Abstract
Stevens - Johnson syndrome (SJS) has manifestation through the exfoliation of epidermis and mucosal tissue. Ocular surface is usually affected in acute and chronic stage. The patients are usually suffered from chronic ocular sequelae including symblepharon, limbal stem cell deficiency, etc. Furthermore, ocular microbiome may also be altered in SJS. This is prospective, age and sex matched analytical study which including 20 chronic SJS patients and 20 healthy subjects for specimen collection from inferior conjunctiva for microbiome analysis by conventional cultures and Next-Generation Sequencing (NGS) methods. Significant higher proportion of positive-cultured specimen was demonstrated in SJS group (SJS group 60%, healthy 10%, p-value = 0.001). In addition, NGS which providing high-throughput sequencing has demonstrated the greater diversity of microbial species. The higher proportion of pathogenic microorganisms including Pseudomonas spp., Staphylococcus spp., Streptococcus spp., Acinetobacter spp. was shown in SJS group. Ocular surface in SJS is usually occupied by more diverse microorganisms with increased proportion of pathogenic species. This condition may affect chronic inflammation and opportunistic infections in SJS group. In order to prevent and treat infection in these patients, appropriate antibiotics based on bacterial examination should be considered as the first-line treatment in the SJS patients.
Highlights
Stevens - Johnson syndrome (SJS) is an abnormal immune-mediated responses stimulated by medications such as sulfonamides, allopurinol, cold medicines including paracetamol[1] and systemic infections caused by virus and mycoplasma
Chronic SJS patients were classified according to severity score based on chronic ocular complications[13]
We found a higher incidence www.nature.com/scientificreports of culture-positive specimens in SJS group comparing with healthy subjects (p = 0.001) as has been shown in the study from Venugopal, et al A greater variation of bacterial species was found in SJS group which is consistent with previous studies[20]
Summary
Stevens - Johnson syndrome (SJS) is an abnormal immune-mediated responses stimulated by medications such as sulfonamides, allopurinol, cold medicines including paracetamol[1] and systemic infections caused by virus and mycoplasma. Et al reported different compositions of microorganisms in SJS patients consisting of 55% of gram-positive cocci, 19% of gram-positive bacilli, and 25% of gram-negative bacilli[4] They found that these pathogenic organisms showed higher tendency of antimicrobial resistance pattern to conventional antibiotics. Alterations in the ocular microbial community may link to higher rate of infection in SJS patients who underwent ocular surgeries, such as high incidence of endophthalmitis following keratoprosthesis[6], ocular surface reconstruction by amniotic membrane with living related corneal limbal/conjunctival. Et al.[8] reported that SJS was a significantly associated factor for patients to develop methicillin-resistant Staphylococcus aureus (MRSA)- methicillin-resistant Staphylococcus epidermidis (MRSE) keratitis This altered microbiome may be affected by abnormality of host innate immunity as reported by Ueta and Kinoshita[9]. We conducted this study using both microbiologic and NGS studies to identify ocular microbiome changes in SJS compared with healthy subjects
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