Successful treatment of Keratitis caused by Mycobacterium chelonae and an overview of previous cases in Europe.

IF 4.6 2区 医学 Q1 MICROBIOLOGY
Rudolf Kukla, Katerina Nouzovska, Lenka Ryskova, Petra Rozsivalova, Ivo Pavlik, Pavel Bostik
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引用次数: 0

Abstract

Introduction and purpose: Mycobacterium (M.) chelonae is responsible for a half of relatively rare nontuberculous mycobacteria (NTM) keratitis. We report a case of M. chelonae keratitis in a woman following sclerocorneal suture extraction after cataract surgery.

Results: A 70-year-old woman presented with a red eye and corneal infiltration of her left eye six weeks following sclerocorneal suture extraction after an elective cataract surgery in another institute. She complained of a sharp, cutting pain and photophobia. Since initial corneal scrapes and conjunctival swabs proved no pathogen using culture and PCR methods, non-specific antibiotics and antifungal agents were administered. As keratitis was complicated by an inflammation in the anterior chamber and vitreous, samples of the vitreous fluid were sent for microbiologic examination. DNA of Epstein-Barr virus (EBV) was repeatedly detected. Since the intrastromal abscess had formed, corneal re-scrapings were performed and M. chelonae was detected using culture, MALDI-TOF MS and PCR methods. Therapy was changed to a combination of oral and topical clarithromycin, intravitreal, topical and intracameral amikacin, and oral and topical moxifloxacin. The successful therapy led to stabilization. The optical penetrating keratoplasty was performed and no signs of the infection recurrence were found.

Conclusions: The diagnosis of nontuberculous mycobacterial keratitis is difficult and often delayed. An aggressive and prolonged antimicrobial therapy should include systemic and topical antibiotics. Surgical intervention in the form of corneal transplantation may be required in the active and nonresponsive infection. In the presented case this was necessary for visual rehabilitation due to scarring.

成功治疗由卡氏分枝杆菌引起的角膜炎以及欧洲以往病例概述。
导言和目的:在相对罕见的非结核分枝杆菌(NTM)角膜炎中,有一半是由切诺氏分枝杆菌(M. chelonae)引起的。我们报告了一例妇女在白内障手术后进行角膜巩膜缝线拔除术后感染切诺氏霉菌性角膜炎的病例:一名 70 岁的妇女在另一家医院接受白内障手术后,进行了角膜硬膜外缝线拔除术,术后六周左眼出现红眼和角膜浸润。她主诉有剧烈的刀割样疼痛和畏光。由于最初的角膜刮片和结膜拭子通过培养和 PCR 方法证明没有病原体,因此使用了非特异性抗生素和抗真菌药物。由于角膜炎并发前房和玻璃体炎症,玻璃体液样本被送去进行微生物学检查。反复检测到爱泼斯坦-巴氏病毒(EBV)的 DNA。由于基质内脓肿已经形成,因此对角膜进行了重新刮片,并使用培养、MALDI-TOF MS 和 PCR 方法检测到了克隆氏疟原虫。治疗方法改为口服和外用克拉霉素,玻璃体内、外用和鞘内阿米卡星,以及口服和外用莫西沙星。治疗成功后,病情趋于稳定。在进行了光学穿透性角膜移植手术后,没有发现感染复发的迹象:结论:非结核分枝杆菌性角膜炎的诊断很困难,而且常常被延误。积极、长期的抗菌治疗应包括全身和局部抗生素。在感染活跃和无反应的情况下,可能需要进行角膜移植手术。在本病例中,由于瘢痕形成,为了恢复视力,必须进行角膜移植手术。
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来源期刊
CiteScore
8.60
自引率
0.00%
发文量
49
审稿时长
>12 weeks
期刊介绍: Annals of Clinical Microbiology and Antimicrobials considers good quality, novel and international research of more than regional relevance. Research must include epidemiological and/or clinical information about isolates, and the journal covers the clinical microbiology of bacteria, viruses and fungi, as well as antimicrobial treatment of infectious diseases. Annals of Clinical Microbiology and Antimicrobials is an open access, peer-reviewed journal focusing on information concerning clinical microbiology, infectious diseases and antimicrobials. The management of infectious disease is dependent on correct diagnosis and appropriate antimicrobial treatment, and with this in mind, the journal aims to improve the communication between laboratory and clinical science in the field of clinical microbiology and antimicrobial treatment. Furthermore, the journal has no restrictions on space or access; this ensures that the journal can reach the widest possible audience.
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