Dacriocistitis por Candida Lusitaniae

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Abstract

Caso clínico: Se presenta el caso de una mujer de 60 años con episodios recurrentes de dacriocistitis aguda derecha que no cedían con tratamiento médico ni tras una dacriocistorrinostomía con intubación bicanalicular. Presentó también una dacriocistitis izquierda que requirió una dacriocistorrinostomía. Se tomaron muestras intraoperatorias y en el cultivo apareció Candida Lusitaniae como germen responsable. Tras tratamiento tópico con Anfotericina B, asociado a dacriocistorrinostomía, la clínica desapareció. Discusión: La dacriocistitis por Candida Lusitaniae es muy rara. Cabría preguntarse si Candida Lusitaniae es el germen primario o la dacriocistitis podría ser por sobreinfección fúngica debido al tratamiento antibiótico de las distintas dacriocistitis agudas sufridas.

Translated abstract

Case report: We report the case of a 60-year-old woman with recurrent dacryocystitis of the right lacrimal sac. She did not recover after medical treatment, nor after dacryocystorhinostomy with canalicular intubation. She also had dacryocystitis on the left side. The material that was obtained during surgery was grown in a culture medium and Candida Lusitaniae was identified as the responsible organism. All symptoms disappeared after topical treatment with amphotericin B and dacryocystorhinostomy. Discussion: Dacryocystitis caused by Candida Lusitaniae is very rare. We should always consider whether Candida Lusitaniae is responsible for the primary infection or is the agent resulting from a superadded infection caused by previous antibiotic therapy.

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Most cited references 8

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Changing bacterial isolates and antibiotic sensitivities of purulent dacryocystitis.

Daniel Briscoe, E Assia, Alexander Rubowitz (2005)

To examine the current spectrum of bacterial isolates in cases of chronic dacryocystitis and dacryoabcess and to determine their antibiotic sensitivities. We carried out a prospective study in which 39 patients who presented to the outpatient clinic with chronic purulent dacryocystitis or acute dacryoabscess had cultures taken. All patients were antibiotic-free for at least one week prior to culturing. The 39 positive cultures grew 41 bacterial isolates, as two patients grew two species of bacteria. Sixteen isolates (39%) were Gram positive and 25 (61%) were Gram negative. The most common isolates were Pseudomonas (22%), Staphylococcus aureus (13%), Enterobacter (10%), Citrobacter (10%), Streptococcus pneumoniae, Escherichia coli, and Enterococcus (7%). Uncommon Gram-negative bacteria were also cultured: Alcaligenes in 2 cases (5%) and one case of Stenotrophomonas maltophilia (2.5%). No anaerobic bacteria were isolated. Gram-negative isolates were sensitive to ceftazidime in 95%, ciprofloxacin in 86% and cefuroxime in 50%, with a sensitivity of less than 30% to cefalexin and ampicillin in those tested. All Pseudomonas isolates (100%) were sensitive to ceftazidime, 86% were sensitive to ciprofloxacin, while only 20% were sensitive to ampicillin and 14% to cefalexin. Alcaligenes was resistant to all antibiotics tested with the exception of ceftazidime. This study demonstrates a significant change in bacterial flora and antibiotic treatment requirements of purulent dacryocystitis from previously published data. A higher incidence of Gram-negative organisms, particularly Pseudomonas, with resistance to commonly used antibiotics was found. The emergence of rarer, highly resistant, Gram-negative microorganisms may also indicate a trend in lacrimal sac infections. These findings suggest that the antibiotic treatment protocol before and after lacrimal surgery should be reconsidered in this subgroup of patients.

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Bacteriology of chronic dacryocystitis in a tertiary eye care center.

Waleed Abu Al-Soud, Sarwat I Chaudhry, Farrukh Shamsi (2005)

To determine the current bacteriology of adult chronic dacryocystitis in a tertiary eye care center and compare it with previously reported studies. Clinical and microbiological records of patients with diagnosis of chronic dacryocystitis between January 1999 and March 2002 were reviewed for age, sex, lacrimal sac side involved, and culture results. Patients younger than 16 years of age and patients who were receiving any systemic or topical antibiotics were excluded from the study. One hundred eighty-eight adult patients with an average age of 50.5 years (range, 16 to 91 years), who had a diagnosis of chronic dacryocystitis, were identified. The study was predominated by female subjects (65.4%). Of the cultures from the nasolacrimal sac, 183 (97.3%) were positive for bacteria, with an average of 2.3 (1 to 6) microorganisms. More than 2 microorganisms were present in 66.1% of the cultures, whereas a single microorganism was recovered from 33.9% of the cultures. The majority of microorganisms in our study were Gram-positive bacteria, representing 53.7% of the overall microorganisms cultured with a predominance of Staphylococcus species. Gram-negative bacteria were recovered from 26.0% of the specimens with predominance of Haemophilus influenzae. Anaerobic microorganisms were present in 19.1% of the samples. The most frequently isolated anaerobic microorganisms were Propionibacterium acne and Peptostreptococcus species. Several bacterial species may be involved in the pathogenesis of chronic dacryocystitis in adults, and the majority of patients harbor multiple microorganisms in their nasolacrimal sacs. The high rate of microorganism-positive lacrimal sac cultures suggests that adult patients should be treated for their infection before any intraocular surgery because of the potential risk of infection.

