Bacterial Ulcers Research Articles

Corneal bacterial infections: A practical approach

SummaryBecause of their potential to permanently impair vision or perforate the eye, bacterial corneal ulcers are an ophthalmologic emergency. “ ey usually follow an insult (sometimes minor) in the corneal epithelium that provides an entry for bacteria. “ e increased use of soft contact lenses in recent years has led to an important rise in the occurrence of bacterial ulcers (especially aggressive Gram‐ bacteria). In this course you will learn about the new concepts in bacterial ulcers diagnosis and treatment.

Infectious keratitis and orthokeratology lens use: a systematic review.

Myopia is a prevalent condition among Asians. Orthokeratology lens has gained popularity as a method of myopia control. This systematic review is to summarize the clinical profile of infectious keratitis in association with orthokeratology lens wear. We searched in the PubMed and EMBASE for articles adopting the search strategy "(orthokeratology lens OR orthokeratology) AND (bacterial eye infection OR keratitis OR cornea ulcer OR microbial keratitis OR bacterial keratitis)", from the start date of the databases to August 23, 2016. Articles reporting infectious keratitis in orthokeratology lens users with data of individual cases were considered eligible for this systematic review. We recorded the outcome measures including method of diagnosis, etiological agents, duration and mode of treatment and treatment outcomes. Our literature search yielded 172 papers. After removing duplicated and irrelevant reports, we included 29 articles for data analysis, involving 173 eyes. Among all reported cases, the mean age at presentation was 15.4±6.2years, with a female preponderance (male-to-female ratio 1:1.7). Positive microbiological cultures were reported in 69.4% of cases, with Pseudomonas aeruginosa and Acanthamoeba being the most common etiological agents. The mean duration of hospitalization was 7.7±6.7days. Mean LogMAR visual acuity at presentation was 1.17±0.78, increased to 0.33±0.41 at final visit (p<0.001). Despite early intervention and treatment, the majority of infections resulted in the formation of corneal scars and almost 10% of eyes needed surgical treatment. Timely awareness and treatment of keratitis should be emphasized to the users.

The results of therapeutic keratoplasties performed in severely thinned or perforated corneas

Purpose: To report the visual and anatomic outcomes of therapeutic keratoplasties performed in severely thinned or perforated corneas.Material and methods: Medical records of 37eyes of 37 patients operated between 2000 to 2014 were reviewed retrospectively. Indications, preoperative findings, surgical procedures, donor size, post-operative graft clarity, visual improvement, globe integrity and follow-up periods were analyzed. Mean age was 57,7 (20-85 ). Nineteen patients were male and 18 female. Mean follow-up was 28.7 (14-132) months.Results: Surgical indication was infectious in 17 (45.9%) and noninfectious in 20 eyes (54.1%). Infectious causes were bacterial ulcer 8 (21.7%), herpes simplex 7 (18.9%) and fungus in 2 (5.4%) eyes. Noninfectious causes were traumatic 6 (16.2%), Stevens-Johnson syndrome 2 (5.4%), desmatocele 2 (5.4%) other causes ( keratectasia, bullous keratopathy, acne rosacea, interstitial keratitis, lagophthalmos, and rheumatoid arthtritis). The underlying cause of cornel melting was unknown in 4 eyes (10.8%). Combined PK was performed in18 of 37 eyes (48.7%), PK alone in 14 (37.8%) and patch graft in 5 (13.5%). Graft survival rate was 30/37 (81.1%) through follow-up. Anatomical integrity was achieved in 23 (92.0%) of 25 perforated corneas. Visual improvement was obtained in 28 eyes (75.6%). Visual acuity was ≥ 0.05 in 6 eyes (16.2%) preoperatively, it increased to 22 eyes (59.4%) post-operatively.Conclusion: Therapeutic keratoplasty including PK and patch grafting is an effective surgical procedure in patients with severe corneal melting or perforation due to varying aetiologies. It restores the globe integrity also provides visual improvement.

