Conjunctival Infection Research Articles

Dry Eye Disease Prevalence and Associated Risk Factors Among the Middle East Population: A Systematic Review and Meta-Analysis.

Dry eye disease (DED) is a common condition characterized by a loss of the tear film function, leading to symptoms of ocular discomfort and damage to the ocular surface. The prevalence and associated risk factors of DED may vary by region due to environmental, cultural, and genetic differences. The aim of the present study is to systematically review and analyze the prevalence and risk factors of DED in the Middle East (ME) region. This study adhered to the PRISMA 2020 guidelines. A comprehensive literature search was conducted using databases such as Web of Science, Scopus, Google Scholar, and PubMed to identify relevant studies published from January 2004 to July 2024. Studies included in the review were those that provided data on the prevalence and risk factors of DED in Middle Eastern populations. Data were extracted and analyzed to determine overall pooled prevalence and associated risk factors using a random-effects model. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number CRD42024583897. The meta-analysis included 17 studies from 10 countries with a total of 22,087 subjects. The estimated pooled prevalence of DED in the ME region was 28.33% (95% CI: 27.74-28.93). The primary risk factors include age, female gender, and smoking. Other risks are contact lens use, prolongedscreen time (over six hours daily), diabetes, glaucoma medications, allergies, autoimmune diseases, refractive surgery, arthritis, high cholesterol, acne treatments, antihistamines, antidepressants, thyroid disease, and a history of conjunctival infections or corneal abrasions. The prevalence of DED in Middle Eastern countries was higher than the global estimate, highlighting significant regional variation. Common risk factors for DED include older age, female gender, and smoking. These findings underscore the need for targeted prevention and management strategies that address the specific risk factors prevalent in the Middle Eastern population.

Macrolide-loaded nanofibrous inserts with polycaprolactone and cellulose acetate base for sustained ocular delivery: Pharmacokinetic study in Rabbit’s eye

The present study aimed to prepare nanofibrous inserts for sustained ocular drug delivery of Azithromycin (AZM) toward conquering the obstacles of conventional topical drug delivery. Nanofibers were fabricated by electrospinning using polycaprolactone (PCL) and cellulose acetate (CA) which are biocompatible and biodegradable polymers. Prepared nanofibers were evaluated in terms of physicochemical, morphological properties, pharmacokinetic study and ocular irritation. SEM images revealed average diameters of about 160 nm and 190 nm for CA and PCL nanofibers, respectively. These ocular drug delivery systems were strong, flexible, and stable under humid and dry conditions. Quantification was performed using microbiological assay by M. luteus as a microorganism. While PCL-based nanofibrous inserts released AZM in a two-step manner initiated by a burst release via Peppas kinetical model, CA-based inserts showed a gradual release profile without any burst release which followed the first-order model. Results showed that these inserts were non-cytotoxic and non-irritating. The nanofibers showed antibacterial efficacy against Escherichia coli and Staphylococcus aureus. In addition, according to a pharmacokinetic study in Rabbit’s Eye, a higher Cmax and lower Tmax were achieved by PCL nanofibers compared to CA-based ones. The pharmacokinetic study of nanofibers in rabbit eyes showed that all formulations were able to maintain the effective concentration of AZM for about 6 days. In conclusion, the prepared nanofibers can be effectively utilized for prolonged ocular delivery of AZM in the treatment of conjunctival infections.

Pangenomic and biochemical analyses of Helcococcus ovis reveal widespread tetracycline resistance and a novel bacterial species, Helcococcus bovis.

