1/18. Nocardia keratitis after traumatic detachment of a laser in situ keratomileusis flap.PURPOSE: Nocardia are gram-positive bacteria existing ubiquitously in the environment; they can cause keratitis. nocardia asteroides keratitis occurred in the interface between the stromal bed and flap after traumatic detachment of the flap 4 months after an initially uncomplicated laser in situ keratomileusis (LASIK) procedure. methods: nocardia asteroides keratitis was confirmed by culture. Therapy included topical and oral trimethoprim-sulfamethoxazole. RESULTS: Thirteen months after the trauma, the patient's spectacle-corrected visual acuity was 20/20 with a manifest refraction of -2.25 -1.00 x 30 degrees. CONCLUSIONS: The immediate steps of management consisting of surgically lifting the corneal flap, rapid microbial identification, and proper treatment with specific antibiotics resulted in the successful treatment of nocardia asteroides keratitis in a traumatized eye after LASIK.- - - - - - - - - - ranking = 1keywords = keratitis (Clic here for more details about this article) |
2/18. Topical bactrim versus trimethoprim and sulfonamide against nocardia keratitis.PURPOSE: The conventional treatment of Nocardia keratitis is with topical sulfonamides. Recently, topical trimethoprim and sulfamethoxazole (Bactrim) has been suggested as treatment. This study compares the in vitro efficacy against nocardia asteroides of Bactrim and various ratios of trimethoprim and a sulfonamide. methods: Antibiotic disks were soaked with various ratios of trimethoprim and sulfacetamide sodium. They contained trimethoprim alone, sulfacetamide sodium alone, and both trimethoprim and sulfacetamide sodium at ratios of 1:40, 1:20, and 1:5. Disks containing Bactrim were also prepared. Each disk was placed on blood agar plates streaked with N. asteroides. The plates were incubated at 37 degrees C for 72 hours and then examined. RESULTS: trimethoprim alone showed minimal effect. sulfacetamide sodium alone had a clearance zone of 12 mm. The plates of trimethoprim and sulfacetamide sodium at ratios of 1:40, 1:20, and 1:5 had clearance zones of 14 mm, 17 mm, and 27 mm, respectively. Bactrim had a clearance zone of 70 mm. CONCLUSION: trimethoprim or sulfacetamide sodium alone is not as effective as both drugs together. As the ratio of the two drugs was changed, potency differed against Nocardia organisms. Bactrim was the most effective antibiotic against Nocardia organisms. It should be the recommended agent for the treatment of Nocardia keratitis.- - - - - - - - - - ranking = 0.75keywords = keratitis (Clic here for more details about this article) |
3/18. nocardia asteroides sclerokeratitis in a contact lens wearer.PURPOSE: To report a case of sclerokeratitis caused by nocardia asteroides in a soft contact lens wearer. CASE REPORT: A 65-year-old male presented with a 2-month history of a corneal ulcer in the left eye. He wore two weekly disposable soft contact lenses on an extended basis. He revealed his history of gardening before the onset of symptoms. On examination, his best-corrected visual acuity was 20/30 in the right eye and 20/400 in the left eye. In the left eye, there was conjunctival injection. His cornea showed multiple patchy infiltrates, with a feathery border that was raised and involved up to the midstroma. There was a 3 anterior chamber reaction. Corneal scrapings were performed for smears and cultures. Topical 2% amikacin sulfate every half hour along with oral clarithromycin therapy was initiated. On follow-up, the sclera lesions worsened. RESULTS: Smears of corneal scrapings revealed gram-positive filamentous bacteria in Gram's stain. The cultures grew nocardia asteroides. The patient was switched to trimethoprim-sulfamethoxazole (Bactrim DS, Roche laboratories, Nutley, NJ) as the sclera was involved. The patient responded to treatment, and the infection resolved. When last seen, approximately 4 months after his initial presentation to us, his visual acuity was 20/40 in the affected eye. There was corneal scarring, and the adjacent sclera showed thinning. CONCLUSIONS: Nocardia sclerokeratitis can be associated with contact lens wear. Nocardia should be considered in the differential diagnosis of a corneal ulcer with an indolent progressive course with feathery infiltrates. Topical amikacin and systemic trimethoprim-sulfamethoxazole are effective drugs in the treatment of nocardial corneal infection with scleral involvement.- - - - - - - - - - ranking = 0.75keywords = keratitis (Clic here for more details about this article) |
4/18. Nocardia keratitis in a human immunodeficiency virus patient.BACKGROUND: The development of Nocardia keratitis in a patient with human immunodeficiency virus infection is rare, and we could find no cases reported in the literature. CASE: A 48-year-old woman who had human immunodeficiency virus infection presented with decreased visual acuity, redness, and irritation in the right eye. OBSERVATIONS: Initially, the diagnosis was fungal keratitis, and she was treated with 0.3% amphotericin b eye drops and oral fluconazole for 1 month without improvement. Then, all former drugs were discontinued, and a corneal scraping was carried out. The culture result disclosed nocardia asteroides, and after treatment with 10% sulfacetamide eye drops and oral trimethoprim-sulfamethoxazole, the keratitis subsided dramatically. CONCLUSIONS: The treatment result for Nocardia keratitis in a human immunodeficiency virus patient was favorable after intensive use of 10% sulfacetamide eyedrops. Nocardia keratitis should be kept in mind as a possible causative organism when antifungal therapy fails in a keratitis case.- - - - - - - - - - ranking = 1.25keywords = keratitis (Clic here for more details about this article) |
