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Dutta Majumder P, Mochizuki M, González-López JJ, Gonzales J, Sharma M, Sharma K, Biswas J. Laboratory Investigations in Infectious Uveitis. Ocul Immunol Inflamm 2023; 31:1405-1415. [PMID: 36698066 DOI: 10.1080/09273948.2022.2164728] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 01/27/2023]
Abstract
Laboratory investigations can play a significant role in the diagnosis and decision-making of infectious uveitis. Though direct demonstration of the infective organism remains the gold standard of diagnosis, it is not always possible with ocular tissues. Recent advancements in molecular techniques have made it possible to overcome these limitations and to identify the genomic DNA of pathogens associated with infectious uveitis. Techniques such as next-generation sequencing can analyze all DNA-based lifeforms, regardless of whether they are bacteria, fungi, viruses, or parasites and have been used in the laboratory diagnosis of intraocular inflammation. On the other hand, serological tests, though they dominate the diagnostic landscape of various infectious etiologies in uveitis in routine clinical practice, have varied specificities and sensitivities in different infectious uveitis. In this review, we focus on various methods of laboratory diagnosis of infectious uveitis and discuss the recent advances in molecular diagnosis and their role in various infectious clinical entities.
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Affiliation(s)
| | - Manabu Mochizuki
- Miyata Eye Hospital, Miyakonojo, Japan
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Julio J González-López
- Ophthalmology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Surgery Department, Universidad de Alcalá, Madrid, Spain
| | - John Gonzales
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Megha Sharma
- Department of Microbiology, All India Institute of Medical Sciences, Bilaspur, India
| | - Kusum Sharma
- Department of Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh (PGIMER), Chandigarh, India
| | - Jyotirmay Biswas
- Director of Uveitis & Ocular Pathology, Sankara Nethralaya, Chennai, India
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2
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Tan CL, Sheorey H, Allen PJ, Dawkins RCH. Endophthalmitis: Microbiology and Organism Identification Using Current and Emerging Techniques. Ocul Immunol Inflamm 2023; 31:393-401. [PMID: 35201917 DOI: 10.1080/09273948.2022.2027468] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Endophthalmitis is an ophthalmological emergency requiring timely and appropriate diagnosis and treatment. Microbiological methods of microscopy (Gram's staining) and culture are the current gold standard for organism identification. However, a significant proportion of endophthalmitis remains culture-negative-perhaps the inflammation is non-infectious in origin, results from a novel organism are unidentifiable or because the causative organism is non-culturable often due to pre-treatment with antibiotics. This review outlines the microbiological profile of endophthalmitis, current clinically used methods for organism identification, and the newer molecular techniques of polymerase chain reaction (PCR) and next-generation sequencing (NGS) technology as diagnostic tools for endophthalmitis. They offer the potential to improve organism identification rates and clinical outcomes in infectious diseases, representing an exciting future direction for organism identification in endophthalmitis. Based on the largest ophthalmic hospital in Australia, we highlight the key practical challenges faced by Australian diagnostic laboratories for their use in a clinical setting.
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Affiliation(s)
- Christine L Tan
- Macular Research Unit, Centre for Eye Research Australia, East Melbourne, Australia.,Department of Ophthalmology, The University of Melbourne, Parkville, Australia
| | - Harsha Sheorey
- Department of Microbiology, St Vincent's Hospital, Fitzroy, Australia
| | - Penelope J Allen
- Macular Research Unit, Centre for Eye Research Australia, East Melbourne, Australia.,Department of Ophthalmology, The University of Melbourne, Parkville, Australia.,Vitreo-retinal Unit, The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Rosie C H Dawkins
- Macular Research Unit, Centre for Eye Research Australia, East Melbourne, Australia.,Department of Ophthalmology, The University of Melbourne, Parkville, Australia.,Vitreo-retinal Unit, The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
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3
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Chiquet C, Bron AM, Lundström M, Maurin M. Acute postoperative endophthalmitis: Microbiology from the laboratory to the bedside. Surv Ophthalmol 2022; 67:1698-1710. [PMID: 35843367 DOI: 10.1016/j.survophthal.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 06/30/2022] [Accepted: 07/11/2022] [Indexed: 11/26/2022]
Abstract
Postoperative endophthalmitis is a dreaded complication of intraocular surgery. Acute presentations need prompt management and good knowledge of differential diagnoses. In the last 10 years, progress in direct microbial detection and identification from intraocular samples included the use of blood culture systems and, more recently, matrix-assisted laser desorption ionization time-of-flight mass spectrometry, improving the rate of bacterial identification. Whatever the method used, diagnostic sensitivity is better for vitreous samples than for aqueous humor samples. Besides, molecular biology techniques have further improved the identification rate of infectious agents in intraocular samples. They also provide faster results compared to culture-based techniques. Quantitative real-time PCR (qPCR) can also determine the bacterial load in intraocular samples. Several studies have shown that intraocular bacterial loads in endophthalmitis patients are usually high, which helps differentiating infection from contamination. The prognostic value of qPCR remains to be validated. Whole genome DNA sequencing technologies facilitate direct and sequencing of single DNA molecules. They have the potential to increase the rate of microbiological identification. Some antibiotic resistance markers (e.g., methicillin resistance in staphylococci and vancomycin resistance in enterococci) may be detected earlier using molecular techniques (usually real-time PCR tests). Early determination of the involved microorganism and their antibiotic resistances can help establishing an earlier therapeutic strategy.
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Affiliation(s)
- Christophe Chiquet
- Department of Ophthalmology, University Hospital of Grenoble, France; Grenoble Alpes University, Grenoble, France; HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.
| | - Alain M Bron
- Department of Ophthalmology, University Hospital, Dijon, France; Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, F-21000, Dijon, France
| | - Mats Lundström
- Department of Clinical Sciences, Ophthalmology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Max Maurin
- Laboratoire de Bactériologie, Institut de Biologie et Pathologie, CHU, Grenoble, Alpes; University Grenoble Alpes, CNRS, Grenoble, INP; CHU Grenoble Alpes, TIMC-IMAG, 38000, Grenoble, France
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4
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Tainsh LT, Tieger MG, Wu DM. Propionibacterium acnes-associated Delayed-onset Pseudophakic Endophthalmitis. Int Ophthalmol Clin 2022; 62:145-156. [PMID: 35325916 DOI: 10.1097/iio.0000000000000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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Fowler BJ, Miller D, Yan X, Yannuzzi NA, Flynn HW. Postoperative Endophthalmitis Caused by Cutibacterium (Formerly Propionibacterium) Acnes: Case Series and Review. Case Rep Ophthalmol 2021; 12:1-10. [PMID: 33613244 PMCID: PMC7879283 DOI: 10.1159/000510208] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/10/2020] [Indexed: 11/22/2022] Open
Abstract
We report the clinical features, treatment strategies and outcomes in a series of patients with infectious endophthalmitis after cataract surgery caused by Cutibacterium acnes (C. acnes), formerly known as Propionibacterium acnes (P. acnes). This retrospective case series includes six eyes of six patients with chronic postoperative endophthalmitis caused by culture-proven C. acnesfrom December 2010 to July 2019 at a University referral center. All patients underwent prior cataract extraction with intraocular lens (CE/IOL) implantation. The mean time between cataract surgery and the microbiologic diagnosis of endophthalmitis was 7.4 ± 5.2 months (range 1.5–17 months). The average time from obtaining the specimen to culture positivity was 7.7 ± 4.4 days (range 3–15 days). Three eyes (50%) presented with hypopyon and three eyes (50%) presented with prominent keratic precipitates without hypopyon. Presenting visual acuity ranged from 20/25 to 2/200. Initial treatments included intravitreal antibiotics alone (n = 2), pars plana vitrectomy (PPV) with partial capsulectomy and intravitreal antibiotics (n = 3), and pars plana vitrectomy with IOL removal and intravitreal antibiotics (n = 1). Follow-up treatments included IOL removal (n = 2), intravitreal antibiotics (n = 1), and topical antibiotics (n = 1). The best-corrected visual acuity at last follow-up was 20/70 or better in all patients. In a literature review, the clinical features and treatment outcomes for all case series of delayed-onset postoperative endophthalmitis caused by C. acnes(n = 120) are listed. A definitive cure (the absence of recurrent inflammation) was achieved in 100% of patients that underwent IOL removal, in 77% of those that underwent PPV/partial capsulectomy and intravitreal antibiotics, and in 18% of cases treated with intravitreal antibiotics alone. Endophthalmitis after CE/IOL caused by C. acnesis characterized by slowly progressive intraocular inflammation and has a protracted course from surgery to microbiologic diagnosis. Visual outcomes are generally favorable, but IOL explantation may be necessary for definitive cure.
