Corynebacterium macginleyi is usually isolated from the eye surfaces and causes ocular infections such as conjunctivitis, keratitis, and endophthalmitis. However, cases that describe C. macginleyi as the causative agent for significant and life-threatening infections in immunocompromised patients are increasingly reported. Herein we report the first documented case of C. macginleyi pneumonia in a human immunodeficiency virus (HIV) patient. A 42-year-old homosexual man with HIV infection was hospitalized with a 1-month history of fever and dry cough. Chest radiograph revealed ill defined ground glass opacities in both lung fields. Methenamine silver stain of bronchoalveolar lavage fluid was negative. He showed clinical improvement after treatment with trimethoprim/sulfamethoxazole and prednisolone for three weeks, and was discharged. One month later, he presented with dyspnea and more progressive pulmonary infiltrations. Bronchial washing fluid culture yielded >100,000 colonies/mL of C. macginleyi, and he was given a 14-day course of antibiotic therapy with vancomycin, after which the patient fully recovered. This case suggest the importance of not overlooking the significance of positive cultures for C. macginleyi obtained from representative clinical samples in patients with signs and symptoms of bacterial infection.
Adult ; Bacterial Infections ; Bronchoalveolar Lavage Fluid ; Conjunctivitis ; Corynebacterium ; Cough ; Dyspnea ; Endophthalmitis ; Eye ; Eye Infections ; Fever ; Glass ; HIV ; HIV Infections ; Homosexuality ; Humans ; Immunocompromised Host ; Keratitis ; Lung ; Methenamine ; Pneumonia ; Prednisolone ; Thorax ; Vancomycin

Thygeson(1950) reported the specific type of superficial punctate keratitis and suspected this probably come from viral origin. Braley(1953) described and illustrated well about the superficial punctate keratitis in his article. According to his paper, its diagnostic features can be summarized as follows; 1) Appearance as a chronic, bilateral punctate epithelial keratitis. 2) Long duration. 3) Eventual healing without scar. 4) Lack of response to systemic or topical antibiotics or sulfonamide, or to removal of corneal epithelium. 5) Striking symptomatic response to topical steroids. These diagnostic features form the basis for this report. 249 cases of this disease has been observed during the period of this study(October, 1960-July, 1962). 25 cases were available for detailed clinical and laboratory analysis. Following observations were made. 1) Corneal punctate opacity is strictly epithelial and located mostly in lower quadrant in chronic cases without associated conjunctivitis. 2) None of the cases gave a history of acute onset. 3) Long duration with remission and exacerbation. 4) No response to topical antibiotics or sulfonamide, or to removal of corneal epithelium. Remarkable symptomatic response to topical steriod. 5) No seasonal and professional relationship with this disease. 6) Normal conjunctival bacterial flora in simple culture. None of them showed inclusion bodies or significant cytological changes. No lesions developed in rabbit cornea inoculartion using scraping from conjunctiva and cornea. 7) Healing without scar. 8) Further detailed virological studies are needed for determinning the etiological agent.
Anti-Bacterial Agents ; Cicatrix ; Conjunctiva ; Conjunctivitis ; Cornea ; Epithelium, Corneal ; Inclusion Bodies ; Keratitis* ; Seasons ; Steroids ; Strikes, Employee

Humans ; Endophthalmitis/microbiology* ; Eye Infections, Bacterial/microbiology* ; Anti-Bacterial Agents/therapeutic use* ; Retrospective Studies

