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1/4. 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. ( info)

2/4. Subepithelial infiltrates associated to viral keratoconjunctivitis following photorefractive keratectomy.

    PURPOSE: To report three cases of adenoviral keratoconjunctivitis in patients who have undergone photorefractive keratectomy and that just developed subepithelial infiltrates. methods: Description of patients that developed postoperative adenoviral keratoconjunctivitis after photorefractive keratectomy without influence in the final visual outcome. RESULTS: All patients presented adenoviral keratoconjunctivitis 2-3 months after refractive surgery. They developed multiple pinpoint subepithelial infiltrates in six eyes, without haze development. The final uncorrected visual acuity was better or equal to 20/30. CONCLUSION: Although patients undergoing photorefractive keratectomy might develop severe corneal scarring following ocular infections, such events may follow their natural evolution. ( info)

3/4. Microsporidial keratoconjunctivitis in acquired immunodeficiency syndrome.

    We describe three patients with acquired immunodeficiency syndrome who presented with a bilateral coarse superficial epithelial keratitis due to infection with the protozoal parasite Microspora, encephalitozoon cuniculi. Despite the extent of the corneal surface disease, conjunctival inflammation was minimal. visual acuity ranged from 20/20 to 20/200. In one patient, the keratitis was complicated by the development of a surface defect with secondary pseudomonas species infection. All patients had a history of exposure to household pets. Standard cultures were negative. diagnosis was established in two of the three cases based on characteristic appearance of the protozoan in conjunctival scrapings. Electron microscopy of a conjunctival biopsy specimen in one patient confirmed the species. No recognized effective treatment is available for this infection. ( info)

4/4. Topical fumagillin in the treatment of microsporidial keratoconjunctivitis in AIDS.

    OBJECTIVE: To report microsporidial keratoconjunctivitis in a patient infected with hiv who was treated with topical fumagillin. CASE SUMMARY: A 37-year-old white man who was experiencing redness, pain, irritation, decreased vision, and a foreign body sensation occurring in both eyes was referred to the ophthalmology clinic. The patient had a medical history significant for AIDS, pneumocystis carinii pneumonia, and cytomegalovirus retinitis. Conjunctival smears were taken and stained positive for the presence of microsporidia. The patient was diagnosed with bilateral microsporidial keratoconjunctivitis and fumagillin therapy was initiated. After 5 days of therapy, the patient reported significant improvements characterized by a decrease in blurred vision with only slight blurring in the left eye, decrease in headache, and decreased foreign body sensation. The patient continued topical fumagillin therapy for more than 14 months, with only slight blurring in the left eye and no apparent ocular toxicity as a result of fumagillin therapy. DISCUSSION: Although rare in occurrence, increasing numbers of documented microsporidial infections are being reported in the medical literature, particularly in individuals who are seropositive for hiv. Clinicians need to be cognizant of microsporidial keratoconjunctivitis as another opportunistic infection in this patient population. CONCLUSIONS: Although a curative agent has yet to be discovered, fumagillin represents a safe, effective, low-cost, topical agent for the treatment of microsporidial keratoconjunctivitis. ( info)

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