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Affiliation(s)
- Benjamin J Fowler
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Darlene Miller
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Xiaohe Yan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.,Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, Jinan University, Shenzhen, China
| | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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Selva Pandiyan A, Siva Ganesa Karthikeyan R, Rameshkumar G, Sen S, Lalitha P. Identification of Bacterial and Fungal Pathogens by rDNA Gene Barcoding in Vitreous Fluids of Endophthalmitis Patients. Semin Ophthalmol 2021; 35:358-364. [PMID: 33390091 DOI: 10.1080/08820538.2020.1864416] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Purpose: To identify the bacterial and fungal pathogens in ocular samples of clinically suspected endophthalmitis patients by conventional culture methods and 16S and 28S rDNA gene sequencing respectively. Methods: A total of 88 patients with clinically suspected endophthalmitis were included in this study. Under sterile operating conditions, a vitreous fluid (0.1-0.2 ml) was obtained by pars plana vitrectomy procedure. The samples were processed for conventional microbiology methods and PCR. PCR targeting 16S rDNA gene for bacteria and 28S rDNA gene for fungus were performed individually using the MightyAmp DNA Polymerase Ver. 2 (TaKaRa China) kit. The PCR amplified samples were sequenced and aligned using CLUSTAL-W tool. The phylogenetic tree was constructed by Neighborhood joining along with the reference sequences downloaded from NCBI database using MEGA X software. Results: 67 Post-operative, 12 Endogenous and 9 traumatic endophthalmitis patients were included as study subjects. By the direct culturing bacterial growth was observed in 17 samples and fungal growth in three samples. PCR was positive for all the culture positive samples, in addition 14 were positive in culture negative samples. The predominant species identified in gram-positive bacteria were Staphylococcus spp., and Pseudomonas spp. in the gram-negative group. Both PCR and culture identified only three samples positive for fungal pathogens which were identified as Aspergillus fumigatus, Candida albicans, and Exerohilum rostratum. Conclusions: PCR based molecular diagnosis is more sensitive than the conventional gold standard culture methods in endophthalmitis. Bacterial pathogens were found to be the predominant in causing endophthalmitis than fungal pathogens.
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Affiliation(s)
| | | | | | - Sagnik Sen
- Department of Vitreoretinal Services, Aravind Eye Hospital , Madurai, India
| | - Prajna Lalitha
- Department of Ocular Microbiology, Aravind Eye Hospital , Madurai, India
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7
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Neha P, Prajna L, Gunasekaran R, Appavu SP, Rajapandian SGK, Naveen R, Namperumalsamy Venkatesh P. Clinical and demographic study of non-tuberculous mycobacterial ocular infections in South India. Indian J Med Microbiol 2020; 39:41-47. [PMID: 33610255 DOI: 10.1016/j.ijmmb.2020.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To describe demographics, risk factors, antibiotic susceptibility, management and outcomes of ocular infections caused by non-tuberculous mycobacteria (NTM). METHODS A retrospective review of medical case records and microbiology records of patients with ocular infections that were culture positive for non-tuberculous Mycobacteria from January 2014 to December 2018 was done. Antibiotic susceptibility profile was done based on the CLSI guidelines. Laboratory diagnosis for the NTM Species was done by conventional microbiological methods. The species identification was done for stored isolated utilizing polymerase chain reaction targeting 16S rDNA and rpoB gene, followed by DNA sequencing and phylogenetic analysis. RESULTS Twenty patients with NTM ocular infections were identified during the study period. A majority of cases presented as 12 infectious keratitis (60%) and three suture-related corneal infiltrates (15%). Common risk factors were history of trauma in 9 (45%) patients and history of ocular surgery in 5 (25%) patients. Patients were treated with combination of amikacin and flouroquinolones/chloramphenicol (70%) and surgical interventions were performed in 25% cases. Only twelve isolates were stored and ten isolates were identified as the M. abscessus subsp. abscessus and two isolates as M. abscessus subsp. massiliense by sequencing and phylogenetic analysis. Majority of the NTM were sensitive to amikacin (75%) followed by moxifloxacin, ciprofloxacin, cephotaxime and tobramycin (35%). CONCLUSION High degree of clinical suspicion, multidrug antibiotic therapy and timely surgical intervention in patients with NTM infections, are advised for better clinical outcomes. Prior ocular trauma, prior ocular surgery and presence of biomaterials were the major predisposing factors. Earlier surgical intervention in cases where abscesses or biomaterials are involved, is necessary for rapid recovery.
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Affiliation(s)
- Pathak Neha
- Department of Cornea and Refractive Surgery Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Lalitha Prajna
- Department of Ocular Microbiology, Aravind Eye Hospital, Madurai, Tamil Nadu, India.
| | | | | | | | - Radhakrishnan Naveen
- Department of Cornea and Refractive Surgery Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
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8
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Moussa G, Bhatt H, Reekie I, Butt G, Ng A, Blanch R, Rauz S. Using the West Midlands CONCERT to characterise regional incidence of acute-onset post cataract surgery endophthalmitis. Eye (Lond) 2020; 35:1730-1740. [PMID: 32873947 PMCID: PMC8169918 DOI: 10.1038/s41433-020-01158-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/27/2020] [Accepted: 08/19/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Whilst research and innovation is embedded within the UK's National Health Service (NHS) constitution, Doctors-in-training have little opportunity to contribute to designing, leading and recruiting into clinical trials or cohort studies. We formed the West Midlands Collaborative Ophthalmology Network for Clinical Effectiveness & Research by Trainees (The West Midlands CONCERT) and undertook a characterisation of post cataract surgery endophthalmitis as a proof-of-concept study to test the feasibility of the CONCERT model. METHODS Doctors-in-training formed a collaborative working group to test the concept of delivering a pan-regional clinical effectiveness study across multiple hospital sites by performing retrospective analyses of post cataract endophthalmitis over a 6-year period. RESULTS Overall, 157,653 cataract surgeries were performed by participating centres accredited to deliver the Royal College of Ophthalmologists training curriculum. Thirty-eight cases of post cataract endophthalmitis were identified, giving an incidence of 2.41 per 10,000 cases (0.0241%). A further 15 endophthalmitis cases presented who had surgery in non-training centres, giving a total of 53 cases. The most common organisms were S. epidermidis (14 (51.9%)) and P. aeruginosa (5 (18.5%)). Anterior-chamber and vitreous sampling yielded positive culture in 33.3% (6/18) and 50.9% (27/53), respectively. At 6 months follow-up, 19 (51.4%) patients achieved visual acuities of ≤0.5 LogMAR. Repeat intravitreal injections (11 (20.8%)) and vitrectomy (n = 22 (41.5%)) were not associated with better outcomes. CONCLUSIONS Using post cataract endophthalmitis as a pilot cohort, this study highlights the feasibility of using the CONCERT model for studies across multiple sites. A UK-CONCERT could provide a powerful infrastructure enabling characterisation of patient cohorts and a platform for high-quality interventional studies, improving patient care.
