Microbial characteristics of post-traumatic infective keratitis

Lim, Blanche Xiao Hong; Koh, Victor; Ray, Manotosh

doi:10.5301/ejo.5001009

Cited by 11 publications

(21 citation statements)

References 14 publications

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“…For our patient, corneal scraping and culture were performed because of the emergence of a corneal ulcer at an early stage of the disease; the results confirmed bacterial infection. Multiple authors have shown that bacteria causing mixed keratitis are generally sensitive to the fluoroquinolone class of antibiotics, 5,7,20,21 which was also confirmed in this case. Our first choice was gatifloxacin because-in addition to the above factors-its ability to permeate into the eyes is much greater than that of the commonly used levofloxacin; moreover, its half-life is longer than that of moxifloxacin.…”

Section: Clinical Practice Pointssupporting

confidence: 83%

“…The treatment of double microbial infection-derived keratitis has been widely reported, [4][5][6] with infection mostly caused by two fungal species, a mixture of fungal and bacterial pathogens, or a mixture of a fungus and Acanthamoeba; in contrast, keratitis caused by triple infection has been extremely rare, constituting only 1.16% of all reported cases of corneal infection. 7 The largest retrospective study of such infections thus far was conducted by Ray et al, 7 who reported that the isolated microorganisms consisted of only two species (bacterial and/or fungal), including two bacterial species (e.g., Neisseria meningitidis and Pseudomonas aeruginosa).…”

Section: Discussionmentioning

confidence: 99%

“…7. When treating triple corneal infection, a full course of drug treatment with the full dose must be performed; an average treatment time of more than 28 days has been reported previously 5,7,23 and was used for treatment of our patient. 8.…”

Section: Clinical Practice Pointsmentioning

confidence: 99%

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Clinical diagnosis and treatment of rare painless keratitis caused by three pathogens: clinical practice and experiential discussion

Sun

Wang

et al. 2020

J Int Med Res

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There have been numerous reports regarding the occurrence of keratitis in patients with soft contact lenses, but few reports in patients with rigid gas permeable contact lenses. To the best of our knowledge, the occurrence of infection associated with three species of pathogens has never been reported. Here, we describe a patient who exhibited refractory painless keratitis caused by three pathogens (Staphylococcus epidermidis, Acanthamoeba, and herpes simplex virus) and summarize similar reports published at multiple centers worldwide, with the aim of providing guidance for clinicians who might encounter mixed-type corneal infections. We describe the results of many ophthalmologic and laboratory investigations, which guided our treatment selection. We achieved good treatment efficacy, such that the patient exhibited a corrected visual acuity of 20/20 in the affected eye after a series of treatments, including curettage of ulcer lesions. Corneal infections caused by multiple pathogens are challenging in clinical practice. This summary of our experience in patient diagnosis and treatment can help clinicians to achieve a favorable prognosis in treatment of future patients.

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Section: Clinical Practice Pointssupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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Clinical diagnosis and treatment of rare painless keratitis caused by three pathogens: clinical practice and experiential discussion

Sun

Wang

et al. 2020

J Int Med Res

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“…Corneal cells of the human eye form a non-polar apical barrier, which is important for function and protection against infection [41]. Infections usually arise after physical damage to the cornea by opportunistic pathogens [41,42]. We found that fully confluent HCE-T cells were not susceptible to infection by PA103 ( Figure 4A) Figure 4C).…”

