1/10. Case Report. Multiple etiology post-surgery endophthalmitis.The case describes a septic endophthalmitis arisen in a convalescence period following surgery of cataract extraction. The infection was due to staphylococcus aureus and three fungal components, candida albicans, candida glabrata and acremonium kiliense, which were subsequently isolated. A careful and prompt laboratory investigation allowed the clinicians to adjust the antimycotic therapy and attain an excellent clinical result.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/10. Novel use of a swimming pool biocide in the treatment of a rare fungal mastoiditis.OBJECTIVE: To describe an extremely rare fungal mastoiditis caused by Lecythophora hoffmannii, its recalcitrant behavior to therapy, and eventual successful treatment with adjunctive therapy using polyhexamethylene biguanide (a common swimming pool biocide). STUDY DESIGN: Case report and review of literature of human Lecythophora hoffmannii infections. methods: medline database was searched using the keywords Lecythophora and hoffmannii. All articles that described Lecythophora hoffmannii as the cause of human infection at any site were identified. literature and patient's records were considered for complete data review and extraction. RESULTS: We present the second known case in the literature of a human infection with Lecythophora hoffmannii. We also present the process to definitively identify and then to successfully eradicate this unusual fungal infection using polyhexamethylene biguanide as adjunctive treatment. CONCLUSIONS: Successful treatment of a chronic Lecythophora hoffmannii fungal mastoiditis involved a combination of radical surgical removal of all apparent infected tissue along with local treatments with polyhexamethylene biguanide, a common swimming pool biocide agent under the brand name Baquacil (Avecia, Manchester, United Kingdom). Given the prolonged course of treatment, this report particularly stresses the importance of concurrent surgery combined with creative local antimicrobial therapy to eliminate an unusual fungal infection in an immunocompetent host.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
3/10. Sensitive and rapid polymerase chain reaction based diagnosis of mycotic keratitis through single stranded conformation polymorphism.PURPOSE: To report a method for early and correct diagnosis of mycotic keratitis. DESIGN: Clinical laboratory diagnostic study. methods: Corneal scraping of all the four patients were processed for dna extraction which were amplified by fungal specific primers of internal transcribed spacer region I (ITS1). These products were sequenced and analyzed by single stranded conformation polymorphism (SSCP) for species identification. RESULTS: The dna samples from corneal scrapings of all the four patients were successfully amplified by the primer pair ITS1 and ITS2 and similarity/dissimilarity were established by Jaccard's coefficient. Patient isolate 1 was identified as nectria hematococca, isolate 2 as candida albicans, and isolates 3 and 4 were identified as Bipolaris papendorfii. This led to prompt initiation of antifungal therapy in all the four cases where useful vision could be restored. CONCLUSIONS: Early and correct diagnosis of mycotic keratitis by polymerase chain reaction could be obtained in all the four cases compared with conventional methods, which helped in the prompt initiation of antifungal therapy in patients.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
4/10. Mycotic infection of the capsular bag in postoperative endophthalmitis.A case of mycotic infection after uncomplicated extracapsular cataract extraction with implantation of a posterior chamber modified C-loop intraocular lens (IOL) is reported. Severe postoperative intraocular inflammation, diagnosed by aqueous cultures as secondary to staphylococcus aureus endophthalmitis, did not respond to antibiotic therapy. Despite IOL and capsular bag removal and further antibiotic treatment, the inflammation persisted and phthisis followed. Retrospective electron microscopic examination of the explanted material demonstrated the presence of abundant fungal elements in the capsular bag and spores on the IOL surface. Vitreous taps performed at the time of explantation were negative for bacteria and fungi, confirming the localized nature of the mycotic infection. To our knowledge this report represents the first observation of a mycotic infection confined to the capsular bag after cataract surgery with implantation of a posterior chamber IOL.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
5/10. Successful treatment of paecilomyces lilacinus endophthalmitis following cataract extraction with intraocular lens implantation.We report a case of mycotic endophthalmitis caused by paecilomyces lilacinus after cataract surgery. Treatment consisted of early vitrectomy, multiple intravitreal injections of amphotericin b and miconazole, intravenous miconazole and, later, oral ketoconazole. The intraocular lens, which initially appeared uninvolved, was removed six weeks after initiation of therapy and found to contain causative organisms. Final visual acuity was 20/20. We recommend aggressive therapy consisting of early vitrectomy, intravitreal injections repeated as necessary, removal of the intraocular lens, avoidance of intraocular steroid, and administration of systemic antifungal agents.- - - - - - - - - - ranking = 4keywords = extraction (Clic here for more details about this article) |