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Affiliation(s)
| | - Hetvi Bhatt
- Birmingham and Midland Eye Centre, Birmingham, UK
| | - Ian Reekie
- University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Gibran Butt
- Birmingham and Midland Eye Centre, Birmingham, UK.,Academic Unit of Ophthalmology, University of Birmingham, Birmingham, UK
| | - Aaron Ng
- Birmingham and Midland Eye Centre, Birmingham, UK
| | - Richard Blanch
- Academic Unit of Ophthalmology, University of Birmingham, Birmingham, UK.,Academic Unit of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK.,University Hospitals Birmingham, Birmingham, UK
| | | | - Saaeha Rauz
- Birmingham and Midland Eye Centre, Birmingham, UK. .,Academic Unit of Ophthalmology, University of Birmingham, Birmingham, UK.
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9
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Deepthi KG, Prabagaran SR. Ocular bacterial infections: Pathogenesis and diagnosis. Microb Pathog 2020; 145:104206. [PMID: 32330515 DOI: 10.1016/j.micpath.2020.104206] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 12/19/2022]
Abstract
The human eye is a rigid asymmetric structure with unique defence system. Despite considerable resident microbiota, eye is exposed to external environment where a range of microorganisms also inhabits. Opportunistically, some of these microorganisms could associate with eye pathogen that could contact incidentally, leading to destructive visual consequences. Among such microbiota, bacteria form the major proportion concerning ocular complications worldwide. The succession of genome based approach through 16S rRNA gene based identification tremendously augmented the knowledge on diversity of ocular surface bacteria. Such evidence suggests that while few bacteria contribute towards normal ocular functions, considerable number of bacteria play active role in pathophysiology of ocular diseases. Thus, understanding the complexity of ocular microflora not only throw light on their critical role towards normal function of the eye, but also enlighten on certain visual exigencies. Under these circumstances, development of a rapid, reliable and cost effective method is essential that eventually evolve as a routine diagnostic protocol. Such precise prognostic modalities facilitate ophthalmologists to formulate pioneering therapeutics towards challenging ocular diseases.
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10
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Gnanam H, Rajapandian SGK, Gunasekaran R, Roshni Prithiviraj S, Ravindran RS, Sen S, Prajna L. Molecular identification of Nocardia species causing endophthalmitis using multilocus sequence analysis (MLSA): a 10-year perspective. J Med Microbiol 2020; 69:728-738. [PMID: 32310744 DOI: 10.1099/jmm.0.001180] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Nocardia spp. can cause several ocular infections, such as keratitis, endophthalmitis and scleral abscesses. Molecular identification of Nocardia spp. by 16S rDNA sequencing is the gold standard method at present for species identification, but closely related species can only be identified by multilocus sequence analysis (MLSA) of housekeeping genes.Aim. The major objective was to profile Nocardia species, antibiotic susceptibility patterns and clinical outcomes in endophthalmitis patients.Methodology. Between January 2009 and December 2018, endophthalmitis patients who were diagnosed with Nocardia infection based on microscopic and culture characteristics were selected. Antibacterial susceptibility tests were performed and Nocardia speciation was performed using MLSA and phylogenetic tree analysis of the 16 s rRNA gene and the gyrB, hsp65 and secA1 genes.Results. A total of 43 culture-proven patients were identified during the study period. All isolates were 100 % sensitive to amikacin and 98 % resistant to ceftazidime. Fluoroquinolone sensitivity was observed in the range of 58 to 72 %. Year-wise analysis of antibiotic resistance patterns revealed there was a significant increase in resistance to fluoroquinolones. Twenty-two isolates were stored and six different species were identified. Nocardia farcinica (n=10) was found to be the most predominant, followed by Nocardia cyriacigeorgica (n=4), Nocardia otitidiscaviarum (n=3), Nocardia amikacinitolerans (n=2), Nocardia puris (n=2) and Nocardia higoensis (n=1).Conclusions. N. farcinica is the major pathogen, and this is the first report to identify N. otitidiscaviarum, N. amikacinitolerans and N. higoensis as causing endophthalmitis. Overall, visual outcomes were mostly poor even after aggressive management.
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Affiliation(s)
- Hariharan Gnanam
- Department of Biotechnology, Alagappa University, Karaikudi, India
| | | | | | | | | | - Sagnik Sen
- Department of Vitreoretinal Services, Aravind Eye Hospital, Madurai, India
| | - Lalitha Prajna
- Department of Ocular Microbiology, Aravind Eye Hospital, Madurai, India
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11
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Lee CS, Khan M, Patrie J, Bajwa A, Shildkrot YE. Pars Plana Vitrectomy for Endophthalmitis: Microbiologic Spectrum and Clinical Outcomes. Ocul Immunol Inflamm 2020; 29:871-876. [PMID: 31906757 DOI: 10.1080/09273948.2019.1698750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To report visual outcomes, microbiologic spectrum, and antibiotic resistance in endophthalmitis patients undergoing pars plana vitrectomy (PPV).Methods: Retrospective study of 32 patients who underwent PPV with microbial analysis. Linear mixed models were utilized to compare visual acuity (VA).Results: Streptococcal species and coagulase-negative staphylococcus (CoNS) were the most common organisms. No resistance to vancomycin or fluoroquinolones was observed. Culture-negative individuals had better VA and lower incidences of retinal detachment (RD) and hypotony and better VA than culture-positive group at post-surgical month 3 (p = .025) and marginally at month 12 (p = .098). CoNS endophthalmitis (final logMAR VA 0.80) was associated with better VA than Streptococcal endophthalmitis (final logMAR VA 2.36) (p = .001). Secondary RD was observed in 33.3% of non-cataract endophthalmitis.Conclusion: No organisms were resistant to vancomycin or fluoroquinolones. Culture-negative endophthalmitis had better VA and lower rates of RD and hypotony than culture-positive group. A high rate of RD was observed in non-cataract endophthalmitis.
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Affiliation(s)
- Chang Sup Lee
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Miraj Khan
- Department of Biology, University of Virginia, Charlottesville, Virginia, USA
| | - Jim Patrie
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Asima Bajwa
- Department of Ophthalmology, University of Virginia, Charlottesville, Virginia, USA
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12
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Thirumalmuthu K, Devarajan B, Prajna L, Mohankumar V. Mechanisms of Fluoroquinolone and Aminoglycoside Resistance in Keratitis-AssociatedPseudomonas aeruginosa. Microb Drug Resist 2019; 25:813-823. [DOI: 10.1089/mdr.2018.0218] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Kannan Thirumalmuthu
- Department of Ocular Microbiology and Aravind Medical Research Foundation, Madurai, India
| | | | - Lalitha Prajna
- Department of Ocular Microbiology and Aravind Medical Research Foundation, Madurai, India
| | - Vidyarani Mohankumar
- Department of Ocular Microbiology and Aravind Medical Research Foundation, Madurai, India
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13
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Sandhu HS, Hajrasouliha A, Kaplan HJ, Wang W. Diagnostic Utility of Quantitative Polymerase Chain Reaction versus Culture in Endophthalmitis and Uveitis. Ocul Immunol Inflamm 2018; 27:578-582. [DOI: 10.1080/09273948.2018.1431291] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Harpal Singh Sandhu
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Amir Hajrasouliha
- Division of Ophthalmology, Cook County Health and Hospitals System, Chicago, Illinois, USA
| | - Henry J. Kaplan
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Wei Wang
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky, USA
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14
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Khurram Butt D, Scott RA, Upendran MR. Chronic low-grade postoperative endophthalmitis in a child with Marfan syndrome. Int Med Case Rep J 2017; 10:377-379. [PMID: 29180908 PMCID: PMC5695254 DOI: 10.2147/imcrj.s147057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This case report describes a 9-year-old male who presented to the emergency department with 2 days' history of left painful red eye. On initial examination, his outside medical records indicated that he had bilateral subluxated lenses and had undergone left eye lensectomy with glued intrascleral fixation of an intraocular lens 8 weeks earlier. Vision in left eye was poor from first postoperative day but with no undue pain or redness, and poor vision was attributed to possible vitreous bleed. Subsequent postoperative course was uneventful. He was discharged from ophthalmic care on topical steroids and antibiotic drops, one week postsurgery. The eye was healing well until he developed pain, for which ophthalmic care was sought. He underwent anterior chamber tap with intravitreal injections. Aqueous samples were positive for Staphylococcus aureus DNA by polymerase chain reaction. Post vitrectomy and implant removal, his recovery was good and vision improved to 0.50 LogMar with aphakic correction.
