CXL appears to be an effective procedure in the management of superficial microbial keratitis. It can be used as an adjunctive treatment in the management of non-resolving microbial keratitis.

Background: Extended Spectrum β-lactamases (ESBLs) are enzymes produced by some bacteria that inactivate oxyimino-cephalosporins, a class of β-lactam antibiotics family. They are mainly encoded by the β-lactamase gene families TEM, SHV and CTX-M. The Enterobacteriaceae expressing these genes, in particular Escherichia coli are widely expanded in the world with different prevalence rate from one region to another. The objective of this study, carried out from strains isolated at the National Institute of Hygiene (INH) in Togo, was to (i) detect and characterize the genes involving in the production of β-lactamase among E. coli strains and (ii) evaluate their prevalence.Methodology: From May 2013 to July 2015, 91 E. coli strains resistant to third generation cephalosporins (C3G) were collected from several specimens and analyzed for the detection of β-lactamase resistance genes, bla TEM , bla SHV and bla CTX-M by simplex and multiplex PCR.Results: The E. coli strains resistant at least to one third generation cephalosporin, were isolated from urine 58/91 (63.74%), vaginal samples 17/91 (17.68%), wound swabs 7/91 (7.69%), 4/91 semen samples (4.40%), urethral curettage CU 2/91 (2.20%), sputum 1/91 (1.1%), stool 1/91 (1.1%) and joint fluid 1/91 (1.1%). Resistance to third generation cephalosporins was associated with a resistance to quinolone (96.67%), trimethoprim/sulfamethoxazole (94.44%), gentamicin (75.82%) and chloramphenicol (59.09%). ESBL genes were present in all E. coli strains with the following proportions: TEM/CTX-M1 52/91 (57.14%), TEM/SHV/CTX-M1 19/91 (20.88%), CTX-M 18/91 (19.78%), TEM 1/91 (1.10%) and TEM/SHV 1/91 (1.10%). Conclusion:The presence of ESBL producing E. coli is a reality in Togo and their wide dissemination compromises the treatment of classical infections such as urinary tract infection, bacterial pneumonia, sepsis or meningitis. The acquisition of molecular data on bacterial resistance to antibiotics is necessary for better therapeutic management of these infections. This is a first determination of the βlactamase genes in Togo.

Corneal tissues harvested from septicemic donors do not necessarily harbor the pathogenic organisms causing the septicemia, suggesting that such corneas may be suitable for transplantation.

Custard apple seeds have been used in native medicine from time immemorial for the management of head lice and skin exfoliation. We report six consecutive patients who developed toxic keratoconjunctivitis within 6–12 h of ocular exposure to custard apple seeds. The use of topical steroid worsens the toxicity and predisposes to the development of microbial keratitis in such cases. Patients showed a good response to primary treatment with topical fortified antibiotics and lubricants. This case series highlights the need to educate the patients regarding the potential toxic effects of the custard seeds and the treating physicians about possible deleterious effects on using topical steroid.