PURPOSE: To report two cases of postoperative endophthalmitis caused by Streptococcus dysgalactiae subspecies equisimilis (SDSE), which appeared as hyperacute presentation and panophthalmitis. CASE SUMMARY: A 68-year-old male was treated with cataract surgery and was evaluated the next day (less than 24 hours after surgery) because of acute loss of vision. There was severe inflammation and the visual acuity was light perception. The patient underwent pars plana vitrectomy (PPV) with intravitreal antibiotic injection. The vitreous culture revealed SDSE. After PPV, regression of inflammation was observed, although the corneal edema had progressed. The cornea evolved to decompensate due to bullous keratopathy and visual acuity of the eye decreased to no light perception after 3 months. A 87-year-old male who underwent phacoemulsification and intraocular lens implantation 2 days previously was hospitalized due to severe ocular pain and visual loss. There was severe inflammation, and the visual acuity was no light perception. The patient received only intravitreal injections of antibiotics due to severe corneal necrosis. The aqueous humor revealed SDSE. Four days after intravitreal injection, erythema and swelling of the eyelid of the affected eye was observed, and diagnosed as panophthalmitis. After treatment with intravenous antibiotics, cellulitis of the eyelid was resolved. The eye progressed as phthisis after 3 months without recurrence. CONCLUSIONS: Postoperative SDSE endophthalmitis showed aggressive and hyperacute presentation, resulting in blindness despite prompt treatment. SDSE is an emerging organism and should be considered a potential cause of postoperative endophthalmitis.
Aged ; Aged, 80 and over ; Anti-Bacterial Agents ; Aqueous Humor ; Blindness ; Cataract ; Cellulitis ; Cornea ; Corneal Edema ; Endophthalmitis ; Erythema ; Eye Infections ; Eyelids ; Humans ; Inflammation ; Intravitreal Injections ; Lens Implantation, Intraocular ; Male ; Necrosis ; Panophthalmitis ; Phacoemulsification ; Recurrence ; Streptococcus ; Visual Acuity ; Vitrectomy

INTRODUCTIONThis study was conducted to determine the epidemiological pattern and risk factors associated with corneal ulcers in rural areas of western Maharashtra, India, and to identify the bacterial and fungal agents responsible for causing keratitis.

METHODSA total of 852 patients with corneal ulceration were included in the study. Sociodemographic data and information pertaining to risk factors were collected. Corneal scrapings obtained from these patients were processed for bacterial and fungal agents using standard techniques.

RESULTSOut of the 852 patients studied, 537 (63.02%) were culture positive. A majority of the culture-positive patients were farmers (52.32%), and ocular trauma was the most common predisposing factor (60.15%). Among these patients, fungal isolates (57.91%) were more frequent than bacterial isolates (42.08%). The most common fungal isolate was Fusarium spp. (35.04%) followed by Aspergillus spp. (18.00%). Streptococcus pneumoniae was the predominant bacterial isolates (32.74%) followed by Staphylococcus spp. (17.25%).

CONCLUSIONCorneal trauma from plant parts or organic matter was found to be the most common risk factor associated with corneal ulceration in the rural areas of western Maharashtra. Epidemiology and aetiology of microbial keratitis vary from region to region, and therefore, careful history taking and proper identification of aetiological agents are necessary for the institution of appropriate therapy.

Adult ; Cornea ; microbiology ; Corneal Ulcer ; epidemiology ; microbiology ; Eye Infections, Bacterial ; epidemiology ; microbiology ; Eye Infections, Fungal ; epidemiology ; microbiology ; Female ; Hospitals, Rural ; Humans ; India ; epidemiology ; Male ; Risk Factors ; Young Adult

INTRODUCTIONCorneal infection is the most common cause of profound ocular morbidity leading to blindness worldwide. Corneal infection in children is difficult to diagnose and treat, as they are unwilling and sometimes unable to cooperate during active management. This study analyses the prevalence, microbiology, demography, therapeutic and visual outcome of infectious microbial keratitis in the paediatric age group seen at a tertiary eye care hospital in south India.

MATERIALS AND METHODSA retrospective review of all cases presenting with keratitis to the ocular microbiology and cornea service at Aravind Eye Hospital, Coimbatore, from February 1997 to January 2004, was done to screen the patients for microbial keratitis. Their records were further analysed for clinical and microbiological details. Cases with culture-proven non-viral keratitis in children

RESULTSOf the 310 patients who attended the cornea clinic, 97 (31.2%) patients were confirmed to be positive for microbial keratitis. 54.6% of cases were male. The most common predisposing cause of ulceration was trauma (69%) with organic matter. Pure bacterial cultures were obtained from 64 (65.9%) eyes, whereas pure fungal cultures were obtained from 37 (38.1%) eyes. Four (4.1%) eyes showed mixed growth.

