1/235. exophiala (Wangiella) dermatitidis keratitis after keratoplasty.We report the first French case of an intraocular infection due to exophiala (Wangiella) dermatitidis. Two months after a second corneal transplant for congenital hereditary endothelial dystrophy, the patient presented with ocular pain and corneal infiltrates leading to the graft rejection. diagnosis was established by positive direct examination and cultures of the same fungus from corneal buttons, iris biopsies and ablated sutures.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
2/235. Fungal keratitis caused by candida utilis--case report.We report the first case of an ocular fungal infection caused by candida utilis in a 72-year-old woman. Although candidiasis is the most common opportunistic fungal infection in humans, C. utilis had not been associated with human morbidity until two cases of fungemia were reported in 1988 and 1993. The clinical features exhibited typical feather-like infiltration at the ulceration margin of this case. After treatment with topical fluconazole and amphotericin-B, the ulceration healed within 3 weeks. The patient underwent penetrating keratoplasty and regained useful vision. We concluded that C. utilis is a new corneal pathogen and should be included in the differential list of mycotic keratitis.- - - - - - - - - - ranking = 2keywords = infection (Clic here for more details about this article) |
3/235. Use of a low nutrient culture medium for the identification of bacteria causing severe ocular infection.A low nutrient culture medium was used to identify the pathogens in four cases of persisting ocular infection. Bacto R2A agar was used in addition to conventional liquid- and solid-phase media to culture pathogenic bacteria from one case of recurrent keratitis, one case of suture-related keratitis with endophthalmitis and two eyes (two patients) with post-operative endophthalmitis. In each case, a pathogen was identified solely with R2A agar after culture for 6 days. Species isolated were pseudomonas aeruginosa (one), propionibacterium acnes (two) and staphylococcus aureus (one). Antibiotic therapy was tailored to conform to the sensitivity of the cultured organism in each case. The use of Bacto R2A low nutrient agar should be considered in culture negative eyes not showing clinical improvement, or for chronic cases where bacteria may have become adapted to more stringent ocular environments.- - - - - - - - - - ranking = 5keywords = infection (Clic here for more details about this article) |
4/235. Mycotic keratitis due to Curvularia senegalensis and in vitro antifungal susceptibilities of Curvularia spp.A case of mycotic keratitis due to Curvularia senegalensis is reported. This case represents the third known reported infection caused by this rare species. Fungal hyphae were detected in corneal scrapings, and repeated cultures were positive for this fungi. The patient was presumed cured after a corneal transplant and treatment with itraconazole, but the infection recurred and the patient is waiting for a keratoplasty. The in vitro antifungal susceptibilities of the case strain and another 24 strains belonging to seven species of Curvularia were tested for six antifungal agents. With the exception of flucytosine, and occasionally fluconazole, the other drugs assayed (amphotericin b, miconazole, itraconazole, and ketoconazole) were highly effective in vitro.- - - - - - - - - - ranking = 2keywords = infection (Clic here for more details about this article) |
5/235. The spectrum of ocular inflammation caused by euphorbia plant sap.OBJECTIVE: To report the spectrum of clinical findings in patients with ocular inflammation caused by plant sap from euphorbia species. DESIGN: Clinical case series. SETTING: ophthalmology emergency referrals in the United Kingdom. patients: We examined 7 patients, all of whom gave a history of recent ocular exposure to the sap of euphorbia species. INTERVENTIONS: All patients were treated with antibiotic drops or ointment (chloramphenicol). Cycloplegic and steroid drops were also used for some patients. patients were observed until all signs and symptoms had resolved. MAIN OUTCOME MEASURES: Symptoms, visual acuity, and clinical signs of inflammation. All patients provided a specimen of the plant for formal identification. RESULTS: Initial symptoms were generally burning or stinging pain with blurred vision. In most cases, visual acuity was reduced between 1 and 2 Snellen lines. In 1 patient with age-related maculopathy, acuity dropped from 20/80 to hand motions before recovering. Clinical findings varied from a mild epithelial keratoconjunctivitis to a severe keratitis with stromal edema, epithelial sloughing, and anterior uveitis. All signs and symptoms had resolved by 1 to 2 weeks. CONCLUSIONS: These cases illustrate the range of severity of euphorbia sap keratouveitis. The condition seems to be self-limiting when managed supportively. People who work with euphorbia plant species should wear eye protection. Clinicians managing keratopathy caused by euphorbia species should be aware of the danger of sight-threatening infection and uveitis, particularly during the first few days.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
6/235. Atrichia, ichthyosis, follicular hyperkeratosis, chronic candidiasis, keratitis, seizures, mental retardation and inguinal hernia: a severe manifestation of IFAP syndrome?A boy with congenital atrichia, ichthyosis follicular, keratitis, cutaneous infections and a huge inguinal hernia, but without deafness is reported. We believe it represents a new case of a rare X-linked recessive syndrome known as ichthyosis follicularis, alopecia, photophobia syndrome (IFAP). The differential diagnosis from keratitis ichthyosis deafness is discussed. The cutaneous infections seen in our case suggest the possibility of considering a genetic link between these syndromes.- - - - - - - - - - ranking = 2keywords = infection (Clic here for more details about this article) |
