Nocardia Keratitis

Lalitha, Prajna; Tiwari, Mamta; Prajna, Nampurumalsamy Venkatesh; Gilpin, Christopher; Prakash, Karthik; Srinivasan, M

doi:10.1097/ico.0b013e318033d853

Cited by 56 publications

(39 citation statements)

References 16 publications

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“…15 Previous case series from South India have shown that Nocardia spp were responsible for a small proportion of bacterial ulcers, however in SCUT, Nocardia was the third most commonly-isolated organism. 5,16 Prior reports have evaluated outcomes in Nocardia keratitis in a retrospective manner, and no information is available on the utility of corticosteroids for this type of keratitis. In this prospective subanalysis of a clinical trial, we found that Nocardia keratitis generally had good outcomes, but the use of corticosteroids resulted in larger infiltrate/scar sizes, suggesting they may not be appropriate for treating this disease.…”

Section: Discussionmentioning

confidence: 99%

“…1–3 Several large case series have shown that patients with Nocardia keratitis typically have good visual outcomes with appropriate diagnosis and therapy. 4,5 However, there is little evidence regarding outcomes of Nocardia keratitis compared to keratitis due to other bacterial organisms, and there is little information on the utility of topical corticosteroids as adjunctive therapy in these cases. Corticosteroids may reduce immune-mediated tissue damage in bacterial corneal ulcers and improve clinical outcomes, however case reports have suggested that topical corticosteroids may cause recurrent infection in Nocardia keratitis.…”

Section: Introductionmentioning

confidence: 99%

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Nocardia Keratitis: Clinical Course and Effect of Corticosteroids

Lalitha

Srinivasan

Rajaraman

et al. 2012

American Journal of Ophthalmology

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Purpose To compare the clinical course of Nocardia spp keratitis with keratitis due to other bacterial organisms, and to assess the effect of corticosteroids as adjunctive therapy using data collected from the Steroids for Corneal Ulcers Trial (SCUT). Design Sub-group analysis of a randomized controlled trial Methods Setting Multicenter randomized controlled trial Study Population 500 patients with bacterial keratitis, randomized 1:1 to topical corticosteroid or placebo who had received at least 48 hours of topical moxifloxacin Intervention/Observation Procedure Topical prednisolone phosphate 1% or placebo; clinical course of Nocardia keratitis Main outcome measures Best spectacle-corrected visual acuity and infiltrate/scar size at 3 months from enrollment Results Of 500 patients enrolled in the trial, 55 (11%) had a Nocardia corneal ulcer. Patients with Nocardia ulcers had better presentation visual acuity compared to non-Nocardia ulcers (median Snellen 20/45 compared to 20/145, P<0.001), and comparable 3-month visual acuity (median 20/25 versus 20/40, P=0.25). Nocardia ulcers had approximately 2 lines less improvement in visual acuity compared to non-Nocardia ulcers (0.21 logMAR, 95% CI 0.09 to 0.33 logMAR, P=0.001). This difference may reflect the better starting visual acuity in patients with Nocardia ulcers. In Nocardia ulcers, corticosteroids were associated with an average 0.4 mm increase in 3-month infiltrate/scar size (95% CI 0.03 to 0.77mm, P=0.03). Conclusion Nocardia ulcers responded well to treatment. They showed less overall improvement in visual acuity than non-Nocardia ulcers, but had better presentation acuity. Corticosteroids may be associated with worse outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nocardia Keratitis: Clinical Course and Effect of Corticosteroids

Lalitha

Srinivasan

Rajaraman

et al. 2012

American Journal of Ophthalmology

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“…Currently, amikacin is the drug of choice for treating nocardiosis. [910] Nocardia sp. also shows susceptibility to some of the second and third generation cephalosporins.…”

Section: Discussionmentioning

confidence: 99%

Endogenous nocardial endophthalmitis in an immunosuppressed patient: A serious warning of an underlying life threatening and blinding disorder

Trehan¹,

Kaushik²,

Jain³

et al. 2017

J Ophthalmic Vis Res

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Purpose:To report a case of bilateral endogenous nocardial endophthalmitis with central nervous system involvement in an immunocompromised individual with an extremely poor outcome.Case Report:A 35-year-old man with a history of long-term, prescribed oral steroid use for membranoproliferative glomerulonephritis presented with profound bilateral vision loss. Patient's diagnosis of bilateral endogenous nocardial endophthalmitis was delayed. Nocardia was finally isolated from a brain biopsy after a repeat magnetic resonance imaging revealed a brain abscess. With anti-nocardia therapy, patient improved systemically, but the visual outcome was poor, with no light perception in both eyes.Conclusion:Ocular nocardiosis is a serious vision and life threatening disorder, particularly in patients on immunosuppressive therapy. A high index of suspicion is required for successful treatment.

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“…The common predisposing factors were surgery and injury (scleral buckle—5, injury—7). Clinical features of Nocardia keratitis like patchy infiltrate, wreath-like pattern has been described [14]. No such clinical feature which is pathognomonic of any causative organism has been described in cases of scleritis.…”

Section: Discussionmentioning

confidence: 99%

Nocardia scleritis—clinical presentation and management: a report of three cases and review of literature

Sahu

Sharma

Das

2011

J Ophthal Inflamm Infect

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AimThis study aims to describe the clinical features and management of Nocardia scleritis.MethodsThe authors retrospectively reviewed medical charts of three patients with microbiologically proven Nocardia scleritis and reviewed literature.ResultsAll the patients presented with areas of well-demarcated, circumscribed abscess. No specific clinical feature could be attributed to the causative organism. Nocardia was identified by smear and culture from the scleral exudates. The medical management was based on the antibiotic sensitivity. Surgical exploration of the suppurated area along with the healthy margins was done on all patients. Two patients required multiple explorations. All three patients resolved with a good visual and tectonic outcome. The literature review also suggests a good outcome with prolonged medical management though the preferred antibiotic has changed over the years.ConclusionThough the prevalence of a disease like Nocardia scleritis is low, the results suggest that specific diagnosis and appropriate management can lead to a good outcome.

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Nocardia Keratitis

Abstract: 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.

Cited by 56 publications

References 16 publications

Nocardia Keratitis: Clinical Course and Effect of Corticosteroids

Nocardia Keratitis: Clinical Course and Effect of Corticosteroids

Endogenous nocardial endophthalmitis in an immunosuppressed patient: A serious warning of an underlying life threatening and blinding disorder

Nocardia scleritis—clinical presentation and management: a report of three cases and review of literature

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