Bacterial keratitis: predisposing factors, clinical and microbiological review of 300 cases.
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AIM: To identify predisposing factors and to define clinical and microbiological characteristics of bacterial keratitis in current practice. METHODS: A retrospective analysis of the hospital records of patients presenting with bacterial keratitis and treated at the Quinze-Vingts National Center of Ophthalmology, Paris, France, was performed during a 20 month period. A bacterial keratitis was defined as a suppurative corneal infiltrate and overlying epithelial defect associated with presence of bacteria on corneal scraping and/or that was cured with antibiotic therapy. Risk factors, clinical and microbiological data were collected. RESULTS: 300 cases (291 patients) of presumed bacterial keratitis were included. Potential predisposing factors, usually multiple, were identified in 90.6% of cases. Contact lens wear was the main risk factor (50.3%). Trauma or a history of keratopathy was found in 15% and 21% of cases, respectively. An organism was identified in 201 eyes (68%). 83% of the infections involved Gram positive bacteria, 17% involved Gram negative bacteria, and 2% were polymicrobial. Gram negative bacteria were associated with severe anterior chamber inflammation (p=0.004), as well as greater surface of infiltrates (p=0.01). 99% of ulcers resolved with treatment, but only 60% of patients had visual acuity better than the level at admission, and 5% had very poor visual outcome. CONCLUSIONS: Contact lens wear is the most important risk factor. Most community acquired bacterial ulcers resolve with appropriate treatment. (+info)
Use of 18S rRNA gene-based PCR assay for diagnosis of acanthamoeba keratitis in non-contact lens wearers in India.
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Identification of Acanthamoeba cysts and trophozoites in ocular tissues requires considerable expertise and is often time-consuming. An 18S rRNA gene-based PCR test, highly specific for the genus Acanthamoeba, has recently been reported in the molecular diagnosis of Acanthamoeba keratitis. This PCR assay was compared with conventional microbiological tests for the diagnosis of Acanthamoeba keratitis. In a pilot study, the PCR conditions with modifications were first tested on corneal scrapings from patients with culture-proven non-contact lens-related Acanthamoeba, bacterial, and fungal keratitis. This was followed by testing of corneal scrapings from 53 consecutive cases of microbial keratitis to determine sensitivity, specificity, and predictive values of the assay. All corneal scrapings from patients with proven Acanthamoeba keratitis showed a 463-bp amplicon, while no amplicon was obtained from patients with bacterial or fungal keratitis. Some of these amplified products were sequenced and compared with EMBL database reference sequences to validate these to be of Acanthamoeba origin. Out of 53 consecutive cases of microbial keratitis included for evaluating the PCR, 10 (18.9%) cases were diagnosed as Acanthamoeba keratitis on the basis of combined results of culture, smear, and PCR of corneal scrapings. Based on culture results as the "gold standard," the sensitivity of PCR was the same as that of the smear (87.5%); however, the specificity and the positive and negative predictive values of PCR were marginally higher than the smear examination (97.8 versus 95.6%, 87.5 versus 77.8%, and 97.8 versus 97.7%) although the difference was not significant. This study confirms the efficacy of the PCR assay and is the first study to evaluate a PCR-based assay against conventional methods of diagnosis in a clinical setting. (+info)
Curvularia haloperoxidase: antimicrobial activity and potential application as a surface disinfectant.
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A presumed antimicrobial enzyme system, the Curvularia haloperoxidase system, was examined with the aim of evaluating its potential as a sanitizing agent. In the presence of hydrogen peroxide, Curvularia haloperoxidase facilitates the oxidation of halides, such as chloride, bromide, and iodide, to antimicrobial compounds. The Curvularia haloperoxidase system caused several-log-unit reductions in counts of bacteria (Pseudomonas spp., Escherichia coli, Serratia marcescens, Aeromonas salmonicida, Shewanella putrefaciens, Staphylococcus epidermidis, and Listeria monocytogenes), yeasts (Candida sp. and Rhodotorula sp.), and filamentous fungi (Aspergillus niger, Aspergillus tubigensis, Aspergillus versicolor, Fusarium oxysporum, Penicillium chrysogenum, and Penicillium paxilli) cultured in suspension. Also, bacteria adhering to the surfaces of contact lenses were killed. The numbers of S. marcescens and S. epidermidis cells adhering to contact lenses were reduced from 4.0 and 4.9 log CFU to 1.2 and 2.7 log CFU, respectively, after treatment with the Curvularia haloperoxidase system. The killing effect of the Curvularia haloperoxidase system was rapid, and 10(6) CFU of E. coli cells/ml were eliminated within 10 min of treatment. Furthermore, the antimicrobial effect was short lived, causing no antibacterial effect against E. coli 10 min after the system was mixed. Bovine serum albumin (1%) and alginate (1%) inhibited the antimicrobial activity of the Curvularia haloperoxidase system, whereas glucose and Tween 20 did not affect its activity. In conclusion, the Curvularia haloperoxidase system is an effective sanitizing system and has the potential for a vast range of applications, for instance, for disinfection of contact lenses or medical devices. (+info)
Contact lenses. The ophthalmologist's role in prescription.
