Visual Recovery Following<i>Mycobacterium chelonae</i>Endophthalmitis

Stewart, Michael W.; Álvarez, Salvador; Ginsburg, William W.; Shetty, Rajesh; McLain, Walter C.; Sleater, Joseph P.

doi:10.1080/09273940600678062

Cited by 18 publications

(9 citation statements)

References 14 publications

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“…Etanercept therapy has been reported in association with fatal MACLD [160], fatal pulmonary M. xenopi infection [161], fatal pulmonary M. abscessus infection [162], M. chelonae endophthalmitis [163], M. xenopi spinal osteomyelitis [164] and pulmonary M. szulgai infection [165]. In the latter case, the patient's treatment changed from etanercept to adalimumab after M. szulgai was identified.…”

Section: Tnf-a Antagonistsmentioning

confidence: 99%

Susceptibility to nontuberculous mycobacterial lung disease: Table 1—

Sexton¹,

Harrison²

2008

Eur Respir J

143

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The nontuberculous mycobacteria (NTM) exhibit heterogeneous pathogenicity in humans. Articles on known and potential human factors capable of producing susceptibility to NTM lung disease (NTMLD) were identified by a systematic search of the medical literature, and are reviewed in the present study.Patients with pre-existing structural lung disease are known to be at risk of NTMLD. Other susceptible groups have become recognised since the 1980s, in particular middle-aged nonsmokers without previous lung disease (a group including those with Lady Windermere syndrome) and patients with genetically determined defects of cell-mediated immunity, including abnormalities of the interleukin-12/interferon-c axis, certain human leukocyte antigen alleles, cystic fibrosis transmembrane conductance regulator mutations, and polymorphisms of solute carrier 11A1 (or natural resistance-associated macrophage protein 1) and the vitamin D receptor.Information is also accruing about acquired systemic causes of susceptibility to NTMLD, including inhibitory antibodies directed against interferon-c, post-menopausal waning of endogenous oestrogen levels, coeliac disease and exposure to use of dietary phyto-oestrogens. It is not known whether immunosuppressive factors, such as oral corticosteroid treatment, chronic renal failure, diabetes mellitus and other known risk factors for pulmonary tuberculosis, are also risk factors for the development of NTMLD. Caution is appropriate in managing such patients.

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Section: Tnf-a Antagonistsmentioning

confidence: 99%

Susceptibility to nontuberculous mycobacterial lung disease: Table 1—

Sexton¹,

Harrison²

2008

Eur Respir J

143

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“…From literature review, there were only 11 eyes that showed nal BCVA of 6/60 or better [7,21,30,32,37,41,43,47,52]. Stewart et al reported a case of M. abscessus endophthalmitis with a full visual recovery [50].…”

Section: Discussionmentioning

confidence: 99%

Nontuberculous Mycobacterial Endophthalmitis: Case Series and Review Literature

Pinitpuwadol

Tesavibul

Boonsophon

et al. 2020

Preprint

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Abstract Background: To report three cases of nontuberculous mycobacterial (NTM) endophthalmitis following multiple ocular surgeries and to review previous literature in order to study the clinical profile, treatment modalities, and visual outcomes among patients with NTM endophthalmitis.Methods: Clinical manifestation and management of patients with NTM endophthalmitis in the Department of Ophthalmology, Faculty of Medicine, Siriraj hospital, Mahidol University, Bangkok, Thailand were described. In addition, a review of previously reported cases and case series from MEDLINE was performed. The clinical information and type of NTM from the previous studies and our cases were summarized.Results: We reported three cases of NTM endophthalmitis caused by M. haemophilum, M. fortuitum and M. abscessus and a summarized review of 95 additional cases previously published. Of 98 patients, there were 85 exogenous endophthalmitis (86.7%) and 13 endogenous endophthalmitis (13.3%). The patients’ age ranged from 13 to 89 years with mean of 61.1±18.7 years with no gender predominance. Exogenous endophthalmitis occurred in both healthy and immunocompromised hosts, mainly caused by cataract surgery (62.4%). In contrast, almost all endogenous endophthalmitis patients were immunocompromised. Among all patients, previous history of tuberculosis infection was identified in 4 cases (4.1%). Rapid growing NTMs were responsible for exogenous endophthalmitis, while endogenous endophthalmitis were commonly caused by slow growers. Treatment regimens consisted of macrolides, fluoroquinolones or aminoglycosides, which were continued for up to 12 months. Initial and final vision were generally worse than 6/60.Conclusions: NTM endophthalmitis is a serious intraocular infection that leads to irreversible loss of vision. The presentation can mimic a chronic recurrent or persistent intraocular inflammation. History of multiple intraocular surgeries or immune-deficiency in patient with chronic panuveitis should raise the practioner’s suspicion of NTM endophthalmitis. Appropriate diagnosis and treatment are important to optimize visual outcome.

