Outbreaks and control of rapidly growing mycobacterium keratitis

Abstract

Objective To study the cause and control of outbreaks of rapidly growing mycobacterium keratitis (RGMK). Methods This was a retrospective case series study. Eleven eyes of 11 patients with RGMK following corneal foreign body trauma were participants in a study at the local hospital. Case histories were taken at the local hospital and patient's workplaces were investigated, and environmental cultures were taken to identify potential contaminants in the new outpatient offices, examination rooms and the patient's workplaces. The control measures stressed the importance of aseptic technique, foreign body removal with disposable needles as opposed to a foreign-body spud soaked in 2% glutaral. The patients received local and systemic antibiotic therapy,lesion cleaning followed by cauterization with tincture of iodine (5%) and even keratoplasty. Results The outbreaks of RGMK were traced to nonsterile foreign bodies or foreign-body spuds treated with frustrane glutaral. Infections in 9 cases were successfully treated with a regimen that included a combination of antimicrobial agents and local lesion cleaning followed by cauterization with 5%tincture of iodine. Two cases that had a poor response to 6 months of antibiotic therapy were successfully treated by keratoplasty. Conclusion RGMK can occur in an epidemic fashion following corneal foreign body trauma. RGMK has a long response period to medical management and the recalcitrant infections can be resolved by keratoplasty. Enhanced workplace protection, attaching importance to aseptic techniques, improved sterilization, multiple antibiotic therapy and close follow-up after removal will help to prevent outbreaks of RGMK. Key words: Mycobacteria,rapidly growing; Keratitis; Disease outbreaks; Control measure