Clinico-microbiological Profile Research Articles

Spectrum and clinicomicrobiological profile of Nocardia keratitis caused by rare species of Nocardia identified by 16S rRNA gene sequencing

To report the predisposing factors, clinical profile, and treatment outcome of patients with keratitis that was caused by a rare species of Nocardia. Between April 2006 and October 2008, medical and microbiology records of patients with keratitis that was caused by Nocardiawere reviewed. Isolates were identified to species level by 16S rRNAgene sequencing, and antibiotic susceptibility testing was performed by E-test to amikacin, azithromycin, clarithromycin, ciprofloxacin, gatifloxacin, and tobramycin. Of 19 cases with Nocardiakeratitis, 8 were caused by unusual isolates. Species distribution among the eight isolates was as follows: the Nocardia levis (2 of 8), Nocardia amamiensis (2 of 8), Nocardia abscessus (1 of 8), Nocardia puris (1 of 8), Nocardia beijingensis (1 of 8), and Nocardia thailandica (1 of 8). All eight (100%) isolates were sensitive to amikacin and tobramycin. Trauma to the cornea was the major predisposing factor in seven of the eight patients. Five patients presented with the characteristic wreath-pattern infiltrate. The infection resolved to topical therapy with amikacin sulphate (2.5%) in six patients, whereas two patients treated with the same antibiotic were lost to follow-up at a point when the lesion was showing signs of resolution. The healing response in Nocardiakeratitis cases was the same, irrespective of species.

Comparison of clinical and microbiological profiles in smear-positive and smear-negative cases of suspected microbial keratitis

To examine the hypothesis that initial smear examination results have a significant bearing on the management and outcome of suspected microbial keratitis. One hundred and seventy consecutive patients with suspected microbial keratitis were included in a prospective nonrandomized comparative study and their detailed clinical and microbiological data (smears and cultures of corneal scrapings) were captured on a predesigned corneal ulcer database. Patients were divided into two groups: Group 1 included 68 patients with corneal scrapings negative in smears while Group 2 included 102 patients with corneal scrapings positive in smears. The two groups were compared for their clinico-microbiological profile, management and clinical outcome. The outcome was noted at three months. Fisher's exact test was applied for statistical analysis. Cultures were sterile in 57.3% of patients in Group 1 compared to 17.6% in Group 2. Scrapings that grew S. pneumoniae, gram-negative organisms, fungi and Acanthamoeba were more often positive in smears (18.6%, 11.8%, 19.6% and 2.9% respectively). While data on duration of prior treatment was not available, prior medication made no significant difference to smear results. More (79.3%) patients of Group 1 had small infiltrate size ( Initial smear examination helps in instituting specific therapy thereby improving the outcome in cases of microbial keratitis. Positive smears indicate greater severity of disease and prior medication may not be a significant cause of smear negativity.

Clinico-microbiological profile and visual outcomes of post-traumatic endophthalmitis at a tertiary eye care center in South India

To analyze the clinical and microbiological characteristics of eyes with post-traumatic endophthalmitis and factors influencing the visual outcomes in these cases. We performed a retrospective chart analysis of the clinical and microbiological data of 97 consecutive patients with post-traumatic endophthalmitis presenting to a tertiary eye care hospital in South India. Thirty-nine (40.2%) cases were culture-positive, gram-positive cocci (n=24/42, 57.1%) being the commonest isolates. Staphylococcus epidermidis and Pseudomonas aeuruginosa were the commonest single isolates (n=10; 23.8%). Majority of the organisms were sensitive to chloramphenicol (n=27) or ciprofloxacin (n=26). Susceptibility to vancomycin (n=3) and amikacin (n=4) was poor. Cases with negative cultures at presentation were more likely to have improvement in visual acuity compared with culture-positive cases (on multivariate analysis, OR: 3.2, 95% CI: 1.1, 9.0). In this series of post-traumatic endophthalmitis, a high prevalence of resistance of the culture isolates to vancomycin and amikacin was observed.

Clinico-microbiological Profile and Visual outcome in Traumatic Endophthalmitis following Pars Plana Vitrectomy at a Tertiary Eye Care Centre of Nepal

Endophthalmitis is a potentially devastating ocular complication of perforating eye injury (PEI) where prompt intervention can save some vision. This study aims to explore the clinico-microbiologic profile and visual outcome following pars plana vitrectomy (PPV) in traumatic endophthalmitis. This is a retrospective interventional case series study conducted at a tertiary eye care centre of Nepal. A total of 49 consecutive cases (49 eyes) of endophthalmitis following PEI, who underwent PPV from January 2007 to June 2010 were included in the study. Mean age was 14.7 years (S.D. 14.27). Twenty seven patients (55%) were of age group below 10 years. Male to female ratio was 2.75:1. Mean duration of presentation was 8.9 days. Nineteen eyes (36.73%) had injuries with wooden sticks, followed by injury with metallic objects in 16 patients (32.56%). PEI involving zone I was found in 31 eyes (63.25%). The retained intraocular foreign body was found in seven patients (14.2%). The post operative vision improved in almost 24 cases (49%) with visual recovery of 20/200 and better in six cases (12.24%). The vitreous culture was positive in five cases (12.8%) with predominant streptococcus pneumonia in four cases (10.25%). Children were the mostly affected group with males outnumbering females. Wooden sticks and metallic objects were the commonest insulting agents. Despite the late presentation and predominant zone I injury, eye could be salvaged in majority with visual recovery of 20/200 and better in six cases (12.24%).