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Affiliation(s)
| | - Robert A Scott
- Moorfields Eye Hospital, Dubai, UAE.,SpaMedica, Manchester, UK
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15
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Abstract
Endophthalmitis is a severe eye infection that may result in permanent loss of useful vision in the affected eye. Most cases are exogenous and occur as a complication of cataract surgery, an intravitreal injection, or penetrating ocular trauma. Endogenous endophthalmitis results from hematogenous seeding of the eye by bacteria or fungi, but bacteremia or fungemia may be transient and patients may present without symptoms of systemic infection. Nearly all endophthalmitis patients present with decreased vision, and some also have eye pain. Eye examination usually reveals a hypopyon and intraocular inflammation. Diagnosis is clinical, supported by cultures of the vitreous and/or aqueous or by blood cultures in some endogenous cases. Molecular diagnostic techniques have been used in research laboratories for pathogen identification in endophthalmitis and offer the possibility of rapid diagnosis, including in culture-negative cases. Intravitreal injection of antibiotics is the most important component of treatment; some cases also benefit from surgical debridement of the vitreous by a vitrectomy. The visual outcome depends partly on the pathogen: coagulase-negative staphylococcal endophthalmitis has a better prognosis than does streptococcal endophthalmitis, for example. Endophthalmitis is a medical emergency, and prompt diagnosis and treatment are essential for saving vision.
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Affiliation(s)
- Marlene L Durand
- Departments of Medicine and Ophthalmology, Harvard Medical School, and Infectious Disease Service, Massachusetts Eye and Ear Infirmary, and Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Naghdi N, Ghane M. A comparison of culture and PCR methods for identifying Propionibacterium acnes in lesions isolated from patients with acne. Turk J Med Sci 2017; 47:967-972. [PMID: 28618752 DOI: 10.3906/sag-1602-51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 01/07/2017] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM One of the factors that affect the occurrence of acne is the presence of Propionibacterium acnes. The present study was conducted to compare the culture and polymerase chain reaction (PCR) methods for identifying P. acnes in lesions isolated from patients with acne. MATERIALS AND METHODS To examine the presence of P. acnes, 70 samples of acne lesions were collected. Microbial culture and the PCR molecular technique were used to identify P. acnes. RESULTS Of the total of 70 samples, 14 cases (20%) were identified as P. acnes positive using microbial culture and 58 cases (82.85%) using PCR. The results obtained showed the lack of a relationship between the frequency of P. acnes and factors such as sex, family history of acne, and history of treatment with either of the techniques examined (i.e. the microbial culture and PCR). In contrast, a significant relationship was observed between the frequency of P. acnes and age with the culture method. CONCLUSION Given the limitations in the identification of P. acnes using microbial culture, PCR is proposed as a better method with a higher efficiency.
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Affiliation(s)
- Negin Naghdi
- Department of Microbiology, Faculty of Biological Sciences, Islamic Azad University, Tonekabon Branch, Tonekabon, Iran
| | - Masood Ghane
- Department of Microbiology, Faculty of Biological Sciences, Islamic Azad University, Tonekabon Branch, Tonekabon, Iran
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Abrishami M, Hashemi B, Abrishami M, Abnous K, Razavi-Azarkhiavi K, Behravan J. PCR detection and identification of bacterial contaminants in ocular samples from post-operative endophthalmitis. J Clin Diagn Res 2015; 9:NC01-3. [PMID: 26023576 PMCID: PMC4437090 DOI: 10.7860/jcdr/2015/10291.5733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 09/05/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND Bacterial endophthalmitis is a sight-threatening complication of ocular surgery which requires urgent medical consideration including comprehensive diagnosis. Polymerase chain reaction (PCR) as a sensitive molecular method has been extensively used for detection of microbial species in clinical specimens. AIM The aim of this study was to identify the causative organisms of endophthalmitis in our patient population using a procedure based on PCR. MATERIALS AND METHODS Vitreous samples from 32 patients with post-operative endophthalmitis were collected. Total vitreous DNA was extracted and then assessed by agarose gel electrophoresis. Bacterial 16S rRNA gene was amplified from genomic DNA using PCR with a pair of HAD2 universal primers. Library of PCR products from 16S rRNA, cloned into the pTZ57R/T vector. The ligated products were then transformed into E. coli DH5α strain and grown in the LB-ampicillin/X-Gal/IPTG plate. RESULTS From the total of 32 vitreous samples, 18 specimens were positive, illustrating the presence of bacterial infection (56.4 %). Twelve species including Escherichia coli, Enterobacter cloacae, Bacillus subtilis, Neisseria gonorrhoeae, Streptococcus pneumoniae, Haemophilus influenzae, Chlamydia trachomatis, Staphylococcus aureus, Neisseria meningitides, Staphylococcus epidermidis, Pseudomonas aeruginosa and Bacillus cereus were identified using BLAST for known 16S rRNA sequences. CONCLUSION Polymerase chain reaction (PCR) accompanied with cloning and sequencing approved to be sensitive and specific. The rapid molecular technique was useful in detection of 12 major microbial species, in infectious endophthalmitis.
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Affiliation(s)
- Majid Abrishami
- Professor, Retina Research Center, Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Behnam Hashemi
- Student, Department of Pharmacodynamy and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojtaba Abrishami
- Assistant Professor, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Khalil Abnous
- Associate Professor, Department of Pharmacodynamy and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kamal Razavi-Azarkhiavi
- PhD Student, Department of Pharmacodynamy and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Behravan
- Professor, Biotechnology Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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Mazoteras P, Bispo PJM, Höfling-Lima AL, Casaroli-Marano RP. DNA extraction methods for panbacterial and panfungal PCR detection in intraocular fluids. Curr Eye Res 2014; 40:697-706. [PMID: 25285466 DOI: 10.3109/02713683.2014.957327] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Three different methods of DNA extraction from intraocular fluids were compared with subsequent detection for bacterial and fungal DNA by universal PCR amplification. MATERIAL AND METHODS Three DNA extraction methods, from aqueous and vitreous humors, were evaluated to compare their relative efficiency. Bacterial (Gram positive and negative) and fungal strains were used in this study: Escherichia coli, Staphylococcus epidermidis and Candida albicans. The quality, quantification, and detection limit for DNA extraction and PCR amplification were analyzed. Validation procedures for 13 aqueous humor and 14 vitreous samples, from 20 patients with clinically suspected endophthalmitis were carried out. RESULTS The column-based extraction method was the most time-effective, achieving DNA detection limits ≥10(2) and 10(3 )CFU/100 µL for bacteria and fungi, respectively. PCR amplification detected 100 fg, 1 pg and 10 pg of genomic DNA of E. coli, S. epidermidis and C. albicans respectively. PCR detected 90.0% of the causative agents from 27 intraocular samples collected from 20 patients with clinically suspected endophthalmitis, while standard microbiological techniques could detect only 60.0%. The most frequently found organisms were Streptococcus spp. in 38.9% (n = 7) of patients and Staphylococcus spp. found in 22.2% (n = 4). CONCLUSIONS The column-based extraction method for very small inocula in small volume samples (50-100 µL) of aqueous and/or vitreous humors allowed PCR amplification in all samples with sufficient quality for subsequent sequencing and identification of the microorganism in the majority of them.