6/10. Impalement injuries.Impalement injuries are unusual, complex surgical problems. We present a case of impalement through the spine and abdomen, describe a two-team approach to operative extraction utilizing simultaneous laminectomy and laparotomy incisions, and outline the management of an infectious complication caused by unusual bacterial and fungal pathogens. General principles of management include: the impaling object must be stabilized and manipulation avoided during extrication and transport. Operative removal requires careful preplanning, and should be tailored to the specific presenting injuries, with early multispecialty involvement as necessary. Extensive exposure is mandatory and may be achieved through a variety of standard or unconventional incisions so as to permit extraction of the impaled object under direct vision. Meticulous care of the traumatic wound is necessary, and careful followup is required for recognition and early management of infectious complications.- - - - - - - - - - ranking = 2keywords = extraction (Clic here for more details about this article) |
7/10. Pityrosporum isolate from the upper respiratory tract.A 49-year-old white man experienced maxillary sinus osteitis after removal of a portion of the maxilla containing root tips from a previous molar tooth extraction. After the patient had received long-term antibiotic therapy for that infection, a yeast-like organism was observed on smears from the patient's left nasal passage and its surgically enlarged communication with the maxillary sinus. The fungus has appeared on all subsequent smears, but early attempts to culture the organism were unsuccessful. A lipophilic yeast-like fungus, morphologically similar to the organisms seen on the direct smears and consistent with the genus Pityrosporum, was isolated in culture at this facility. Electron microscopy of the organism revealed cellular morphologic features believed to be unique to the Pityrosporum genus, thereby confirming the identity of the isolate as a member of that genus.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
8/10. Ovadendron sulphureo-ochraceum endophthalmitis after cataract surgery.PURPOSE: We examined an 82-year-old woman with delayed-onset endophthalmitis caused by an opportunistic pathogen, Ovadendron sulphureo-ochraceum. methods: Tissue obtained during vitrectomy was cultured and examined by light and electron microscopy. An enucleation specimen was examined by light microscopy. RESULTS: The patient had fungal endophthalmitis, with O. sulphureo-ochraceum present in the lens capsule. The eye developed a necrotizing scleritis secondary to O. sulphureo-ochraceum. The patient failed to respond to intravitreous, subconjunctival, and systemic amphotericin b, and the eye was enucleated. CONCLUSION: In this case of O. sulphureo-ochraceum as a human pathogen, the organism caused endophthalmitis after cataract extraction.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
9/10. Chronic basidiomycetous endophthalmitis after extracapsular cataract extraction and intraocular lens implantation.BACKGROUND: Basidiomycetes are known as rare pathogens for meningitis, sinusitis, pneumonia, ulcerative lesions of the hard palate and onychomycosis. To our knowledge, no filamentous basidiomycete has been reported from a case of fungal endophthalmitis. PATIENT: We report on a 67-year-old man with delayed-onset endophthalmitis caused by an opportunistic basidiomycete. Tissue obtained during vitrectomy was cultured and examined by light and transmission electron microscopy. After enucleation the eye was examined by light microscopy. CONCLUSION: The patient had endophthalmitis from a sterile hyphomycete, harboured in remnants of lens capsule and a granuloma on the ciliary body. It was recognized as a Holobasidiomycete on the basis of its dolipore structure with perforated pore cap, seen with transmission electron microscopy. Species identification was not possible because fruiting bodies were absent. The patient failed to respond to intravitreal and systemic amphotericin b and systemic itraconazole. The eye was enucleated. This case demonstrates that filamentous basidiomycetes can cause endophthalmitis when inoculated during cataract extraction.- - - - - - - - - - ranking = 5keywords = extraction (Clic here for more details about this article) |
10/10. Corneal chromoblastomycosis.PURPOSE: We sought to illustrate the difficulty in managing uncommon, pigmented mold-related corneal ulceration and to highlight the role of itraconazole in treating these patients. METHOD: We describe the management and clinical course of a patient with a recurring corneal infection caused by Fonsecaea pedrosoi and discuss this experience in the light of existing literature on management of cutaneous chromoblastomycosis. RESULTS: A corneal ulcer caused by this organism healed initially on treatment with topical and systemic antifungal medication, but infection recurred in the deep stroma 4 months after cessation of therapy. After failure to respond to a further period of medical therapy, a small therapeutic penetrating keratoplasty was performed. culture of a fibrinous membrane from the anterior iris surface demonstrated intraocular fungal infection, and postoperatively, an episode of marked fibrinous uveitis developed, suggesting the presence of viable intraocular fungal elements. A large penetrating keratoplasty was therefore performed with excision of involved iris in combination with extracapsular cataract extraction. F. pedrosoi was again cultured from the fibrinous membrane adherent to the iris and from the anterior lens capsule. Postoperatively the patient received a 5-month course of systemic itraconazole, and no further recurrences have been encountered after a further 2 months. CONCLUSION: F. pedrosoi is the organism most commonly isolated from the chronic cutaneous mycosis, chromoblastomycosis, and is relatively resistant to medical therapy. As has been reported for cutaneous disease, surgery in combination with systemic itraconazole may provide the best chance of cure in corneal chromoblastomycosis.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
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