Document Detail


Nocardia keratitis: species, drug sensitivities, and clinical correlation.
MedLine Citation:
PMID:  17413948     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To correlate the clinical presentation and treatment outcome of Nocardia keratitis with the time to diagnosis, different species and with the drug sensitivity pattern. METHOD: Patients with Nocardia corneal ulcers were studied at a tertiary eye care center. Speciation of Nocardia isolates was done by sequencing the 16s rRNA gene. Clinical response to treatment was assessed by chart review. RESULTS: Twenty one (65.3%) patients presented within 15 days of the onset of symptoms with typical clinical features of Nocardia keratitis, ie, a ring-like distribution of superficial infiltrates in a wreath pattern. Eight patients (25%) who presented after 15 days and within 30 days had an ulcer resembling fungal keratitis. N. Cyriacigeorgica (n = 11; 34.37%), N. asteroides (n = 9; 28%), N. farcinica (n = 7; 22%,) and N. Otitidiscaviarum (n = 5; 16%). All the species had 100% sensitivity to amikacin, sulphamethoxazole, imipenem and co-trimoxazole. Time to diagnosis of the infection was significantly associated with the different types of clinical presentation; those presenting early having the typical clinical picture (P = 0.004). Patients (73%) presenting within 15 days showed a highest recovery rate. (P = 0.045). The recovery time of the patients when compared with species showed those who were infected with N. cyriageorgica had a healing time of less than 15 days. Clinically, healing was faster when treated with 2% amikacin. Visual outcome improved in fourteen patients (44%) and sixteen (50%) patients remained the same (P = 0.0001). CONCLUSION: 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.
Authors:
Prajna Lalitha; Mamta Tiwari; Nampurumalsamy Venkatesh Prajna; Christopher Gilpin; Karthik Prakash; Muthaiah Srinivasan
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Cornea     Volume:  26     ISSN:  0277-3740     ISO Abbreviation:  Cornea     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-04-06     Completed Date:  2007-04-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8216186     Medline TA:  Cornea     Country:  United States    
Other Details:
Languages:  eng     Pagination:  255-9     Citation Subset:  IM    
Affiliation:
Department Of Ocular Microbiology, Aravind Eye Hospital, Madurai, Tamil Nadu, India . lalitha@aravind.org
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Amikacin / therapeutic use
Anti-Bacterial Agents / therapeutic use
Bacterial Typing Techniques
Child
Child, Preschool
Corneal Ulcer / diagnosis,  drug therapy,  microbiology*
DNA, Bacterial / analysis
Eye Infections, Bacterial / diagnosis,  drug therapy,  microbiology*
Female
Humans
Imipenem / therapeutic use
Infant
Male
Microbial Sensitivity Tests
Middle Aged
Nocardia / classification,  drug effects,  isolation & purification*
Nocardia Infections / diagnosis,  drug therapy,  microbiology*
Polymerase Chain Reaction
RNA, Ribosomal, 16S / genetics
Retrospective Studies
Sulfamethoxazole / therapeutic use
Treatment Outcome
Trimethoprim-Sulfamethoxazole Combination / therapeutic use
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/DNA, Bacterial; 0/RNA, Ribosomal, 16S; 37517-28-5/Amikacin; 723-46-6/Sulfamethoxazole; 74431-23-5/Imipenem; 8064-90-2/Trimethoprim-Sulfamethoxazole Combination

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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