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Affiliation(s)
- Paloma Mazoteras
- Department of Surgery, School of Medicine, University of Barcelona (UB) , Barcelona , Spain
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Comparison of polymerase chain reaction and standard microbiological techniques in presumed bacterial corneal ulcers. Int Ophthalmol 2014; 35:159-65. [DOI: 10.1007/s10792-014-9925-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 02/12/2014] [Indexed: 10/25/2022]
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Cornut PL, Boisset S, Romanet JP, Maurin M, Carricajo A, Benito Y, Vandenesch F, Chiquet C. Principles and applications of molecular biology techniques for the microbiological diagnosis of acute post-operative endophthalmitis. Surv Ophthalmol 2013; 59:286-303. [PMID: 24359808 DOI: 10.1016/j.survophthal.2013.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 08/01/2013] [Accepted: 08/06/2013] [Indexed: 10/25/2022]
Abstract
The systematic microbiological evaluation of endophthalmitis allows the confirmation of the infectious nature of the disease and the possible adaptation of treatment at the individual level and, at the collective level, the epidemiological characterization of the bacterial spectrum of endophthalmitis. Long reserved for research, the use of molecular biology techniques to complement conventional culture techniques has become important for the diagnosis of endophthalmitis in recent years. These new diagnostic techniques are particularly useful for the microbiological study of bacteria that are difficult or impossible to grow because of their intrinsic properties, their presence in only a small inoculum, their sequestration on prosthetic materials, or their inactivation by prior antibiotic treatment. These techniques are based on the polymerase chain reaction (PCR), which allows the amplification and detection of extracted bacterial deoxyribonucleic acid (DNA) that is initially present in minute quantities in an ocular sample. In practice, these conventional or real-time PCRs allow either the a priori detection of bacterial DNA (universal PCR) or the identification of a specific DNA fragment of a bacterial genus or species (specific PCR). New techniques of PCR will allow more rapid bacterial identification and also characterization of genotypic properties, such as genes of virulence or antibiotic resistance.
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Affiliation(s)
- Pierre-Loïc Cornut
- Department of Ophthalmology, Hospices Civils de Lyon, Université Lyon I, Lyon, France.
| | - Sandrine Boisset
- Department of Microbiology, CHU de Grenoble, Université Joseph Fourier, Grenoble, France; Department of Microbiology, Hospices Civils de Lyon, Université Lyon 1, Centre, National de référence des Staphylocoques, and INSERM, U851, Bron, France
| | - Jean-Paul Romanet
- Department of Ophthalmology, CHU de Grenoble, Université Joseph Fourier, Grenoble, France
| | - Max Maurin
- Department of Microbiology, CHU de Grenoble, Université Joseph Fourier, Grenoble, France
| | - Anne Carricajo
- Department of Microbiology, CHU de Saint-Etienne, Université de Saint-Etienne, Saint-Etienne, France
| | - Yvonne Benito
- Department of Microbiology, Hospices Civils de Lyon, Université Lyon 1, Centre, National de référence des Staphylocoques, and INSERM, U851, Bron, France
| | - François Vandenesch
- Department of Microbiology, Hospices Civils de Lyon, Université Lyon 1, Centre, National de référence des Staphylocoques, and INSERM, U851, Bron, France
| | - Christophe Chiquet
- Department of Ophthalmology, CHU de Grenoble, Université Joseph Fourier, Grenoble, France
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Aarthi P, Bagyalakshmi R, Therese KL, Madhavan HN. Development of a novel reverse transcriptase polymerase chain reaction to determine the Gram reaction and viability of bacteria in clinical specimens. Microbiol Res 2013; 168:497-503. [PMID: 23602123 DOI: 10.1016/j.micres.2013.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 03/15/2013] [Accepted: 03/17/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To develop a novel RNA based assay to determine the Gram reaction and viability of bacteria in clinical specimens. MATERIALS AND METHODS Reverse transcriptase PCR (RT-PCR) targeting 16SrRNA region was optimized using Staphylococcus aureus ATCC 25923 and Pseudomonas aeruginosa ATCC 27853 by using two novel sets of primers. Sixty clinical specimens consisting of 31 intraocular specimens (19 vitreous fluids and 12 aqueous humor), 11 peripheral blood specimens and 18 other clinical specimens were subjected to standard microbiological culture and RT-PCR to determine the Gram reaction and viability of bacteria. The amplified products were subjected to DNA sequencing to identify the bacterium. RESULTS The sensitivity of RT-PCR was 0.4fg and the primers amplified bacterial cDNA. RT-PCR detected the presence of bacteria in 60 clinical specimens indicating the presence of viable bacteria. Concordant results were obtained with both primer sets. Seventy five bacterium comprising 52 single (69.3%) and 23 mixed bacteria (30.6%), both Gram positive and Gram negative were detected. These results correlated with the bacterial identity by PCR based DNA sequencing. CONCLUSION RT-PCR is a reliable tool to identify the presence of viable bacteria and to precisely determine Gram reaction.
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Affiliation(s)
- P Aarthi
- Larsen and Toubro Microbiology Research Centre, Kamal Nayan Bajaj Research Centre, Vision Research Foundation, No. 41, College Road, Chennai 600006, India
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Bharathi MJ, Murugan N, Rameshkumar G, Ramakrishnan R, Venugopal Reddy YC, Shivkumar C, Ramesh S. Comparative evaluation of uniplex, nested, semi-nested, multiplex and nested multiplex PCR methods in the identification of microbial etiology of clinically suspected infectious endophthalmitis. Curr Eye Res 2013; 38:550-62. [PMID: 23448514 DOI: 10.3109/02713683.2013.772205] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This study is aimed to determine the utility of various polymerase chain reaction (PCR) methods in vitreous fluids (VFs) for detecting the infectious genomes in the diagnosis of infectious endophthalmitis in terms of sensitivity and specificity. METHODS This prospective and consecutive analysis included a total of 66 VFs that were submitted for the microbiological evaluation, which were obtained from 66 clinically diagnosed endophthalmitis patients presented between November 2010 and October 2011 at the tertiary eye care referral centre in South India. Part of the collected VFs were subjected to cultures and smears, and the remaining parts were utilized for five PCR methods: uniplex, nested, semi-nested, multiplex and nested multiplex after extracting DNA, using universal eubacterial and Propionibacterium acnes species-specific primer sets targeting 16S rRNA gene in all bacteria and P. acnes, and panfungal primers, targeting 28S rRNA gene in all fungi. RESULTS Of the 66 VFs, five (7.5%) showed positive results in smears, 16 (24%) in cultures and 43 (65%) showed positive results in PCRs. Among the 43 positively amplified VFs, 10 (15%) were positive for P. acnes genome, one for panfungal genome and 42 (62%) for eubacterial genome (including 10 P. acnes positives). Among 42 eubacterial-positive VFs, 36 were positive by both uniplex (first round) and multiplex (first round) PCRs, while nested (second round) and nested multiplex (second round) PCRs produced positive results in 42 and 41 VFs, respectively. Of the 43 PCR-positive specimens, 16 (37%) had positive growth (15 bacterial and one fungal) in culture. Of 50 culture-negative specimens, 27 (54%) were showed positive amplification, of which 10 were amplified for both P. acnes and eubacterial genomes and the remaining 17 were for eubacterial genome alone. CONCLUSIONS Nested PCRs are superior than uniplex and multiplex PCR. PCRs proved to be a powerful tool in the diagnosis of endophthalmitis, especially for detecting uncultured microbes.
