House finches with high coccidia burdens experience more severe experimental Mycoplasma gallisepticum infections

Parasites co-infecting hosts can interact directly and indirectly to affect parasite growth and disease manifestation. We examined potential interactions between two common parasites of house finches: the bacterium Mycoplasma gallisepticum that causes conjunctivitis and the intestinal coccidian parasite Isospora sp. We quantified coccidia burdens prior to and following experimental infection with M. gallisepticum, exploiting the birds' range of natural coccidia burdens. Birds with greater baseline coccidia burdens developed higher M. gallisepticum loads and longer lasting conjunctivitis following inoculation. However, experimental inoculation with M. gallisepticum did not appear to alter coccidia shedding. Our study suggests that differences in immunocompetence or condition may predispose some finches to more severe infections with both pathogens.

Characterization of baseline polybacterial versus monobacterial infections in three randomized controlled bacterial conjunctivitis trials and microbial outcomes with besifloxacin ophthalmic suspension 0.6

Background/Purpose

To date, studies examining polymicrobial infections in ocular disease have mostly been limited to keratitis or endophthalmitis. We characterized polybacterial infections compared to monobacterial infections in prior clinical studies evaluating besifloxacin ophthalmic suspension 0.6% for the treatment of bacterial conjunctivitis and report on associated microbiological outcomes.

Methods

In this post-hoc analysis, microbiological data for subjects with conjunctivitis due to one or more than one bacterial species in three previous studies (two vehicle-, one active-controlled) of besifloxacin were extracted. Bacterial species identified at baseline were deemed causative if their colony count equaled or exceeded species-specific prespecified threshold criteria. In subjects with polybacterial infections, the fold-increase over threshold was used to rank order the contribution of individual species. Baseline pathogens and their minimum inhibitory concentrations (MICs) for common ophthalmic antibiotics were compared by infection type, as were microbial eradication rates following treatment with besifloxacin.

Results

Of 1041 subjects with culture-confirmed conjunctivitis, 17% had polybacterial and 83% had monobacterial conjunctivitis at baseline. In polybacterial compared to monobacterial infections, Haemophilus influenzae and Streptococcus pneumoniae were identified less frequently as the dominant infecting species (P = 0.042 and P<0.001, respectively), whereas Streptococcus mitis/S. mitis group was identified more frequently as dominant (P<0.001). Viral coinfection was also identified more frequently in polybacterial infections (P<0.001). Staphylococcus aureus was the most common coinfecting species in polybacterial infections and the second most common dominant species in such infections. With few exceptions, MICs for individual species were comparable regardless of infection type. Clinical microbial eradication rates with besifloxacin were high regardless of infection type (P≤0.016 vs vehicle at follow-up visits).

Conclusions

Approximately one in five subjects with bacterial conjunctivitis are infected with more than one bacterial species underscoring the need for a broad-spectrum antibiotic for such infections. Besifloxacin treatment resulted in robust eradication rates of these infections comparable to monobacterial infections.

Trial registration

NCT000622908, NCT00347932, NCT00348348

Antibiotic resistance among bacterial conjunctival pathogens collected in the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) surveillance study

The Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) surveillance study evaluates in vitro antibiotic resistance among Staphylococcus aureus, coagulase-negative staphylococci (CoNS), Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae isolates from ocular infections. Here we report resistance rates and trends among conjunctival-sourced ocular isolates collected across the US from 2009 through 2016. A total of 1198 conjunctival isolates (483 S. aureus, 305 CoNS, 208 H. influenzae, 118 S. pneumoniae, and 84 P. aeruginosa) were collected from patients with presumed bacterial conjunctivitis from 57 sites across 40 states. A large proportion of staphylococci demonstrated resistance to oxacillin and azithromycin, while resistance was low against the majority of antibiotics tested for S. pneumoniae, P. aeruginosa, and H. influenzae. Multidrug resistance (≥3 antibiotic classes) was found in 30.2% of S. aureus and 39.0% of CoNS isolates, and methicillin resistance more than doubled the rate of multi-drug resistance (methicillin-resistant S. aureus [MRSA], 76.5%; methicillin-resistant CoNS isolates, 72.8%). There was a pattern of increasing mean percent resistance with increasing age by decade of life among S. aureus, MRSA, and CoNS (P≤0.038). Over the eight-year study period, there were small yet significant decreases in resistance rates among S. aureus to azithromycin, ciprofloxacin, tobramycin, trimethoprim, and oxacillin (P≤0.003), and among CoNS and P. aeruginosa (both P<0.05) to ciprofloxacin. These data indicate that antibiotic resistance is high, but did not increase, among conjunctival-sourced isolates collected in the US from 2009 through 2016. For certain antibiotic/pathogen combinations, there was a trend of decreased resistance, including a decrease in oxacillin resistance among S. aureus.

Conjunctival Scrapings and Impression Cytology in Chronic Conjunctivitis. Correlation with Microbiology

To assess the utility of exfoliative cytology in the diagnosis of chronic conjunctivitis, we compared its findings with microbiological examination and established the correlation between cytology and microbiology in 32 patients with conjunctivitis lasting four weeks or more, with a nonspecific clinical picture. The material for cytology was collected by scraping and by imprint of the ocular surface on Millipore filter paper. The specimens were stained with Giemsa. Material for bacterial culture and fluorescent antibody test for viruses and Chlamydia were obtained at the same time. In 12 patients neutrophils predominated in cytology, in six eosinophils were found and in four there were more lymphocytes. One patient had a basophilic intracytoplasmic inclusion specific for Chlamydia infection. In eight patients coagulase-negative Staphylococcus species and in one Staphylococcus aureus were isolated, in two the fluorescent antibody test for Chlamydia was positive and in three for viruses. In all patients with a positive bacterial culture, a predominance of neutrophils was observed. All patients with a positive test for viruses had lymphocytosis in conjunctival scrapings. In two patients microbiology detected Chlamydia, but characteristic intracytoplasmic inclusions were observed only in one. Scrapings gave more specific results, that correlated well with microbiology in bacterial and viral infection, whereas the results of impression cytology showed minor metaplastic changes of epithelial cells that were nonspecific for the type of inflammation. Cytology remains a useful non-invasive tool and is an adjunct to clinical and microbiological examination. It proved especially helpful in allergic conjunctivitis.