Helcococcus ovis (H. ovis) is an opportunistic bacterial pathogen of a wide range of animal hosts including domestic ruminants, swine, avians, and humans. In this study, we sequenced the genomes of 35 Helcococcus sp. clinical isolates from the uterus of dairy cows and explored their antimicrobial resistance and biochemical phenotypes in vitro. Phylogenetic and average nucleotide identity analyses classified four Helcococcus isolates within a cryptic clade representing an undescribed species, for which we propose the name Helcococcus bovis sp. nov. By establishing this new species clade, we also resolve the longstanding question of the classification of the Tongji strain responsible for a confirmed human conjunctival infection. This strain did not neatly fit into H. ovis and is instead a member of H. bovis. We applied whole genome comparative analyses to explore the pangenome, resistome, virulome, and taxonomic diversity of the remaining 31 H. ovis isolates. An overwhelming 97% of H. ovis strains (30 out of 31) harbor mobile tetracycline resistance genes and displayed significantly increased minimum inhibitory concentrations of tetracyclines in vitro. The high prevalence of mobile tetracycline resistance genes makes H. ovis a significant antimicrobial resistance gene reservoir in our food chain. Finally, the phylogenetic distribution of co-occurring high-virulence determinant genes of H. ovis across unlinked and distant loci highlights an instance of convergent gene loss in the species. In summary, this study showed that mobile genetic element-mediated tetracycline resistance is widespread in H. ovis, and that there is evidence of co-occurring virulence factors across clades suggesting convergent gene loss in the species. Finally, we introduced a novel Helcococcus species closely related to H. ovis, called H. bovis sp. nov., which has been reported to cause infection in humans.

Multimodal mucosal and systemic immune characterization of a non-human primate trachoma model highlights the critical role of local immunity during acute phase disease.

Trachoma is a leading cause of infection-related blindness worldwide. This disease is caused by recurrent Chlamydia trachomatis (Ct) infections of the conjunctiva and develops in two phases: i) active (acute trachoma, characterized by follicular conjunctivitis), then long-term: ii) scarring (chronic trachoma, characterized by conjunctival fibrosis, corneal opacification and eyelid malposition). Scarring trachoma is driven by the number and severity of reinfections. The immune system plays a pivotal role in trachoma including exacerbation of the disease. Hence the immune system may also be key to developing a trachoma vaccine. Therefore, we characterized clinical and local immune response kinetics in a non-human primate model of acute conjunctival Ct infection and disease. The conjunctiva of non-human primate (NHP, Cynomolgus monkeys-Macaca fascicularis-) were inoculated with Ct (B/Tunis-864 strain, B serovar). Clinical ocular monitoring was performed using a standardized photographic grading system, and local immune responses were assessed using multi-parameter flow cytometry of conjunctival cells, tear fluid cytokines, immunoglobulins, and Ct quantification. Clinical findings were similar to those observed during acute trachoma in humans, with the development of typical follicular conjunctivitis from the 4th week post-exposure to the 11th week. Immunologic analysis indicated an early phase influx of T cells in the conjunctiva and elevated interleukins 4, 8, and 5, followed by a late phase monocytic influx accompanied with a decrease in other immune cells, and tear fluid cytokines returning to initial levels. Our NHP model accurately reproduces the clinical signs of acute trachoma, allowing for an accurate assessment of the local immune responses in infected eyes. A progressive immune response occurred for weeks after exposure to Ct, which subsided into a persistent innate immune response. An understanding of these local responses is the first step towards using the model to assess new vaccine and therapeutic strategies for disease prevention.

Acceptability and feasibility of tests for infection, serological testing, and photography to define need for interventions against trachoma.

Trachoma causes blindness due to repeated conjunctival infection by Chlamydia trachomatis (Ct). Transmission intensity is estimated, for programmatic decision-making, by prevalence of the clinical sign trachomatous inflammation-follicular (TF) in children aged 1-9 years. Research into complementary indicators to field-graded TF includes work on conjunctival photography, tests for ocular Ct infection, and serology. The perceived acceptability and feasibility of these indicators among a variety of stakeholders is unknown. Focus group discussions (FGDs) with community members and in-depth interviews (IDIs) with public health practitioners in Tanzania were conducted. FGDs explored themes including participants' experience with, and thoughts about, different diagnostic approaches. The framework method for content analysis was used. IDIs yielded lists of perceived strengths of, and barriers to, implementation for programmatic use of each indicator. These were used to form an online quantitative survey on complementary indicators distributed to global stakeholders via meetings, mailing lists, and social media posts. Sixteen FGDs and 11 IDIs were conducted in October-November 2022. In general, all proposed sample methods were deemed acceptable by community members. Common themes included not wanting undue discomfort and a preference for tests perceived as accurate. Health workers noted the importance of community education for some sample types. The online survey was conducted in April-May 2023 with 98 starting the questionnaire and 81 completing it. Regarding barriers to implementing diagnostics, the highest agreement items related to feasibility, rather than acceptability. No evidence of significant differences was found in responses pertaining to community acceptability based on participant characteristics. All of the indicators included were generally deemed acceptable by all stakeholders in Tanzania, although community education around the benefits and risks of different sample types, as well as addressing issues around feasibility, will be key to successful, sustainable integration of these indicators into trachoma programs.