THE ROLE OF MICROTRAUMA IN THE DEVELOPMENT OF BACTERIAL CORNEAL ULCERS

Purpose: To study the role of corneal microtrauma in the development of complications, leading to bacterial ulcers. Performed clinical assessment, conservative therapy, and surgical interventions for 236 patients with the complication of microtrauma, mainly related to the prolonged presence of foreign bodies in the cornea (86.1% they had a metallic nature). Methods included ophthalmologic investigations and laboratory procedures, which revealed the presence of bacterial corneal ulcer in 97 cases (41.1%), recurrent erosion — 62 cases (26.3%), traumatic keratitis — 25 cases (10.6%) and deep cornea’s infiltrate — 52 cases (22.0%). The development of complications was due to the later removal of FB (in some cases more than 1 month after the trauma), incomplete removal of foreign bodies, non-compliance with aseptic and antiseptic rules during in the removal of FB’s without follow up of patients. Streptococcus, staphylococcus, pneumococcus, and isolated cases of Pseudomonas aeruginosa and Escherichia coli were mainly diagnosed. Conservative therapy included specific, pathogenetic, symptomatic and antiallergic medications. Nitric oxide (NO) in the gas stream was used to accelerate the reparative processes, weakening of the inflammatory exudation and cellular proliferation. Surgical interventions were performed for preserving of eyes, prophylactic and therapeutic purposes in the form autoconjunctiveal plast y, deep lamellar and penetrating keratoplast y (preserved and fresh corneas) and amniotic membrane transplantation. According to the results of treatment of 236 patients with the corneal erosion completed with elimination of inflammatory reaction, restoration of corneal transparency; 52 patients with corneal infiltrate -development of opacities in the stromal cornea layers; patients with keratitis –formation of corneal leucoma and 52% — keratoplast y were performed. In cases of corneal ulcer process ended with the formation of a rough leucoma in 30 patients (30.9%), surgical interventions with a partial improvement of visual function were observed in 62 patients (63.9%), the removal of the eye were done in 5 patients (5.2%).

Epidemiologic characteristics, predisposing risk factors, and etiologic diagnosis of corneal ulceration in Belagavi

Purpose: To evaluate the factors predisposing to the onset of corneal ulceration and to identify the specific causative organisms. Materials and Methods: This was a 1-year cross-sectional study. Fifty patients with infectious keratitis were included in the study. A detailed history with documenting his/her sociodemographic information, presenting complaints, previous treatment, predisposing ocular conditions, and associated risk factors was noted, followed by slit lamp biomicroscopy and scraping for staining and culture analysis. Results: Bacterial infections were noted more commonly (28%) than fungal infections (12%) with Streptococcus pneumoniae and Staphylococcus aureus accounting for the majority of bacterial ulcers (68.75%), and Fusarium species and Aspergillus species were equally (50% each) responsible for most of the fungal infections. The most common predisposing risk factor is ocular trauma (74%). Conclusion: Comprehensive surveys are necessary to assess the specific epidemiological characteristics of corneal ulceration, which are unique for each region and population. It in turn helps to define the magnitude of the problem and design efficient public health programs for its management.

Demographic profile of Suppurative keratitis

Background: Corneal infections are the second most common cause of ocular blindness due to lack of diagnostic facilities and initiation of appropriate antimicrobial therapy. Suppurative Kerititis is defined as loss of corneal epithelium with underlying stromal infiltration and suppuration associated with signs of inflammation with or without hypopyon. The epidemiological pattern and causative agents for suppurative corneal ulcer varies. It is important to determine the aetiology for comprehensive strategy for the diagnosis and treatment of corneal ulcer. Materials and Methods: This is a prospective study conducted on 819 consecutive patients with clinical diagnosis of suppurative keratitis. Results: 819 cases with clinical diagnosis of suppurative keratitis were enrolled in this study. A history of previous corneal injury was present in 512 patients (62.5%). Central corneal ulcers were found in 680(83%) patients. Superficial corneal ulcers found in 699(85.3%) patients. Cornea cultures were positive in 730 patients (89%). Of those individuals with positive cultures 498 (60.8%) had pure bacterial infections, 232 (28.3%) had pure fungal infection.In this study of 498 bacterial isolates Staphylococcus.epidermidis 62.2%, Staph.aureus 32.12 % and Pseudomonas aeroginosa 4%. Conclusion: Trauma with stick and stone particles was an important cause. Staphylococcus.epidermidis and Staph.aureus were common bacteriological agents. . corneal ulceration is a common problem in India and most often occurs after a superficial corneal injury with organic material. Bacterial infections with Staph.epidermidis accounting for the majority of bacterial ulcers. These findings have important public health implications for the treatment and prevention of corneal ulcer.

