Document Detail

Nocardia keratitis: species, drug sensitivities, and clinical correlation.
MedLine Citation:
PMID:  17413948     Owner:  NLM     Status:  MEDLINE    
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.
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    
Department Of Ocular Microbiology, Aravind Eye Hospital, Madurai, Tamil Nadu, India .
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MeSH Terms
Amikacin / therapeutic use
Anti-Bacterial Agents / therapeutic use
Bacterial Typing Techniques
Child, Preschool
Corneal Ulcer / diagnosis,  drug therapy,  microbiology*
DNA, Bacterial / analysis
Eye Infections, Bacterial / diagnosis,  drug therapy,  microbiology*
Imipenem / therapeutic use
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
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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