Laboratory diagnosis of Mycoplasma spp. from the upper respiratory tract and conjunctival infections in shelter cats

Laboratory diagnosis of Mycoplasma spp. from the upper respiratory tract and conjunctival infections in shelter cats

Carbon-in-carbon: Hybrid carbonized nanomaterials with multifunctional activities for the treatment of endophthalmitis

Infectious endophthalmitis (EO) is a severe eye condition characterized by inflammation of the eye’s internal fluids and tissues, often resulting from infection by bacteria or fungi. Patients with EO typically experience reduced vision, pain, and conjunctival infection. Despite the use of antibiotics, challenges such as inflammation and drug resistance remain. In this work, we have developed dextran/aliphatic diamines carbonized nanogels (DEX/ADA-CNGs) as board-spectrum antimicrobial agents by a one-step mild carbonization procedure. The CNGs exhibit not only antimicrobial properties but also show good drug delivery potential. Curcumin-based carbon quantum dots (Cur-CQDs) as an anti-inflammatory agent are loaded into DEX/ADA-CNGs to form hybrid carbon-in-carbon nanocomposites (Cur-CQDs@DEX/ADA-CNGs), showing combined antimicrobial, antioxidative, and anti-inflammatory activities. Impressively, CQDs@DEX/ADA-CNGs maintain strong antibacterial effectiveness against drug-resistant strains, with minimum inhibitory concentrations below 110 µg mL−1. The Cur-CQDs@DEX/ADA-CNGs have demonstrated high biocompatibility both in vitro and in vivo. In a rat model of EO, they rapidly (less than 5 days) reduce microbial infection and inflammation in the eye. Given these promising results, Cur-CQDs@DEX/ADA-CNGs show great potential as an enduring intravitreal treatment option for infectious EO.

Distribution of pathogenic bacteria and antimicrobial sensitivity of eye infections in Suzhou.

To investigate the types of bacteria in patients with eye infections in Suzhou and their drug resistance to commonly used antibacterial drugs. The clinical data of 155 patients were retrospectively collected in this study, and the pathogenic bacteria species and drug resistance of each pathogenic bacteria were analyzed. Among the 155 patients (age from 12 to 87 years old, with an average age of 57, 99 males and 56 females) with eye infections (160 eyes: 74 in the left eye, 76 in the right eye and 5 in both eyes, all of which were exogenous), 71 (45.81%) strains were gram-positive bacteria, 23 (14.84%) strains were gram-negative bacteria and 61 (39.35%) strains were fungi. Gram-positive bacteria were highly resistant to penicillin and erythromycin (78.87% and 46.48% respectively), but least resistant to vancomycin at 0. Gram-negative bacteria were highly resistant to cefoxitin and compound sulfamethoxazole (100% and 95.65% respectively), but least resistant to meropenem at 0. Comparison of the resistance of gram-positive and gram-negative bacteria to some drugs revealed statistically significant differences (P<0.05) in the resistance of both to cefoxitin, cotrimoxazole, levofloxacin, cefuroxime, ceftriaxone and ceftazidime, and both had higher rates of resistance to gram-negative bacteria than to gram-positive bacteria. The distribution of bacterial infection strains showed that Staphylococcus epidermidis was the most common strain in the conjunctiva, cornea, aqueous humor or vitreous body and other eye parts. Besides, Fusarium and Pseudomonas aeruginosa were also among the most common strains of conjunctival and corneal infections. Gram-positive bacteria are the dominant bacteria in eye infections, followed by gram-negative bacteria and fungi. Considering the resistance of gram-negative bacteria to multiple drugs, monitoring of bacteria should be strengthened in eye bacterial infections for effective prevention and control to reduce complications caused by eye infections.

