1/47. Streptococcal keratitis after myopic laser in situ keratomileusis.A 24-year-old healthy male underwent uncomplicated laser in situ keratomileusis (LASIK) in left eye. One day after the surgery, he complained of ocular pain and multiple corneal stromal infiltrates had developed in left eye. Immediately, the corneal interface and stromal bed were cleared, and maximal antibiotic treatments with fortified tobramycin (1.2%) and cefazolin (5%) were given topically. The causative organism was identified as 'Streptococcus viridans' both on smear and culture. Two days after antibiotic therapy was initiated, the ocular inflammation and corneal infiltrates had regressed and ocular pain was relieved. One month later, the patient's best corrected visual acuity had returned to 20/20 with -0.75 -1.00 x 10 degrees, however minimal stromal scarring still remained. This case demonstrates that microbial keratitis after LASIK, if treated promptly, does not lead to a permanent reduction in visual acuity.- - - - - - - - - - ranking = 1keywords = keratitis (Clic here for more details about this article) |
2/47. pyomyositis due to non-haemolytic streptococci.We present a unique case of a multifocal non-tropical pyomyositis due to non-haemolytic streptococci in a 36-y-old woman. The initial infection was in an area of contused muscle in the left anterior thigh and spread to the contralateral femoral and gluteal musculature. There was a previous history of Staphylococcus aureus pyomyositis and colitis ulcerosa. The patient was treated successfully with surgical drainage and parenteral antibiotics.- - - - - - - - - - ranking = 0.0037927820227735keywords = ulcer (Clic here for more details about this article) |
3/47. A devastating ocular pathogen: beta-streptococcus Group G.PURPOSE: To report the clinical findings, treatment, and outcomes of four cases of beta-streptococcus Group G (BHS-G) ocular infection. methods: The medical and microbiologic records of four cases of BHS-G ocular infection were retrospectively reviewed. RESULTS: Two cases of BHS-G endophthalmitis and two cases of BHS-G keratitis were recorded. Three patients developed fulminant infection within 12 hours of the onset of symptoms. One patient's history was incomplete. One patient developed endophthalmitis from a contaminated donor button; another following cataract surgery. One developed keratitis in a keratoplasty suture tract; and another patient developed a corneal abscess after being struck with a tree branch. The patient with the contaminated donor button developed overwhelming endophthalmitis resulting in no light perception vision, severe pain, and evisceration. The postoperative cataract patient developed a purulent endophthalmitis and is still hypotonus with light perception vision. The second keratitis patient developed a significant suture abscess with marked stromal loss but eventually healed. The traumatic keratitis patient developed a large ulcer with hypopyon and descemetocele but was lost to follow-up. CONCLUSIONS: This is the first report of a series of BHS-G ocular infections. The ocular infections were characterized by rapid onset, extreme inflammation, and--despite in vitro antibiotic sensitivity--a poor or sluggish response to antibiotic therapy.- - - - - - - - - - ranking = 0.80379278202277keywords = keratitis, ulcer (Clic here for more details about this article) |
4/47. Infiltrative keratitis associated with extended wear of hydrogel lenses and abiotrophia defectiva.PURPOSE: Infiltrative keratitis is a common complication associated with extended wear of hydrogel lenses. Causative bacteria are often isolated from the lens at the time of an event. We report a case where three repeated occurrences of infiltrative keratitis were associated with contamination of the contact lenses by abiotrophia defectiva. methods: A 34-year-old man participating in a clinical trial of extended wear hydrogel contact lenses experienced three episodes of infiltrative keratitis. The clinical presentation was observed using a biomicroscope. At the time of each event, the contact lenses were removed aseptically and ocular swabs were taken for bacterial identification and enumeration. The condition was monitored until full resolution. RESULTS: The condition was characterized by irritation, marked bulbar and limbal injection, and multiple focal subepithelial infiltrates. Many of the infiltrates also showed overlying staining with fluorescein. In each of the three events of infiltrative keratitis, A. defectiva was cultured from the contact lens and ocular swabs. CONCLUSION: This is the first reported occurrence of infiltrative keratitis associated with A. defectiva contamination of contact lenses.- - - - - - - - - - ranking = 1.8keywords = keratitis (Clic here for more details about this article) |
5/47. Infectious crystalline keratopathy in an immunosuppressed patient.PURPOSE: To report a case of infectious crystalline keratopathy (ICK) in a patient with systemic malignancy on immunosuppressive chemotherapy. The patient wore frequent replacement contact lenses on an extended wear basis. methods: A 51-year-old female with carcinoma of the breast and systemic metastases was referred for a corneal ulcer. She received intravenous docetaxel, trastuzumab, and systemic dexamethasone. She wore frequent replacement Acuvue lenses on an extended wear basis. Her visual acuity was 20/200 in the right eye and 20/400 in the left eye. The right eye examination revealed diffuse superficial punctate keratopathy. In the left eye, there was a 3.8 x 4.5 mm corneal infiltrate with projecting crystalline processes. Corneal scrapings were performed for smears and cultures. Treatment with topical fortified cefazolin and fortified tobramycin every hour around the clock was initiated. RESULTS: culture of the corneal scrapings grew streptococcus anginosus and Staphylococcus aureus. There was a good response to medical therapy. When last seen after 4 weeks of treatment, the infiltrate measured about 1 mm and the visual acuity was 20/40 with pinhole. CONCLUSIONS: Systemic immunosuppression may be a predisposing factor for the development of ICK. This case suggests that debilitated patients may be at risk for unusual infections and should be discouraged from overnight wear of contact lenses.- - - - - - - - - - ranking = 0.94451310947182keywords = corneal ulcer, ulcer (Clic here for more details about this article) |