Comparative Evaluation of Efficacy and Safety of Ciprofloxacin and Norfloxacin Ophthalmic Solutions

The efficacy and safety of ciprofloxacin ophthalmic solution 0.3% and norfloxacin ophthalmic solution 0.3% in the treatment of bacterial conjunctivitis and blepharitis were compared in a double masked randomised study. A total of 131 patients, 65 treated with ciprofloxacin (42 with conjunctivitis and 23 with blepharitis) and 66 treated with norfloxacin (39 with conjunctivitis and 27 with blepharitis) were enrolled in the study at five centres in France. In the efficacy population, pathogens were eradicated or reduced in 96% (24/25) of patients in the ciprofloxacin group and 89% (24/27) in the norfloxacin group. There was no difference between treatments with regard to eradication of particular pathogens. In the efficacy population, clinical cure or improvement was seen in 96% of the patients (24/25 in the ciprofloxacin group and 26/27 in the norfloxacin group). There were no significant differences between ciprofloxacin and norfloxacin with respect to improvements in four symptoms or ten clinical signs. No serious treatment-related adverse events were reported and both ciprofloxacin and norfloxacin were well tolerated.

Anterior segment complications secondary to continuous positive airway pressure machine treatment in patients with obstructive sleep apnea

BACKGROUND

Obstructive sleep apnea (OSA) is a disorder that, when left untreated, can have serious complications, mainly cardiovascular. OSA is commonly treated with a continuous positive airflow pressure (CPAP) machine. Patients using CPAPs routinely complain of dryness of the nose and eyes.

CASES

Case 1: A keratoconic woman, wearing gas-permeable lenses began therapy with a CPAP, and vascularized limbal keratitis (VLK) developed. She now wears soft lenses, compromising visual acuity, but preventing the VLK. Case 2: A man with 20/20 visual acuity in the right eye (O.D.) and hand motion in the left eye (O.S.), presented with recurring corneal ulcers O.D. after starting treatment with a CPAP. Case 3: A man with pellucid degeneration started using a CPAP, which increased his complaint of dryness with his lenses. He subsequently had 2 occurrences of bacterial conjunctivitis.

CONCLUSION

It is unclear if the complications seen in these cases come from leakage of air into the eyes causing drying, from bacteria trapped under the mask being forced up into the eyes, or from air passing from the nose into the eye via the nasolacrimal duct. In the care of these patients, being aware of complications, suggesting nighttime lubricants, and knowing the alternatives to CPAP could help maintain ocular health and successful lens wear.

Enhanced release of IL-6 and IL-8 into tears in various anterior segment eye diseases

OBJECTIVE

To determine the levels of interleukin 6 (IL-6) and interleukin 8 (IL-8/CXCL-8) in tears collected from the eyes of normal individuals and of patients with different irritative eye diseases, in order to acquire information on the immunological changes occurring during the early postoperative period following various forms of eye surgery, including penetrating keratoplasty (PKP).

METHODS

IL-6 and IL-8 levels were measured with the aid of human ultrasensitive ELISA kits in the non-stimulated tears of patients in the early postoperative period following PKP or cataract operation, and of patients with acute bacterial conjunctivitis or with a corneal foreign body. The IL-6 and IL-8 concentrations, the total amounts released in a given time and the rates of their release were calculated.

RESULTS

A significant increase in IL-6 release was observed in all patient groups compared with the normal controls (p < or = 0.003). The IL-8 release levels were significantly higher in the tears of all patient groups (p < or = 0.03), except for the cataract operation group, where the IL-8 release was not significantly higher (p = 0.053) than in the control samples. No significant differences in IL-6 or IL-8 release were observed when the various patient groups were compared with each other.

CONCLUSION

The release of IL-6 and IL-8 into the tears is enhanced in various anterior segment eye diseases, and this may be used as an indicator of various inflammatory reactions in the early postoperative period.

EXPERIMENTAL INFECTION OF HOUSE FINCHES WITH MYCOPLASMA GALLISEPTICUM

Mycoplasma gallisepticum (MG) has caused an endemic upper respiratory and ocular infection in the eastern house finch (Carpodacus mexicanus) after the epidemic first described in 1994. The disease has been studied by a number of investigators at a population level and reports describe experimental infection in group-housed MG-free house finches. Because detailed observation and evaluation of individual birds in group-housed passerines is problematic, we studied individually housed house finches that were experimentally inoculated with the finch strain of MG in a controlled environment. To accomplish this, a study was conducted spanning the period of November 2001-April 2002 with 20 MG-free (confirmed by the rapid plate agglutination assay and polymerase chain reaction [PCR] assay) eastern house finches captured in the Cayuga Basin area of central New York (USA) in the summer of 2001. After a period of acclimatization and observation (12 wk), 20 finches were inoculated with a 0.05-ml aliquot of MG (3.24 x 10(5) colony-forming units/ml) via bilateral conjunctival sac instillations. Two additional finches acted as controls and were inoculated in the same manner with preservative-free sterile saline solution. After inoculation, all finches except the controls exhibited clinical signs of conjunctivitis within 2-6 days. The progression of the disease was evaluated by several methods, including PCR, behavioral observations, and physical examination including eye scoring, body weight, and body condition index. Over a period of 21 wk, MG-infected finches developed signs of disease and recovered (80%), developed signs of disease and progressed to become chronically infected (15%), or died (5%). We hypothesize that the high survival rate and recovery of these finches after infection was associated with the use of controlled environmental conditions, acclimatization, a high plane of nutrition, and low stocking (housing) density, all of which are factors documented to be important in the outcome of MG infections in domestic poultry and other species.

