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Actinobacillus actinomycetemcomitans Keratitis After Glaucoma Infiltration Surgery

View Article: PubMed Central - PubMed

ABSTRACT

Actinobacillus actinomycetemcomitans infection is a rare and easily misdiagnosed ocular disease. In this article, the authors report a chronic, purulent, and difficult-to-treat case of A actinomycetemcomitans keratitis following a glaucoma infiltration surgery.

A 56-year-old man with a long-standing history of open-angle glaucoma in both eyes presented with a 12-week history of ocular pain, redness, and blurred vision in his right eye. He underwent a glaucoma infiltration surgery in his right eye 6 months ago. Three months postoperatively, he developed peripheral corneal stromal opacities associated with a white, thin, cystic bleb, and conjunctival injection. These opacities grew despite topical treatment with topical tobramycin, levofloxacin, natamycin, amikacin, and metronidazole eye drops.

Multiple corneal scrapings revealed no organisms, and no organisms grew on aerobic, anaerobic, fungal, or mycobacterial cultures. The patient's right eye developed a severe purulent corneal ulcer with a dense hypopyon and required a corneal transplantation. Histopathologic analysis and 16S ribosomalribonucleic acid polymerase chain reaction sequencing revealed A actinomycetemcomitans as the causative organism. Postoperatively, treatment was initiated with topical levofloxacin and cyclosporine, as well as oral levofloxacin and cyclosporine. Graft and host corneal transparency were maintained at the checkup 1 month after surgery.

Although it is a rare cause of corneal disease, A actinomycetemcomitans should be suspected in patients with keratitis refractory to topical antibiotic therapy. Delay in diagnosis and appropriate treatment can result in vision loss.

No MeSH data available.


Related in: MedlinePlus

Laboratory examinations of Actinomyces keratitis. Histopathologic analysis revealed filamentous, branching, gram-positive bacteria (black arrow) in the deep corneal stroma consistent with Actinomyces species with intense corneal inflammation, showing staining with hematoxylin and eosin stain (original magnification ×400) (A) and acid fast stain (original magnification ×400) (B). Polymerase chain reaction products from corneal specimens revealed that the causative organism in this patient was caused by 16S ribosomal deoxyribonucleic acid+, leukotoxin+, and fimbria-associated protein− Actinobacillus actinomycetemcomitans (C).
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Figure 2: Laboratory examinations of Actinomyces keratitis. Histopathologic analysis revealed filamentous, branching, gram-positive bacteria (black arrow) in the deep corneal stroma consistent with Actinomyces species with intense corneal inflammation, showing staining with hematoxylin and eosin stain (original magnification ×400) (A) and acid fast stain (original magnification ×400) (B). Polymerase chain reaction products from corneal specimens revealed that the causative organism in this patient was caused by 16S ribosomal deoxyribonucleic acid+, leukotoxin+, and fimbria-associated protein− Actinobacillus actinomycetemcomitans (C).

Mentions: To control the ocular conditions and to prevent possible endophthalmitis, we performed a penetrating keratoplasty on his right eye. Histopathologic analysis of the removed cornea revealed intense corneal inflammation associated with intrastromal colonies of strongly and uniformly gram-positive bacteria with short, stubby branches typical of Actinomyces species (Figure 2A). Acid-fast staining was negative, suggesting Actinomyces rather than mycobacteria (Figure 2B). We performed the third microbial laboratory examination, and finally detected the microbe from a corneal biopsy specimen by using a molecular genetic method. We performed molecular identification by PCR amplification and 16S rRNA gene sequencing analysis using deoxyribonucleic acid extracted from the corneal biopsy specimen (Figure 2C). The universal primers for the Actinomyces species, including 16S rRNA gene in a 443 bp length (forward, 5′-GCTAATACCGCGTAGAGTCGG-3′; reverse, 5′-ATTTCACACCTCACTTAAAGGT-3′), leukotoxin gene in a 285 bp length (forward, 5′-TCGCGAATCAGCTCGCCG-3′; reverse, 5′-GCTTTGCAAGCTCCTCACC-3′), and fimbria-associated protein gene in a 210 bp length (forward, 5′-ATTAAATACTTTAACTACTAAAGC-3′; reverse, 5′-GCACTGTTAACTGTACTAGC-3′), were used as described previously.8 Polymerase chain reaction results revealed that the causative organism in our patient was caused by 16S ribosomal deoxyribonucleic acid+, leukotoxin+, and fimbria-associated protein− A actinomycetemcomitans.


