Rapid diagnosis of Mycobacterium abscessus endophthalmitis

Abstract

Nontuberculous mycobacteria are widely distributed in the environment and have the potential to cause a wide spectrum of infections including pulmonary, bone, soft tissue or ocular infections. They are a rare cause of endophthalmitis, a potentially devastating condition, which may be acquired through contamination of water or antiseptic solutions. Diagnosis is often delayed due to low clinical suspicion, resulting in poor clinical outcomes. Newer laboratory techniques such as real-time PCR can be used for rapid detection, identification and speciation of mycobacteria and allow for initiation of focused antibiotic therapy. We describe a case of Mycobacterium abscessus endophthalmitis that developed 30 years after traumatic loss of cornea in a patient with diabetes mellitus. Case ReportA 56-year-old woman with a history of non-insulin dependent diabetes mellitus presented to the emergency room with a 1 week history of worsening right eye pain with purulent drainage, headache, nausea and fever. Thirty years ago, she had suffered a traumatic injury to the right eye while living in India, which resulted in a blind eye. After a failed corneal transplant, she was fitted with a cosmetic lens (prosthesis) that fitted over her natural residual eye. She reported that she removed the prosthesis each night and stored it in a glass of tap water. The patient denied any prior upper respiratory infections or recent travel.On physical examination, the patient was afebrile. Examination of the eye revealed proptosis, uveal prolapse, conjunctival infection and yellowish discharge (Fig. 1). White blood cell count was 16.1610 3 ml 21, sedimentation rate was 37 mm h 21 and haemoglobin A1c was 6.8 %. Initial Gram stain of the drainage showed few polymorphonuclear cells and no organisms. Computed tomography (CT) scan of the orbits showed a 1.760.861.3 cm fluid collection with gas in the preseptal soft tissues raising concern about an abscess; multiple metallic foreign bodies were also present (Fig. 2). The right globe appeared proptotic. The patient was hospitalized and treated empirically with vancomycin and piperacillin-tazobactam, as well as trimethoprim-polymyxin ophthalmic solution.On hospital day 2, culture of the eye drainage grew few colonies of Staphylococcus aureus; piperacillin-tazobactam was discontinued. Despite treatment with vancomycin the patient continued to have persistent pain and drainage.On hospital day 5, Lowenstein-Jensen agar revealed one colony of a beaded, non-branching, Gram-positive bacillus which was Kinyoun stain positive. Initial PCR was positive for mycobacterial species. Given the speed of culture growth and PCR findings, it was felt that the organism was probably in the Mycobacterium fortuitum or M. abscessus-M. chelonae group of bacteria. Single-tube multiplex, real-time PCR testing (Richardson et al., 2009) for Mycobacterium tuberculosis complex, M. avium complex, the M. fortuitum group and the M. chelonae-M. abscessus group were performed. Results of this assay suggested M. abscessus.Antibiotics were ...

Nontuberculous Mycobacterial Endophthalmitis: Case Series and Review Literature

“…Up to September 2019, there were 95 cases of culture positive NTM endophthalmitis reported in the literature apart from three cases of this current study [1,[5][6][7]. Demographic data of all 98 cases were shown in table 1.…”

“…Since then, the infections have been increasingly reported in a variety of ocular infections range from periocular, conjunctival, scleral, corneal, orbital and intraocular infections [1,3,4]. Rapid growers especially M. chelonae, M. fortuitum and M. abscessus are the most common causes of ocular infections and generally associated with poor visual outcomes [4][5][6][7][8][9][10][11].…”

Nontuberculous Mycobacterial Endophthalmitis: Case Series and Review Literature

“…Total of 82.3% of cases ended up with visual impairment, evisceration, enucleation, or phthisis. The poor prognosis is due to delay diagnosis and treatment and the organism's ability to form a bio lm [1,6,9]. The diagnosis of our case was made within 6 weeks after capsulotomy which caused acute active in ammation.…”

“…Rapid growers especially M. chelonae, M. fortuitum and M. abscessus are the most common causes of ocular infections and generally associated with poor visual outcomes [4][5][6][7][8][9][10][11].…”

Update on the prevention and treatment of endophthalmitis

“…For example, PCR has been reported to identify Prevotella species [17], Mycobacterium abscessus [18], Curvularia lunata [19]and Eschericia fergusonii [20], as well as multiple cases of post-filtering bleb endophthalmitis [21]. …”