A Novel Technique for scleral fixation of Carlevale Intraocular Lens without conjunctival opening utilizing Hoffman Pockets

Purpose: To report a novel surgical technique for scleral fixation of Carlevale intraocular lens (IOL) without conjunctival dissection using Hoffman pockets. Methods: An 80-years-old female with IOL dislocation in her right eye required IOL exchange. After removing the dislocated IOL, a Carlevale IOL was implanted, securing the self-blocking harpoons within scleral pockets which were constructed using Hoffman technique. Results: Surgical procedure was uneventful. During the next 3 months follow up, Carlevale IOL remained stable within the scleral pockets, and no signs of IOL dislocation or decentration were observed. Visual acuity significantly improved from 20/200 preoperatively up to 20/32 postoperatively due to corneal scaring from previous herpetic keratitis. No postoperative complications were recorded. Conclusion: Creating scleral pockets without conjunctival dissection using Hoffman pockets technique, represent a reliable and effective method for achieving both secure fixation and effective scleral covering of Carlevale IOL haptics. Absence of conjunctival opening, apart from patient postoperative comfort, reduces risk of postoperative complications, including conjunctival erosion and infection. The presented technique offers a promising alternative for Carlevale IOL scleral fixation.

Molecular determination of virulence factors of Mycoplasma cynos isolated from household dogs

Mycoplasma cynos is a member of the class Mollicutes. It is more pathogenic, more host specific than other canine Mycoplasma, and only associated with respiratory diseases in dogs due to producing many virulence factors, recently neuraminidase and hemagglutinin. The study was done to detect the neuraminidase and hemagglutinin of Mycoplasma cynos isolated from the upper respiratory tract and conjunctival infections in household dogs. Mycoplasma isolates obtained from nasal, oropharyngeal, and conjunctival swabs from household dogs suffering from respiratory diseases in different veterinary clinics in Mosul city. DNA extraction was prepared , PCR and sequencing of 16S rRNA, then Mycoplasma cynos was examined for neuraminidase and hemagglutinin using specific primers.The results showed the identification of Mycoplasma cynos strain "SM-MY-M23" under accession number“OQ446513” in percentage (67.6%), and detection of neuraminidase only. Results obtained are considered the first record of M. cynos and the important virulence factor (Neuraminidase) from household dogs in Iraq.

Investigation of healthy horse eyes microbiota and evaluation of its antimicrobial susceptibility

SummaryBackgroundThe conjunctiva of the eye is a mucosal surface that is colonised by various bacteria. Following surgery, trauma or other underlying conditions the normal flora may cause eye infection such as conjunctival and corneal infections, or endophthalmitis.ObjectivesThis study aimed to investigate the bacterial population and antibiotic resistance of the conjunctiva in healthy horses.Study designRandom sampling of ocular samples from 20 horses during the winter (2019).MethodsSwab samples were collected from the eyes of 20 healthy horses of different breeds, ages and sexes in Tehran province, Iran. The swabs were cultured on blood agar and MacConkey agar and incubated at 37°C for 24–48 h. The isolated bacteria were characterised using cellular morphology, gram‐staining and biochemical tests. Sensitivity and resistance to 10 different antibiotics were measured using an antibiogram test.ResultsResults showed that the bacterial population consisted of various species, with Bacillus cereus being the most frequent. There were no significant differences in the frequency of isolated bacteria between sexes and age groups. There were no significant differences in the sensitivity of the bacterial flora of the eyes to colistin, ceftiofur, florfenicol, amoxicillin and ampicillin between either different age groups or different sexes of the horses (p &gt; 0.05). However, sensitivity to enrofloxacin and ciprofloxacin was significantly correlated with the age groups of the horses (p &gt; 0.05). A significant difference in sensitivity to trimethoprim‐sulfamethoxazole between various sexes of horses was observed.Main limitationsThe nonuniformity of the follow‐up examination, reliance on owners or caregivers of the horse for follow‐up information and lack of adequate financial resources to study more horses.ConclusionsThe study suggests that the frequency of individual bacteria comprising the bacterial flora in horses' eyes is influenced by housing and management conditions rather than age and sex.

Varying conjunctival immune response adaptations of house finch populations to a rapidly evolving bacterial pathogen.

