Late-onset Endophthalmitis Caused by Streptococcus Cristatus after Trabeculectomy

Purpose: To report a case of late-onset bleb-associated endophthalmitis caused by streptococcus cristatus (S. cristatus) after trabeculectomy.Case summary: A 59-year-old woman presented with left ocular pain and visual disturbance. She had undergone trabeculectomy of the left eye 2 years ago. At the initial visit, she was only able to count fingers from the left eye. Whitish thin bleb, conjunctival injection, and inflammation were observed in the left anterior chamber, and the fundus could not be visualized. Despite administering topical and systemic antibiotics, the chamber reaction worsened, and hypopyon and inflammatory membrane were noticed the next day. Vitrectomy with phacoemulsification and intravitreal antibiotic injection was performed, and the intravitreal antibiotic injections were repeated over the next two days. Bacterial culture of vitreous fluid showed a growth of S. cristatus 5 days after the surgery, and inflammation improved after 7 days. One month later, she was still only able to count fingers from the left eye, but there were no signs of endophthalmitis.Conclusions: Postoperative endophthalmitis after glaucoma filtering surgeries caused by S. cristatus has not been reported previously from Korea. To the best of our knowledge, this is the first Korean case of late-onset bleb-associated endophthalmitis caused by S. cristatus. If gram-positive cocci are grown in samples from the patients with endophthalmitis after trabeculectomy, resident oral microflora such as S. cristatus should be considered as the causative pathogen.

Download Full-text

Vogt-Koyanagi-Harada Disease Following COVID-19 Infection

Case Reports in Ophthalmology ◽

10.1159/000518834 ◽

2021 ◽

pp. 804-808

Author(s):

Juan B. Yepez ◽

Felipe A. Murati ◽

Michele Petitto ◽

Jazmin De Yepez ◽

Jose M. Galue ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Optic Nerve ◽

Plexiform Layer ◽

Visual Disturbance ◽

Ocular Pain ◽

Ocular Movements ◽

Interdigitation Zone ◽

The Right ◽

Retinal Folds

A 29-year-old female presented to the emergency clinic with gradual visual disturbance in both eyes for 15 days duration, accompanied by bilateral tinnitus, and ocular pain that increased with ocular movements. One month prior to presentation, the patient had tested positive for severe acute respiratory syndrome coronavirus-2 but without complications. Visual acuity was 20/100 in the right eye and 20/300 in the left eye. Funduscopy demonstrated optic nerve swelling, radial nerve fiber striation disruption, and bilateral retinal folds. Optical coherence tomography showed serous (bacillary) retinal detachment and multifocal areas of hyper-reflective changes in the inner and outer plexiform layer with inner nuclear layer thickening and disruption of the interdigitation zone bilaterally. We present a case of incomplete Vogt-Koyanagi-Harada disease following COVID-19 infection.

Download Full-text

Radius-Maumenee Syndrome Presenting with Ocular Pain and Conjunctival Injection: A Case Report

Journal of the Korean Ophthalmological Society ◽

10.3341/jkos.2015.56.12.1969 ◽

2015 ◽

Vol 56 (12) ◽

pp. 1969

Author(s):

Byeong Soo Kang ◽

Eun Ji Lee ◽

Hee Kyung Yang

Keyword(s):

Case Report ◽

Conjunctival Injection ◽

Ocular Pain

Download Full-text

A Pathological Analysis of Canaliculitis Concretions: More Than JustActinomyces

Scientifica ◽

10.1155/2016/6313070 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Balaji Perumal ◽

John Andrew Carlson ◽

Dale Robert Meyer

Keyword(s):

Bacterial Culture ◽

Histopathological Analysis ◽

Filamentous Bacteria ◽

Gram Positive ◽

Pathological Analysis ◽

Methenamine Silver ◽

The Mean ◽

Almost All ◽

Gram Positive Cocci ◽

Total Bacteria

Purpose.Canaliculitis is classically associated withActinomycesspecies, which are filamentous bacteria; the purpose of this study was to evaluate the extent to which nonfilamentous bacteria colonize canalicular concretions by using graded histopathological analysis.Methods.This is a series of 16 cases. The percentage of Gram-positive/Gomori’s methenamine silver-positive filamentous bacteria (Actinomyces) versus the total bacteria identified was graded, and the types of bacteria seen were recorded. Nonfilamentous bacteria were categorized based upon Gram stain (positive or negative) and morphology (cocci or rods).Results. There were 11 females and 5 males. Nonfilamentous bacteria were identified in 16 of 16 (100%) specimens and filamentous bacteria were identified in 15 of 16 (94%) specimens. The mean percentage of filamentous bacteria relative to total bacteria was 57%. Regarding the nonfilamentous bacteria present, 69% of specimens had Gram-positive cocci only, 25% had Gram-positive and Gram-negative cocci, and 6% had Gram-positive cocci and Gram-positive rods.Conclusion. In the current study, there was a mix of filamentous and nonfilamentous bacteria in almost all canalicular concretions analyzed. Nonfilamentous bacteria may contribute to the pathogenesis of canaliculitis. In addition, the success of bacterial culture can be variable; therefore, pathological analysis can assist in determining the etiology.

