Posts filed under ‘Infecciones oftalmológicas’

Microbiota conjuntival en el preoperatorio de pacientes que se someterán a cirugía de cataratas

Revista Chilena de Infectología ABRIL 2015 V.32 N.2

Fernando Barría von-B., Henriette Chabouty, René Moreno, Freddy Ortiz y Fernando Barría M

Hospital Clínico Regional de Concepción Dr. Guillermo Grant Benavente, Concepción, Chile. Servicio de Oftalmología (FBvB). Asociación Panamericana de Oftalmología, Comité de Prevención de la Ceguera (FBvB). Laboratorio de Microbiología (hc). Universidad de Concepción, Facultad de Medicina, Chile. Residente de Oftalmología (rm, fo). Estudiante de Medicina (fbM)

La cirugía de cataratas es la intervención oftalmológica más realizada en el mundo. Sin embargo, a pesar de nuestros esfuerzos, la catarata sigue siendo la principal causa de ceguera en el mundo, siendo su único tratamiento una cirugía para recuperar la visión.

Actualmente, 85 a 95% de los pacientes intervenidos logra recuperar la visión, lo que mejora su calidad de vida y permite reincorporarlo a la comunidad.

Esto ha traído aparejado un aumento de las expectativas en los resultados visuales de la cirugía de cataratas, por lo cual una infección intraocular o endoftalmitis post-quirúrgica por colonización microbiana es una de las complicaciones post-operatorias más temidas y devastadoras con un pronóstico visual incierto, pudiendo ocasionar secuelas graves, e incluso comprometer la integridad anatómica del globo ocular, lo que se asocia a un costo sanitario elevado, y además podría derivar en problemas médico legales ..

PDF

http://www.scielo.cl/pdf/rci/v32n2/art03.pdf

November 18, 2016 at 7:53 pm

A Cluster of Ocular Syphilis Cases – Seattle, Washington, and San Francisco, California, 2014-2015.

MMWR Morb Mortal Wkly Rep. 2015 Oct 16 V.64 N.40 P.1150-1.

Woolston S, Cohen SE, Fanfair RN, Lewis SC, Marra CM, Golden MR.

1Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington; 2San Francisco Department of Public Health; 3Division of Infectious Diseases, University of California, San Francisco; 4Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC; 5Department of Neurology, University of Washington; 6HIV/STD Control Program, Public Health – Seattle & King County.

Corresponding author: Robyn Neblett Fanfair, 404-639-6044, iyo5@cdc.gov

From December 1, 2014, to January 30, 2015, in King County, Washington, four cases of ocular syphilis, defined as clinical signs or symptoms consistent with ocular disease (e.g., uveitis or vision loss) in a person with laboratory-confirmed syphilis of any stage, were reported.

All four cases occurred in men who have sex with men (MSM), two of whom were sex partners. Median age of the four patients was 39 years (range = 29–52 years).

Three of the patients were infected with human immunodeficiency virus (HIV). Among the three HIV-infected patients, the median CD4 count was 111 cells/ml, and the median HIV-RNA was 34,740 copies/ml.

All four patients had visual symptoms, including vision loss, flashing lights, and blurry vision.

Ophthalmologic examinations were performed and all four were diagnosed with uveitis. All four patients had positive serum from rapid plasma reagin (RPR) testing (titer range = 1:256–1:4096).

Based on history, one patient had late latent syphilis, and the remaining three received diagnoses of early latent syphilis. The three patients with early latent syphilis had cerebrospinal fluid (CSF) analysis performed; two had positive CSF in venereal disease research laboratory (VDRL) testing.

Three patients received treatment with aqueous crystalline penicillin G for 14 days, and one was treated with 10 days of procaine penicillin and probenecid. All four patients had initial improvement in ocular symptoms after treatment.

However, one patient still had a blind spot in one eye 1 month after treatment, and two patients were considered legally blind after 5 months; the fourth patient was lost to follow-up.