CONCLUSIONThe most commonly isolated organism was Pseudomonas aeruginosa. The most common predisposing cause of infectious microbial keratitis was corneal trauma. Early stage of diagnosis and formulation of an uncompromising management protocol can prevent profound visual morbidity.

Adolescent ; Child ; Child, Preschool ; Eye Infections, Bacterial ; diagnosis ; therapy ; transmission ; Eye Infections, Fungal ; diagnosis ; therapy ; transmission ; Female ; Humans ; India ; Infant ; Keratitis ; diagnosis ; etiology ; microbiology ; therapy ; Male

OBJECTIVETo evaluate the outcome and analyze the methods of surgical treatment of traumatic endophthalmitis following penetrating eye injuries with retained eye foreign bodies.

METHODSA total of 62 consecutive cases (58 men, 4 women) from January 1999 to December 2001 with IOFBs following penetrating eye injuries were retrospectively studied. The ages ranged from 8 to 46 years (mean 23 years). Sixty patients (63 eyes) underwent pars plana vitreotomy and 1 patient underwent external magnet extraction. The follow-up ranged from 3 to 36 months (mean 12.5 months).

RESULTSTen eyes developed endophthalmitis, among which 7 (10.94%) were diagnosed preoperatively. The most frequently cultured organism was Staphylococcus epidermis (44.44%, 4/9). Postoperatively, retinal detachment due to vitreoretinal proliferation occurred in 5 patients with endophthalmitis and in 9 patients without endophthalmitis. All the retinal detachments were reattached with additional vitreoretinal surgery. Two eyes with endophthalmitis and two without endophthalmitis were eviscerated.

CONCLUSIONSPost-traumatic endophthalmitis with intraocular foreign bodies (IOFBs) deserves great attention because of its high incidence and poor prognosis. Vitrectomy is suggested for the treatment of IOFBs and its complications, and it should be performed as soon as possible. Routine intravenous administration of antibiotics combined with periocular injection and topical antibiotics postoperatively are recommended.

Adolescent ; Adult ; Anti-Bacterial Agents ; therapeutic use ; Child ; Endophthalmitis ; etiology ; Eye Foreign Bodies ; complications ; therapy ; Eye Infections, Bacterial ; drug therapy ; etiology ; Eye Injuries, Penetrating ; complications ; therapy ; Female ; Humans ; Injections ; Male ; Middle Aged ; Vitrectomy

PURPOSE: To report the clinical manifestation, predisposing factors, microbiological profiles and treatment outcome of infectious keratitis following penetrating keratoplasty (PK). METHODS: Medical records of the post-PK patients later diagnosed with culture-positive keratitis, between January 2003 and June 2008 at our hospital were retrospectively reviewed. RESULTS: Among 228 eyes of 226 patients who previously had PK, 18 eyes (7.89%) of 16 patients developed microbial keratitis. Fifteen patients had a bacterial infection, of which a Streprococcus species was the most common causative microorganism (6 eyes, 33.3%). Three eyes had fungal infection; one case was co-infected with bacteria. Six eyes (33.3%) presented with a suture-related problem, and sixteen eyes (88.9%) had been using topical glaucoma medications. The suture-related problem and use of glaucoma medication were significantly associated with the development of infectious keratitis (p=0.040 and 0.013, respectively). Remission was achieved in all cases within the mean duration of 2.47 months after treatment initiation. However, visual improvement was not achieved in 11 eyes (68.7%) due to graft opacity. CONCLUSIONS: Early identification of predisposing factors and appropriate management at an early stage may prevent the occurrence of graft infection and improve graft survival.
Bacteria ; Bacterial Infections ; Cornea ; Eye ; Glaucoma ; Graft Survival ; Humans ; Keratitis ; Keratoplasty, Penetrating ; Medical Records ; Retrospective Studies ; Transplants ; Treatment Outcome

INTRODUCTIONThe aim of this case series is to describe the clinical course of 2 patients with Neisseria meningitidis corneal ulcers.