Download Full-text

Antimicrobial Susceptibility among Pathogens Isolated in Early- versus Late-Onset Ventilator-Associated Pneumonia

Infectious Disease Reports ◽

10.3390/idr13020038 ◽

2021 ◽

Vol 13 (2) ◽

pp. 401-410

Author(s):

Hend Ben Lakhal ◽

Aymen M’Rad ◽

Thierry Naas ◽

Nozha Brahmi

Keyword(s):

Early Onset ◽

Bacterial Culture ◽

Late Onset ◽

Multidrug Resistant ◽

First Episode ◽

High Morbidity ◽

Ventilator Associated Pneumonia ◽

Bacterial Isolates ◽

Positive Bacterial Culture ◽

Significant Difference

Ventilator-associated pneumonia (VAP) is associated with increased hospital stay and high morbidity and mortality in critically ill patients. The aims of this study were to (i) determine the incidence of multidrug-resistant (MDR) pathogens in the first episodes of VAP and to assess potential differences in bacterial profiles of subjects with early- versus late-onset VAP. This was a retrospective cohort study over a period of 18 months including all patients who had a first episode of VAP confirmed by positive bacterial culture. Subjects were distributed into two groups according to the number of intubation days: early-onset VAP (<5 days) or late-onset VAP (≥5 days). The primary endpoint was the nature of causative pathogens and their resistance profiles. Sixty patients were included, 29 men and 31 women, with an average age of 38 ± 16 years. The IGS 2 at admission was 40.5 [32–44] and APACHE was 19 [15–22]. Monomicrobial infections were diagnosed in 77% of patients (n = 46). The most frequently isolated bacteria were A. baumannii, 53% (n = 32); P. aeruginosa in 37% (n = 22); Enterobacterales in 28% (n = 17) and S. aureus in 5% (n = 3). Ninety-seven percent of the bacteria were MDR. The VAP group comprised 36 (60%) episodes of early-onset VAP and 24 (40%) episodes of late-onset VAP. There was no significant difference in the distribution of the bacterial isolates, nor in terms of antibacterial resistances between early- and late-onset VAPs. Our data support recent observations that there is no microbiological difference in the prevalence of potential MDR pathogens or in their resistance profiles associated with early- versus late-onset VAPs, especially in countries with high rates of MDR bacteria.

Download Full-text

Intraorbital Arteriovenous Malformation Treated by Transarterial Embolization: Technical Case Report

Operative Neurosurgery ◽

10.1227/neu.0b013e31821522ec ◽

2011 ◽

Vol 68 (suppl_2) ◽

pp. onsE383-onsE387 ◽

Cited By ~ 2

Author(s):

Kenichi Sato ◽

Yasushi Matsumoto ◽

Ryushi Kondo ◽

Teiji Tominaga

Keyword(s):

Clinical Presentation ◽

Transarterial Embolization ◽

Visual Disturbance ◽

Digital Subtraction ◽

Wada Test ◽

Ocular Pain ◽

Superselective Angiography ◽

Digital Subtraction Angiogram ◽

Retinal Artery

Abstract Background And Importance: Intraorbital arteriovenous malformations (AVMs) are rare, and their clinical management is controversial. A case of orbital AVM successfully treated by transarterial embolization with diluted glue is reported. Clinical Presentation: A 53-year-old man developed a left pulsating exophthalmos, chemosis, and ocular pain, revealing the presence of a left intraorbital AVM. A microcatheter was selectively placed into the feeders arising from the left ophthalmic artery. Diluted glue was injected toward the nidus through the microcatheter, with monitoring by digital subtraction angiogram. These procedures were performed for 2 individual proper feeders. Superselective angiography for the central retinal artery was also performed instead of a retinal Wada test. His orbital symptoms improved immediately after the procedure without further visual disturbance. Follow-up digital subtraction angiogram revealed the disappearance of the AVM. Conclusion: Transarterial embolization can be considered one of the radical treatments for orbital AVMs.