FULL TEXT

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6440a6.htm

PDF (see p.1150-1)

http://www.cdc.gov/mmwr/pdf/wk/mm6440.pdf

 

October 22, 2015 at 2:01 pm

Cat-scratch disease: a wide spectrum of clinical pictures.

Postepy Dermatol Alergol. 2015 Jun;32(3):216-20.

Mazur-Melewska K1, Mania A1, Kemnitz P1, Figlerowicz M1, Służewski W1.

Author information

1Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, Poznan, Poland. Head of the Department: Prof. Wojciech Służewski MD, PhD.

Abstract

The aim of this review is to present an emerging zoonotic disease caused by Bartonella henselae.

The wide spectrum of diseases connected with these bacteria varies from asymptomatic cases, to skin inflammation, fever of unknown origin, lymphadenopathy, eye disorders, encephalitis and endocarditis.

The reservoirs of B. henselae are domestic animals like cats, guinea pigs, rabbits and occasionally dogs. Diagnosis is most often based on a history of exposure to cats and a serologic test with high titres of the immunoglobulin G antibody to B. henselae.

Most cases of cat-scratch disease are self-limited and do not require antibiotic treatment. If an antibiotic is chosen, however, azithromycin has been shown to speed recovery.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4495109/pdf/PDIA-32-23148.pdf

August 16, 2015 at 10:53 am

Propionibacterium acnes: an underestimated pathogen in implant-associated infections.

Biomed Res Int. 2013;2013:804391.

Portillo ME1, Corvec S, Borens O, Trampuz A.

Author information

1Microbiology Laboratory, Laboratori de Referencia de Catalunya, Barcelona, Spain.

Abstract

The role of Propionibacterium acnes in acne and in a wide range of inflammatory diseases is well established. However, P. acnes is also responsible for infections involving implants.

Prolonged aerobic and anaerobic agar cultures for 14 days and broth cultures increase the detection rate.

In this paper, we review the pathogenic role of P. acnes in implant-associated infections such as prosthetic joints, cardiac devices, breast implants, intraocular lenses, neurosurgical devices, and spine implants.

The management of severe infections caused by P. acnes involves a combination of antimicrobial and surgical treatment (often removal of the device). Intravenous penicillin G and ceftriaxone are the first choice for serious infections, with vancomycin and daptomycin as alternatives, and amoxicillin, rifampicin, clindamycin, tetracycline, and levofloxacin for oral treatment.

Sonication of explanted prosthetic material improves the diagnosis of implant-associated infections.

Molecular methods may further increase the sensitivity of P. acnes detection.

Coating of implants with antimicrobial substances could avoid or limit colonization of the surface and thereby reduce the risk of biofilm formation during severe infections.

Our understanding of the role of P. acnes in human diseases will likely continue to increase as new associations and pathogenic mechanisms are discovered.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3838805/pdf/BMRI2013-804391.pdf

November 18, 2014 at 8:17 am

Effectiveness of Antimicrobial Peptide Immobilization for Preventing Perioperative Cornea Implant-Associated Bacterial Infection

Antimicrobial Agents and Chemotherapy Sept 2014 V.58 N.9 P.5229-5238

Xiao Wei Tana, Tze Wei Goha, P. Saraswathib, Chan Lwin Nyeina, Melina Setiawana, Andri Riaua, R. Lakshminarayananb,e, Shouping Liub,e, Donald Tanc,d,e, Roger W. Beuermanb,c,f and Jodhbir S. Mehtaa,b,d,e

aTissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore

bAntimicrobials Group, Singapore Eye Research Institute, Singapore

cYong Loo Lin School of Medicine, National University of Singapore, Singapore

dSingapore National Eye Centre, Singapore

eDuke-NUS Graduate Medical School, Singapore

fDuke-NUS SRP Neuroscience and Behavioral Disorders, Singapore

Titanium (Ti) is a promising candidate biomaterial for an artificial corneal skirt. Antimicrobial peptide (AMP) immobilization may improve the bactericidal effect of the Ti substrate.

In this study, we tested the bactericidal efficacy of a functionalized Ti surface in a rabbit keratitis model. A corneal stromal pocket was created by a femtosecond laser.