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Changing bacterial isolates and antibiotic sensitivities of purulent dacryocystitis.

Alexander Rubowitz, Daniel Briscoe, Ehud Assia (2005)

To examine the current spectrum of bacterial isolates in cases of chronic dacryocystitis and dacryoabcess and to determine their antibiotic sensitivities. We carried out a prospective study in which 39 patients who presented to the outpatient clinic with chronic purulent dacryocystitis or acute dacryoabscess had cultures taken. All patients were antibiotic-free for at least one week prior to culturing. The 39 positive cultures grew 41 bacterial isolates, as two patients grew two species of bacteria; 16 isolates (39%) were Gram-positive and 25 (61%) were Gram-negative. The most common isolates were Pseudomonas (22%), Staphylococcus aureus (13%), Enterobacter (10%), Citrobacter (10%), Streptococcus pneumoniae, E. coli, and Enterococcus (7%). Uncommon Gram-negative bacteria were also cultured: Alcaligenes in two cases (5%), and one case of Stenotrophomonas maltophilia (2.5%). No anaerobic bacteria were isolated. Gram-negative isolates were sensitive to ceftazidime in 95%, ciproxin in 86%, and cefuroxime in 50% of cases, with sensitivity of less than 30% to cephalexin and ampicillin in those tested. All Pseudomonas isolates (100%) were sensitive to ceftazidine, 86% were sensitive to ciprofloxacin, with only 20% being sensitive to ampicillin and 14% to cephalexin. Alcaligenes was resistant to all antibiotics tested with the exception of ceftazidine. This study demonstrates a significant change in bacterial flora and antibiotic treatment requirements of purulent dacryocystitis from previously published data. A higher incidence of Gram-negative organisms, particularly Pseudomonas, with resistance to commonly used antibiotics was found. The emergence of rarer highly resistant Gram-negative microorganisms may also indicate a trend in lacrimal sac infections. These findings suggest that the antibiotic treatment protocol before and after lacrimal surgery should be reconsidered in this subgroup of patients.

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Author and article information

Contributors

F. Pastor-Pascual: Role: ND

E. España-Gregori: Role: ND

J. Aviñó-Martínez: Role: ND

R. Gallego-Pinazo: Role: ND

Journal

Journal ID (publisher-id): aseo

Title: Archivos de la Sociedad Española de Oftalmología

Abbreviated Title: Arch Soc Esp Oftalmol

Publisher: Sociedad Española de Oftalmología (, , Spain )

ISSN (Print): 0365-6691

Publication date (Print and electronic): June 2007

Volume: 82

Issue: 6

Pages: 365-367

Affiliations

[02] orgnameUniversidad de Valencia orgdiv1Departamento de Óptica

[01] Valencia orgnameHospital Universitario La Fe orgdiv1Servicio de Oftalmología España

Article

Publisher ID: S0365-66912007000600009

DOI: 10.4321/s0365-66912007000600009

SO-VID: f0aebad9-edc2-40b7-984c-ba291c715ea4

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This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

History

Date accepted : 24 May 2007

Date received : 13 June 2006

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Figures: 0, Tables: 0, Equations: 0, References: 5, Pages: 3

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SciELO Spain

Keywords: dacriocistitis fúngica,Candida Lusitaniae,dacriocistitis crónica,dacriocistorrinostomía,anfotericina B,Chronic Dacryocystitis,Fungal Dacryocystitis,Dacryocystorhinostomy,Amphotericin B

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Keywords: dacriocistitis fúngica, Candida Lusitaniae, dacriocistitis crónica, dacriocistorrinostomía, anfotericina B, Chronic Dacryocystitis, Fungal Dacryocystitis, Dacryocystorhinostomy, Amphotericin B

Dacriocistitis por Candida Lusitaniae Translated title: Dacryocystitis caused by Candida Lusitaniae

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Most cited references 8

Changing bacterial isolates and antibiotic sensitivities of purulent dacryocystitis.

Bacteriology of chronic dacryocystitis in a tertiary eye care center.

Changing bacterial isolates and antibiotic sensitivities of purulent dacryocystitis.

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