Pearls and paradigms in Infective Keratitis

Acharya, Manisha; Farooqui, Javed Hussaina; Jain, Shikha; Mathur, Umang

doi:10.22336/rjo.2019.18

Cited by 21 publications

(18 citation statements)

References 36 publications

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“…The method of obtaining the corneal scrapes has been described with many instruments, such as sterile cotton swab, sterile calcium alginate swab, heatsterilized platinum (Kimura) spatula, 26 or 23-gauge needle, blade, cotton-tipped applicator 2,33,34 . In our study, we used sterile steel spatulas that were changed for each smear.…”

Section: Discussionmentioning

confidence: 99%

Microbial profile in infectious keratitis over 8 years in Sao Paulo, Brazil: pathogens and microbial resistance

Oliveira

Tanaka

Kato

et al. 2021

Preprint

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Objective Infectious keratitis remains a sight-threatening disease and its prompt diagnosis and treatment are critical. This study investigated the microbiological patterns of isolates in corneal ulcers in a tertiary health center in an 8-year period. Methods Retrospective analysis of scrapes of microbial keratitis performed from January 2013 to December 2020. Demographics and microbiological data were collected. Results A total of 446 scrapes were performed on eyes of 433 patients, 270 male (62.4%), mean age 51.7 years. 304 organisms were isolated from 248 (55.6%) positive samples. Polymicrobial infections occurred in 47 samples (19.0%). Bacterial isolates represented 86.8%: 53.3% gram-positive (GP), 33.5% gram-negative (GN). Cutibacterium acnes (12.2%) and Pseudomonas aeruginosa (9.9%) were the most common bacteria. Fungal keratitis comprised 11.8% of the isolates; Fusarium sp (6.2%) was the main fungus isolated. GP tested were sensitive to vancomycin, 98.7% of the GN were sensitive to ceftazidime. All Pseudomonas aeruginosa were sensitive to gentamicin and ciprofloxacin. Conclusion Gram-positive bacteria were predominant in keratitis isolates. In severe bacterial keratitis in our area, vancomycin should be considered as empirical treatment.

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Section: Discussionmentioning

confidence: 99%

Microbial profile in infectious keratitis over 8 years in Sao Paulo, Brazil: pathogens and microbial resistance

Oliveira

Tanaka

Kato

et al. 2021

Preprint

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“…Since the bacterial ophthalmic infections (both corneal, keratitis, and intraocular, endophthalmitis) are still one very important cause of eye disease, unquestionably, it is critical to improve the clinical results with antimicrobial agents [33]. Further studies on this topic are warranted.…”

Section: Discussionmentioning

confidence: 99%

Minimum inhibitory concentrations and resistance for selected antimicrobial agents (including imipenem, linezolid and tigecycline) of bacteria obtained from eye infections

Galvis

Tello

Sánchez

et al. 2020

rjo

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Objective: To determine bacteria obtained from eye infections, both resistance and minimal inhibitory concentration (MIC) to gatifloxacin, moxifloxacin, tigecycline, linezolid and imipenem, in vitro. Methods: A cross-sectional descriptive study was undergone with 50 samples from 50 eyes of patients diagnosed with keratitis or endophthalmitis, who came to a consultation at the Fundación Oftalmológica de Santander (Floridablanca, Colombia) from August to November 2014. The MICs of the isolated microorganisms were established through Etest® strips (BioMérieux SA, Marcy-l'Etoile -France). Results: Of the 50 samples in total, 17 different bacteria species or groups were isolated. The main isolate for gram-positives was Methicillin Resistant Coagulase-Negative Staphylococcus (17 samples), and for gram-negatives was Pseudomonas aeruginosa (6 samples). The susceptibility percentages sorted from highest to lowest for gram-positive isolates (n=38) were: imipenem 90.3%, linezolid 87.9%, tigecycline 78.1%, gatifloxacin 68.8% and moxifloxacin 68.8%. For gram-negative isolates (n=12), they were: imipenem 72.7%, gatifloxacin 70%, moxifloxacin 66.7% (no reference cut-off points were found for Pseudomonas aeruginosa), tigecycline 22.2%, and linezolid 0% (as expected according to its inhibition spectrum). Conclusions: Although fourth generation fluoroquinolones are currently the preferred initial empirical monotherapy in our practice, given the increasing bacterial resistance, in cases in which gram-positive bacteria were isolated in the initial staining imipenem, linezolid or tigecycline could be used as an alternative. On the other hand, for cases of gram-negative bacteria, no antimicrobial susceptibility exceeded 80%, so using two antimicrobials looking for a synergy between them could be a better option.

