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Nontuberculous mycobacterial ocular and adnexal infections.
Surv Ophthalmol. 2012 May-Jun; 57(3):202-35.SO

Abstract

The nontuberculous (also called "atypical") mycobacteria have become increasingly important causes of systemic as well as ocular morbidity in recent decades. All ocular tissues can become infected with these organisms, particularly in patients who are predisposed following ocular trauma, surgery, use of corticosteroids, or are immunocompromised. Because of their relative resistance to available antibiotics, multidrug parenteral therapy continues to be the mainstay of treatment of more serious ocular and adnexal infections caused by nontuberculous mycobacteria (NTM). Periocular cutaneous, adnexal, and orbital NTM infections remain rare and require surgical debridement and long-term parenteral antibiotic therapy. NTM scleritis may occur after trauma or scleral buckling and can cause chronic disease that responds only to appropriate antibiotic therapy and, in some cases, surgical debridement and explant removal. NTM infectious keratitis following trauma or refractive surgical procedures is commonly confused with other infections such as Herpes simplex keratitis and requires aggressive topical therapy and possible surgical debridement, particularly in those cases occuring after laser in situ keratomileusis. Only 18 cases of endophthalmitis due to NTM have been reported. Systemic and intraocular antibiotic therapy and multiple vitrectomies may be needed in NTM endophthalmitis; the prognosis remains poor, however. Disseminated NTM choroiditis in acquired immune deficiency syndrome patients with immune reconstitution during highly active anti-retroviral therapy is a rare infection that can present as a necrotizing chorioretinitis with dense vitritis, mimicking many other entities and needs to be recognized so that timely, life-saving treatment can be administered. Regardless of which ocular tissue is infected, all NTM ocular infections present similar challenges of recognition and of therapeutic intervention. We clarify diagnosis and delineate modern, effective therapy for these conditions.

Authors+Show Affiliations

Indiana University Medical Center, Department of Ophthalmology, Vincent Hospital, Indianapolis, IN 46260, USA. rsmoorthy46032@yahoo.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

22516536

Citation

Moorthy, Ramana S., et al. "Nontuberculous Mycobacterial Ocular and Adnexal Infections." Survey of Ophthalmology, vol. 57, no. 3, 2012, pp. 202-35.
Moorthy RS, Valluri S, Rao NA. Nontuberculous mycobacterial ocular and adnexal infections. Surv Ophthalmol. 2012;57(3):202-35.
Moorthy, R. S., Valluri, S., & Rao, N. A. (2012). Nontuberculous mycobacterial ocular and adnexal infections. Survey of Ophthalmology, 57(3), 202-35. https://doi.org/10.1016/j.survophthal.2011.10.006
Moorthy RS, Valluri S, Rao NA. Nontuberculous Mycobacterial Ocular and Adnexal Infections. Surv Ophthalmol. 2012 May-Jun;57(3):202-35. PubMed PMID: 22516536.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nontuberculous mycobacterial ocular and adnexal infections. AU - Moorthy,Ramana S, AU - Valluri,Shailaja, AU - Rao,Narsing A, PY - 2010/01/13/received PY - 2011/10/01/revised PY - 2011/10/04/accepted PY - 2012/4/21/entrez PY - 2012/4/21/pubmed PY - 2012/6/12/medline SP - 202 EP - 35 JF - Survey of ophthalmology JO - Surv Ophthalmol VL - 57 IS - 3 N2 - The nontuberculous (also called "atypical") mycobacteria have become increasingly important causes of systemic as well as ocular morbidity in recent decades. All ocular tissues can become infected with these organisms, particularly in patients who are predisposed following ocular trauma, surgery, use of corticosteroids, or are immunocompromised. Because of their relative resistance to available antibiotics, multidrug parenteral therapy continues to be the mainstay of treatment of more serious ocular and adnexal infections caused by nontuberculous mycobacteria (NTM). Periocular cutaneous, adnexal, and orbital NTM infections remain rare and require surgical debridement and long-term parenteral antibiotic therapy. NTM scleritis may occur after trauma or scleral buckling and can cause chronic disease that responds only to appropriate antibiotic therapy and, in some cases, surgical debridement and explant removal. NTM infectious keratitis following trauma or refractive surgical procedures is commonly confused with other infections such as Herpes simplex keratitis and requires aggressive topical therapy and possible surgical debridement, particularly in those cases occuring after laser in situ keratomileusis. Only 18 cases of endophthalmitis due to NTM have been reported. Systemic and intraocular antibiotic therapy and multiple vitrectomies may be needed in NTM endophthalmitis; the prognosis remains poor, however. Disseminated NTM choroiditis in acquired immune deficiency syndrome patients with immune reconstitution during highly active anti-retroviral therapy is a rare infection that can present as a necrotizing chorioretinitis with dense vitritis, mimicking many other entities and needs to be recognized so that timely, life-saving treatment can be administered. Regardless of which ocular tissue is infected, all NTM ocular infections present similar challenges of recognition and of therapeutic intervention. We clarify diagnosis and delineate modern, effective therapy for these conditions. SN - 1879-3304 UR - https://www.unboundmedicine.com/medline/citation/22516536/Nontuberculous_mycobacterial_ocular_and_adnexal_infections_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0039-6257(11)00225-6 DB - PRIME DP - Unbound Medicine ER -