11
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Primer reporte de queratitis por Nocardia brasiliensis en Paraguay Translated title: Queratitisdue to Nocardia brasiliensis.First reportin Paraguay

      case-report

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          La queratitis producida por Nocardia spp es raramente reportada en el mundo por lo que su incidencia no está aún bien establecida. En el presente estudio se reporta el primer caso de queratitis por Nocardia brasiliensis en Paraguay en un paciente de sexo masculino, de profesión jardinero, procedente de la ciudad de Asunción, y con antecedente de traumatismo con rama de arbusto quince días antes de la consulta. El paciente acude al servicio de Oftalmología del Hospital de Clínicas, debido a ojo rojo, agudeza visual disminuida e intenso dolor en el ojo izquierdo con una semana de evolución. Se realiza tratamiento con la aplicación de colirio reforzado de gentamicina 14 mg/ml y cefazolina 50 mg/ml, cada una hora, observándose mejoría de los síntomas y de la agudeza visual a los 10 días de seguimiento. La evolución clínica en queratitis a Nocardia spp es buena siempre que el diagnóstico etiológico se realice sin demora y correctamente. Es muy importante diferenciar los bordes de las lesiones de la úlcera de córnea producidas por hongos, bacterias filamentosas y otras bacterias, además considerar la presencia de lesiones satélites.

          Translated abstract

          Keratitis caused by Nocardia species is rarely reported in the world and therefore, its impact is not yet well established. The present study reports the first case of keratitis by Nocardia brasiliensis in Paraguay in a male patient, a gardener from Asuncion with a history of trauma with a bush branch two weeks before consultation. The patient came to the Department of Ophthalmology of the Hospital de Clinicas because of a red eye, decreased visual acuity and intense pain in the left eye with a week of evolution. The treatment was performed with the application of reinforced eye drops of gentamicin 14 mg/ml and cefazolin 50 mg/ml, every one hour. Improvement of the symptoms and visual acuity was observed at 10 days of follow-up. The clinical outcome of Nocardia spp keratitis is good as long as the etiologic diagnosis is made promptly and correctly. It is very important to distinguish the borders of the lesions of the corneal ulcer caused by fungi, filamentous bacteria and other bacteria apart from considering the presence of satellite lesions.

          Related collections

          Most cited references12

          • Record: found
          • Abstract: found
          • Article: not found

          Identification of medically relevant Nocardia species with an abbreviated battery of tests.

          Identification of Nocardia to the species level is useful for predicting antimicrobial susceptibility patterns and defining the pathogenicity and geographic distribution of these organisms. We sought to develop an identification method which was accurate, timely, and employed tests which would be readily available in most clinical laboratories. We evaluated the API 20C AUX yeast identification system as well as several biochemical tests and Kirby-Bauer susceptibility patterns for the identification of 75 isolates encompassing the 8 medically relevant Nocardia species. There were few biochemical reactions that were sufficiently unique for species identification; of note, N. nova were positive for arylsulfatase, N. farcinica were positive for opacification of Middlebrook 7H11 agar, and N. brasiliensis and N. pseudobrasiliensis were the only species capable of liquefying gelatin. API 20C sugar assimilation patterns were unique for N. transvalensis, N. asteroides IV, and N. brevicatena. There was overlap among the assimilation patterns for the other species. Species-specific patterns of susceptibility to gentamicin, tobramycin, amikacin, and erythromycin were obtained for N. nova, N. farcinica, and N. brevicatena, while there was overlap among the susceptibility patterns for the other isolates. No single method could identify all Nocardia isolates to the species level; therefore, a combination of methods was necessary. An algorithm utilizing antibiotic susceptibility patterns, citrate utilization, acetamide utilization, and assimilation of inositol and adonitol accurately identified all isolates. The algorithm was expanded to include infrequent drug susceptibility patterns which have been reported in the literature but which were not seen in this study.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Nocardia keratitis: species, drug sensitivities, and clinical correlation.

            To correlate the clinical presentation and treatment outcome of Nocardia keratitis with the time to diagnosis, different species and with the drug sensitivity pattern. Patients with Nocardia corneal ulcers were studied at a tertiary eye care center. Speciation of Nocardia isolates was done by sequencing the 16s rRNA gene. Clinical response to treatment was assessed by chart review. Twenty one (65.3%) patients presented within 15 days of the onset of symptoms with typical clinical features of Nocardia keratitis, ie, a ring-like distribution of superficial infiltrates in a wreath pattern. Eight patients (25%) who presented after 15 days and within 30 days had an ulcer resembling fungal keratitis. N. Cyriacigeorgica (n = 11; 34.37%), N. asteroides (n = 9; 28%), N. farcinica (n = 7; 22%,) and N. Otitidiscaviarum (n = 5; 16%). All the species had 100% sensitivity to amikacin, sulphamethoxazole, imipenem and co-trimoxazole. Time to diagnosis of the infection was significantly associated with the different types of clinical presentation; those presenting early having the typical clinical picture (P = 0.004). Patients (73%) presenting within 15 days showed a highest recovery rate. (P = 0.045). The recovery time of the patients when compared with species showed those who were infected with N. cyriageorgica had a healing time of less than 15 days. Clinically, healing was faster when treated with 2% amikacin. Visual outcome improved in fourteen patients (44%) and sixteen (50%) patients remained the same (P = 0.0001). Characteristic clinical picture of Nocardia is dependant on early presentation. It could be mistaken for fungal keratitis. Microbiological confirmation is important. Drug of choice for Nocardia keratitis is amikacin.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Nocardia keratitis after laser in situ keratomileusis: clinicopathologic correlation.

              A case of Nocardia asteroides keratitis occurring 3 weeks after laser in situ keratomileusis (LASIK) in a nontraumatized eye is reported. The patient presented with decreased vision, inflammation, and stromal melting of the LASIK flap, discrete infiltrates, and an anterior chamber cellular reaction. Cultures for acid-fast bacteria grew Nocardia asteroides after 5 days. Infection progressed despite treatment with topical antibiotics and eventually required penetrating keratoplasty (PKP). Postoperatively, the patient was placed on moxifloxacin, a fourth-generation flouroquinolone. The patient experienced a recurrence of Nocardia keratitis at the graft-host interface 2 months after the PKP. This eventually resolved with a combination of topical moxifloxacin and imipenem therapy.
                Bookmark

                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                iics
                Memorias del Instituto de Investigaciones en Ciencias de la Salud
                Mem. Inst. Investig. Cienc. Salud
                Instituto de Investigaciones en Ciencias de la Salud (Asunción, , Paraguay )
                1812-9528
                June 2012
                : 10
                : 1
                : 85-88
                Affiliations
                [02] orgnameUniversidad Nacional de Asunción orgdiv1Cátedra de Oftalmología del Hospital de Clínicas
                [01] orgnameUniversidad Nacional de Asunción orgdiv1Instituto de Investigaciones en Ciencias de la Salud orgdiv2Dpto. de Análisis Clínicos y Microbiología
                Article
                S1812-95282012000100011
                24dd036a-79f8-4ddb-b4fa-bb9ef4bb925f

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 13, Pages: 4
                Product

                SciELO Paraguay

                Categories
                Reporte de Casos

                keratitis,queratitis,Gentamicina,N. brasiliensis,gentamicin
                keratitis, queratitis, Gentamicina, N. brasiliensis, gentamicin

                Comments

                Comment on this article