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Affiliation(s)
- Madasamy Jayahar Bharathi
- Department of Microbiology & Molecular Biology, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, SN High Road, Tirunelveli 627001, Tamil Nadu, India.
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Do DV, Nguyen QD. Vitreous, Retinal, and Choroidal Biopsy. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00124-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Joseph CR, Lalitha P, Sivaraman KR, Ramasamy K, Behera UC. Real-time polymerase chain reaction in the diagnosis of acute postoperative endophthalmitis. Am J Ophthalmol 2012; 153:1031-7.e2. [PMID: 22381364 DOI: 10.1016/j.ajo.2011.12.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 12/17/2011] [Accepted: 12/19/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the efficacy of quantitative real-time polymerase chain reaction (qPCR) in the diagnosis of postoperative bacterial endophthalmitis among patients who underwent cataract surgery at a tertiary care center. DESIGN Prospective experimental study. METHODS This was a single-center study of 64 eyes of 64 patients presenting with clinical signs and symptoms of endophthalmitis within 1 year of cataract surgery. Patients with glaucoma filtering or cornea surgery in the past year, postoperative trauma, fungal endophthalmitis, or preoperative inflammatory conditions were excluded. Vitreous samples were obtained during vitreous tap or vitrectomy and sent for both culture and qPCR with sequencing. Vitreous samples obtained from 50 patients undergoing vitrectomy for noninflammatory indications served as controls. The main outcome measures were the sensitivity of qPCR compared to culture and concordance of results of pathogen identification with sequencing vs phenotypic speciation. RESULTS qPCR detected 16s bacterial DNA in 37 patients (66%), compared to 19 (34%) with traditional culture. Only 1 patient had a positive result by culture (Nocardia species) but negative result by qPCR. For the 18 samples positive by both qPCR and culture, there was a 100% concordance in pathogen identification between sequencing and phenotypic speciation. CONCLUSION In cases of suspected bacterial endophthalmitis, qPCR offers an improved diagnostic yield and may be a useful adjunct to traditional culture. Further large-scale clinical studies are needed to elucidate the full clinical utility of qPCR.
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Affiliation(s)
- Cornelia Reena Joseph
- Department of Microbiology, Dr G. Venkasamy Eye Research Institute Aravind Medical Research Foundation, Madurai, Tamil Nadu, India
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Chronic postoperative endophthalmitis: a review of clinical characteristics, microbiology, treatment strategies, and outcomes. Int J Inflam 2012; 2012:313248. [PMID: 22550607 PMCID: PMC3328945 DOI: 10.1155/2012/313248] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Revised: 01/10/2012] [Accepted: 01/29/2012] [Indexed: 01/30/2023] Open
Abstract
Chronic postoperative endophthalmitis (CPE) is a delayed infectious intraocular inflammation process that occurs more than six weeks after ocular surgery and frequently masquerades as autoimmune uveitis. These cases are at risk of delayed diagnosis and erroneous long-term treatment with corticosteroids. This paper aims to review the epidemiology, microbiology, clinical characteristics, diagnosis, management strategies, and outcome of chronic postoperative endophthalmitis. The incidence of CPE is still uncommon, and multiple pathogens have been reported with varying frequencies. Review of the literature reveals that CPE cases have a high incidence of visual impairment and recurrence rate might be decreased with aggressive surgical approach.
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Park IK, Kim JH, Kim JC, Chun YS. Nd:YAG Photodisruption of Toxic Anterior Segment Syndrome Related to Amoeboic Deposits. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.9.1334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- In Ki Park
- Department of Ophthalmology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Hoon Kim
- Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae Chan Kim
- Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yeoun Sook Chun
- Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Species-specific probes and real-time PCR as a tool for fast detection and differentiation of 15 bacteria relevant in intensive care medicine. World J Microbiol Biotechnol 2011. [DOI: 10.1007/s11274-011-0661-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kang HM, Chung EJ. Late-onset Citrobacter koseri endophthalmitis with suture exposure after secondary intraocular lens implantation. KOREAN JOURNAL OF OPHTHALMOLOGY 2011; 25:285-8. [PMID: 21860579 PMCID: PMC3149143 DOI: 10.3341/kjo.2011.25.4.285] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 05/10/2010] [Indexed: 11/23/2022] Open
Abstract
A 54-year-old male patient was seen in clinic for ocular pain and decreased vision in the right eye with duration of two days. He underwent a cataract operation for his right eye 12 years ago, then a sclera-fixated secondary intraocular implantation and pars plana vitrectomy three years ago due to intraocular lens dislocation. At the initial visit, his visual acuity was restricted to the perception of hand motion. An edematous cornea, cells, flare with hypopyon, and exposed suture material at were observed at the six o'clock direction by slit lamp. Vitreous opacity was noted from B-scan ultrasonography. The patient was diagnosed with late-onset endophthalmitis and an intravitreal cocktail injection was done. On the next day, the hypopyon was aggravated, and therefore a pars plana vitrectomy was performed. A vitreous culture tested positive for Citrobacter koseri. After 12 weeks, the best corrected visual acuity of the right eye improved to 0.7 and a fundus examination revealed a relatively normal optic disc and retinal vasculature. We herein report the first case of endophthalmitis caused by Citrobacter koseri in Korea. Exposed suture material was suspected as the source of infection in this case and prompt surgical intervention resulted in a relatively good visual outcome.
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Affiliation(s)
- Hae Min Kang
- Department of Ophthalmology, Yonsei University Medical Center, Seoul, Korea
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Aarthi P, Harini R, Sowmiya M, Malathi J, Therese KL, Madhavan HN. Identification of bacteria in culture negative and polymerase chain reaction (PCR) positive intraocular specimen from patients with infectious endopthalmitis. J Microbiol Methods 2011; 85:47-52. [DOI: 10.1016/j.mimet.2011.01.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 01/11/2011] [Accepted: 01/12/2011] [Indexed: 11/16/2022]
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Kim H, Kim J, Ihm C. The usefulness of multiplex PCR for the identification of bacteria in joint infection. J Clin Lab Anal 2011; 24:175-81. [PMID: 20486199 DOI: 10.1002/jcla.20384] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The diagnosis of septic arthritis (SA) relies on synovial analysis and conventional culture. But, these methods lack of sensitivity and culture is time consuming to establish a definite diagnosis. This study evaluated a new multiplex PCR assay which entailed screening PCR for Gram typing and identification PCR for species identification using two primer mixes. METHODS A total of 80 synovial fluid samples from patients with suspected SA were collected. Culture, multiplex PCR, and 16S rRNA gene PCR were performed. RESULTS The analytical sensitivity of multiplex PCR assay was 10(1) CFU/ml for each type of bacteria. There was no cross-reactivity with common bacterial pathogens. Bacteria were detected in 20, 25, and 26 of 80 samples for culture, multiplex PCR, and 16S rRNA gene PCR, respectively. Nineteen (95%) of 20 culture-positive samples and 6 (10%) of 60 culture-negative samples were positive for the multiplex PCR. Five of six samples which were positive only from multiplex PCR were also positive in 16S rRNA gene PCR. The multiplex PCR showed 2 false-negative in 27 true-positive samples but no false-positive. The sensitivity and specificity of the multiplex PCR were 92.6 and 100%, and the agreement with culture and 16S rRNA gene PCR were 91.3 and 96.3%, respectively. The time to detection for multiplex PCR was a maximum of 6 hr. CONCLUSION This multiplex PCR assay offers high sensitivity and improved detection speed relative to culture. The appropriate combination of this new multiplex PCR assay with culture may contribute to the accurate and rapid diagnosis of SA.