Pathogen adaptations during host-pathogen co-evolution can cause the host balance between immunity and immunopathology to rapidly shift. However, little is known in natural disease systems about the immunological pathways optimised through the trade-off between immunity and self-damage. The evolutionary interaction between the conjunctival bacterial infection Mycoplasma gallisepticum (MG) and its avian host, the house finch (Haemorhous mexicanus), can provide insights into such adaptations in immune regulation. Here we use experimental infections to reveal immune variation in conjunctival tissue for house finches captured from four distinct populations differing in the length of their co-evolutionary histories with MG and their disease tolerance (defined as disease severity per pathogen load) in controlled infection studies. To differentiate contributions of host versus pathogen evolution, we compared house finch responses to one of two MG isolates: the original VA1994 isolate and a more evolutionarily derived one, VA2013. To identify differential gene expression involved in initiation of the immune response to MG, we performed 3'-end transcriptomic sequencing (QuantSeq) of samples from the infection site, conjunctiva, collected 3-days post-infection. In response to MG, we observed an increase in general pro-inflammatory signalling, as well as T-cell activation and IL17 pathway differentiation, associated with a decrease in the IL12/IL23 pathway signalling. The immune response was stronger in response to the evolutionarily derived MG isolate compared to the original one, consistent with known increases in MG virulence over time. The host populations differed namely in pre-activation immune gene expression, suggesting population-specific adaptations. Compared to other populations, finches from Virginia, which have the longest co-evolutionary history with MG, showed significantly higher expression of anti-inflammatory genes and Th1 mediators. This may explain the evolution of disease tolerance to MG infection in VA birds. We also show a potential modulating role of BCL10, a positive B- and T-cell regulator activating the NFKB signalling. Our results illuminate potential mechanisms of house finch adaptation to MG-induced immunopathology, contributing to understanding of the host evolutionary responses to pathogen-driven shifts in immunity-immunopathology trade-offs.

Determinação da diversidade microbiana na conjuntiva ocular de cães saudáveis pelo sequenciamento completo do DNA

Abstract The conjunctiva plays an essential role in eye health and immunity and acts as a barrier to the entry of microorganisms. Conjunctival infections are common in dogs and result from both the invasion of pathogenic microorganisms and the uncontrolled growth of the existing microbiota. Most of the existing data come from studies based on traditional culture methods. These reports indicate the predominance of gram-positive bacteria, especially Staphylococcus spp. In the present study, we analyzed the microbiota present on the conjunctival surface from a heterogeneous dog population without ophthalmological disorders using DNA sequencing. After a thorough ophthalmological examination, conjunctival swabs were collected from both eyes of 30 dogs. After processing and nucleic acid extraction, the sample pool was subjected to shotgun DNA sequencing through the Illumina platform and analyzed via the Metagenomic Rapid Annotations using Subsystems Technology (MGRAST) server. A predominance of the phylum Proteobacteria and the genera Ralstonia and Burkholderia were identified along with a minority of fungi, whereas viruses were not found. Microbial DNA sequencing has provided new data on this subject, revealing the presence of noncultivable organisms that were previously unknown as part of the ocular microbiome.

Genetically diagnosis of Mycoplasma isolated from respiratory and conjunctival infections in household dogs

Genetically diagnosis of Mycoplasma isolated from respiratory and conjunctival infections in household dogs

Kinetics of infection and local immune response in a model of chlamydia trachomatis conjunctival infection

Aims/Purpose: Trachoma is caused by Chlamydia trachomatis conjunctival infections and evolves in two phases: i) active or acute trachoma caused by repeated infections and ii) scarring or chronic trachoma leading to conjunctival scarring, eyelid malposition, and corneal opacification. It remains the first cause of infectious blindness in developing countries. The purpose of this study was to precisely describe the kinetics of infection and local immune response in a non‐human primate model of acute trachoma.Methods: Cynomolgus Macaques received a single conjunctival inoculation of B/Tunis‐864 strain (104 IFU) and were assessed at weeks 2, 4, 6, 9, and 11. Clinical evaluation was performed by 3 independent masked observers on standardized ocular surface photographs graded using specific scores for both inflammation and follicles. Local immune response was assessed using multiparameter flow cytometry of conjunctival cells eluted from conjunctival prints. Tears cytokines were quantified using bead‐based Luminex multiplex assay. Bacterial quantification in conjunctival fluids was performed with quantitative PCR.Results: All animals (n = 12) developed typical follicular conjunctivitis (n = 12). The first 4 weeks post‐exposure were characterized by a conjunctival T cell influx (63% of CD45+ cells at week 3), with elevated interleukins 4, 8, and 5. In the later phase, after 9 weeks, we observed an influx of monocytes (53,2% of CD45+ cells at week 11) with reduced immune cells and a return to the initial cytokines level.Conclusion: This model faithfully mimics trachoma's acute phase. Local immunologic assays showed an early lymphocyte response with long‐term persistence of innate immune effectors. It offers an opportunity to assess potential preventive therapeutic strategies. Further studies, including implementing repeated bacterial conjunctival inoculations, are warranted to investigate the later stages of the diseases.

