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Conjunctivitis due to Neisseria sicca: a case report.

Eser I, Akcali A, Tatman-Otkun M, Taskiran-Comez A - Indian J Ophthalmol (2014)

Bottom Line: We report the first case, in Medline-based literature, of conjunctivitis caused by gram negative diplococcus, Neisseria sicca.Positive culture for this organism should not be readily dismissed.Such conjunctivitis responded favorably to treatment with netilmicin eye drops.

View Article: PubMed Central - PubMed

Affiliation: Acibadem Maslak Hospital, Eye Clinic, Istanbul, Turkey.

ABSTRACT
We report the first case, in Medline-based literature, of conjunctivitis caused by gram negative diplococcus, Neisseria sicca. Although it is not widely accepted as such, isolation from cultures of repeated eye swab samples suggests that N. sicca may be a pathogen in conjunctival infections. Positive culture for this organism should not be readily dismissed. Such conjunctivitis responded favorably to treatment with netilmicin eye drops.

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Gram stain of Neisseria sicca
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Figure 1: Gram stain of Neisseria sicca

Mentions: The patient was empirically put on fucidic acid (Fucithalmic gel 1%) therapy four times daily, but did not respond to this treatment. On the third day, treatment was changed to ofloxacin (Exocin 0.3%, Allergan) four times daily with fluorometholon (Efemoline 1%, Novartis) four times daily added in spite of the fact that usage of corticosteroids is controversial as it may contribute to progression of the infection by inhibiting the immune response.[4] Then, a second sample was taken. In the first sample, gram stain revealed large numbers of polymorphonuclear leukocytes and gram variable diplococci [Fig. 1]. On sheep blood agar and chocolate agar plates, small, pale colonies grew [Fig. 2]. The same organism grew in the culture of the sample taken at the second visit. The isolated organism was gram negative diplococci. The identification of the organism was accomplished by standard biochemical tests and with a NH card on Vitek2 compact system. The organism was oxidase positive, DNase negative, catalase positive, nitrate reduction positive and produced acid from glucose, fructose, maltose, and sucrose. Using the Vitek2 system, the organism was identified as N. sicca with a bionumber of 0632400000 and 98% probability. There are no accepted criteria for evaluation of the antimicrobial susceptibility of this organism according to the Clinical and Laboratory Standards Institute (CLSI).[5] Furthermore, in vitro susceptibility testing of the isolated bacteria cannot always guide the therapy of conjunctival infections, while susceptibility interpretations of minimum inhibitory concentration (MIC) values are based on serum concentrations.[1] MIC values of ceftriaxone (0.125 μg/ml), benzylpenicillin (2 μg/ml), tetracycline (1 μg/ml) and netilmicin (1 μg/ml) were determined using Etest (AB BIODISK, Solna, Sweden) on Muller Hinton agar with 5% sheep blood agar. As the patient did not respond to the previous treatments and slit-lamp examination findings remained the same, she was given netilmicin (Netira® SIFI, SpA, Catania, Italy) drops four times daily. Three days later, there was no evidence for conjunctivitis and the patient's complaint resolved.


Conjunctivitis due to Neisseria sicca: a case report.

Eser I, Akcali A, Tatman-Otkun M, Taskiran-Comez A - Indian J Ophthalmol (2014)

Gram stain of Neisseria sicca
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061680&req=5

Figure 1: Gram stain of Neisseria sicca
Mentions: The patient was empirically put on fucidic acid (Fucithalmic gel 1%) therapy four times daily, but did not respond to this treatment. On the third day, treatment was changed to ofloxacin (Exocin 0.3%, Allergan) four times daily with fluorometholon (Efemoline 1%, Novartis) four times daily added in spite of the fact that usage of corticosteroids is controversial as it may contribute to progression of the infection by inhibiting the immune response.[4] Then, a second sample was taken. In the first sample, gram stain revealed large numbers of polymorphonuclear leukocytes and gram variable diplococci [Fig. 1]. On sheep blood agar and chocolate agar plates, small, pale colonies grew [Fig. 2]. The same organism grew in the culture of the sample taken at the second visit. The isolated organism was gram negative diplococci. The identification of the organism was accomplished by standard biochemical tests and with a NH card on Vitek2 compact system. The organism was oxidase positive, DNase negative, catalase positive, nitrate reduction positive and produced acid from glucose, fructose, maltose, and sucrose. Using the Vitek2 system, the organism was identified as N. sicca with a bionumber of 0632400000 and 98% probability. There are no accepted criteria for evaluation of the antimicrobial susceptibility of this organism according to the Clinical and Laboratory Standards Institute (CLSI).[5] Furthermore, in vitro susceptibility testing of the isolated bacteria cannot always guide the therapy of conjunctival infections, while susceptibility interpretations of minimum inhibitory concentration (MIC) values are based on serum concentrations.[1] MIC values of ceftriaxone (0.125 μg/ml), benzylpenicillin (2 μg/ml), tetracycline (1 μg/ml) and netilmicin (1 μg/ml) were determined using Etest (AB BIODISK, Solna, Sweden) on Muller Hinton agar with 5% sheep blood agar. As the patient did not respond to the previous treatments and slit-lamp examination findings remained the same, she was given netilmicin (Netira® SIFI, SpA, Catania, Italy) drops four times daily. Three days later, there was no evidence for conjunctivitis and the patient's complaint resolved.

Bottom Line: We report the first case, in Medline-based literature, of conjunctivitis caused by gram negative diplococcus, Neisseria sicca.Positive culture for this organism should not be readily dismissed.Such conjunctivitis responded favorably to treatment with netilmicin eye drops.

View Article: PubMed Central - PubMed

Affiliation: Acibadem Maslak Hospital, Eye Clinic, Istanbul, Turkey.

ABSTRACT
We report the first case, in Medline-based literature, of conjunctivitis caused by gram negative diplococcus, Neisseria sicca. Although it is not widely accepted as such, isolation from cultures of repeated eye swab samples suggests that N. sicca may be a pathogen in conjunctival infections. Positive culture for this organism should not be readily dismissed. Such conjunctivitis responded favorably to treatment with netilmicin eye drops.

Show MeSH
Related in: MedlinePlus