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“…The presence or absence of hypopyon was recorded and the height measured in millimeters. Based on the severity grading system for infectious corneal ulcers, 8 , 9 patients with AK were graded as mild (corneal ulcer diameter <2 mm, ulcer depth <20%, and infiltration depth <20%), moderate (corneal ulcer diameter 2–5 mm and/or ulcer depth 20%–50% and/or infiltration depth 20%–50%), and severe (corneal ulcer diameter >5 mm or ulcer depth >50% or infiltration depth >50%). The grouped results were graded with priority given to the most serious criteria.…”

Section: Methodsmentioning

confidence: 99%

“…Similarly, as persistent inflammatory responses are present in some cases of AK, systemic or local steroids, or immunosuppressive agents, have occasionally been used, but no clear consensus has been defined on their use. 7 – 9 Consequently, it is important to investigate the mechanisms of inflammation in AK as well as the relationship between Acanthamoeba and the corneal inflammatory response.…”

Section: Introductionmentioning

confidence: 99%

Corneal Changes in Acanthamoeba Keratitis at Various Levels of Severity: An In Vivo Confocal Microscopic Study

Wei

Cao

Wang

et al. 2021

Trans. Vis. Sci. Tech.

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Purpose To investigate the relationship between Acanthamoeba cysts and inflammatory cells in Acanthamoeba keratitis (AK) by in vivo confocal microscopy (IVCM). Methods A case-control study included 30 patients with AK and 20 normal controls. The severity of the AK was divided into mild, moderate, and severe. The central cornea and four standard quadrants of the peripheral cornea were imaged by IVCM. The cyst infiltration and dendritic cell (DC) density and maturity (size, length, field, and number of dendrites) were quantified. The relationship between clinical severity, cyst density, and DC alterations was characterized by Spearman correlation analysis. Results The maximum cyst density in the mild, moderate, and severe groups was 31.3 cysts/mm 2 (17.2–32.8), 62.5 cysts/mm 2 (59.3–103.1), and 162.5 cysts/mm 2 (65.6–215.6), respectively. Compared to normal participants, a significant increase in the mean corneal DC density was detected in patients with AK (290.2 ± 97.0 vs. 25.3 ± 8.3 cells/mm 2 ; P < 0.001). Patients with AK presented an increase in median DC size (178.3 vs. 63.6 µm 2 /cell, P < 0.001), median DC field (518.1 vs. 256.6 µm 2 /cell, P = 0.008), and median DC dendrite length (42.3 vs. 14.7 µm/cell, P < 0.001). Increased AK severity was correlated with an increase in cyst density, DC size, and dendrite length (all P < 0.05). An increase in cyst density was significantly correlated with an increase in DC density (β = 0.484, P = 0.026) and DC size (β = 0.557, P = 0.009). Conclusions Cyst density and depth of infiltration as well as maturity of the surrounding DC increased significantly with the severity of AK. Translational Relevance Quantitative analysis of cyst density and DC maturity may provide a new method of evaluating the severity of AK.

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Pearls and paradigms in Infective Keratitis

Cited by 21 publications

References 36 publications

Microbial profile in infectious keratitis over 8 years in Sao Paulo, Brazil: pathogens and microbial resistance

Microbial profile in infectious keratitis over 8 years in Sao Paulo, Brazil: pathogens and microbial resistance

Minimum inhibitory concentrations and resistance for selected antimicrobial agents (including imipenem, linezolid and tigecycline) of bacteria obtained from eye infections

Corneal Changes in Acanthamoeba Keratitis at Various Levels of Severity: An In Vivo Confocal Microscopic Study

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