Download Full-text

Bacterial Aetiology and Susceptibility of Pathogens Associated with Acne Vulgaris

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/49350.15512 ◽

2021 ◽

Author(s):

M Deborah Pusushottam ◽

Nasepogu Padmaja ◽

A Venkateshwara Rao

Keyword(s):

Antimicrobial Agents ◽

Bacterial Culture ◽

Acne Vulgaris ◽

Bacterial Strains ◽

Biochemical Tests ◽

Gram Positive ◽

Dermatology Department ◽

Bacterial Aetiology ◽

Aerobic And Anaerobic ◽

Gram Positive Cocci

Introduction: Acne vulgaris is a pilosebaceous disorder among youth during puberty and also in young adults. Hormonal imbalance, bacterial activity and inflammation can cause acne formation. Due to some anti-inflammatory effects and temporary self treatment of acne using some antibiotics, there is overuse/ improper use of antimicrobial agents which leads to resistance in bacterial strains. Aim: To provide an overview of bacteria that may cause acne and determine their susceptibility to antibiotics and reduce the overuse of antibiotics which leads to antibiotic resistance. Materials and Methods: This was a cross-sectional study done on samples from from 100 patients with chief complaints of acne, attending Dermatology Department at Konaseema Institute of Medical Sciences and Research Foundation (KIMS RF). This study was done between November 2019 to February 2021. Acne pustules were cultured on all the basic media like blood agar and Mac Conkey agar, under aerobic and anaerobic conditions. Bacterial identification was performed by gram staining and relevant biochemical tests. Antibiotic susceptibility was done based on the Clinical and Laboratory Standards Institute (CLSI) 2019. Data was calculated and analysed statistically by Statistical Package for Social Science (SPSS) version 21.0. Results: Total 100 participants were taken for the study. Females (63%) were more commonly affected as compared to males (37%) and the most commonly affected age group was teenage i.e., 10 to 20 years in both male and females. Among 100 subjects, 77 cases showed bacterial growth by aerobic and anaerobic culture and 23 cases showed negative for bacterial culture. All isolates were susceptible to rifampin (100%) (p<0.001). Propionibacterium acnes (P. acnes) was susceptible to doxycycline (88.8%) and minocycline (88.8%), while 22.3% was resistant to erythromycin, clindamycin, and tetracycline while 33.3% showed resistance to ofloxacin. Gram positive cocci like Staphylococcus epidermidis (S.epidermidis) was susceptible to the antibiotic minocycline and rifampin (100%); but resistant to quinolines like ofloxacin (52.5%) macrolides like erythromycin (62.5%), clindamycin (47.5%) and tetracycline (17.5%). The susceptibility of gram positive cocci like S. epidermidis to doxycycline was (87.5%), which was lower than that of P. acnes (88.8%). Staphylococcus aureus (S. aureus) was found to be sensitive to minocycline (90.9%), doxycycline (72.7%), clindamycin (63.6%), and tetracycline (63.6%); but it was resistant to macrolide like erythromycin (45.5%) and quinolines like ofloxacin (36.5%). Conclusion: This study suggested that bacterial culture and antibiotic sensitivity can be better suggested if the culture and sensitivity is available so that, sensitivity and resistant pattern is known. The use of clindamycin and macrolide (erythromycin) needs to be reduced as most gram positive cocci like S. epidermidis were resistant to both.

Download Full-text

Idiopathic Chiasmal Optic Neuritis in a Pediatric Patient

Journal of the Korean Ophthalmological Society ◽

10.3341/jkos.2021.62.12.1679 ◽

2021 ◽

Vol 62 (12) ◽

pp. 1679-1684

Author(s):

Jae Pyeong Jeon ◽

Donghun Lee ◽

Jong Won Moon

Keyword(s):

Visual Acuity ◽

Optic Neuritis ◽

Pediatric Patient ◽

Demyelinating Disease ◽

Late Onset ◽

Systemic Disease ◽

Brain Magnetic Resonance Imaging ◽

Visual Disturbance ◽

Systemic Steroid ◽

The Right

Purpose: We report a case of idiopathic chiasmal optic neuritis in a pediatric patient.Case summary: A 13-year-old boy with no history of systemic disease was referred to our ophthalmology clinic because of visual disturbance in both eyes of 5 days in duration. The best-corrected visual acuity was 0.08 in the right eye and finger counting at 30 cm in the left eye; mild blurring of the disc margins (both eyes) was evident on fundus examination, as were temporal hemianopsia in the right eye and diffuse field loss in the left eye. Brain magnetic resonance imaging revealed focal nodular enhancement in the optic chiasm. Blood and cerebral fluid analysis yielded no evidence of infection or autoimmune disease. Therefore, we diagnosed isolated idiopathic chiasmal optic neuritis and commenced a systemic steroid. After 5 days, the visual acuity began to improve, and the field defect was almost eliminated (except for a small central scotoma) at 1 month. He has remained stable to the time of writing (4 months after treatment) and his visual acuity has normalized.Conclusions: Isolated idiopathic chiasmal optic neuritis developed in a pediatric patient and the visual function improved after steroid treatment. Although there was no evidence of systemic demyelinating disease, regular observation is scheduled given the possibility of late-onset disease.