The Ti films were then inserted into the pocket, and Staphylococcus aureus or Pseudomonas aeruginosa was inoculated into the pocket above the implant films.

The corneas with Ti-AMP implants were compared with the corneas implanted with unprotected Ti by slit lamp observation and anterior segment optical coherence tomography (AS-OCT). Inflammatory responses were evaluated by bacterium counting, hematoxylin-eosin staining, and immunostaining.

There was a lower incidence and a lesser extent of infection on rabbit corneas with Ti-AMP implants than on those with unprotected Ti implants.

The bactericidal effect of AMP against S. aureus was comparable to that of postoperative prophylactic antibiotic treatment; hence, SESB2V AMP bound to the Ti implant provided functional activity in vivo, but its efficacy was greater against S. aureus than against P. aeruginosa.

This work suggests that SESB2V AMP can be successfully functionalized in a rabbit keratitis model to prevent perioperative corneal infection.

PDF

http://aac.asm.org/content/58/9/5229.full.pdf+html

September 24, 2014 at 8:14 pm

Postoperative endophthalmitis.

Clin Infect Dis. 2004 Feb 15;38(4):542-6.

Hanscom TA.

Author information

Jules Stein Eye Institute, University of California-Los Angeles School of Medicine, and Saint John’s Hospital, Santa Monica, California, USA. retinalsurg@earthlink.net

Abstract

Postoperative endophthalmitis remains a serious clinical problem in ophthalmology, with an incidence of approximately 0.5%. Prognosis is largely determined by the virulence of the offending organism.

The Endophthalmitis Vitrectomy Study (EVS) was a prospective, randomized trial comparing various diagnostic and treatment modalities in cases of endophthalmitis that followed cataract surgery. The EVS found that vitrectomy was only beneficial for patients presenting with very poor visual acuity and that intravenous antibiotic treatments had no additional benefit, compared with intravitreal antibiotic therapy alone.

However, weaknesses of the EVS leave these conclusions open to modification in the future. Preoperative application of povidone-iodine preparation to the skin and conjunctiva is the only proven endophthalmitis prophylaxis.

Endophthalmitis may be chronic and may follow glaucoma surgery and intravitreal injection of gas and drugs. The EVS did not study these issues, although they are associated with specific features that may require alterations in patient management.

PDF

http://cid.oxfordjournals.org/content/38/4/542.full.pdf+html

July 23, 2014 at 7:44 pm

Roth Spots in Infective Endocarditis

N Engl J Med 2014 V.370 e38

IMAGES IN CLINICAL MEDICINE

Omar A. Mahroo, Ph.D., and Elizabeth M. Graham, F.R.C.Ophth.

St. Thomas’ Hospital, London, United Kingdom   oarm2@cam.ac.uk

A 34-year-old man presented to the eye emergency department with reduced vision in the right eye that had developed that morning. He was well, apart from episodes of dizziness and dyspnea after exercise during the previous 4 months.

These episodes had started 1 week after the patient had undergone a dental treatment. Previous extensive investigations had been inconclusive. His retinal appearance and symptoms prompted referral to the cardiology team, which admitted him that day.

He was afebrile but had a pansystolic murmur and a solitary splinter hemorrhage on the right thumb. Echocardiography revealed moderate-to-severe mitral-valve regurgitation, with thickening and signs of vegetations.

The ejection fraction was 65%. The other values were normal. Four sets of blood cultures yielded Streptococcus viridans, and intravenous antibiotics were started immediately. His symptoms improved, and his visual acuity gradually improved from 20/200 at presentation to 20/20 8 months after presentation. His right fundal appearance is shown, at presentation (Panel A), 3 days later (Panel B), and 3 months later (Panel C).

The presence of white-centered hemorrhages (Roth spots) should prompt the consideration of possible infective endocarditis. A comparison of Panel A and Panel B (3 days apart) shows how quickly such spots can change. Monitoring of the patient’s mitral-valve regurgitation, which was started after complete resolution of the endocarditis, is ongoing….

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMicm1312093

July 13, 2014 at 7:01 pm

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