Actinobacillus actinomycetemcomitans Keratitis After Glaucoma Infiltration Surgery
Laboratory examinations of Actinomyces keratitis. Histopathologic analysis revealed filamentous, branching, gram-positive bacteria (black arrow) in the deep corneal stroma consistent with Actinomyces species with intense corneal inflammation, showing staining with hematoxylin and eosin stain (original magnification ×400) (A) and acid fast stain (original magnification ×400) (B). Polymerase chain reaction products from corneal specimens revealed that the causative organism in this patient was caused by 16S ribosomal deoxyribonucleic acid+, leukotoxin+, and fimbria-associated protein− Actinobacillus actinomycetemcomitans (C).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998293&req=5

Figure 2: Laboratory examinations of Actinomyces keratitis. Histopathologic analysis revealed filamentous, branching, gram-positive bacteria (black arrow) in the deep corneal stroma consistent with Actinomyces species with intense corneal inflammation, showing staining with hematoxylin and eosin stain (original magnification ×400) (A) and acid fast stain (original magnification ×400) (B). Polymerase chain reaction products from corneal specimens revealed that the causative organism in this patient was caused by 16S ribosomal deoxyribonucleic acid+, leukotoxin+, and fimbria-associated protein− Actinobacillus actinomycetemcomitans (C).
Mentions: To control the ocular conditions and to prevent possible endophthalmitis, we performed a penetrating keratoplasty on his right eye. Histopathologic analysis of the removed cornea revealed intense corneal inflammation associated with intrastromal colonies of strongly and uniformly gram-positive bacteria with short, stubby branches typical of Actinomyces species (Figure 2A). Acid-fast staining was negative, suggesting Actinomyces rather than mycobacteria (Figure 2B). We performed the third microbial laboratory examination, and finally detected the microbe from a corneal biopsy specimen by using a molecular genetic method. We performed molecular identification by PCR amplification and 16S rRNA gene sequencing analysis using deoxyribonucleic acid extracted from the corneal biopsy specimen (Figure 2C). The universal primers for the Actinomyces species, including 16S rRNA gene in a 443 bp length (forward, 5′-GCTAATACCGCGTAGAGTCGG-3′; reverse, 5′-ATTTCACACCTCACTTAAAGGT-3′), leukotoxin gene in a 285 bp length (forward, 5′-TCGCGAATCAGCTCGCCG-3′; reverse, 5′-GCTTTGCAAGCTCCTCACC-3′), and fimbria-associated protein gene in a 210 bp length (forward, 5′-ATTAAATACTTTAACTACTAAAGC-3′; reverse, 5′-GCACTGTTAACTGTACTAGC-3′), were used as described previously.8 Polymerase chain reaction results revealed that the causative organism in our patient was caused by 16S ribosomal deoxyribonucleic acid+, leukotoxin+, and fimbria-associated protein− A actinomycetemcomitans.

View Article: PubMed Central - PubMed

ABSTRACT

Actinobacillus actinomycetemcomitans infection is a rare and easily misdiagnosed ocular disease. In this article, the authors report a chronic, purulent, and difficult-to-treat case of A actinomycetemcomitans keratitis following a glaucoma infiltration surgery.

A 56-year-old man with a long-standing history of open-angle glaucoma in both eyes presented with a 12-week history of ocular pain, redness, and blurred vision in his right eye. He underwent a glaucoma infiltration surgery in his right eye 6 months ago. Three months postoperatively, he developed peripheral corneal stromal opacities associated with a white, thin, cystic bleb, and conjunctival injection. These opacities grew despite topical treatment with topical tobramycin, levofloxacin, natamycin, amikacin, and metronidazole eye drops.

Multiple corneal scrapings revealed no organisms, and no organisms grew on aerobic, anaerobic, fungal, or mycobacterial cultures. The patient's right eye developed a severe purulent corneal ulcer with a dense hypopyon and required a corneal transplantation. Histopathologic analysis and 16S ribosomalribonucleic acid polymerase chain reaction sequencing revealed A actinomycetemcomitans as the causative organism. Postoperatively, treatment was initiated with topical levofloxacin and cyclosporine, as well as oral levofloxacin and cyclosporine. Graft and host corneal transparency were maintained at the checkup 1 month after surgery.

Although it is a rare cause of corneal disease, A actinomycetemcomitans should be suspected in patients with keratitis refractory to topical antibiotic therapy. Delay in diagnosis and appropriate treatment can result in vision loss.

No MeSH data available.


Related in: MedlinePlus