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“…Causes of M. chelonae endophthalmitis include prior cataract surgery,9–12 glaucoma surgery,13 iridocyclitis,14 intravitreal steroid injections,9,15 neurotrophic cornea,9 and systemic immunosuppression 16,17. The patient had several risk factors for an ocular RGNTM infection: 1) an immunosuppressed state after completion of chemotherapy during which herpes zoster infections are more common; 2) a neurotrophic cornea secondary to HZO with a non-healing ulcer and recurrent perforations; and 3) multiple diagnostic and therapeutic ocular surgeries, long-term antibiotic therapy, and steroid immunosuppression during periods of active infection.…”

Section: Discussionmentioning

confidence: 99%

Recurrent nontuberculous mycobacterial endophthalmitis: a diagnostic conundrum

Venkateswaran

Yeaney

Chung

et al. 2014

OPTH

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ObjectiveTo report a case of recurrent nontuberculous mycobacterial endophthalmitis in the context of neurotrophic keratopathy secondary to herpes zoster ophthalmicus that had an atypical presentation and complex course, and highlights the challenges of causative organism identification and therapeutic interventions in this condition.MethodsA retrospective chart review was conducted to determine the visual outcomes of the patient.ResultsA 68-year-old pseudophakic male with long-standing neurotrophic keratopathy and perforated descemetocele managed with cyanoacrylate glue and a contact bandage lens in the left eye, began experiencing recurrent episodes of endophthalmitis after undergoing a penetrating keratoplasty. Several therapeutic procedures including an anterior chamber washout, two pars plana vitrectomies, explantation of the posterior chamber intraocular lens and capsular bag, and multiple intravitreal antimicrobial injections, were performed to which he has ultimately responded favorably, with no signs of infection to date and stable visual acuity. The causative organism of his recurrent infections was initially identified as Mycobacterium abscessus through biochemical testing and 16S ribosomal ribonucleic acid gene sequencing; however, repeat polymerase chain reaction (PCR) and sequencing of the 65 kDa heat shock protein (hsp65) gene for experimental purposes confirmed the accurate identification of the organism to be Mycobacterium chelonae. Given the greater reliability of PCR and sequencing of the hsp65 gene over traditional biochemical tests and culture techniques, M. chelonae was likely the infectious agent all along, and the organism was originally misidentified on the basis of less accurate tests.ConclusionRecurrent atypical mycobacterial endophthalmitis requires expedient identification and management to prevent poor visual outcomes. Standard biochemical testing can identify the causative organism but is limited by the inability to distinguish between nontuberculous species reliably. We recommend the use of PCR in conjunction with sequencing of the hsp65 gene for reliable differentiation of M. chelonae and M. abscessus in atypical mycobacterial ocular infections. Minimum inhibitory concentration antibiotic susceptibility tests on cultured strains are the best guide to antibiotic selection, given the rapidly rising resistance to antimicrobials in atypical mycobacterial species.

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Visual Recovery FollowingMycobacterium chelonaeEndophthalmitis

Cited by 18 publications

References 14 publications

Susceptibility to nontuberculous mycobacterial lung disease: Table 1—

Susceptibility to nontuberculous mycobacterial lung disease: Table 1—

Nontuberculous Mycobacterial Endophthalmitis: Case Series and Review Literature

Recurrent nontuberculous mycobacterial endophthalmitis: a diagnostic conundrum

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