(s)
Cavernous Sinus Thrombosis/diagnosis , Eye Foreign Bodies/complications , Mucormycosis/diagnosis , Osteomyelitis/diagnosis , Skull Base/microbiology , Adult , Amphotericin B/therapeutic use , Animals , Cavernous Sinus/diagnostic imaging , Cavernous Sinus Thrombosis/drug therapy , Cavernous Sinus Thrombosis/etiology , Coleoptera/microbiology , Drainage , Drug Therapy, Combination , Enoxaparin/therapeutic use , Eye Foreign Bodies/diagnosis , Eye Foreign Bodies/microbiology , Eye Foreign Bodies/therapy , Fatal Outcome , Female , Humans , Hyphae/isolation & purification , Magnetic Resonance Imaging , Meropenem/therapeutic use , Mucorales/isolation & purification , Mucormycosis/microbiology , Mucormycosis/therapy , Osteomyelitis/microbiology , Osteomyelitis/therapy , Skull Base/diagnostic imaging , Skull Base/pathology , Skull Base/surgery , Vancomycin/therapeutic useABSTRACT
Acinetobacter species are widely distributed in soil, water and hospital environment. In addition to A. calcoaceticus-baumannii complex, the clinically most relevant species, there are other genomospecies which are less frequently identified, mostly due to lack of accurate methods for routine identification. We describe the first case of post-traumatic endophthalmitis caused by otherwise non-pathogenic A. radioresistens, in India. Gram-negative coccobacilli were observed on Gram stain and culture of vitreous fluid specimen, and identified biochemically as Acinetobacter spp. The species was identified by Matrix Assisted Laser Desorption Ionization- Time of Flight Mass Spectrometry (MALDI-TOF MS). The pathogenic potential of 'commensal' A. radioresistens and its role in dissemination of carbapenem resistance genes underlines the importance of species-level identification in Acinetobacter infections.
Subject(s)
Acinetobacter/isolation & purification , Endophthalmitis/microbiology , Endophthalmitis/therapy , Eye Infections, Bacterial/etiology , Eye Injuries, Penetrating/complications , Adult , Anti-Bacterial Agents/administration & dosage , Eye Foreign Bodies/microbiology , Eye Foreign Bodies/surgery , Eye Infections, Bacterial/therapy , Humans , India , Male , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization/methods , VirulenceSubject(s)
Eye Foreign Bodies/surgery , Orbit/surgery , Orbital Diseases/surgery , Adult , Bacillaceae Infections/drug therapy , Bacillaceae Infections/etiology , Bacillus cereus/drug effects , Bacillus cereus/isolation & purification , Eye Foreign Bodies/complications , Eye Foreign Bodies/drug therapy , Eye Foreign Bodies/microbiology , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/etiology , Eye Infections, Bacterial/surgery , Eye Injuries, Penetrating/diagnosis , Eye Injuries, Penetrating/etiology , Eye Injuries, Penetrating/surgery , Humans , Male , Orbit/microbiology , Orbital Diseases/drug therapy , Orbital Diseases/etiology , WoodABSTRACT
ABSTRACT Purpose: To determine whether a correlation exists between pathogenic species and clinical findings, disease severity, and visual outcome in patients with keratitis and fungal growth in microbiological culture. Methods: A retrospective study of patients with fungal growth in the microbiological culture of corneal scrapings. Patients were treated at an ophthalmologic reference center in Southeastern Brazil from January 1992 to October 2015. Results: Medical records of 181 patients (131 males and 50 females) with a mean age of 47 ± 18 years were analyzed. The three most common etiologies were Fusarium sp. (38.7%), Aspergillus sp. (15%), and Candida sp. (13.2%). Among these, Fusarium sp. was the most frequent in patients aged £50 years (p=0.002) and in those with a recent history of a foreign body and/or ocular trauma (p=0.01). Candida sp. was the most frequent etiology in patients aged >50 years (p=0.002), in those with postoperative ocular surgery (p=0.002); in those with a previous ocular pathology (p=0.0007); and in immunodepressed patients (p=0.0004). Conclusion: Fusarium sp. was predominant in patients aged £50 years and those with a recent history of foreign body and/or ocular trauma, whereas Candida sp. was predominant in older adults, in those with a postoperative ocular surgery, in those with a previous ocular pathology, and in immunodepressed patients.