Download Full-text

Uveitis

Complications of Glaucoma Surgery ◽

10.1093/oso/9780195382365.003.0034 ◽

2013 ◽

Author(s):

Mahmoud A. Khaimi

Keyword(s):

Anterior Chamber ◽

Late Onset ◽

Early Recognition ◽

Rare Condition ◽

Conjunctival Injection ◽

Diverse Range ◽

Delayed Onset ◽

Appropriate Treatment ◽

Body Sensation ◽

Filtering Procedure

Delayed-onset postoperative inflammation can result from a diverse range of factors, such as blebitis, bleb-related endophthalmitis, underlying uveitis, mitomycin-C mediated inflammation, herpes infection, phaco-anaphylactic and phacogenic uveitis, intraocular lens (IOL) chafing of the iris, and sympathetic ophthalmia. Delayed postoperative uveitis is defined as inflammation occurring 6 weeks or later postoperatively and is a rare condition that may occur following a glaucoma filtering procedure. Currently, there are very few documented cases of this condition. Even though it is rare, it is important to differentiate the infectious sources of delayed-onset postoperative uveitis after glaucoma filtering surgery from those that are noninfectious so that the appropriate treatment is administered. Infectious cases of uveitis should be considered first. The most common form of late-onset postoperative uveitis after a filtering procedure is blebitis . Brown and colleagues were the first to use the term “blebitis” to describe a limited infection centered around a bleb with or without anterior chamber reaction and no vitreous involvement. In contrast, on the other end of the spectrum, is bleb-related endophthalmitis , which is characterized by a more fulminant course with anterior chamber reaction and the presence of vitritis. Blebitis and bleb-related endophthalmitis typically manifest several months to years after the surgery. Blebitis may often be a precursor to bleb-related endophthalmitis, and early recognition of late-onset bleb-related infections should be taken seriously and promptly treated to avoid severe ocular and visual sequelae. Both forms of bleb-related infection can be differentiated by the extent of ocular inflammation. Patients with blebitis typically complain of redness, foreign body sensation, pain, photophobia, and conjunctival discharge. The conjunctiva around the bleb is also significantly injected. Additionally, the bleb itself usually has a whitish or chalky appearance with or without an epithelial defect. The anterior chamber may have variable degrees of reaction, and a hypopyon may be present in the anterior chamber as well as in the bleb itself. Conversely, patients with bleb-related endophthalmitis typically present with a more fulminant course, which includes rapidly deteriorating vision, redness, pain, and diffuse conjunctival injection. Vitritis, while absent in blebitis, is present in bleb-related endophthalmitis.

Download Full-text

Acantholytic Folliculitis and Epidermitis Associated With Staphylococcus hyicus in a Line of White Leghorn Laying Chickens

Veterinary Pathology ◽

10.1177/0300985811415705 ◽

2011 ◽

Vol 49 (2) ◽

pp. 284-287 ◽

Cited By ~ 5

Author(s):

S. Chénier ◽

L. Lallier

Keyword(s):

Genetic Background ◽

Bacterial Culture ◽

Follicular Epithelium ◽

Poultry Production ◽

Variable Amount ◽

White Leghorn ◽

Subcutaneous Nodules ◽

Scaly Skin ◽

Close Genetic Relationship ◽

Gram Positive Cocci

Several mature Leghorn-type hens with the same genetic background experienced skin and feather problems in a breeder flock. There was almost-total feather loss on the head and neck, as well as thickened, scaly skin, and follicular ostia were plugged with keratin debris. Other individuals exhibited prominent subcutaneous nodules multifocally on the head. Histologic examination of the skin revealed a severe hyperplasia of follicular epithelium with hyperkeratosis and cystic dilation. Numerous clefts and vesicles were detected along the epidermis and follicular epithelium, some containing acantholytic keratinocytes. A mild heterophilic inflammation was associated with these lesions, and few gram-positive cocci were present in the keratin plugs. Bacterial culture of the skin yielded a variable amount of Staphylococcus hyicus. Immunochemistry looking for chicken IgY revealed no intercellular staining in the epidermis or follicular epithelium. All these findings supported a diagnosis of Staphylococcus-associated acantholytic epidermitis and folliculitis. This case suggests that S. hyicus could be a significant pathogen in poultry production. The close genetic relationship among affected individuals could indicate a hereditary predisposition in this line of White Leghorn laying chickens.

Download Full-text