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Affiliation(s)
- Hwanjung Kim
- Department of Orthopedic Surgery, Eulji University Hospital, Dunsandong, Daejeon, Korea
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Abstract
Endophthalmitis refers to bacterial or fungal infection of the vitreous and/or aqueous humors of the eye. Bacterial endophthalmitis occurs most commonly after eye surgery or penetrating ocular trauma (exogenous endophthalmitis), but may also occur from hematogenous seeding during bacteremia (endogenous endophthalmitis). The presentation is usually acute, with eye pain and decreased vision. In exogenous endophthalmitis, infection is confined to the eye. There is no fever and minimal, if any, peripheral leukocytosis. Treatment includes direct injection of antibiotics into the vitreous, and vitrectomy in more severe cases. Systemic antibiotics are indicated in endogenous endophthalmitis; their role in exogenous endophthalmitis is controversial. Visual outcome depends on the virulence of the bacterial pathogen and the speed with which treatment is given. Acute bacterial endophthalmitis is a medical emergency, because delay in treatment may result in vision loss.
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Affiliation(s)
- Marlene L Durand
- Infectious Disease Service, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.
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Mulet ME, Pérez-Santonja JJ, Ferrer C, Alió JL. Microbial Keratitis After Intrastromal Corneal Ring Segment Implantation. J Refract Surg 2010; 26:364-9. [DOI: 10.3928/1081597x-20090617-06] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Accepted: 04/28/2009] [Indexed: 11/20/2022]
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Chen KJ, Sun MH, Hwang YS, Chen TL, Lai CC, Chen YP. Endophthalmitis Caused byCitrobacterSpecies. Ocul Immunol Inflamm 2009; 16:147-53. [DOI: 10.1080/09273940802184190] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Goldschmidt P, Ferreira CC, Degorge S, Benallaoua D, Boutboul S, Laroche L, Batellier L, Chaumeil C. Rapid detection and quantification of Propionibacteriaceae. Br J Ophthalmol 2008; 93:258-62. [DOI: 10.1136/bjo.2008.146639] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Seal D, Reischl U, Behr A, Ferrer C, Alió J, Koerner RJ, Barry P. Laboratory diagnosis of endophthalmitis: comparison of microbiology and molecular methods in the European Society of Cataract & Refractive Surgeons multicenter study and susceptibility testing. J Cataract Refract Surg 2008; 34:1439-50. [PMID: 18721702 DOI: 10.1016/j.jcrs.2008.05.043] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 05/16/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate and compare the use of molecular biology with the use of traditional Gram stain and organism culture for the laboratory diagnosis of postoperative endophthalmitis. SETTING Twenty-four ophthalmology units together with 9 microbiology laboratories and 2 European reference molecular biology laboratories. METHODS A prospective randomized partially masked multicenter cataract surgery study recruited 16 603 patients. This resulted in 29 cases of presumed postoperative endophthalmitis. Gram stain and culture were performed in the local laboratory according to agreed protocols. Samples of aqueous and/or vitreous were transported to the first referenced molecular biology laboratory (Regensburg, Germany) for polymerase chain reaction (PCR) testing, and an extracted aliquot of DNA was then referred to the second laboratory (Alicante, Spain) for PCR. RESULTS Of the 29 who presented with presumed postoperative endophthalmitis, 20 were classified as proven infective endophthalmitis with positive Gram stain, culture, or PCR. Fourteen patients were culture-positive; all but 1 of these was also positive by PCR. Six patients were positive by PCR but negative by Gram stain or culture. Nine patients were negative by both microbiology and PCR testing. CONCLUSIONS Use of molecular biology technique increased the laboratory rate of identifying the pathogen by 20%, confirming the technique is very useful for the endophthalmitis specimen. Samples of both aqueous and vitreous should be collected and stored at -20 degrees C for PCR at the time of the diagnostic taps.
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Affiliation(s)
- David Seal
- Applied Vision Research Centre, City University, London, United Kingdom
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Microbiologic Identification of Bleb-related Delayed-onset Endophthalmitis Caused by Moraxella Species. J Glaucoma 2008; 17:541-5. [DOI: 10.1097/ijg.0b013e31816299ec] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Diagnostic vitrectomy for the diagnosis and management of posterior uveitis of unknown etiology. Curr Opin Ophthalmol 2008; 19:218-24. [DOI: 10.1097/icu.0b013e3282fc261d] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Drancourt M, Berger P, Terrada C, Bodaghi B, Conrath J, Raoult D, LeHoang P. High prevalence of fastidious bacteria in 1520 cases of uveitis of unknown etiology. Medicine (Baltimore) 2008; 87:167-176. [PMID: 18520326 DOI: 10.1097/md.0b013e31817b0747] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The etiologic evaluation of uveitis is frequently unsuccessful when noninvasive methods are used. We conducted a prospective study to evaluate systematic screening for pathogens of uveitis. All patients with uveitis referred to the participating tertiary ophthalmology departments from January 2001 to September 2007 underwent intraocular and serum specimen collection. The standardized protocol for laboratory investigations included universal polymerase chain reaction (PCR)-based detection of any bacteria and mycoses, specific PCR-based detection of fastidious (difficult-to-grow) bacteria and herpes viruses, and culture of vitreous fluid. Sera were tested for fastidious bacteria. Among the 1321 included patients (1520 specimens), infection was diagnosed in 147 (11.1%) patients: 78 (53%) were caused by fastidious bacteria that included spirochetes, Bartonella species, intracellular bacteria (Chlamydia species, Rickettsia species, Coxiella burnetii), and Tropheryma whipplei; 18 by herpes viruses; and 9 by fungi. Bartonella quintana, Coxiella burnetii, Paracoccus yeei, Aspergillus oryzae, and Cryptococcus albidus were found to be associated with uveitis for the first time, to our knowledge. We recommend applying a 1-step diagnostic procedure that incorporates intraocular, specific microbial PCR with serum analyses in tertiary centers to determine the etiology of uveitis.
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Affiliation(s)
- Michel Drancourt
- From Fédération de Microbiologie Clinique et Unité des Rickettsies (MD, PB, DR), CNRS UMR 6020, Université de la Méditerranée, Marseille; Department of Ophthalmology (CT, BB, PLH), Pitié-Salpétriè Hospital, Paris; and Department of Ophthalmology (JC), Timone Hospital, Marseille, France
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Mochizuki K, Murase H, Sawada A, Suzuki T. Detection of staphylococcus species by polymerase chain reaction in late-onset endophthalmitis after cataract surgery and posterior capsulotomy. Clin Exp Ophthalmol 2008; 35:873-5. [PMID: 18173423 DOI: 10.1111/j.1442-9071.2007.01606.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a case of late-onset endophthalmitis that developed 5 years after an uneventful phacoemulsification with implantation of a posterior chamber intraocular lens. Posterior capsulotomy was performed with by Nd:YAG laser 1 month after the cataract surgery. Polymerase chain reaction with agarose gel electrophoresis identified a Staphylococcus species in a sample from the aqueous humour. The endophthalmitis was responsive to medical therapy including antibiotic agents, and it resolved without any surgical intervention.
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Ghosh A, Basu S, Datta H, Chattopadhyay D. Evaluation of polymerase chain reaction-based ribosomal DNA sequencing technique for the diagnosis of mycotic keratitis. Am J Ophthalmol 2007; 144:396-403. [PMID: 17631849 DOI: 10.1016/j.ajo.2007.05.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Revised: 05/01/2007] [Accepted: 05/10/2007] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the polymerase chain reaction (PCR) and sequencing-based ribosomal deoxyribonucleic acid (rDNA) typing technique for rapid and sensitive diagnosis of fungal keratitis. DESIGN Laboratory investigation. METHODS The present study included culture-based methods along with PCR and ITS2/5.8S rDNA sequencing to evaluate fungal infections in 32 corneal scrapings from patients with suspected mycotic keratitis. RESULTS Good correlation was found between the culture and PCR rDNA sequencing-based methods. We also identified fungal strains that were noncultivable in routine culture medium and fungal strains, which have been reported scarcely in previous reports from eastern Indian studies. CONCLUSIONS The PCR and rDNA sequencing-based approaches may be useful alternatives to culture-based techniques for the rapid and sensitive diagnosis of fungal keratitis. We found that clinically significant pathogenic fungal strains can be detected and differentiated by this method in a short period. This method therefore is useful for the early treatment of fungal infection.