RESUMO Objetivo: Determinar se existe uma correlação entre espécies patogênicas e achados clínicos, gravidade da doença e resultado visual em pacientes com ceratite e crescimento de fungos em cultura microbiológica. Métodos: Estudo retrospectivo de pacientes com crescimento de fungos na cultura microbiológica de raspado de córnea. Os pacientes foram tratados em um centro de referência oftalmológica no Sudeste do Brasil de janeiro de 1992 a outubro de 2015. Resultados: Foram analisados registros médicos de 181 pacientes (131 homens e 50 mulheres) com idade média de 47 ± 18 anos. As três etiologias mais comuns foram Fusarium sp. (38,7%), Aspergillus sp. (15%) e Candida sp. (13,2%). Entre estas, Fusarium sp. foi a mais frequente em pacientes com idade £50 anos (p=0,002) e naqueles com história recente de corpo estranho e/ou trauma ocular (p=0,01). Candida sp. foi a etiologia mais frequente em pacientes com idade >50 anos (p=0,002), naqueles com cirurgia ocular pós-operatória (p=0,002); naqueles com patologia ocular prévia (p=0,0007); e em pacientes imunodeprimidos (p=0,0004). Conclusão: Fusarium sp. foi predominante em pacientes com idade £50 anos e naqueles com história recente de corpo estranho e/ou trauma ocular; enquanto Candida sp. foi predominante em adultos mais velhos, naqueles com cirurgia ocular pós-operatória, naqueles com patologia ocular prévia e em pacientes imunodeprimidos.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Eye Infections, Fungal/microbiology , Eye Infections, Fungal/pathology , Corneal Ulcer/microbiology , Corneal Ulcer/pathology , Aspergillus/pathogenicity , Severity of Illness Index , Candida/pathogenicity , Visual Acuity , Eye Infections, Fungal/drug therapy , Corneal Ulcer/drug therapy , Eye Foreign Bodies/microbiology , Eye Foreign Bodies/pathology , Retrospective Studies , Risk Factors , Corneal Injuries/microbiology , Corneal Injuries/pathology , Fusarium/pathogenicity , Antifungal Agents/therapeutic useABSTRACT
PURPOSE: To determine whether a correlation exists between pathogenic species and clinical findings, disease severity, and visual outcome in patients with keratitis and fungal growth in microbiological culture. METHODS: A retrospective study of patients with fungal growth in the microbiological culture of corneal scrapings. Patients were treated at an ophthalmologic reference center in Southeastern Brazil from January 1992 to October 2015. RESULTS: Medical records of 181 patients (131 males and 50 females) with a mean age of 47 ± 18 years were analyzed. The three most common etiologies were Fusarium sp. (38.7%), Aspergillus sp. (15%), and Candida sp. (13.2%). Among these, Fusarium sp. was the most frequent in patients aged £50 years (p=0.002) and in those with a recent history of a foreign body and/or ocular trauma (p=0.01). Candida sp. was the most frequent etiology in patients aged >50 years (p=0.002), in those with postoperative ocular surgery (p=0.002); in those with a previous ocular pathology (p=0.0007); and in immunodepressed patients (p=0.0004). CONCLUSION: Fusarium sp. was predominant in patients aged £50 years and those with a recent history of foreign body and/or ocular trauma, whereas Candida sp. was predominant in older adults, in those with a postoperative ocular surgery, in those with a previous ocular pathology, and in immunodepressed patients.
