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

Abstract

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.

Diversity and frequency of Nocardia spp. in the soil of Isfahan province, Iran

“…So far, more than 50 species in the genus Nocardia are described among which Nocardia asteroids (N. asteroids) complex, Nocardia brasiliensis (N. brasiliensis), Nocardia transvalensis (N. transvalensis), Nocardia otitidiscaviarum (N. otitidiscaviarum), Nocardia farcinica and Nocardia pseudobrasiliensis are more pathogenic in humans [2] . These organisms are found in sludge, soil, contaminated soils water, plants, spoiled material and plant and cause opportunistic infections in humans and animals [3][4][5][6][7][8][9][10] .…”

Second report of a Nocardia beijingensis infection in the United States: nodular scleritis with in vitro imipenem resistance

“…18 Our patient was treated for more than 10 months. The literature confirms that surgical debridement is an essential component of treatment.…”

“…11 A majority of patients with Nocardia scleritis present with nonspecific signs, such as pain, conjunctival injection, scleral abscess, or scleral nodule. 12,14,17,18 A high index of suspicion for Nocardia infection should be maintained when a patient presents with a history of ocular trauma, associated history of farm work, or a unilateral lesion. 16 In our case, the patient's primary risk factor included contact-lens wear.…”

“…Surgical intervention is employed in the majority of cases that result in complete cure. 14,15,17,18,20,21 Jain et al maintains that surgical debridement is important in facilitating the penetration of antibiotics and in debulking infected tissue. 20 Despite limited data, we believe that there could be a role for subconjunctival and sub-Tenon's antibiotics, even though we did not use them.…”

Infectious Scleritis

“…Although rare, Nocardia scleritis has been reported frequently in literature as isolated case reports [27][28][29][30][31][32][33][34][35][36][37][38][39]. Sahu et al [27] reported a series of three patients and reviewed the literature for this entity. While Jain et al [1 • ] reported Nocardia to occur as an extension of corneal infection involving the limbus, other authors have described isolated scleritis with positive history of surgery and injury.…”