Deep stromal mycobacterial keratitis: viable bacteria after six months of treatment: case report and literature review

Deep stromal mycobacterial keratitis: viable bacteria after six months of treatment: case report and literature review

Alternative title Ceratite estromal profunda por micobactéria: bactéria viável após seis meses de tratamento: relato de caso e revisão da literatura
Author Gusmão, Filipe Accioly de Autor UNIFESP Google Scholar
Alvarenga, Lênio Autor UNIFESP Google Scholar
Barbosa, Luciene Autor UNIFESP Google Scholar
Sampaio, Jorge Google Scholar
Leao, Sylvia Cardoso Autor UNIFESP Google Scholar
Hofling-Lima, Ana Luisa Autor UNIFESP Google Scholar
Freitas, Denise de Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Laboratório Fleury
Abstract To report the presence of viable mycobacteria in a patient with keratitis treated for 6 months. Species identification was performed using the PRA method (polymerase chain reaction followed by restriction endonuclease analysis). Clonality was evaluated with RAPD (randomly amplified polymorphic DNA) and ERIC-PCR (enterobacterial repetitive intergenic consensus - polymerase chain reaction) methods. The patient reported trauma due to a metallic foreign body 3 weeks prior to presentation. Initial corneal scraping cultures revealed Mycobacterium abscessus. After 6 months of topical and systemic treatment the patient presented with no active inflammation and was considered clinically cured. An optic penetrating keratoplasty was performed. Culture of the excised cornea revealed Mycobacterium abscessus. Both isolates had the same clonal origin. The most interesting finding of this case report was the positive culture of the excised cornea after 6 months of intensive specific topical therapy. To our knowledge, this is the first report in the literature showing this possibility in the treatment of Mycobacterial keratitis. Thus, Mycobacterium abscessus may present viable bacteria after long-term treatment and should be followed carefully for a long period of time after tapering the medication.

O objetivo do caso é descrever a presença de micobactérias viáveis em pacientes com ceratite, 6 meses após tratamento intensivo. A identificação de espécies, foi efetuada usando método PRA (polymerase chain reaction seguida pela restriction endonuclease analysis). Clonalidade foi avaliada pelos métodos RAPD (randomly amplified polymorphic DNA) e ERIC-PCR (enterobacterial repetitive intergenic consensus - polymerase chain reaction). Paciente refere trauma com corpo estranho metálico há 3 semanas. A cultura da córnea revelou Mycobacterium abscessus. Após 6 meses de tratamento tópico e sistêmico, paciente apresentava-se sem inflamação, sendo considerado clinicamente curado. Realizou-se então, uma ceratoplastia penetrante com intuitos ópticos. A cultura da córnea transplantada revelou micobactérias de mesma origem clonal. O achado mais interessante neste relato, foi a positividade da cultura da córnea transplantada após 6 meses de intenso tratamento específico. Ao nosso conhecimento, esse é o primeiro caso relatado na literatura mostrando essa possibilidade em tratamento de ceratites por micobactérias. Assim, os pacientes com ceratite por Mycobacterium abscessus podem apresentar bactérias viáveis após longo tempo de tratamento específico e precisam ser seguidos cuidadosamente por um longo período de tempo.
Keywords Eye foreign bodies
Keratitis
Cornea
Eye infections, bacterial
Mycobacteria, atypical
Mycobacterium fortuitum
Mycobacterium chelonae
Case report
Corpos estranhos no olho
Ceratite
Córnea
Infecções oculares bacterianas
Micobactérias atípicas
Mycobacterium fortuitum
Mycobacterium chelonae
Relato de caso
Language English
Date 2005-08-01
Published in Arquivos Brasileiros de Oftalmologia. Conselho Brasileiro de Oftalmologia, v. 68, n. 4, p. 551-553, 2005.
ISSN 0004-2749 (Sherpa/Romeo)
Publisher Conselho Brasileiro de Oftalmologia
Extent 551-553
Origin http://dx.doi.org/10.1590/S0004-27492005000400024
Access rights Open access Open Access
Type Article
SciELO ID S0004-27492005000400024 (statistics in SciELO)
URI http://repositorio.unifesp.br/handle/11600/2620

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