Entropion, corneal ulcer and corneal haemorrhages in a one-humped camel (Camelus dromedarius)

An unusual case of entropion, corneal ulcer and corneal haemorrhages in a one-humped camel (Camelus dromedaries) is described. The most prominent clinical findings were entropion of both eyelids, severe blephrospasm, epiphora, conjunctivitis, conjunctival oedema, mucopurulent conjunctival discharges, hyperaemia, lacrimation and photophobia. Corneal ulcers and corneal haemorrhages were also observed.

Corynebacterium macginleyi: a conjunctiva specific pathogen

BACKGROUND

Although non-diphtherial corynebacteria are ubiquitous in nature and commonly colonise the skin and mucous membranes of humans, they rarely account for clinical infection.

METHODS AND RESULTS

10 patients with unilateral conjunctivitis are described in which Corynebacterium macginleyi was isolated. This species has only recently been reported to be exclusively isolated form ocular surfaces. C macginleyi was uniformly susceptible to topical antibiotics commonly used in ophthalmology.

CONCLUSION

Despite the fact that the pathogenicity of C macginleyi is not yet assured, this micro-organism should be recognised as a potential cause of bacterial superinfections. Appropriate antibiotic therapy leads to its elimination and resolution of the conjunctivitis.

Acute conjunctivitis associated with biofilm formation on a punctal plug

BACKGROUND

Punctal plugs are used for the treatment of tear-deficient type dry eye. We recently examined a case of acute conjunctivitis associated with bacterial biofilm formation on a punctal plug.

CASE

A 63-year-old woman diagnosed as having tear-deficient type dry eye came to our hospital with a complaint of soreness in her right eye. Punctal plugs had been inserted into this eye 5 1/2 months previously. On the day of her visit, she presented with acute conjunctivitis.

OBSERVATIONS

In biomicroscopical examination, the top of the punctal plug was seen to be covered with a whitish soft material. Microbiological analysis performed on a part of this material was positive for Staphylococcus haemolyticus and Candida tropicalis. Scanning electron microscopy of the removed punctal plug revealed widespread bacterial colonization embedded within an extensive extracellular matrix. Treatment consisted of the replacement of the plug, and administration of a combination of antibacterial eyedrops and preservative-free artificial solution. As a result, the acute conjunctivitis cleared up within 1 month.

CONCLUSIONS

This case suggests that a punctal plug poses a potential risk of causing the formation of bacterial biofilm. In such a case, replacement of the plug and/or removal of the accumulated materials should be considered.

Infectious keratitis after photorefractive keratectomy in a comanaged setting

A 48-year-old man had simultaneous bilateral photorefractive keratectomy (PRK). The surgeon who performed the PRK did not see the patient in follow-up, and there was confusion regarding the comanaging doctor. Therefore, the patient was not examined immediately postoperatively. Several days later, he was hospitalized for an unrelated, painful orthopedic problem and heavily sedated. Seven days after the PRK, an ophthalmologist was consulted for ocular irritation and discharge. Examination showed bilateral, purulent conjunctivitis and severe infectious keratitis in the left eye. The patient was treated with periocular and topical antibiotics. Corneal cultures yielded Staphylococcus aureus. The keratitis resolved slowly, leaving the patient with hand motion visual acuity. A corneal transplant and cataract extraction was performed 15 months later, resulting in a best corrected visual acuity of 20/400 because of glaucomatous optic nerve damage. Severe infectious keratitis may occur after PRK. Poor communication between the surgeon, comanaging doctor, and patient may result in treatment delay.

Comparison of cyclosporin A and dexamethasone in the treatment of canine nictitans plasmacytic conjunctivitis

Thirteen dogs with nictitans plasmocytic conjunctivitis were treated with 2.0 per cent cyclosporin drops in the right eye and with 0.1 per cent dexamethasone ointment in the left eye. The response to both therapies was monitored for six weeks, repeat biopsy specimens were taken, and the time for the clinical signs to recur recorded. Conjunctival cultures were taken before and after both therapies. There were no significant differences between the treatments in the remission of clinical signs, the reduction of inflammatory infiltrate in the biopsy specimens, or the time to recurrence of the condition or its subsequent severity. However, the eyes treated with 0.1 per cent dexamethasone tended to recover more rapidly than the eyes treated with 2.0 per cent cyclosporin, and the eyes treated with 2.0 per cent cyclosporin tended to be protected from a recurrence for longer than the eyes treated with 0.1 per cent dexamethasone.

Bacterial conjunctivitis in Muc1 null mice

PURPOSE

In contrast to wild-type mice, genetically engineered Mucin1 (Muc1) null animals display a marked propensity for development of blepharitis and conjunctivitis. Molecular approaches confirmed the presence of Muc1 mRNA and protein in the conjunctival tissue of wild-type mice and identified the bacterial species in Muc1 null symptomatic mice.

