Challenges in the management of Neisseria gonorrhoeae keratitis

Abstract

We describe the presentation and subsequent management of a case of keratitis caused by Neisseria gonorrhoeae. A thirty-nine year old gentleman presented with a purulent ocular discharge. Corneal melt with corneal perforation occurred. Neisseria gonorrhoeae was cultured. Systemic and topical antibiotics were given. Deep lamellar keratoplasty was performed for corneal perforation. At three months post treatment no recurrence of infection was noted. The possibility of Neisseria gonorrhoeaea keratitis should always be considered in patients with a purulent ocular discharge even if the case history is not immediately suggestive of the same. Severe gonococcal keratitis may be unilateral. Deep lamellar keratoplasty can be considered as a therapeutic option in patients with severe gonococcal keratitis.

Modern treatments for purulent corneal ulcers

“…При гонококковом поражении роговицы, как и при синегнойной инфекции, стремительно развива-ется расплавление роговицы, чреватое перфораци-ей, эндофтальмитом и гибелью глаза. В большин-стве публикаций на тему лечения гонококковой яз-вы роговицы авторы рассматривают исключительно хирургическое лечение, прежде всего СКП [48,49].…”

Purulent corneal ulcers: clinical presentation, diagnosis, and conservative treatment

“…В обоих случаях возникает быстрое расплавление роговицы, чреватое перфорацией, эндофтальмитом, гибелью глаза. В большинстве публика-ций на тему лечения гонококковой язвы роговицы авторы рассматривают исключительно хирургическое лечение, прежде всего сквозную кератопластику [81]. Однако в слу-чае раннего обращения пациента с гонококковым керати-том терапевтическое лечение имеет лечебный потенциал.…”

The Growing Threat of Gonococcal Blindness

“…In addition to causing the sexually transmitted infection known as gonorrhea, Neisseria gonorrhoeae can infect the eye, where it is capable of causing ulceration of the cornea, perforation of the globe of the eye, and permanent blindness [ 1 , 2 , 3 ]. Up to 48% of infants born to mothers infected with N. gonorrhoeae develop ophthalmia neonatorum, and up to 10% of those who receive antibiotic prophylaxis still develop infection [ 2 , 3 ]. Infants can become infected in utero, and delivery via Caesarean section, in addition to carrying higher risks for the mother, does not necessarily eliminate the risk of ophthalmia neonatorum [ 4 ].…”