5/18. Nocardia keratitis after laser in situ keratomileusis: clinicopathologic correlation.A case of nocardia asteroides keratitis occurring 3 weeks after laser in situ keratomileusis (LASIK) in a nontraumatized eye is reported. The patient presented with decreased vision, inflammation, and stromal melting of the LASIK flap, discrete infiltrates, and an anterior chamber cellular reaction. Cultures for acid-fast bacteria grew nocardia asteroides after 5 days. infection progressed despite treatment with topical antibiotics and eventually required penetrating keratoplasty (PKP). Postoperatively, the patient was placed on moxifloxacin, a fourth-generation flouroquinolone. The patient experienced a recurrence of Nocardia keratitis at the graft-host interface 2 months after the PKP. This eventually resolved with a combination of topical moxifloxacin and imipenem therapy.- - - - - - - - - - ranking = 0.75keywords = keratitis (Clic here for more details about this article) |
6/18. Nocardia keratitis: a case report.PURPOSE: To describe a case of Nocardia keratitis resistant to 2% amikacin, with a toxic-allergic reaction to fortified topical 5% amikacin, and recurrence of the infection with topical corticosteroids. methods: Nocardia was diagnosed from a smear and positive culture and identified as nocardia asteroides by gas chromatography and quantitative fatty acid analysis using the Microbial Identification System. Treatment was started with topical 2% amikacin, which was subsequently raised to 5% because of clinical resistance. RESULTS: A toxic-allergic reaction was observed after 5% amikacin so the drug was discontinued and commercially available drugs combining 1% chloramphenicol, 0.5% tetracycline, and 18 mil IU colistin with 0.3% ofloxacin were given. These were well tolerated and the infection improved quickly. After 1 month the antibiotics were discontinued and topical 0.1% clobetasone was given to reduce scar formation. The infection recurred after 1 week but responded to 3 months of the previous antibiotic combination and its sensitivity was checked with the Epsilometer test. CONCLUSIONS: Nocardia keratitis may not respond to 2% topical amikacin and fortified topical 5% amikacin may cause a strong toxic-allergic reaction. A commercially available combination of chloramphenicol, tetracycline, and colistin, with ofloxacin, may be effective but the treatment must be continued for several months. Topical steroids should only be used with considerable caution since they can lead to relapse of the infection.- - - - - - - - - - ranking = 0.75keywords = keratitis (Clic here for more details about this article) |
7/18. Confocal microscopy for Nocardia keratitis.PURPOSE: To assess the role of confocal microscopy for in vivo detection of Nocardia in patients with microbial keratitis. DESIGN: Retrospective interventional case series. PARTICIPANTS: Three patients with microbiologically proven Nocardia keratitis. INTERVENTION: Confocal microscopy. methods: We performed confocal microscopy in microbiologically proven cases of nocardia asteroides keratitis. A masked observer examined the images. For better understanding of the images, we also performed confocal microscopy on a blood agar culture plate with Nocardia growth. RESULTS: Confocal microscopy of infiltrated cornea revealed highly reflective, short, thin branching filaments with bright inflammatory cells in the background. The filaments were seen clearly at the edge of the infiltrate. In scans with faint images, these filaments became more visible on inversion of bright and dark components. Confocal microscopy of cultured organisms also revealed filamentous beaded structures with a morphology identical to that of those seen in vivo. CONCLUSION: Nocardia, a filamentous bacterium, produces a distinct image on confocal microscopy. This in vivo examination technique may be useful in cases of deep-seated infiltrates where routine microbiology workup does not yield positive results.- - - - - - - - - - ranking = 0.875keywords = keratitis (Clic here for more details about this article) |
8/18. nocardia asteroides keratitis: a case associated with soft contact lens wear.Ocular nocardiosis is rare. Most cases of nocardial keratitis have resulted from corneal trauma by objects contaminated with the organism. We describe the first case of nocardia asteroides keratitis associated with an extended wear soft contact lens. We also describe its successful treatment with topical trimethoprim-sulfamethoxazole in combination sulfacetamide.- - - - - - - - - - ranking = 0.75keywords = keratitis (Clic here for more details about this article) |
9/18. nocardia asteroides keratitis presenting as a persistent epithelial defect.An elderly male presented with epithelial defect which resisted all medical and therapeutic approaches until Gram stain and cultural report documented the presence of nocardia asteroides of the offending organism. A 3-month course of chronic keratitis with persistent epithelial defect resolved in 48 h following the use of topical trimethoprim-sulfamethoxazole.- - - - - - - - - - ranking = 0.625keywords = keratitis (Clic here for more details about this article) |
10/18. nocardia asteroides keratitis associated with extended-wear soft contact lenses.Chronic unilateral keratitis developed in a 34-year-old woman who wore extended-wear contact lenses. A clinical response was not obtained until nocardia asteroides was correctly identified as the causal agent. The response to 30% sulfacetamide was dramatic. We review the clinical presentation of Nocardia keratitis and recommendations for management. Use of corticosteroids should be avoided in Nocardia keratitis. This opportunistic organism should be considered in patients who wear contact lenses in whom infectious keratitis develops.- - - - - - - - - - ranking = 1keywords = keratitis (Clic here for more details about this article) |
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