Current diagnostic tools and management modalities of Nocardia keratitis

Mohammad Soleimani,Ahmad Masoumi,Mostafa Heidari,Alireza Izadi,Sadegh Khodavaisy,Ali A Haydar

doi:10.1186/s12348-020-00228-w

Mohammad Soleimani, Ahmad Masoumi + Show 4 more

Open Access

https://doi.org/10.1186/s12348-020-00228-w

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Abstract

Nocardia species are an uncommon but important cause of keratitis. The purpose of this review is to discus previous published papers relation to the epidemiology, etiology, diagnosis and management of Nocardia keratitis. Nocardia asteroides is the most frequently reported from Nocardia keratitis. Pain, photophobia, blepharospasm and lid swelling are mainly clinical manifestations. Usual risk factors for Nocardia keratitis are trauma, surgery, corticosteroids, and contact lens wear. Several antibiotics were used for treatment of Nocardia infection but according to studies, topical amikacin is the drug of choice for Nocardia keratitis. Topical steroid should not prescribe in these patients. In conclusion, although Nocardia keratitis is rare, early diagnosis and treatment are essential to prevent any scar formation and preserve a good visual acuity.

Highlights

IntroductionA review of the literature conducted based on the database sources such as MEDLINE, web of scence, Scopus, PubMed and Google scholar from 2000 up to now
Nocardia are a rare cause of infectious keratitis
Patients present after being treated with multiple empiric antibiotics for bacterial and/or fungal keratitis which may not have an appropriate effect on Nocardia species

Summary

Introduction

A review of the literature conducted based on the database sources such as MEDLINE, web of scence, Scopus, PubMed and Google scholar from 2000 up to now. We searched all valuable and relevant information considering the epidemiology, etiology, diagnosis and management of Nocardia keratitis. The following keywords were used: Nocardia, keratitis, corneal ulcer, confocal microscopy, amikacin, keratoplasty, actinomycetes, and ocular trauma. Bacteriology The genus Nocardia is an aerobic Actinomycete known to cause disseminated and focal infections in humans. Nocardia species are Gram-variable, obligate aerobic, non-motile, branching, beaded filamentous, weakly acidfast bacilli, of the family Actinomycetaceae. Nocardia are a rare cause of infectious keratitis. The diagnosis of Nocardia keratitis is challenging because they are not commonly encountered in clinical practice and mainly mimic fungal keratitis [2]. Patients present after being treated with multiple empiric antibiotics for bacterial and/or fungal keratitis which may not have an appropriate effect on Nocardia species. Nocardia keratitis clinical presentation includes ocular pain—out of proportion to exam—photophobia, blepharospasm, and eyelid edema.

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