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Journal of Clinical Microbiology, July 1999, p. 2389-2389, Vol. 37, No. 7
0095-1137/99/$04.00+0
LETTERS TO THE EDITOR
Diagnosis and Management of Nocardia Keratitis
 |
LETTER |
We read with interest the recent article by Tendolkar et al.
(5). We have been seeing and treating cases of
Nocardia keratitis for a long time and have published our
experiences previously (3, 4). We would like to share some
of our observations on this condition for the benefit of JCM's
readers. Nocardia keratitis can occur in immunocompetent
patients following minor trauma (3). While lagophthalmos may
predispose patients to Nocardia keratitis, it is not
specific for this organism. Lagophthalmos is known to predispose
individuals to a variety of bacterial and fungal infections of the
cornea (our unpublished experience).
Cases of infectious keratitis are normally investigated by smear
examination and culture of corneal scrapings. Gynecological and
otolaryngological investigations are of little relevance.
The treatment of Nocardia keratitis is quite well
established, with amikacin emerging as the best drug (1)
with the lowest MIC for Nocardia isolates from corneal
ulcers. Traditionally used sulfa group drugs are now being replaced
with aminoglycosides and biguanides (2). Systemic
antibiotics have little role in the treatment of bacterial keratitis.
| |
REFERENCES |
| 1.
|
Boiron, P., and F. Provost.
1988.
In-vitro susceptibility testing of Nocardia spp. and its taxonomic implication.
J. Antimicrob. Chemother.
22:623-629[Abstract/Free Full Text].
|
| 2.
|
Julianne, C. L.,
P. W. Thomas,
A. B. David,
M. Peter, and K. K. Kenyon.
1977.
Treatment of Nocardia asteroides keratitis with polyhexamethylene biguanide.
Ophthalmology
104:1306-1313[Medline].
|
| 3.
|
Sridhar, M. S.,
S. Sharma,
M. K. Reddy,
P. Mrithyunjaya, and G. N. Rao.
1998.
Clinicomicrobiological review of Nocardia keratitis.
Cornea
17:17-22[Medline].
|
| 4.
|
Srinivasan, M., and S. Sharma.
1987.
Nocardia asteroides as a cause of corneal ulcer.
Arch. Ophthalmol.
105:464.
|
| 5.
|
Tendolkar, U. M.,
A. Varaiya,
A. S. Ahuja,
S. A. Motwane, and A. S. Gogate.
1998.
Corneal ulcer caused by Nocardia asteroides in a patient with leprosy.
J. Clin. Microbiol.
36:1154-1156[Abstract/Free Full Text].
|
| | | | |
Savitri Sharma
M. S. Sridhar
Jhaveri Microbiology Centre
L. V. Prasad Eye Institute
Road #2, Banjara Hills
Hyderabad 500 034, India
|
| |
AUTHOR'S REPLY |
In response to Dr. Sharma, I would like to mention that lagophthalmos
occurring in the patient with tuberculoid leprosy could have been the
predisposing factor for development of the Nocardia corneal
ulcer due to the dry eye resulting from the deformity, a fact clearly
mentioned in our article (2). We did not intend to suggest
that lagophthalmos is a condition specific for Nocardia. It
is rather the effect of dry eye caused by lagophthalmos that could
result in ulcerations caused by various opportunistic organisms, including Nocardia, as stated in our article.
Nocardia species are associated with environmental material.
Pulmonary and disseminated nocardioses are known clinical entities, with occasional seeding of the eye and traumatized tissue
(1). Gynecological, medical, otolaryngological, and dental
examinations are carried out on all our patients with corneal ulcers as
a policy to rule out any active septic focus. Moreover, our patient was not otherwise healthy but had a systemic disease, leprosy, and had
developed an ulcer spontaneously, which warranted a thorough examination.
Since the corneal ulceration with the serious sequela of hypopyon had
occurred in the patient spontaneously, systemic therapy was given. In a
patient debilitated with disease, the treatment modality differs, with
adequate and often long-term therapy (1). In a patient with
disease, defenses are compromised, so that the patient may be little
more than culture medium as viewed by the organism. With the therapy
described in our article, the patient showed a marked improvement
within 12 days and was discharged after a 2-week stay in the hospital.
| |
REFERENCES |
| 1.
|
Rippon, J. W.
1982.
Medical mycology, p. 51-67.
W. B. Saunders Co., Philadelphia, Pa.
|
| 2.
|
Tendolkar, U. M.,
A. Varaiya,
A. S. Ahuja,
S. M. Motwane, and A. S. Gogate.
1998.
Corneal ulcer caused by Nocardia asteroides in a patient with leprosy.
J. Clin. Microbiol.
36:1154-1156.
|
| | | | |
Uma M. Tendolkar
Department of Microbiology
Lokmanya Tilak Municipal Medical College and Hospital
Sion
Mumbai 400 022, India
|
Journal of Clinical Microbiology, July 1999, p. 2389-2389, Vol. 37, No. 7
0095-1137/99/$04.00+0
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