Section: A Scratch and Infection Assay To Evaluate The Therapeutic Pomentioning

confidence: 87%

Evaluation of ExoU inhibitors in aPseudomonas aeruginosascratch infection assay

Foulkes

McLean

Harris

et al. 2020

Preprint

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Pseudomonas aeruginosa has recently been highlighted by the World Health Organisation (WHO) as a major threat with high priority for the development of new therapies. The type III secretion system of P. aeruginosa delivers the toxin ExoU into the cytosol of target host cells, where its plasma membrane directed phospholipase activity induces rapid cell lysis. Therefore, inhibition of the phospholipase activity of ExoU would be an important treatment strategy in P. aeruginosa infections. We evaluated a panel of ExoU small molecule inhibitors, previously identified from high throughput cellular based assays, and analysed their inhibition of ExoU phospholipase activity in vitro. A corneal epithelial (HCE-T) scratch and infection model using florescence microscopy, and cell viability assays, were used to test the efficacy of compounds to inhibit ExoU from P. aeruginosa. Compounds Pseudolipasin A, compound A and compound B were effective at mitigating ExoU mediated cytotoxicity after infection at concentrations as low as 0.5 µM. Importantly, by using the antimicrobials moxifloxacin and tobramycin to control bacterial load, these assays were extended from 6 h to 24 h. P. aeruginosa remained cytotoxic to HCE-T cells with moxifloxacin, present at the minimal inhibitory concentration (MIC) for 24 h, but, when used in combination with either PSA, compound A or compound B, partial scratch healing was observed. These results provide evidence that ExoU inhibitors could be used in combination with certain antimicrobials as a novel means to treat clinical infections of ExoU producing P. aeruginosa.

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“…However, these were performed on all types of microbial keratitis regardless of etiology [22]. In the study of Lim et al [23], no Gram-positive organisms were isolated in culture-positive eyes. Pseudomonas aeruginosa was the commonest Gram-negative organism isolated in their study.…”

Section: Discussionmentioning

confidence: 99%

Corneal Collagen Cross Linking With Photo-Activated Chromophore for keratitis (PACK-CXL) As AdjunctiveTherapy for Infectious Keratitis

Tawfeek

Ammar

Enany

et al. 2019

Zagazig University Medical Journal

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Background : The aim of this work is to evaluate efficacy and safety of corneal collagen cross linking as adjunctive therapy for treating infectious keratitis. Methods: This is a randomized prospective controled clinical trial. Seventy eight (78) eyes with clinically suspected infectious keratitis were enrolled in this study. The range of age of the enrolled patients was more than or equal to18 years. They were randomly classified into two groups each of 39 eyes, Group A(control group): received topical appropriate conventional broad spectrum antimicrobial therapy alone based on sensitivity reports and Group B: received combined topical appropriate conventional broad spectrum antimicrobial therapy based on sensitivity reports and corneal collagen cross linking for infectious keratitis (PACK-CXL). Identification of organisms was done by lab study before treatment. Corneal healing was evaluated by corneal examination and anterior segment OCT ( AS-OCT). Written informed consent was obtained from all participants and the study was approved by the research ethical committee of Faculty of Medicine, Zagazig and Cairo University. The work has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for studies involving humans. Results: Complete healing and resolution (Successful treatment) was observed in 76.9 % of eyes and 97.4 % of patients in groups (A & B), respectively. They showed a statistically highly significant difference (P <0.001). Mean resolution period was 10.87±3.28 and 7.02±2 weeks in group (A & B), respectively, with statistically significant difference (P = 0.002) between both groups, being shorter in group (B).Only 2.6% of our cases had resistance to treatment in CXL compared to group A, who had 23.1% of resistance. There was no statistically significant difference between both groups as regards complications of treatment. Conclusions: PACK-CXL is a promising , non-invasive and available treatment option. It has a synergistic effect with antimicrobial treatment that gives a good outcome results in treatment of infectious keratitis. Also, it avoids the antibiotics resistance that has become rapidly spreading worldwide.

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Microbial characteristics of post-traumatic infective keratitis

Cited by 11 publications

References 14 publications

Clinical diagnosis and treatment of rare painless keratitis caused by three pathogens: clinical practice and experiential discussion

Clinical diagnosis and treatment of rare painless keratitis caused by three pathogens: clinical practice and experiential discussion

Evaluation of ExoU inhibitors in aPseudomonas aeruginosascratch infection assay

Corneal Collagen Cross Linking With Photo-Activated Chromophore for keratitis (PACK-CXL) As AdjunctiveTherapy for Infectious Keratitis

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