Subject(s)
Corneal Ulcer/microbiology , Corneal Ulcer/pathology , Eye Infections, Fungal/microbiology , Eye Infections, Fungal/pathology , Adult , Aged , Antifungal Agents/therapeutic use , Aspergillus/pathogenicity , Candida/pathogenicity , Corneal Injuries/microbiology , Corneal Injuries/pathology , Corneal Ulcer/drug therapy , Eye Foreign Bodies/microbiology , Eye Foreign Bodies/pathology , Eye Infections, Fungal/drug therapy , Female , Fusarium/pathogenicity , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Severity of Illness Index , Treatment Outcome , Visual AcuitySubject(s)
Cornea/pathology , Corneal Injuries/diagnosis , Corneal Ulcer/diagnosis , Eye Foreign Bodies/diagnosis , Eye Infections, Bacterial/diagnosis , Anti-Bacterial Agents/therapeutic use , Collagen/metabolism , Contact Lenses , Corneal Injuries/microbiology , Corneal Injuries/surgery , Corneal Stroma/metabolism , Corneal Ulcer/drug therapy , Corneal Ulcer/microbiology , Eye Foreign Bodies/microbiology , Eye Foreign Bodies/surgery , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/microbiology , Humans , Male , Middle Aged , Organ Size , Tissue Adhesives/therapeutic useSubject(s)
Cornea/pathology , Corneal Injuries/diagnosis , Corneal Ulcer/diagnosis , Eye Foreign Bodies/diagnosis , Eye Infections, Bacterial/diagnosis , Anti-Bacterial Agents/therapeutic use , Collagen/metabolism , Corneal Injuries/microbiology , Corneal Injuries/surgery , Corneal Stroma/metabolism , Corneal Ulcer/drug therapy , Corneal Ulcer/microbiology , Eye Foreign Bodies/microbiology , Eye Foreign Bodies/surgery , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/microbiology , Humans , Male , Middle Aged , Organ SizeSubject(s)
Cornea/pathology , Corneal Injuries/diagnosis , Corneal Ulcer/diagnosis , Eye Foreign Bodies/diagnosis , Eye Infections, Bacterial/diagnosis , Anti-Bacterial Agents/therapeutic use , Collagen/metabolism , Corneal Injuries/microbiology , Corneal Injuries/surgery , Corneal Stroma/metabolism , Corneal Ulcer/drug therapy , Corneal Ulcer/microbiology , Cyclophosphamide/therapeutic use , Eye Foreign Bodies/microbiology , Eye Foreign Bodies/surgery , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/microbiology , Eyelids/surgery , Humans , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Organ Size , Tissue Adhesives/therapeutic useSubject(s)
Cornea/pathology , Corneal Injuries/diagnosis , Corneal Ulcer/diagnosis , Eye Foreign Bodies/diagnosis , Eye Infections, Fungal/diagnosis , Anti-Bacterial Agents/therapeutic use , Collagen/metabolism , Corneal Injuries/microbiology , Corneal Injuries/surgery , Corneal Stroma/metabolism , Corneal Ulcer/drug therapy , Corneal Ulcer/microbiology , Eye Foreign Bodies/microbiology , Eye Foreign Bodies/surgery , Eye Infections, Fungal/drug therapy , Eye Infections, Fungal/microbiology , Humans , Male , Middle Aged , Organ SizeSubject(s)
Cornea/pathology , Corneal Injuries/diagnosis , Corneal Ulcer/diagnosis , Eye Foreign Bodies/diagnosis , Eye Infections, Bacterial/diagnosis , Anti-Bacterial Agents/therapeutic use , Collagen/metabolism , Corneal Injuries/microbiology , Corneal Injuries/surgery , Corneal Stroma/metabolism , Corneal Ulcer/drug therapy , Corneal Ulcer/microbiology , Eye Foreign Bodies/microbiology , Eye Foreign Bodies/surgery , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/microbiology , Humans , Male , Microscopy, Confocal , Middle Aged , Organ SizeSubject(s)
Cornea/pathology , Corneal Injuries/diagnosis , Corneal Ulcer/diagnosis , Eye Foreign Bodies/diagnosis , Eye Infections, Bacterial/diagnosis , Amnion/transplantation , Anti-Bacterial Agents/therapeutic use , Collagen/metabolism , Contact Lenses , Corneal Injuries/microbiology , Corneal Injuries/surgery , Corneal Stroma/metabolism , Corneal Ulcer/drug therapy , Corneal Ulcer/microbiology , Eye Foreign Bodies/microbiology , Eye Foreign Bodies/surgery , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/microbiology , Fibrin Tissue Adhesive/therapeutic use , Humans , Male , Middle Aged , Organ Size , Surgical FlapsABSTRACT
BACKGROUND: We present a case of post-traumatic endophthalmitis with relatively good prognosis caused by Gordonia sputi, which, to our knowledge is the first case in the literature. CASE PRESENTATION: A 24 year old man, who underwent an intraocular foreign body extraction half a month before presentation in the left eye, was referred to us complaining of blurred vision and slight pain for 5 days. His first presentation showed moderate intracameral and intravitreous purulent inflammation with a best corrected vision of counting fingers. After gram staining of the intravitreous samples revealed a gram-positive bacilli infection, a combination of amikacin and vancomycin was initially injected intravitreously. The left eye kept stable for three days but deteriorated on the 4th day. On the 5th day after presentation conventional culture characterized the bacterium as an Actinomyces sp. while 16S ribosomal RNA gene sequencing confirmed it as Gordonia sputi. Thereby a complete pars plana vitrectomy combined with lensectomy and silicone oil tamponade was performed. During the surgery an intraocular irrigation with penicillin G was adopted, followed by administration of intravenous penicillin G twice one day for a week. A relatively normal fundus with slight intracameral inflammation was observed a week after the operation, and the best corrected vision recovered to 0.15. One year later his vision remained 0.1. CONCLUSION: Gordonia sputi should be taken into consideration in patients with post-traumatic endophthalmitis especially due to foreign body penetration. Compared to conventional laboratories, molecular methods are recommended for an accurate diagnosis. A comprehensive strategy of antimicrobial agents and vitrectomy may render a satisfactory result.