METHODS

Muc1 null animals housed in a conventional facility were examined for visually apparent inflammation of the eye and surrounding tissue. Blood taken from overtly affected animals was assayed for antibodies to common murine viral agents. Swabs of infected eyes and whole eye preparations were used to detect and speciate bacterial pathogens. Frozen sections of whole eye, lid margin, and Harderian gland were immunostained with antibodies to Muc1 and cytokeratin 14, both epithelial cell markers. Northern blot analysis and reverse transcription-polymerase chain reaction (RT-PCR) were performed on RNA isolated from conjunctiva and Harderian gland of wild-type mice to compare relative levels of transcript.

RESULTS

Student's unpaired t-test performed on the eye inflammation frequency of Muc1 null mice confirmed a statistical significance (P < 0.01) when compared to wild-type background animals housed in the same room. Analysis of blood samples from affected Muc1 null animals detected no common murine viral pathogens. Bacterial analysis of conjunctival swabs and whole eye preparations demonstrated the presence of coagulase-negative Staphylococcus, Streptococcus type alpha, and Corynebacterium group G2. Muc1 antibody staining of wild-type sections revealed the presence of Muc1 on conjunctival goblet and non-goblet cells and on the epithelium of the Harderian gland. Serial sections stained with cytokeratin 14 antibody confirmed the epithelial nature of cells expressing the Muc1 protein. RNA from conjunctiva and Harderian gland subjected to RT-PCR and northern blot analysis showed an abundance of Muc1 transcript in these tissues.

CONCLUSIONS

Muc1 mRNA and protein are present in murine conjunctival and Harderian gland epithelia. Animals lacking Muc1 mRNA and protein are predisposed to developing eye inflammation when compared to wild-type animals with an intact Muc1 gene. Muc1 appears to play a critical protective role at the ocular surface, presumably by acting as a barrier to infection by certain bacterial strains.

Nosocomial Klebsiella pneumoniae conjunctivitis resulting in infectious keratitis and bilateral corneal perforation

PURPOSE

Klebsiella pneumoniae is a known cause of metastatic endophthalmitis. However, the organism has never been described to cause severe infectious keratoconjunctivitis. We report a fulminant case of nosocomial K. pneumoniae conjunctivitis complicated by infectious keratitis and corneal perforation in both eyes.

METHODS

An 83-year-old previously healthy Chinese woman, blind in the right eye from rubeotic glaucoma and with bilateral dense cataracts, was admitted for observation after a head injury. While in hospital, she developed purulent bilateral conjunctivitis. Repeated cultures grew K. pneumoniae. This rapidly progressed to severe infectious keratitis and corneal perforation in both eyes, despite intensive antibiotics to which the organism was susceptible. The patient was otherwise well, and investigations did not reveal any source of endogenous sepsis.

RESULTS

The patient lost complete vision in both eyes. The left eye turned phthisical, and the right eye was eviscerated for uncontrolled endophthalmitis.

CONCLUSION

Although not previously reported, K. pneumoniae can cause devastating keratoconjunctivitis resulting in corneal melt, perforation, and uncontrolled endophthalmitis.

Susceptibility of alpine ibex to conjunctivitis caused by inoculation of a sheep-strain of Mycoplasma conjunctivae

We evaluated the susceptibility of alpine ibex (Capra ibex ibex) to mycoplasmal conjunctivitis induced by a strain of Mycoplasma conjunctivae isolated from domestic sheep by inoculation of three alpine ibexes with 1.2 x 10(6) colony forming units of M. conjunctivae in the conjunctival sac of both eyes. One more ibex was exposed to the infection by contact. Experimental animals were free of M. conjunctivae and ocular Chlamydia infection before inoculation. Conjunctivitis and serous to mucous lachrymation became apparent in all four ibexes. Clinical signs began within 2 days in inoculated animals and 22 days after the beginning of the experiment in the contact ibex. M. conjunctivae was demonstrated up to the 63th day post-inoculation by cultural and PCR-methods. After 63 days, histopathologic examination revealed nearly normal ocular tissues, and M. conjunctivae could be detected from two eyes only. No other infectious agents which might cause conjunctivitis or keratitis, including Chlamydia psittaci and Branhamella ovis, were involved. Our investigation indicates that sheep-strains of M. conjunctivae can induce conjunctivitis in alpine ibex, thus showing pathogenicity of this organism for Caprinae species other than domestic sheep and goats.

Natural Mycoplasma gallisepticum infection in a captive flock of house finches

Naturally-occurring mycoplasmal conjunctivitis is described among 104 wild-caught, and initially seronegative, house finches (Carpodacus mexicanus) maintained in captivity for 12 wk during November 1995 through January 1996. Finches housed in three pens were monitored for clinical signs, and > or = 10 birds were euthanatized for necropsy and mycoplasma testing every 2 wk. Within 2 to 4 wk following initial detection of lesions, > 50% of the birds in each of three pens developed a debilitating disease characterized by mild to severe ocular swelling, conjunctivitis, and ocular and nasal discharge. Microscopic lesions in affected finches consisted of mild to severe lymphoplasmacytic inflammation with epithelial and lymphoid hyperplasia in conjunctivae, nasal turbinates, and trachea. Mycoplasma gallisepticum infection was confirmed by culture or polymerase chain reaction (PCR) in all birds with conjunctival lesions and in 43% of birds without lesions. An arbitrary primer PCR was used to confirm M. gallisepticum isolates as identical to a field strain previously associated with house finch conjunctivitis. Most birds (89%) with conjunctivitis developed a concurrent antibody response detectable by serum plate agglutination (SPA) within 2 wk of lesion development. Hemagglutination inhibition (HI) and enzyme-linked immunosorbent assay (ELISA) tests were less sensitive than the SPA test. The clinical severity of this disease and high proportion of affected birds suggests that M. gallisepticum may have a negative impact on free-flying house finch populations.