CLINICAL PICTUREA 49-year-old man (Patient 1) and a 22- year-old man (Patient 2) both experienced eye pain and were found to have corneal ulcers with surrounding infiltrate and ground-glass appearance. Gram-negative diplococci were seen in the first case. N. meningitidis was isolated in culture of corneal scrapings from both patients.

TREATMENTPatient 1 was treated with levofloxacin (0.5%) and cefazolin (50 mg/mL) eye drops hourly and intravenous ceftriaxone and oral rifampicin. Patient 2 was treated with cefazolin (50 mg/mL) and gentamicin (14 mg/mL) eye drops hourly, as well as intravenous ceftriaxone.

OUTCOMEThe corneal ulcers resolved with anterior stromal scarring and no impairment of vision.

CONCLUSIONSCorneal ulcers caused by N. meningitidis may respond well to treatment without permanent visual sequelae. However, in view of the potential ocular and systemic complications, it is important to investigate and treat patients with N. meningitidis infection aggressively.

Adult ; Cornea ; microbiology ; pathology ; Diagnosis, Differential ; Eye Infections, Bacterial ; microbiology ; pathology ; Humans ; Keratitis ; microbiology ; pathology ; Male ; Meningococcal Infections ; microbiology ; pathology ; Middle Aged ; Neisseria meningitidis ; isolation & purification

PURPOSE: To identify the risk factors associated with fluoroquinolone resistance in patients undergoing cataract surgery. METHODS: A total of 1,125 patients (1,125 eyes) who underwent cataract surgery at Veterans Health Service Medical Center from May 2011 to July 2012 were enrolled in this study. Conjunctival cultures were obtained from the patients on the day of surgery before instillation of any ophthalmic solutions. The medical records of patients with positive coagulase negative staphylococcus (CNS) and Staphylococcus aureus (S. aureus) cultures were reviewed to determine factors associated with fluoroquinolone resistance. RESULTS: Of 734 CNS and S. aureus cultures, 175 (23.8%) were resistant to ciprofloxacin, levofloxacin, gatifloxacin, or moxifloxacin. Use of fluoroquinolone within 3 months and within 1 year before surgery, topical antibiotic use other than fluoroquinolone, systemic antibiotic use, recent hospitalization, ocular surgery, intravitreal injection and use of eyedrops containing benzalkonium chloride were significantly more frequent in resistant isolates than in susceptible isolates. In multivariable logistic regression analysis, ocular surgery (odds ratio [OR], 8.457), recent hospitalization (OR, 6.646) and use of fluoroquinolone within 3 months before surgery (OR, 4.918) were significant predictors of fluoroquinolone resistance, along with intravitreal injection (OR, 2.976), systemic antibiotic use (OR, 2.665), use of eyedrops containing benzalkonium chloride (OR, 2.323), use of fluoroquinolone within 1 year before surgery (OR, 1.943) and topical antibiotic use other than fluoroquinolone (OR, 1.673). CONCLUSIONS: Recent topical fluoroquinolone use, hospitalization and ocular surgery were significantly associated with fluoroquinolone resistance in CNS and S. aureus isolates from ocular culture.
Aged ; Anti-Bacterial Agents/*administration & dosage ; *Drug Resistance, Bacterial ; Eye Infections, Bacterial/drug therapy/*microbiology ; Female ; Fluoroquinolones/*administration & dosage ; Humans ; Male ; Ophthalmic Solutions ; Retrospective Studies ; Risk Factors ; Staphylococcal Infections/drug therapy/*microbiology ; Staphylococcus aureus/drug effects/*isolation & purification