Correlates of bacterial ulcers and acute HSV-2 infection among men with genital ulcer disease in South Africa: age, recent sexual behaviours, and HIVi,ii

Data from baseline surveys and STI/HIV laboratory tests (n=615 men) were used to examine correlates of bacterial ulcers (Treponema pallidum, Haemophilus ducreyi, or Chlamydia trachomatis L1-L3 detected in ulcers) and acute HSV-2 ulcers (HSV-2 positive ulcer specimen, HSV-2 sero-negative, and negative for bacterial pathogens) versus recurrent HSV-2 ulcers (seropositive), separately. Men with bacterial ulcers had larger ulcers compared to men with recurrent HSV-2 ulcers, but were less likely to be HIV-positive; whereas, men with acute HSV-2 ulcers were younger with fewer partners. Acute HIV was higher among men with bacterial and acute HSV-2 ulcers; however, this difference was not statistically significant.

Emerging trends in contact lens-related infections.

This article reviews the literature on past and recent trends in contact lens-related microbial keratitis from bacterial, fungal, and Acanthamoeba infections. Contact lens wear is the most important risk factor for microbial keratitis. Despite increased use of daily disposable contact lens wear, the incidence of bacterial ulcers related to contact lens wear remains high. Overnight contact lens wear is the leading risk factor in contact lens-related bacterial infections. There may be a trend towards increasing antibiotic resistance of Gram-positive bacteria to fourth-generation fluoroquinolones. The incidence of Acanthamoeba and fungal infections, despite resolution of two outbreaks involving multipurpose solutions, are also on the rise. Contact lens-related microbial keratitis is rising and may be associated with more severe, vision threatening, infections.

Correlates of Bacterial Ulcers and Acute HSV-2 Infection among Men with Genital Ulcer Disease in South Africa: Age, Recent Sexual Behaviors, and HIV.

Data from baseline surveys and STI/HIV laboratory tests (n=615 men) were used to examine correlates of bacterial ulcers (Treponema pallidum, Haemophilus ducreyi, or Chlamydia trachomatis L1-L3 detected in ulcer) and acute HSV-2 ulcers (HSV-2 positive ulcer specimen, HSV-2 sero-negative, and negative for bacterial pathogens) vs. recurrent HSV-2 ulcers (sero-positive), separately. Compared to men with recurrent HSV-2 ulcers, men with bacterial ulcers had larger ulcers but were less likely to be HIV-positive whereas men with acute HSV-2 ulcers were younger with fewer partners. Acute HIV was higher among men with bacterial and acute HSV-2 ulcers; the difference was not statistically significant.

Abomasal ulcers in slaughtered cattle in Austria.

In this preliminary study, the prevalence of abomasal ulcers in cattle in Austria was evaluated for the first time. Furthermore, possible management factors contributing to the formation of abomasal ulcers and the diagnostic ability of faecal occult blood tests were evaluated. Abomasa of 91 calves, 33 cows and 91 bulls were examined for abomasal ulcers after slaughter. The ulcers were recorded, abomasal content pH was measured and faeces were examined for occult blood. The carcass classification was recorded and the owners were presented with a voluntary questionnaire targeted at health-, management- and feeding-practices that could influence gastric health. The median abomasal pH was 3.0 in calves, 3.6 in bulls and 3.9 in cows. More than 50% of all animals had abomasal ulcers, all of which belonged to the slightest kind of lesion. Faecal occult blood tests proved not to be suitable for detecting these ulcers. From the questionnaire no clear tendencies as far as causative factors for abomasal ulcers could be determined. It can be assumed that cattle management systems in Austria contribute to the formation of low-grade abomasal ulcers. Due to the lack of a suitable in vivo model to research the formation of abomasal ulcers in cattle all further speculations must remain elusive. Further influencing factors, such as bacterial ulcer colonization, and the true economic and animal welfare impact of these findings need further investigation. The results of this study should be corroborated in a larger, prospective trial.