Characterization of the systemic disease and ocular signs induced by experimental infection with Chlamydia psittaci in cats

In addition to the commonly reported ocular signs, Chlamydia psittaci infection of kittens resulted in fever, lethargy, lameness and reduction in weight gain following ocular instillation of virulent organisms. The appearance of these systemic signs was late with respect to the appearance of ocular symptoms and occurred simultaneously with increasing levels of chlamydia-specific IgG. Measurement of acute phase reactants and IL-6 in plasma indicated that both became elevated concurrent with or slightly after the appearance of fever and remained elevated after the fever began to resolve. Preliminary data also indicated that infectious C. psittaci was present in the blood stream during this time period. The results of ocular instillation of three different levels of C. psittaci (10(3.8), 10(2.8) and 10(1.5) TCID50) indicated that the frequency of infection and the severity of ocular signs were diminished in the group receiving the lowest dose. However, the magnitude of systemic disease was similar in all animals which exhibited clinical signs, irrespective of the dose administered. The immune response to infection included elementary body (EB)-specific lymphocyte proliferation as well as the development of EB-specific IgG and IgM antibodies. The predominant antibody response was to a 45 kDa protein, the major outer membrane protein (MOMP), lipopolysaccharide (LPS), a 58 kDa doublet and 32 and 16-19 kDa proteins.

Mycoplasmal conjunctivitis in a European starling

Bilateral conjunctivitis and episcleritis were identified in an adult European starling (Sturnus vulgaris). A novel mycoplasma species, Mycoplasma sturni, was isolated in pure culture from the conjunctiva of both eyes. The clinical presentation was similar to that of conjunctivitis in house finches (Carpodacus mexicanus) caused by Mycoplasma gallisepticum. However, the histologic lesions were distinct, by the presence of ulceration and by the absence of epithelial hyperplasia and lymphoplasmacytic infiltration [corrected]. Mycoplasma sturni ferments glucose, does not hemadsorb or hemagglutinate chicken erythrocytes, and grows rapidly at 37 C in comparison to other Mycoplasma spp. The role of M. sturni in conjunctivitis in other passerine species is presently unknown.

Treatment of chlamydial conjunctivitis

Adult inclusion conjunctivitis and neonatal inclusion conjunctivitis are important infectious diseases commonly encountered by ophthalmologists in industrialized countries. Patients with inclusion conjunctivitis are frequently complicated by genitourinary and epipharyngeal chlamydial infections. Thus, treatment of chlamydial conjunctivitis must include systemic antibiotics and not be limited to topical application of antibiotics to the eye. Effective anti-chlamydial agents include tetracyclines, macrolides, and some of the fluoroquinolones. Prolonged and frequent application of ophthalmic agents is vital for successful treatment of conjunctivitis.

Topical lomefloxacin twice daily compared with fucidic acid in acute bacterial conjunctivitis

Forty-five patients with presumed acute bacterial conjunctivitis were treated in an investigator-masked randomized multicenter study with either lomefloxacin 0.3% or fucidic acid 1% eye drops twice daily. Clinical signs and symptoms were rated by slit-lamp examination and conjunctival swab cultures were performed to evaluate clinical and microbiological efficacy. A total of 57 ocular isolates were tested for susceptibility to nine antibiotics. A significant decrease in clinical symptomatology was achieved by both treatments with a gradual improvement over the treatment period of 7-9 days. Bacteriological recovery was frequently achieved already at the first control visit (day 3-5), but the recovery rate was statistically significant (p = 0.014) only in the lomefloxacin group. The relatively high in vitro resistance rate (46%) to fucidic acid was not reflected by lower clinical efficacy. Two unrelated adverse events (one in each treatment group) and minimal local intolerance problems were observed in both treatment groups. A significantly higher incidence of burning sensation was observed with fucidic acid than with lomefloxacin (p < 0.01). All four treatment failures in the study occurred in the fucidic acid group. Lomefloxacin 0.3% ophthalmic solution demonstrated a high efficacy and good tolerance in the management of acute bacterial conjunctivitis.

Conjunctival mycobacteriosis in two emus (Dromaius novaehollandiae)

Avian tuberculosis was diagnosed in two young adult female commercial emus (Dromaius novaehollandiae) with granulomatous conjunctivitis. Histologically, the granulomas appeared typical of avian tuberculosis. Caseonecrotic cores were surrounded by a broad ring of palisading epithelioid macrophages and multinucleate giant cells with a moderate admixture of heterophils, lymphocytes, and plasma cells. One conjunctival granuloma had multifocal mineralization. At necropsy, granulomas were also found in visceral organs of both birds. Acid-fast bacilli were demonstrated in all lesions using Ziehl-Neelsen or Fite's stains. Culture confirmed the bacilli to be Mycobacterium avium (complex).

[Perinaud's oculoglandular syndrome as a manifestation of cat-scratch disease]

The first Danish case of Parinaud's oculoglandular syndrome, a manifestation of cat-scratch disease, is reported in a 35-year-old man presenting with an enlarged preauricular lymph node and an ipsilateral conjunctival granuloma. Surgical removal of the granulomatous lesion was followed by rapid healing. The diagnosis was verified by demonstrating a high antibody tire against Rochalimaea (Bartonella) henselae. On subsequent questioning the man gave a history of acquiring a kitten six weeks before his illness. The importance of eye examination in patients presenting with preauricular lymphadenopathy is emphasized.