6/47. Bacterial meningoencephalitis in patients undergoing chronic hemodialysis: two case reports.Two patients with bacterial meningoencephalitis (BME) undergoing chronic hemodialysis (HD) are reported. Patient 1 died of bacterial empyema caused by streptococcus intermedius. Patient 2 was successfully treated by intravenous vancomycin (VCM), panipenem-betamipron and intrathecal VCM. enterococcus avium from a sacral decubitus ulcer was suggested as a possible pathogen of BME in Patient 2. autopsy findings in Patient 1 and antimicrobial options in Patient 2 are discussed with a review of the literature. In the two BME patients presented here, sepsis played an important role in their pathogenesis during the chronic HD state.- - - - - - - - - - ranking = 0.0037927820227735keywords = ulcer (Clic here for more details about this article) |
7/47. A 10-year case report and current clinical review of chronic beta-hemolytic streptococcal keratoconjunctivitis.BACKGROUND: Streptococcus is a common source of bacterial keratoconjunctivitis in adults. Affected patients often report decreased vision, foreign body sensation, redness, and a mucous discharge. Clinical signs reveal diffuse conjunctival injection, a conjunctival papillary response, corneal superficial punctate keratitis, and a mucopurulent discharge with corresponding visual acuity decrease. Culturing is mandatory in hyperacute cases and broad-spectrum treatment is advised until culture results are definitive. Recurrent cases may change in clinical appearance. Bacterial exotoxins may induce a severe inflammatory response as well. CASE REPORT: A case of bilateral recurrent bacterial keratoconjunctivitis in a 61-year-old man is reported, as well as a current clinical review of the literature. Aerobic culture yielded streptococcus pyogenes, a beta-hemolytic group A streptococcus. After unsuccessful broad-spectrum antibiotic treatment with several agents, culture and sensitivity testing confirmed the diagnosis and adjustment of the treatment plan accordingly was successful. During the following 10 years, there were six episodes in the left eye and three episodes in the right eye with resultant inflammation and comeal pannus. Recent repeat culture and sensitivity testing showed that the streptococcus had changed to an atypical presentation. The university laboratory reported the findings to the State Department of public health, as this was a nonrespiratory isolate of group A streptococcus. CONCLUSION: Although culture is indicated in hyperacute bacterial keratoconjunctivitis, consider sensitivity testing in non-responsive cases. If the condition is recurrent and the clinical presentation appears different from previous episodes, suspect that the initial pathogen may be changing. Severe secondary inflammation may occur due to bacterial exotoxin reactions. Identification of the underlying causes is advised.- - - - - - - - - - ranking = 0.2keywords = keratitis (Clic here for more details about this article) |
8/47. Pathophysiology and treatment of streptococcal toxic shock syndrome.We have recently encountered three cases of streptococcal toxic shock syndrome, each of which had a different cause. All the patients had inflammation of soft tissue in the lower extremities, and developed shock and multiple organ failure immediately after the clinical visit. The inflammation of soft tissue was necrotising fasciitis in one case, myositis in one case, and phlegmon in one. In the first case the debridement was incomplete, which resulted in an extensive ulceration. Wary of repeating this experience, we made an early diagnosis and did a thorough debridement in the second case. The patient was ultimately discharged without complications. It is rare that a patient with extensive myositis survives without amputation of the extremity. The third patient responded well to early treatment with antibiotics.- - - - - - - - - - ranking = 0.0037927820227735keywords = ulcer (Clic here for more details about this article) |
9/47. Anaerobic streptococcal corneal ulcer.An anaerobic streptococcus caused a central corneal ulcer in a 10-year-old girl. There were no identifying clinical findings. The lesion healed promptly and satisfactorily with antibiotic therapy.- - - - - - - - - - ranking = 4.7225655473591keywords = corneal ulcer, ulcer (Clic here for more details about this article) |
10/47. Infectious keratitis after photorefractive keratectomy.PURPOSE: To elucidate risk factors, microbial culture results, and visual outcomes for infectious keratitis after photorefractive keratectomy (PRK). DESIGN: Multicenter, retrospective chart review, case report, and literature review. methods: The records of 12 patients with infectious keratitis after PRK were reviewed. MAIN OUTCOME MEASURES: Causative organism, response to medical treatment, and visual outcome. RESULTS: Infectious keratitis developed in 13 eyes of 12 patients after PRK. Organisms cultured were Staphylococcus aureus (n = 5), including a bilateral case of methicillin-resistant staphylococcus aureus; staphylococcus epidermidis (n = 4); streptococcus pneumoniae (n = 3); and Streptococcus viridans (n = 1). Four patients manipulated their contact lenses, and 2 patients were exposed to nosocomial organisms while working in a hospital environment. Prophylactic antibiotics used were tobramycin (nine cases), polymyxin b-trimethoprim (three cases), and ciprofloxacin (one case). Final best spectacle-corrected visual acuity ranged from 20/20 to 20/100. CONCLUSIONS: Infectious corneal ulceration is a serious potential complication of PRK. Gram-positive organisms are the most common pathogens. antibiotic prophylaxis should be broad spectrum and should include gram-positive coverage.- - - - - - - - - - ranking = 2.3445131094718keywords = corneal ulcer, keratitis, ulcer (Clic here for more details about this article) |
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