Watch your step: caring for feet

Keeping our toenails neat and our underfoot callouses under control is something we take for granted when we’re relatively young and able bodied. As Age UK’s Foot Care Coordinator for Chorley, West Lancs and Sefton, I work with people who can no longer undertake their own basic foot care independently. If people in this situation cannot readily get someone to help with their feet, for financial reasons or otherwise, serious foot problems can develop. Toenails, for instance, can grow over the toes, piercing the skin and leading to possible infection, mobility problems and falls. The skin in-between toes can also become macerated, providing an ideal environment for fungal infections, which if untreated, can develop into bacterial infection and ulceration. Painful corns and calluses can also cause problems with walking, which can lead to falls, especially if some degree of instability co-exists. Frequently, these serious and often embarrassing foot problems could have been avoided with daily foot care. If only family, friends and carers were given the knowledge and confidence to help with basic foot care, and to recognise when to seek professional help! With this in mind, I developed the concept of Footcareunited: a voluntary initiative to provide free training on basic foot health to family, friends, carers and volunteers involved in care for the elderly. The idea is that Footcareunited will offer basic foot care advice and training to anyone in a caring role, giving them the knowledge and confidence to provide ongoing help to those who need it. This would not only mean that many serious foot problems could be avoided, but would also help to further develop closeness between the care giver and receiver. In 2014 I applied for the Cosyfeet Podiatry Award in the hope that the £1000 prize money could be used to turn the Footcareunited concept into a reality. I’m pleased to say that I was successful! I am now in the planning stages of setting up Footcareunited with Cosyfeet’s help. Now in its tenth year, the Cosyfeet Podiatry Award assists podiatrists and podiatry students to develop their professional knowledge and skills while benefitting others. The award is open to those who are planning voluntary work, a work placement or research, whether in the UK or abroad. As I am currently studying podiatry part-time at Salford University I qualified to enter and am so pleased I did. In a future issue of Nursing and Residential Care I hope to write about how the Footcareunited concept has been turned into a reality, and let you know how you, as a carer, can get involved.

Astaxanthin supplementation delays physical exhaustion and prevents redox imbalances in plasma and soleus muscles of Wistar rats.

Astaxanthin (ASTA) is a pinkish-orange carotenoid commonly found in marine organisms, especially salmon. ASTA is a powerful antioxidant and suggested to provide benefits for human health, including the inhibition of LDL oxidation, UV-photoprotection, and prophylaxis of bacterial stomach ulcers. Exercise is associated to overproduction of free radicals in muscles and plasma, with pivotal participation of iron ions and glutathione (GSH). Thus, ASTA was studied here as an auxiliary supplement to improve antioxidant defenses in soleus muscles and plasma against oxidative damage induced by exhaustive exercise. Long-term 1 mg ASTA/kg body weight (BW) supplementation in Wistar rats (for 45 days) significantly delayed time to exhaustion by 29% in a swimming test. ASTA supplementation increased scavenging/iron-chelating capacities (TEAC/FRAP) and limited exercise-induced iron overload and its related pro-oxidant effects in plasma of exercising animals. On the other hand, ASTA induced significant mitochondrial Mn-dependent superoxide dismutase and cytosolic glutathione peroxidase antioxidant responses in soleus muscles that, in turn, increased GSH content during exercise, limited oxidative stress, and delayed exhaustion. We also provided significant discussion about a putative “mitochondrial-targeted” action of ASTA based on previous publications and on the positive results found in the highly mitochondrial populated (oxidative-type) soleus muscles here.

Surgical therapies for corneal perforations: 10 years of cases in a tertiary referral hospital.