Conjunctival biopsy in patients with Kawasaki disease

Kawasaki disease (KD) is an acute vasculitis of infants and young children that is associated with bilateral nonexudative conjunctivitis during the acute illness. Epidemiologic evidence has suggested an infectious cause but the etiology of KD remains unknown. We examined conjunctival biopsy specimens from seven patients with typical KD to characterize the pathologic changes during the acute disease. Light microscopic examination revealed nonspecific, mild inflammatory changes that included vascular dilatation, infiltration with scattered lymphocytes, increased numbers of plasma cells in the conjunctival stroma, and increased prominence of goblet cells in the epithelium. No pathogens were identified by special stains for bacteria and rickettsiae, nor were viral particles seen by electron microscopy. We conclude that the conjunctivitis of acute KD is characterized by vascular dilatation with a mild mononuclear cell response with no pathognomonic features. The conjunctiva can be readily sampled in these patients and biopsy may prove useful in selected patients to exclude other clinical entities in the differential diagnosis.

Conjunctivitis and keratoconjunctivitis associated with chlamydiae in swine

Two swine herds housed in confinement had high prevalences of conjunctivitis and keratoconjunctivitis. Necropsies were performed on 7 pigs (2 to 8 weeks old) with mucopurulent conjunctivitis from one farm and on 1 sow with keratoconjunctivitis from another farm. Histologically, the small pigs had lymphoplasmacytic conjunctivitis with mild lymphofollicular hyperplasia. The sow had marked conjunctival lymphofollicular hyperplasia and ulcerative keratitis with neovascularization. Ultrastructural examination of conjunctival specimens from the pigs and sow revealed chlamydiae, often associated with glycogen within intracytoplasmic vacuoles in conjunctival cells. The identity of the chlamydiae isolated from 2 necropsied pigs as well as from conjunctival swab specimens from other pigs on the same farm was unknown. It is possible that the chlamydiae seen ultrastructurally within intracytoplasmic vacuoles containing glycogen in conjunctival cells were Chlamydia trachomatis. Results of this investigation suggested an etiologic role, at least in part, for chlamydiae in the disease process of these swine. On the basis of ultrastructural findings, mycoplasmal coinfection could not be ruled out. Several pigs also had cytomegalic inclusion virus rhinitis.

Antiseptics versus antibiotics in the treatment of the experimental conjunctivitis caused by Staphylococcus aureus

To evaluate the effect of some antiseptics, which have fewer side effects than antibiotics, an experimental model of bacterial conjunctivitis in vivo was used. This model imitates traumatic Staphylococcus aureus conjunctivitis in the rabbit. At 48 h after infection, polyvinylpyrrolidine (PVP)-iodine, bibrocathol (Noviform, NF), ethacridine (Biseptol, BS) and bacitracin+polymyxin B+neomycin (Polyspectran, PS) were applied. NaCl served as the control. At days 2, 5, 8, 11 and 14 a photographic documentation was done, and a swab was taken every 2nd day. In achieving regression of hyperemia, the substance tested were ranked in the following order: PVP, NF, BS, PS, and NaCl. In the elimination of S. aureus, the ranking order was BS, PVP, PS, NaCl, and NF. The overall ranking was PVP, BS, PS, NF, and NaCl. However, the differences were not significant. In this standardized in vivo model of bacterial conjunctivitis, antiseptics are superior over an antibiotic in accomplishing regression of hyperemia and germ elimination.

Acute conjunctivitis in childhood

We obtained specimens for culture from the lids and conjunctivae of 95 patients with acute conjunctivitis and 91 control children of similar age and, in addition, stained the conjunctival scrapings with Giemsa and Gram stains. The conjunctivitis was attributed to bacterial infection in 76 patients, viral infection in 12 children, and allergy in 2 patients; no cause was identified in the remaining 5 patients. In most cases the etiologic diagnosis was based on the results of laboratory studies. By separately culturing microorganisms in specimens from the lids and conjunctivae of patients and control subjects, we could distinguish normal flora from pathogens, and blepharitis from conjunctivitis. Staphylococci, corynebacteria, and alpha-hemolytic streptococci were the predominant organisms recovered from the lids of control subjects. In contrast, Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis were the major pathogens cultured from the conjunctival specimens from patients with bacterial conjunctivitis. Gram stains of conjunctival scrapings provided a rapid means of predicting the pathogen in 51 of 55 cases of bacterial conjunctivitis. Giemsa stains of conjunctival scrapings provided etiologic information in 81 of 84 cases, showing neutrophilia in bacterial infections, lymphocytosis in viral infections, and eosinophilia in allergic disease. These results indicate that most cases of acute conjunctivitis in children can be diagnosed on the basis of differential cultures of microorganisms from the lid and conjunctiva, together with Giemsa stains of conjunctival scrapings.

[Reproducible model of a bacterial conjunctivitis]

To test the efficiency of antimicrobial substances on bacterial conjunctivitis under standardized conditions a reproducible model is needed. As there are no data in the literature concerning this topic we have developed a model of bacterial conjunctivitis in the rabbit eye. Instillation of a suspension of Haemophilus influenzae, Staphylococcus epidermidis or Staphylococcus aureus into the cul-de-sac did not result in any effect. Thus, standardized techniques of conjunctival incision were used additionally. A follow-up was done for a period of 2 weeks (degree of conjunctival hyperemia, microbiology). Radial incision of the conjunctiva with injection of an S. aureus suspension (50 microliters of ATCC 29213; 1.35 x 10(8) cells) was done mimicking a branch injury. This resulted in a purulent conjunctivitis over a period of 1 week and disappeared within 14 days. The swabs were negative on day 7. This is the first model establishing a reproducible purulent conjunctivitis in the rabbit. Using this model antimicrobial substances may be tested under standardized conditions.