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Affiliation(s)
- Abhrajyoti Ghosh
- Dr. B C Guha Centre for Genetic Engineering and Biotechnology, University of Calcutta, Kolkata, India
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Abstract
PURPOSE To review the current state of evaluation and management of various forms of endophthalmitis. METHODS A review of the literature is included, encompassing endophthalmitis occurring after ocular surgeries, intravitreal injection, trauma, and systemic infection. Based on this review, current principles and techniques for evaluating and treating these forms of endophthalmitis are discussed. RESULTS Postoperative endophthalmitis after cataract surgery is the most common presentation. Conclusions from the Endophthalmitis Vitrectomy Study (EVS) remain a foundation for management of postcataract surgery endophthalmitis, notably prompt intravitreal antibiotic administration after vitreous sampling, with consideration for pars plana vitrectomy in severe cases. The potential impact of advances since the EVS, such as oral fourth generation fluoroquinolones and new vitrectomy techniques, are also discussed. The management of postcataract endophthalmitis is compared and contrasted to endophthalmitis occurring after other ocular surgeries, intravitreal injection, trauma, and systemic infection. Although some principles remain common, treatment rationales differ with other forms of endophthalmitis based on differing clinical circumstances, such as the virulence of organisms that are frequently encountered. CONCLUSIONS Endophthalmitis is a serious, potentially vision threatening condition which can present in various settings. Prompt recognition and treatment are key in maximizing outcomes.
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Affiliation(s)
- Craig A Lemley
- Medical College of Wisconsin, Department of Ophthalmology, Vitreoretinal Section, Milwaukee, WI 53226-4812, USA
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Chiquet C, Lina G, Benito Y, Cornut PL, Etienne J, Romanet JP, Denis P, Vandenesch F. Polymerase chain reaction identification in aqueous humor of patients with postoperative endophthalmitis. J Cataract Refract Surg 2007; 33:635-41. [PMID: 17397736 DOI: 10.1016/j.jcrs.2006.12.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Accepted: 12/01/2006] [Indexed: 11/22/2022]
Abstract
PURPOSE To identify bacterial agents in the aqueous humor of patients with postoperative endophthalmitis using eubacterial polymerase chain reaction (PCR) and conventional culture. SETTING University Hospital of Lyon E. Herriot, Lyon, France. METHODS Broad-range eubacterial PCR amplification followed by direct sequencing was used to identify microbial pathogens in ocular samples from 30 patients with acute or delayed-onset endophthalmitis, mainly after cataract surgery. Ocular samples included aqueous humor collected before the first intravitreal injection of antibiotics and vitreous samples collected at the time of the therapeutic pars plana vitrectomy. RESULTS Cultures were positive in 32% of cases and PCR in 61% of cases with aqueous humor samples. When associated, culture and PCR of aqueous humor samples allowed for a microbiological diagnosis in 71% of cases. Microorganisms cultured by conventional techniques matched those identified by PCR. When applied on vitreous pretreated with intravitreal antibiotics, PCR increased the identification rate from 18% to 62%. CONCLUSIONS Polymerase chain reaction assay of initial aqueous humor samples contributed to the diagnosis of endophthalmitis in 30% of cases. Previous use of intravitreal antibiotics did not seem to affect the ability to PCR-amplify DNA in the short term. Polymerase chain reaction-based technology was a useful adjunct to conventional culture because when used with aqueous humor samples only, the association of both techniques allowed for a microbiological diagnosis in 71% of cases of postoperative acute and delayed-onset endophthalmitis.
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Affiliation(s)
- Christophe Chiquet
- Department of Ophthalmology, Hôpital Edouard Herriot, Université Lyon, France.
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Fenollar F, Roux V, Stein A, Drancourt M, Raoult D. Analysis of 525 samples to determine the usefulness of PCR amplification and sequencing of the 16S rRNA gene for diagnosis of bone and joint infections. J Clin Microbiol 2006; 44:1018-28. [PMID: 16517890 PMCID: PMC1393109 DOI: 10.1128/jcm.44.3.1018-1028.2006] [Citation(s) in RCA: 180] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The 16S rRNA gene PCR in the diagnosis of bone and joint infections has not been systematically tested. Five hundred twenty-five bone and joint samples collected from 525 patients were cultured and submitted to 16S rRNA gene PCR detection of bacteria in parallel. The amplicons with mixed sequences were also cloned. When discordant results were observed, culture and PCR were performed once again. Bacteria were detected in 139 of 525 samples. Culture and 16S rRNA gene PCR yielded identical documentation in 475 samples. Discrepancies were linked to 13 false-positive culture results, 5 false-positive PCR results, 9 false-negative PCR results, 16 false-negative culture results, and 7 mixed infections. Cloning and sequencing of 16S rRNA gene amplicons in 6 of 8 patients with mixed infections identified 2 to 8 bacteria per sample. Rarely described human pathogens such as Alcaligenes faecalis, Comamonas terrigena, and 21 anaerobes were characterized. We also detected, by 16S rRNA gene PCR, four previously identified bacteria never reported in human infection, Alkanindiges illinoisensis, dehydroabietic acid-degrading bacterium DhA-73, unidentified Hailaer soda lake bacterium, and uncultured bacterium clone HuCa4. Seven organisms representing new potential species were also detected. PCR followed by cloning and sequencing may help to identify new pathogens involved in mixed bone infection.
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Affiliation(s)
- Florence Fenollar
- Unité des Rickettsies, CNRS UMR 6020, IFR 48, Faculté de Médecine, Université de la Méditerranée, 27 Boulevard Jean Moulin, 13385 Marseille cedex 05, France
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Affiliation(s)
- Rishi P Singh
- Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
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Dhaulakhandi DB, Ahluwalia KB, Ravi AK, Garg LC. Detection of 16S rRNA gene in round bodies isolated from polyps of rhinosporidiosis. INFECTION GENETICS AND EVOLUTION 2006; 6:331-6. [PMID: 16418014 DOI: 10.1016/j.meegid.2005.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2005] [Revised: 11/16/2005] [Accepted: 11/22/2005] [Indexed: 10/25/2022]
Abstract
Polyps of rhinosporidiosis contain microscopic round bodies, believed to be causative agents of the disease. The source and identity of these round bodies has been debated ever since the first case was described in the year 1900. Most patients have a history of exposure to pond water. Collection and microscopic analysis of pond water samples where patients had been dipping led to the idea that a cyanobacterium could possibly develop into round bodies after entering the patient's nose. Molecular genomic studies based on PCR, cloning, and sequencing were, therefore, carried out using purified DNA, extracted from individually separated round bodies from polyp samples. Parallel investigations were also conducted on DNA extracted from cyanobacterium Microcystis isolated from pond water samples. The results of these experiments presented here provide evidence of the presence of 1458 bp 16S rRNA gene in round bodies. This is the first molecular study indicating the prokaryotic identity of round bodies in rhinosporidiosis.
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Affiliation(s)
- Dhara B Dhaulakhandi
- Cell Biology and EM Section, Department of Biophysics, All India Institute of Medical Sciences, New Delhi 110 029, India
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Do DV, Loewenstein A, Green WR, Haller JA. Vitreous, Retinal, and Choroidal Biopsy. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50047-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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