Subject(s)
Actinomycetales Infections/diagnosis , Endophthalmitis/diagnosis , Eye Foreign Bodies/diagnosis , Eye Infections, Bacterial/diagnosis , Eye Injuries, Penetrating/diagnosis , Gordonia Bacterium/isolation & purification , Actinomycetales Infections/microbiology , Actinomycetales Infections/therapy , Anti-Bacterial Agents/therapeutic use , Combined Modality Therapy , Endophthalmitis/microbiology , Endophthalmitis/therapy , Endotamponade , Eye Foreign Bodies/microbiology , Eye Foreign Bodies/therapy , Eye Infections, Bacterial/microbiology , Eye Infections, Bacterial/therapy , Eye Injuries, Penetrating/microbiology , Eye Injuries, Penetrating/therapy , Gordonia Bacterium/genetics , Humans , Lens, Crystalline/surgery , Male , Penicillin G/therapeutic use , RNA, Bacterial/genetics , RNA, Ribosomal, 16S/genetics , Silicone Oils/administration & dosage , Vitrectomy , Young AdultABSTRACT
PurposePhaeohyphomycosis are melanin-containing fungi that rarely infect the eye. We describe three cases of ocular infection with some unusual clinical features.MethodsSeries of three case reports describing three different presentations of phaeohyphomycosis of the eye, their histopathology, and management.ResultsCase 1 mimicked an inflamed conjunctival naevus and was excised on this basis, revealing a conjunctival retention cyst containing pigmented fungal hyphae. Case 2 showed a wooden foreign body incidentally associated with pigmented fungal hyphae, which required treatment with topical antifungal therapy. Case 3 clinically was thought to be a perforated uveal melanoma and comprised an extensive plaque of pigmented fungal hyphae over ulcerated cornea.ConclusionThe pigmented melanin containing hyphae of phaeohyphomycosis mimicked melanocytic lesions in two cases and was an incidental finding in the context of a surface foreign body.
Subject(s)
Conjunctival Diseases/diagnosis , Corneal Ulcer/diagnosis , Cysts/diagnosis , Eye Foreign Bodies/diagnosis , Eye Infections, Fungal/diagnosis , Granuloma, Foreign-Body/diagnosis , Phaeohyphomycosis/diagnosis , Adult , Antifungal Agents/therapeutic use , Child , Conjunctival Diseases/drug therapy , Conjunctival Diseases/microbiology , Corneal Ulcer/drug therapy , Corneal Ulcer/microbiology , Cysts/drug therapy , Cysts/microbiology , Diagnosis, Differential , Eye Foreign Bodies/drug therapy , Eye Foreign Bodies/microbiology , Eye Infections, Fungal/drug therapy , Eye Infections, Fungal/microbiology , Female , Granuloma, Foreign-Body/drug therapy , Granuloma, Foreign-Body/microbiology , Humans , Male , Middle Aged , Phaeohyphomycosis/drug therapy , Phaeohyphomycosis/microbiology , Voriconazole/therapeutic useABSTRACT
Cedecea is a gram-negative bacterium from the family Enterobacteriaceae, rarely associated with human infection. We report the first case of an orbital cellulitis and corneal ulcer due to Cedecea in a patient who sustained a motor vehicle accident and was then found to have a retained wooden orbital foreign body.