Cytological evaluation of conjunctival scrape smears in cases of conjunctivitis

The present study was conducted on 130 cases of untreated conjunctivitis and 25 control cases to assess the diagnostic value of cytology. Conjunctival scrapings from all cases were stained with Giemsa and Papanicoloau's stain and categorized cytologically and later correlated with the clinical profile. Normal cytologic profile was obtained in 7 cases (5.4%) of the study group and 14 cases (56%) of the control group. Cytologic diagnosis of trachoma was made in 63 cases (48.5%) including 48 out of 51 clinically diagnosed cases of trachoma, 9 cases of allergic conjunctivitis and 6 cases of acute follicular conjunctivitis, positive clinico cytologic correlation being 76.2%. Mucopurulent conjunctivitis was diagnosed in 24 cases (18.5%) both clinically as well as by cytological technique. Viral conjunctivitis was diagnosed in 24 cases (18.5%) including 19 cases (14.6%) of clinically diagnosed viral conjunctivitis and 5 cases (3.9%) of acute follicular conjunctivitis, positive correlation being 79.2%. Only 2 cases (1.5%) out of 15 clinically diagnosed cases of allergic conjunctivitis were confirmed cytologically. In all the 4 cases (3.1%) of spring catarrh and 6 cases (4.6%) of phlyctenular conjunctivitis the cytologic features were found to be consistent with the clinical diagnosis.

Clinical and bacteriological study of normal and inflamed neonatal conjunctivae

Maternal vaginal and neonatal conjunctival flora were prospectively studied in a 117 mother baby pairs. The commonest isolates from both vaginal and conjunctival flora were E. coli, Staphylococcus aureus and Klebsiella species. In 85% of mother-baby dyads, isolates from vagina and conjunctiva were similar. The commonest bacterial isolates in neonates with conjunctivitis were Staphylococcus aureus (37.4%), E. coli (27.9%) and Klebsiella species (19.3%). Maternal coitus, infections, rupture of membranes and baby's birth weight and sex did not influence the occurrence of conjunctivitis.

Taxon 20 (Fam. Pasteurellaceae) infections in European brown hares (Lepus europaeus)

Hemolytic bacteria, phenotypically related to organisms previously identified as Pasteurella haemolytica and tentatively named Taxon 20, were isolated from cases of purulent bronchopneumonia and from conjunctivitis in European brown hares (Lepus europaeus). The bronchopneumonia, sometimes accompanied by lesions in other organs, occurred without other concomitant disease. The conjunctivitis was found mainly in animals suffering from the European brown hare syndrome.

[Keratomalacia in rheumatoid arthritis: immunohistologic and enzyme histochemical studies]

Corneal and conjunctival biopsies of 13 patients with rheumatoid arthritis and corneal ulceration (RA-keratomalacia) have been characterized by immunohistological and histochemical analysis. Biopsies from 13 patients with bacterial conjunctivitis, 7 patients with allergic conjunctivitis, 15 patients with senile cataract and 15 patients with keratokonus served as controls. The phenotypic composition of the conjunctival inflammatory infiltration of rheumatoid corneal ulceration was not significantly different from the other inflammatory eye diseases studied. However, conjunctival epithelial cells of all RA-patients showed strong de novo expression of HLA-DR- and DP-antigens. HLA-DQ-antigens were only weakly expressed in a minority of patients. In bacterial conjunctivitis a less intense HLA-class-II-expression was found to be restricted to HLA-DR-antigens. Furthermore, in RA patients stromal fibroblasts of the cornea expressed lysosomal elastase. Both observations could be explained by paracrine action of interleukins produced by infiltrating T-lymphocytes and macrophages. Thus, it might be tempting to speculate that immunologically induced, elastase mediated autodegradation of corneal stroma may be an important factor in the pathogenesis of rheumatoid corneal ulceration.

Identification of a conjunctivitis-associated gene locus from the virulence plasmid of Yersinia enterocolitica

The virulence plasmid (pYV) of Yersinia enterocolitica is necessary for production of conjunctivitis in guinea pigs and for mouse lethality. To identify the genes responsible for production of conjunctivitis in guinea pigs, we subcloned the BamHI and SalI restriction fragments of the virulence plasmid of Y. enterocolitica A2635 (serotype O:8) into derivatives of the broad-host-range plasmid pRK290 and introduced the constructions into plasmid-negative Y. enterocolitica strains. A mild, transient conjunctivitis was evident 24 h after inoculation with strains containing a 2.8-kilobase (kb) BamHI fragment of pYV. These strains were cytotoxic to HEp-2 cells but did not cause death in iron-loaded adult mice. When the 2.8- and adjacent 0.5-kb BamHI fragments were deleted from the virulence plasmid of a fully virulent Y. enterocolitica isolate, the resultant strain did not cause conjunctivitis in guinea pigs and was not cytotoxic to HEp-2 cells. However, the strain with the deletion appeared to be more virulent for mice, with more rapid dissemination after orogastric inoculation, compared with that of the parent strain. When the deletion was complemented by introduction of a plasmid containing the 2.8-kb BamHI fragment, the strain again caused conjunctivitis but had decreased virulence for mice.

