Cornea – III
Nocardia keratitis-Co relation of clinical features, time of presentation & antibiotic sensitivity
- Nocardia keratitis-Co relation of clinical features, time of presentation & antibiotic sensitivity
- PRESENTING AUTHOR : Dr.rajesh.v
- CO-AUTHOR : DR.SHIVANANDA
- Nocardia
- Aerobic , non motile , branching , filamentous bacteria
- METHODS
- Retrospectice study : ALL CULTURE POSITIVE NOCARDIA CASES WERE COLLECTED FROM jan 2016- dec 2017 WERE INCLUDED IN OUR STUDY AND ANALYSED .
- METHODS
Corneal scraping
- SMEAR – Gram’s stain , koh , acid-fast stain
- Culture : blood agar , potato dextrose agar
- Isolation rate
- Demographics
- Age – ranging from 26 yrs to 75 yrs with a mean age of 51 yrs
- Sex – males – 10 females – 5
- Microbiological profile
- Grams STAIN
- Koh
- Acid-fast (kinyoun’s method)
- Clinical profile
- Predisposing factor : trauma – 11 (73%)patients
- Injury with stick – 4
- Fall of dust / foreign body – 4 (1 removal of fb by tongue , removal of fb with rod )
- Fall of mud – 1
- Injury with a rope – 1
- Injury with iron wire – 1
- Interval from onset of symptoms to diagnosis ranges from 7 to 24 days with an average of 11 days
- Clinical profile
- Type of corneal infiltrate :
- Wreath like : 4
- Diffuse patchy : 3
- feathery : 4
- Clinical profile
- Depth :
- Anterior stromal – 11 patients (80%)
- Mid stromal – 2
- Full thickness – 1
- Hypopyon – hypopyon was seen in 11 (73%) patients
- Streak – 6
- 1mm – 3
- 2 mm – 2
- Clinical profile
- Endothelial plaque : 7 (46%) patients
- Endothelial dusting / kps – 3 paients
- Surrounding stromal edema – 10 pATIENTS
- Antibiotic sensitivity
- Visual outcome
- Visual acquity improved in 9 patients
- In 2 patients it remained the same and decreased in 4 patients
- Visual outcome
- Time of diagnosis to healing varies from 15 days to 4 mts with a mean of 21 days
- No perforation of corneal ulcer
- RESULTS
- RESULTS
- Patients presenting early < 15 days had a typical presentation
- Patients with anterior infiltrate had better visual recovery
- Those presenting early have a faster recovery (native medication)
- Why this Study ?
- EARLY DIAGNOSIS AND TREATMENT WITH AMIKACIN RESULTS IN BETTER PROGNOSIS
- Nocardia keratitis can resemble fungal keratitis .
- A high index of suspicion should be kept in mind when treating ulcers of long duration .
- REFERENCES
- Bharathi MJ, Ramakrishnan R, Vasu S, Meenakshi R,Chirayath A, Palaniappan R. Nocardia asteroides keratitis in South India. Ind J Med Microbiol 2003;21: 31–36
- Manikandan P, Bhaskar M, Revathi R, Anita R, Lakshmi LA, Narendran V. Isolation and antimicrobial susceptibility pattern of Nocardia among people with culture-proven ocular infections attending a tertiary care eye hospital in Tamilnadu, South India. Eye. 2007;21(8):1102.
- Sridhar MS, Sharma S, Reddy MK, Mruthyunjay P, Rao GN. Clinicomicrobiological review of Nocardia keratitis. Cornea. 1998;17(1):17-22.
- Matulionyte R, Rohner P, Uckay I, Lew D, Garbino J. Secular trends of nocardial infection over 15 years in a tertiary care hospital. J Clin Pathol 2004;57: 807–812.
- Srinivasan M, Reddy J. Ocular Nocardiosis. Journal of TNOA 1998;38:25-29.
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