Subject(s)
Corneal Ulcer/microbiology , Enterobacteriaceae Infections/microbiology , Eye Foreign Bodies/microbiology , Eye Infections, Bacterial/microbiology , Orbit/injuries , Orbital Cellulitis/microbiology , Accidents, Traffic , Anti-Bacterial Agents/therapeutic use , Combined Modality Therapy , Corneal Ulcer/diagnostic imaging , Corneal Ulcer/therapy , Enterobacteriaceae Infections/diagnostic imaging , Enterobacteriaceae Infections/therapy , Eye Foreign Bodies/diagnostic imaging , Eye Foreign Bodies/therapy , Eye Infections, Bacterial/diagnostic imaging , Eye Infections, Bacterial/therapy , Humans , Magnetic Resonance Imaging , Male , Ophthalmologic Surgical Procedures , Orbital Cellulitis/diagnostic imaging , Orbital Cellulitis/therapy , Tomography, X-Ray Computed , Young AdultSubject(s)
Endothelium, Corneal/pathology , Eye Foreign Bodies/pathology , Eye Infections, Fungal/pathology , Geographic Atrophy/pathology , Heart , Love , Retinal Detachment/pathology , Endothelium, Corneal/microbiology , Eye Foreign Bodies/microbiology , Eye Infections, Fungal/microbiology , Humans , Laser Therapy , Retinal Detachment/surgery , VitrectomySubject(s)
Corneal Injuries/microbiology , Endophthalmitis/microbiology , Enterococcus/isolation & purification , Eye Foreign Bodies/microbiology , Eye Infections, Bacterial/microbiology , Gram-Positive Bacterial Infections/microbiology , Anti-Bacterial Agents/therapeutic use , Combined Modality Therapy , Corneal Injuries/therapy , Drug Therapy, Combination , Endophthalmitis/therapy , Eye Foreign Bodies/therapy , Eye Infections, Bacterial/therapy , Gram-Positive Bacterial Infections/therapy , Humans , Male , Metals , Middle Aged , Ophthalmologic Surgical Procedures , Tomography, X-Ray Computed , Vitreous Body/microbiologyABSTRACT
Post-traumatic endophthalmitis comprises 25-30% of all endophthalmitis cases. Post-traumatic endophthalmitis is an important clinical condition that may have serious anatomical and functional consequences. The type of pathogenic microorganism, nature of the injury, the presence of a foreign body, and the geographical region in which the trauma occurred are all important factors influencing both treatment and prognosis. Unlike postoperative endophthalmitis, there is not a confirmed treatment protocol recommended by the Endophthalmitis-Vitrectomy Study Group in traumatic cases. In this study, we examine the incidence, risk factors, diagnosis, microbiological features, and treatment principles of post-traumatic endophthalmitis in order to guide clinicians who often encounter eye trauma related to this potential complication.
Subject(s)
Endophthalmitis/microbiology , Eye Foreign Bodies/microbiology , Eye Infections, Bacterial/microbiology , Eye Injuries, Penetrating/microbiology , Anti-Bacterial Agents/therapeutic use , Endophthalmitis/diagnosis , Endophthalmitis/therapy , Eye Foreign Bodies/diagnosis , Eye Foreign Bodies/therapy , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/therapy , Eye Injuries, Penetrating/diagnosis , Eye Injuries, Penetrating/therapy , Humans , Incidence , Risk Factors , VitrectomySubject(s)
Alternariosis/microbiology , Anterior Chamber/microbiology , Corneal Injuries/microbiology , Eye Foreign Bodies/microbiology , Eye Infections, Fungal/microbiology , Keratitis/microbiology , Alternaria/isolation & purification , Alternariosis/diagnosis , Alternariosis/therapy , Antifungal Agents/therapeutic use , Combined Modality Therapy , Corneal Injuries/diagnosis , Corneal Injuries/therapy , Eye Foreign Bodies/diagnosis , Eye Foreign Bodies/therapy , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/therapy , Humans , Keratitis/diagnosis , Keratitis/therapy , Male , Middle Aged , Ophthalmologic Surgical Procedures , Tomography, Optical CoherenceSubject(s)
Endophthalmitis/microbiology , Eye Foreign Bodies/microbiology , Eye Infections, Bacterial/microbiology , Eye Injuries, Penetrating/microbiology , Staphylococcal Infections/microbiology , Staphylococcus hominis/isolation & purification , Anti-Bacterial Agents/therapeutic use , Cataract/etiology , Cataract Extraction , Child , Chronic Disease , Corneal Injuries/etiology , Drug Therapy, Combination , Endophthalmitis/diagnosis , Endophthalmitis/therapy , Eye Foreign Bodies/diagnosis , Eye Foreign Bodies/therapy , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/therapy , Eye Injuries, Penetrating/diagnosis , Eye Injuries, Penetrating/therapy , Female , Humans , Lens, Crystalline/injuries , Staphylococcal Infections/diagnosis , Staphylococcal Infections/therapy , VitrectomyABSTRACT
Stachybotrys eucylindrospora was characterised as a new species in 2007, and we present the first report of this organism isolated from foreign material recovered from a patient. It is probable that isolates of this species have been previously identified as either Stachybotrys chartarum or Stachybotrys cylindrospora.