PurposeTo report surgical therapies for corneal perforations in a tertiary referral hospital.MethodsThirty-one eyes of 31 patients (aged 62.4±18.3 years) with surgically treated corneal perforations from January 2002 to July 2013 were included in this study. Demographic data such as cause of corneal perforation, surgical procedures, and visual outcomes were retrospectively analyzed.ResultsThe causes of corneal perforation (n=31) were divided into infectious (n=8, 26%) and noninfectious (n=23, 74%) categories. Infectious causes included fungal ulcer, herpetic stromal necrotizing keratitis, and bacterial ulcer. The causes of noninfectious keratopathy included corneal melting after removal of a metal foreign body, severe dry eye, lagophthalmos, canaliculitis, the oral anticancer drug S-1, keratoconus, rheumatoid arthritis, neurotrophic ulcer, atopic keratoconjunctivitis, and unknown causes. Initial surgical procedures included central large corneal graft (n=17), small corneal graft (n=7), and amniotic membrane transplantation (n=7). In two cases the perforation could not be sealed during the first surgical treatment and required subsequent procedures. All infectious keratitis required central large penetrating keratoplasty to obtain anatomical cure. In contrast, several surgical options were used for the treatment of noninfectious keratitis. After surgical treatment, anatomical cure was obtained in all cases. Mean postoperative best corrected visual acuity was better at 6 months (logMAR 1.3) than preoperatively (logMAR 1.8).ConclusionSurgical therapies for corneal perforations in our hospital included central large lamellar/penetrating keratoplasty, small peripheral patch graft, and amniotic membrane transplantation. All treatments were effective. Corneal perforation due to the oral anticancer drug S-1 is newly reported.

In vitro studies on medicinal plants used against bacterial diabetic foot ulcer (BDFU) and urinary tract infected (UTI) causing pathogens

The pus samples from diabetic foot ulcer patients and urine samples from urinary tract infected patients were collected and inoculated in nutrient agar plates. The colonies showing different morphologies were streaked on selective agar plates. The antibacterial assay of selected commercial antibiotics was tested against the foot ulcer and urinary tract isolates. The result revealed that most of the organisms were found to be resistant against the antibiotics. Screening of antibacterial activity of selected plants, methanol extracts of plants were prepared and tested against foot ulcer pathogens. Among the plants used, the methanolic extract Tragia involucrata was very effective against the foot ulcer pathogens and to separate the compounds present in the methanolic extract of T. involucrata, when it was subjected to column chromatography. The fractions obtained were further checked for their antibacterial property and fraction 1 which inhibited the pathogens, were subjected to thin layer chromatography and the structure of the particular phytochemical compound was elucidated by NMR study. The spices were tested for their antibacterial property against the urinary tract pathogens. Among the spices tested; Allium sativum inhibited the growth of the pathogens isolated from urinary tract infection. It can be concluded that the plants extract can be used to discover natural products that may serve as lead for the development of new pharmaceuticals addressing the major therapeutic needs.

An update on corneal bacterial infections

AbstractBecause of their potential to permanently impair vision or perforate the eye, bacterial corneal ulcers are an ophthalmologic emergency. They usually follow an insult (sometimes minor) in the corneal epithelium that provides an entry for bacteria. The increased use of soft contact lenses in recent years has led to an important rise in the occurrence of bacterial ulcers (especially aggressive Gram‐ bacteria). The goal of this presentation is to propose a practical, systematic approach of the management of bacterial corneal ulcers, as well as an update on new concepts in the diagnosis and treatment of those conditions.

Role of argon laser as an adjunctive therapy for treatment of resistant infected corneal ulcers.

PurposeTo evaluate the role of argon laser as an adjunctive therapy in ten patients with resistant infected corneal ulcers with or without hypopyon.MethodsThe study included 20 patients, split into two groups of ten, with resistant infected corneal ulcers with or without hypopyon. One group was considered as the control group and treated with local and systemic specific antimicrobial drugs guided with culture and sensitivity tests. The other group started with the same specific therapy as the control group for 1 week with no obvious improvement and then was further treated with argon laser. The ten patients in the control group included five cases of fungal ulcers, three mixed (fungal and bacterial) ulcers, and two viral ulcers. The ten patients in the other group included three cases of fungal ulcers, three mixed (fungal and viral) ulcers, three viral ulcers, and one bacterial ulcer as proven with microbial culture and sensitivity tests. Eight cases of the control group and seven cases of the other group were associated with hypopyon. Before laser treatment, a drop of benoxinate hydrochloride 0.4% and a single drop of fluorescein sodium 0.25% were instilled. Argon laser irradiation of the affected cornea was performed using an argon 532 nm wavelength (Carl Zeiss LSL 532s AG; Carl Zeiss Meditec AG, Jena, Germany). A spot size of 500 μm, pulse duration of 0.2 seconds, and power of 900 mW were used. All cases were followed up for 3 months after healing was achieved.ResultsDuring the first 4 weeks after laser treatment, all patients showed complete healing of the epithelial defect and resolution of stromal infiltration with no adverse effects. In the control group, four cases needed an amniotic membrane graft due to thinning and the other six cases were healed in a duration that ranged from 3 to 7 weeks.ConclusionArgon laser phototherapy is useful as an adjunctive treatment for resistant infected corneal ulcers. More cases are needed to get more reliable results and to confirm our findings.