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It is the responsibility of ophthalmologists to determine which patients can suitably use contact lenses, to instruct them in care and use of the lenses, to write the prescription and to check the fitting, vision and tolerance of the eyes to avoid injury. This very important component of eye care should not be given over to nonmedical technicians by default. (+info)
Congenital nystagmus: rebound phenomenon following removal of contact lenses.
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Symptoms resulting from congenital nystagmus can be significantly reduced by wearing corneal contact lenses. A 90 minute therapeutic trial with contact lenses was performed on a 20-year-old affected patient and produced a beneficial effect. Upon removal of the lenses however the patient showed a transient rebound phenomenon with oscillopsia lasting about 20 minutes. This phenomenon, although it might be expected in theory, has apparently not previously been observed either because it is rare or because in most patients it is not clinically apparent. The purpose of this report is not to discourage treating patients with congenital nystagmus by means of contact lenses, but rather to draw attention to the occasional occurrence of such a rebound phenomenon and to discuss its theoretical significance. (+info)
Acanthamoeba keratitis: synergy between amebic and bacterial cocontaminants in contact lens care systems as a prelude to infection.
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We encountered a patient with Acanthamoeba keratitis whose contact lens care solution contained numerous trophozoites and cysts admixed with Xanthomonas maltophilia organisms, many of which were adherent to the trophozoite surface and internalized within endocytic vacuoles. Because of this finding, we investigated the role of bacterial cocontaminants in contact lens care systems as substrates for the growth of Acanthamoeba spp. Individual cocultivation of Acanthamoeba castellanii and A. polyphaga with X. maltophilia, Flavobacterium breve, and Pseudomonas paucimobilis showed better enhancement (1.5x) of ameba growth after 96 h than that obtained in the presence of Staphylococcus aureus, S. epidermidis, and Escherichia coli, the standard cocultivation species used for isolation of amebae from clinical specimens. Our data suggest that contamination of contact lens care systems with Acanthamoeba spp. and a bacterial species capable of supporting amebic growth may be the first step in the pathogenesis of ameba-induced keratitis by the provision of large inocula of amebae. (+info)
PRESENT STATUS OF CORNEAL CONTACT LENSES IN MEDICAL PRACTICE.
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Common indications for and contraindications to corneal contact lens wear are outlined. The processes of adaptation of the cornea to a correctly fitted contact lens are described. Biomicroscopic examination of the cornea revealed that 29 of 250 eyes in the authors' series showed small abrasions at some time during the fitting period. The dangers of infection of a simple corneal abrasion by such pathogens as Pseudomonas aeruginosa are stressed. Prophylactic treatment of abrasions with a topical antibiotic preparation containing polymyxin is recommended. Serious criticism is levelled at the practice of estimating the fit of a contact lens by the fluorescein pattern only, and repeated keratometry readings combined with biomicroscopy are considered to be essential. It is proposed that the evaluation, fitting and after-care of the contact lens patient should be the responsibility of an ophthalmologist. (+info)
Acanthamoeba polyphaga strain age and method of cyst production influence the observed efficacy of therapeutic agents and contact lens disinfectants.
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The effects of age in culture and the type of medium used for induction of Acanthamoeba polyphaga (Ros) cysts on susceptibilities to polyhexamethylene biguanide (PHMB; 3 micro g/ml), chlorhexidine digluconate (30 micro g/ml), myristamidopropyl dimethylamine (20 micro g/ml), H(2)O(2) (3%), and two multipurpose contact lens solutions (MPS-1 and MPS-2, based on 1 micro g of PHMB per ml) were examined. Strain Ros-02 was cryopreserved on isolation in 1991, while strain Ros-91 had been in continuous axenic culture. Significant differences in susceptibilities to the disinfectants were found depending on the medium used for cyst preparation and the age of the test strain, with Ros-02 generally being more resistant. For example, the killing of Ros-91 cysts produced from an axenic culture of trophozoites in the presence of 50 mM MgCl(2) by MPS-2 was 4 logs, but the killing of Ros-02 by MPS-2 was only 2 logs (P < 0.05) and killing of both strains with cysts obtained from monoxenic cultures with Escherichia coli was only 1 log (P < 0.001). Assays repeated with different batches of the various cyst types gave consistent results. A batch of Ros-91 cysts stored at 4 degrees C and tested over an 8-week period with MPS-1 showed progressively increasing susceptibility to disinfection, although there was no loss of viability during storage (P < 0.01). These observations have important implications for the standardization and interpretation of Acanthamoeba disinfectant and therapeutic agent testing. (+info)