7/235. Severe sclerokeratitis due to pseudomonas aeruginosa in noncontact-lens wearers.PURPOSE: To review the clinical presentation, treatment and outcome in four cases of severe anterior segment infection by pseudomonas aeruginosa unrelated to contact lens wear. methods: Four cases presenting over an 18 month period were reviewed. RESULTS: The cases had variable presenting features and outcomes. Complications such as persistent infection, corneal thinning and phthisis bulbi were noted. Possible factors influencing adherence and tissue disruption are discussed. CONCLUSIONS: Suspicion of infection by P. aeruginosa and prompt isolation of the organism is needed early in the course of disease. Intensive and prolonged treatment with parenteral and topical antibiotics combined with judicious use of topical steroid gives the best chance of a favourable outcome.- - - - - - - - - - ranking = 3keywords = infection (Clic here for more details about this article) |
8/235. Mycobacterium keratitis after laser in situ keratomileusis.PURPOSE: The authors report two cases of Mycobacterium keratitis following LASIK. methods: The case reports are based on a retrospective review of clinical history and associated findings. RESULTS: Two patients developed infectious keratitis after undergoing laser in situ keratomileusis (LASIK). In case #1, the infection developed after manipulation of the lamellar flap to remove epithelium from the stromal bed. In case #2, prior radial keratotomy may have been a contributing factor to development of the infection. Corneal infiltrates appeared as focal, white, stromal deposits. Cultures isolated mycobacterium fortuitum from case #1 and mycobacterium chelonae from case #2. Topical fortified amikacin, clarithromycin, tobramycin, and ciprofloxacin eventually controlled the infection. Topical prednisolone acetate and bandage contact lenses were necessary to control inflammation and pain. Infiltrates were slow to resolve until focal necrosis eroded through the flaps leading to rapid clearing of the infiltrates; however, scarring of the cornea developed at the site of necrosis. Visual recovery was good in the first case but limited in the second. CONCLUSIONS: Mycobacterium keratitis complicating LASIK may be difficult to eradicate until the sequestered stromal infiltrate drains. Rapid recognition of the causative organism and aggressive medical and surgical management of the infection may improve the outcome.- - - - - - - - - - ranking = 4keywords = infection (Clic here for more details about this article) |
9/235. Vannella sp. harboring microsporidia-like organisms isolated from the contact lens and inflamed eye of a female keratitis patient.Viable hartmannella sp. and two strains of Vannella sp.--but no Acanthamoebae--multiplied on NN-agar inoculated with pieces of the contact lens from a female keratitis patient. Within the cytoplasm of one Vannella isolate, intracellular parasites could be observed whose earliest stages were developing within the nucleus, resembling those microsporidia-like parasites seen within Vannella isolated recently from a warm tapwater system. This assumption was also confirmed by electron microscopy. In swabs taken directly from the cornea, pseudomonas aeruginosa were identified, but they did not yield any growth of amebas in culture. However, cocultivation of parasite-free Vannella strains with the above-mentioned swab matter resulted in infected amebas harboring the same intracellular parasites seen before. This infection could be established only if the corresponding spores were present as infective agents in the swab matter. The successful treatment of the patient with antibiotics supports the assumption that P. aeruginosa was the main cause of the corneal ulceration. The extent to which the microsporidia-like organisms may have been involved in the development of keratitis remains a matter of discussion.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
10/235. aspergillus flavus keratitis after laser in situ keratomileusis.PURPOSE: To report a case of fungal keratitis caused by aspergillus flavus after laser in situ keratomileusis surgery. methods: Case report. A 24-year-old woman developed pain, redness, decreased vision, and an infiltrate posterior to the corneal flap in her right eye 3 days after laser in situ keratomileusis. On referral, approximately 3 weeks after laser in situ keratomileusis, examination of the right eye revealed light perception vision, a large full-thickness corneal infiltrate, and hypopyon. Corneal scrapings were taken for direct microscopic examination and culture. RESULTS: Corneal scraping revealed the presence of fungal filaments in smears and in culture. The fungus was identified as A. flavus. Intensive topical natamycin and systemic ketoconazole therapy was initiated. Despite intensive medical treatment, the infiltrate progressed and the patient was subjected to a therapeutic penetrating keratoplasty. There was no recurrence of infection after surgery. At last follow-up 4 months after surgery, the eye was quiet with graft edema. CONCLUSION: Fungal keratitis is a rare complication of laser in situ keratomileusis surgery. In a case that does not respond to medical treatment, early surgical intervention must be considered.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
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