THE ROLE OF OXIDATIVE STRESS IN THE PATHOGENESIS OF THE BACTERIAL CORNEAL ULCER

In the article the current ideas of a role of free radical processes in physiology of a cornea and microorganisms are surveyed. The role of an oxidative stress in the pathogenesis of the bacterial corneal ulcer is discussed. The review of researches on the application of antioxidants for treatment of a bacterial ulcer is done.

Evidence of the anti-Helicobacter pylori, gastroprotective and anti-inflammatory activities of Cuphea aequipetala infusion

Ethnopharmacological relevanceCuphea aequipetala (Lythraceae) is a medicinal plant highly appreciated in Mexico to treat stomach ailments such as pain and burning sensation, stomach infections, ulcers, diarrhea, dysentery, and different types of tumors and bruises. In this work, the infusion of aerial parts of this plant (CAI) was investigated for its polypharmacological potential. Materials and methodsIn vitro anti-Helicobacter pylori activity was assessed by broth dilution method. Pharmacological studies included acute toxicity in mice using Lorke´s model, anti-inflammatory activity by xylene and TPA induced ear edema assay, as well as gastroprotection with ethanol-induced gastric ulcer model. DPPH and ABTS assays were used to determine antioxidant capacity. Polyphenols and flavonoid contents were determined by Folin–Ciocalteu method and AlCl3 reaction, respectively. ResultsCAI showed good anti-Helicobacter pylori activity with a MIC of 125μg/mL. The infusion was not toxic according to Lorke's model with a LD50 greater than 5g/kg. CAI exhibited low anti-edematogenic action in the models assayed. Oral administration of 300mg/kg CAI significantly reduced gastric lesions by 87.9%. The effect was reversed only by indomethacin and N-ethylmaleimide demonstrating the role of endogenous prostaglandins and sulfhydryl compounds in gastroprotection. Total phenolic and flavonoid contents of CAI were 109.9mg GAE/g DW and 28.1mg QE/g DW, respectively, and the infusion exhibited a good antioxidant activity that is thought to play a role in its biological activity. The analysis of a preliminary fractionation of the infusion indicates that the complete extract conserves all its pharmacological activities in contrast to fractionated extracts. ConclusionsCuphea aequipetala is a promising native herb in an integral therapy for the treatment of bacterial or non-bacterial gastric ulcer because it possesses some anti-inflammatory properties, as well as exhibits good gastroprotective and antibacterial effects. It represents an important source for the isolation of anti-Helicobacter pylori compounds. This work provides ethnopharmacological evidence that supports the traditional use of this species.

Corneal bacterial infections: A practical approach

AbstractBecause of their potential to permanently impair vision or perforate the eye, bacterial corneal ulcers are an ophthalmologic emergency. They usually follow an insult (sometimes minor) in the corneal epithelium that provides an entry for bacteria. The increased use of soft contact lenses in recent years has led to an important rise in the occurrence of bacterial ulcers (especially aggressive Gram‐ bacteria). The goal of this course is to present a practical, systematic approach of the management of bacterial corneal ulcers, as well as an update on new concepts in the diagnosis and treatment of those conditions.

Corneal bacterial infections

AbstractBecause of their potential to permanently impair vision or perforate the eye, bacterial corneal ulcers are an ophthalmologic emergency. They usually follow an insult (sometimes minor) in the corneal epithelium that provides an entry for bacteria. The increased use of soft contact lenses in recent years has led to an important rise in the occurrence of bacterial ulcers (especially aggressive Gram‐ bacteria). In this course you will learn about the new concepts in bacterial ulcers diagnosis and treatment.