Tularemia – a re-emerging disease with growing concern

Tularemia caused by Gram-negative, coccobacillus bacterium, Francisella tularensis, is a highly infectious zoonotic disease. Human cases have been reported mainly from the United States, Nordic countries like Sweden and Finland, and some European and Asian countries. Naturally, the disease occurs in several vertebrates, particularly lagomorphs. Type A (subspecies tularensis) is more virulent and causes disease mainly in North America; type B (subspecies holarctica) is widespread, while subspecies mediasiatica is present in central Asia. F. tularensis is a possible bioweapon due to its lethality, low infectious dosage, and aerosol transmission. Small mammals like rabbits, hares, and muskrats are primary sources of human infections, but true reservoir of F. tularensis is unknown. Vector-borne tularemia primarily involves ticks and mosquitoes. The bacterial subspecies involved and mode of transmission determine the clinical picture. Early signs are flu-like illnesses that may evolve into different clinical forms of tularemia that may or may not include lymphadenopathy. Ulcero-glandular and glandular forms are acquired by arthropod bite or handling of infected animals, oculo-glandular form as a result of conjunctival infection, and oro-pharyngeal form by intake of contaminated food or water. Pulmonary form appears after inhalation of bacteria. Typhoidal form may occur after infection via different routes. Human-to-human transmission has not been known. Diagnosis can be achieved by serology, bacterial culture, and molecular methods. Treatment for tularemia typically entails use of quinolones, tetracyclines, or aminoglycosides. Preventive measures are necessary to avoid infection although difficult to implement. Research is underway for the development of effective live attenuated and subunit vaccines.

The Gambia Trachomatous Trichiasis Surveys: Results from Five Evaluation Units Confirm Attainment of Trachoma Elimination Thresholds

ABSTRACT Introduction Trichiasis is present when in-turned eyelashes touch the eyeball. It may result in permanent vision loss. Trachomatous trichiasis (TT) is caused by multiple rounds of inflammation associated with conjunctival Chlamydia trachomatis infection. Surveys have been designed to estimate the prevalence of TT in evaluation units (EUs) of trachoma-endemic countries in order to help develop appropriate programme-level plans. In this study, TT-only surveys were conducted in five EUs of The Gambia to determine whether further intensive programmatic action was required. Methods Two-stage cluster sampling was used to select 27 villages per EU and ~25 households per village. Graders assessed the TT status of individuals aged ≥15 years in each selected household, including the presence or absence of conjunctival scarring in those with TT. Results From February to March 2019, 11595 people aged ≥15 years were examined. A total of 34 cases of TT were identified. All five EUs had an age- and gender-adjusted prevalence of TT unknown to the health system <0.2%. Three of five EUs had a prevalence of 0.0%. Conclusion Using these and other previously collected data, in 2021, The Gambia was validated as having achieved national elimination of trachoma as a public health problem. Trachoma is still present in the population, but as its prevalence is low, it is unlikely that today’s youth will experience the exposure to C. trachomatis required to precipitate TT. The Gambia demonstrates that with political will and consistent application of human and financial resources, trachoma can be eliminated as a public health problem.

Ocular Mycobacterium haemophilum infection originating in the cornea: a case report

BackgroundMycobacterium haemophilum is a slow-growing non-chromogenic nontuberculous Mycobacterium species that can cause skin infection or arthritis in an immunocompromised population or in children. Primary infection of the healthy adult cornea is rare. The special requirements for culture make this pathogen difficult to diagnose. The study aims to report the clinical manifestation and treatment process of corneal infection and notify the awareness of M. Haemophilus keratitis among clinicians. This is the first case report of primary M. haemophilum infection in the cornea of healthy adults reported in the literature.Case presentationA 53-year-old healthy goldminer presented with left eye redness and a history of vision loss for four months. The patient was misdiagnosed with herpes simplex keratitis until M. haemophilum was detected using high-throughput sequencing. Penetrating keratoplasty was performed, and a large number of mycobacteria were detected by Ziehl-Neelsen staining of the infected tissue. Three months later, the patient developed conjunctival and eyelid skin infections that manifested as caseous necrosis of the conjunctiva and skin nodules. After excision and debridement of the conjunctival lesions and systemic antituberculosis drug treatment for 10 months, the patient was cured.ConclusionM. haemophilum could cause primary corneal infection in healthy adults, which is an infrequent or rare infection. Owing to the need for special bacterial culture conditions, conventional culture methods do not provide positive results. High-throughput sequencing can rapidly identify the presence of bacteria, which aids in early diagnosis and timely treatment. Prompt surgical intervention is an effective treatment option for severe keratitis. Long-term systemic antimicrobial therapy is crucial.