Conjunctiva-associated lymphoid tissue (CALT) in normal and Bordetella avium-infected turkeys

Conjunctiva-associated lymphoid tissue (CALT) was characterized in normal and Bordetella avium-infected turkey poults during the first 5 weeks of life. At 1, 5, 12, 19, 25, and 33 days post-hatching (DPH), upper and lower eyelids were examined by gross, histologic, and electron microscopic techniques. CALT was confined to the proximal part of the lower eyelid near the conjunctival fornix; it appeared by 5 DPH as individual lymphoid nodules and as dense masses by 19 DPH. In the upper eyelid, CALT was present only as isolated nodules. Histologically, CALT was composed of dense lymphocyte infiltrates within subepithelial connective tissue, intraepithelial lymphocytes, and flattened lymphoid-associated epithelium that lacked goblet cells. Germinal centers were in CALT by 19 DPH. By scanning electron microscopy, epithelial cells over lymphoid areas were flat and had short, irregular microvilli; non-lymphoid areas were covered by cells with tall, regular microvilli. Transmission electron microscopy revealed that with increasing age of birds, the epithelium over conjunctival lymphoid infiltrates became progressively flattened and infiltrated by lymphocytes. Some blood vessels in CALT had high endothelial cells; lymphocytes were in the lumen and between or beneath endothelial cells. In B. avium-infected poults, CALT was increased, developed earlier, and contained more germinal centers than in normal poults. We conclude that CALT of turkeys closely resembles other mucosal lymphoid tissues and may serve as a site for local antigen uptake.(ABSTRACT TRUNCATED AT 250 WORDS)

Early morphological changes of intracellular bacteria in Salmonella typhimurium infection of the guinea pig conjunctival epithelium

Conjunctival epithelium of the guinea pig was incubated with a virulent strain of Salmonella typhimurium 395 MS for 1 h. Intracellular bacteria were observed in superficial and intermediate cell layers, but not in basal cells. The majority of the bacteria were located within primary or secondary phagosomes; a few were seen free in the cytoplasm. A number of intraphagosomal bacteria showed morphological signs of degradation. Ultrastructurally, the initial phases of Salmonella typhimurium infection of the guinea pig conjunctival epithelium appear to be consistent with endocytic uptake of bacteria by the epithelial cells, followed by their degradation in secondary phagosomes. The conjunctival epithelial cells seem able to inactivate a certain number of virulent bacteria and thus, to a degree, to control the infection in its early phase with defence mechanisms pertaining to the cells themselves, without support from the professional phagocytic cells.

Acute fibrinopurulent blepharitis and conjunctivitis associated with Staphylococcus hyicus, Escherichia coli, and Streptococcus sp. in chickens and turkeys

Multiple outbreaks of acute severe fibrinopurulent lesions of the eyelids occurred in chickens and turkeys. Lesions began as tiny foci of epidermal necrosis and ulceration and spread to involve the entire eyelid. Scabs overlying the epidermis contained large gram-positive cocci; lesser numbers of small cocci and gram-negative bacilli were in more superficial areas. Staphylococcus hyicus was isolated from birds in all stages of the disease. Escherichia coli and Streptococcus sp. were isolated only during severe stages; no anaerobic bacterial pathogens were isolated. Vasculitis and perivascular lymphocytic infiltrates in deep layers of the dermis suggested that a staphylococcal toxin may have been involved. The disease was not reproduced by scarifying S. hyicus onto the eyelids or by intravenous inoculation of retrovirus-infected chickens.

Surface interactions on hydrogel contact lenses: scanning electron microscopy (SEM)

SEM was used to visualize tear-film/hydrogel polymer surface interactions. Lenses were preserved by fixation including a quaternary ammonium complex to aid in mucin preservation. In less than 2 weeks of continuous wear the anterior surface was completely coated, yet the coating was absent from the posterior lens surface. Tear-film break-up over the deposited lens surface, combined with degradation and deformation at the polymer surface boundary, as well as entrapment of moieties within the polymer matrix, all occurred. These are the likely culprits which can contribute to adverse reactions as well as cause light scatter and diminished vision. Lenses removed directly from the eyes of patients suffering with different forms of conjunctivitis were obtained. Bacterial and viral conjunctivitis can induce a microbially contaminated as well as a heavily deformed and deposited lens. Viable and intact microbes were not typically observed in the mucoprotein layer of hydrogel contact lenses.

Conjunctival lesions caused by Moraxella bovis in gnotobiotic calves

Hemolytic Moraxella bovis was instilled into the conjunctival sac of gnotobiotic calves, and conjunctivae were sampled serially after infection. Bilateral lesions developed in seven of eight infected calves. Histologically, M. bovis was first seen within swollen epithelial cells near the lid margins and occasionally within superficial epithelium in other areas. Conjunctival erosions and ulcers were seen in later stages. Scanning electron microscopy showed M. bovis in pits on surfaces of epithelial cells and in erosions on palpebral conjunctivae; lesions were prominent near lid margins. By transmission electron microscopy, M. bovis was seen within swollen epithelial cells near lid margins; many epithelial cells had undergone cytolysis. This study demonstrates that virulent M. bovis can invade bovine conjunctival epithelial cells and cause conjunctivitis in the absence of injurious ultraviolet irradiation or other predisposing environmental factors.

[Morphologic studies of the pathogenesis of ligneous conjunctivitis]

The cases of ligneous conjunctivitis published since 1964 are presented in a review of the literature. A total of 84 cases have been described. The predominance of this disease in women is lower than was previously thought. Ligneous conjunctivitis tends to occur more frequently in children. However, it is not a "disease of little girls". Two cases are described in the present paper, including pathomorphological studies. In both cases, neutrophilic granulocytes were studied by electron microscopy. The results are compared with a control case and with corresponding reports in the literature. The number of granules in the neutrophilic granulocytes was significantly reduced in both cases. In one of the cases studied the granules were increased in size. These findings support the hypothesis that ligneous conjunctivitis could be the result of a lowered resistance associated with a disturbance of wound healing.