PS-C05-8: ERYTHROCYTE SEDIMENTATION RATE LEVELS AND ITS ASSOCIATION WITH CORONARY ARTERY INVOLVEMENT IN KAWASAKI DISEASE

Objectives: The general objective of this study is to determine association of ESR with cardiovascular involvement in Kawasaki Disease (KD) patients. Specific Objectives: Design and method: This is a cross sectional study conducted at National Childrens Hospital (NCH), a tertiary pediatric hospital. Data was gathered using charts from the medical records of patients diagnosed with KD. Study population included patients diagnosed with KD with classical presentation from year 2013–2018. The diagnostic criteria for KD require presence of fever for five days or more and at least four of five of the following: bilateral conjunctival infection without exudates, polymorphous exanthema, strawberry tongue, desquamation of palms and soles, and cervical lymphadenopathy. ESR levels were recorded both as a numerical variable and categorical variable based on the level (below 80 mm/hr, more than 80 mm/hr). Patients with coronary artery involvement included perivascular brightness, coronary artery dilatation, or coronary aneurysm on two-dimensional echocardiography done during admission for KD. Descriptive statistics was done using frequency and percentages for categorical variables, and standard deviations for continuous variables was calculated to describe the profile of the respondents. Determination of the association between ESR and CAD among KD patients was analyzed using Chi square test and stratified analysis. Odds ratio and the 95% confidence interval was also calculated. Significance was set at p value of &lt; 0.05. Results: Of the 116 patients, 72.4% of the population were noted to have cardiac involvement and 50% had coronary artery involvement. The most common coronary artery involvement was on the proximal right coronary artery. Moreover, pericardial effusion and valvular regurgitation mostly involving the mitral valve were the most common cardiac involvement. In the population, 61 (52.6%) were male, and 26 (42.6%) of which developed CAD however no correlation between sex and CAD was revealed. Conclusion: This study showed no correlation between the level of ESR and the development of CAD. It is not recommended to obtain ESR in patients who qualify as complete KD. Hence the study does not support the practice of obtaining ESR upon admission of KD patients. Further studies on the association of ESR with CAD with higher sample size and adjusting for other confounding variables are needed.

Mycoplasma from the upper respiratory tract and conjunctival infections in household dogs

The study was performed to isolate and detect Mycoplasma as a causative agent of the upper respiratory tract and conjunctival infections in household dogs in Mosul city. One hundred household dogs of different ages, sex, and breed were subjected to the study, including 60 dogs suffering from moderate to severe respiratory infections and 40 healthy dogs in Mosul city from 1/2/2022 to 15/6/2022. Three hundred swabs were collected, including nasal swabs 100, oropharyngeal swabs 100, and conjunctival swabs 100. The swabs were cultured in Mycoplasma media and incubated at 37ºC with 5% CO2 in a candle jar for 4-14 days. Light and the dissecting microscope examined the growing colonies microscopically under low magnification. The colonies were also stained with modified Dienes stain. The results of the current study indicated that respiratory infections were predominant in young male household dogs compared with conjunctival infections in all examined dogs. The conjunctival infections were obvious only in Husky and Belgium dogs. The high isolation rate of Mycoplasma was from upper respiratory tract infections in diseased female dogs more than one-year age 100%. In contrast, the conjunctival infections were more dominant and had a higher isolation rate in less than one-year males. The current study revealed a high Mycoplasma isolation rate in respiratory swabs of Terrier and German dogs, while the conjunctival swabs were positive for mycoplasmal culture in Husky and Belgium dogs 100%. In conclusion, mycoplasmal infections were more dominant in upper respiratory infections in female German and Terrier dogs.