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Ophthalmic Manifestation of Tsukamurella Species: A Case Series and First Report of Ocular Implant Infection After Enucleation.
Cornea 2019; 38(10):1328-1331C

Abstract

PURPOSE

Tsukamurella is an important and emerging organism that causes opportunistic human infection. We present the largest case series of Tsukamurella species-associated ophthalmic infections, with an emphasis on clinical spectrum, risk factors, treatment, and outcome.

METHODS

A case series of culture-positive Tsukamurella species in ocular microbiological specimens was identified retrospectively from 2005 to 2018. Tsukamurella species were identified by phenotypic, molecular, and genotypic methods. Diagnoses were clinical and were supplemented by microbiological findings. Treatment including antibiotic type, number of antibiotics, treatment duration, and clinical outcome was documented.

RESULTS

Eleven cases of culture-positive Tsukamurella ocular infection were identified. Of these 54.5% (6/11) of cases resulted in conjunctivitis, 18% (2/11) of cases resulted in keratitis, and 9% (1/11) of cases resulted in blepharitis. One case of canaliculitis and 1 case of postenucleation ocular implant-related infection were reported, which were both novel findings. The presence of ocular implant and preexisting ocular surface diseases such as exposure keratopathy and ectropion were thought to be predisposing factors. We have demonstrated that treatment of Tsukamurella ocular conjunctivitis, keratitis, and blepharitis was effective using a combination therapy of 2 antibiotics (fluoroquinolone, fusidic acid, or chloramphenicol). Canaliculitis and ocular implant infection required further addition of oral antibiotics (macrolide or doxycycline), canaliculotomy, and removal of the infected implant for satisfactory management.

CONCLUSIONS

Tsukamurella tyrosinosolvens and Tsukamurella pulmonis were found to be the predominant species that caused ocular infection. Ocular manifestation of Tsukamurella has a wider spectrum than that previously reported. A high-level of suspicion and a low threshold for microbiological sampling in cases with prolonged ocular surface infection are recommended to diagnose Tsukamurella infections.

Authors+Show Affiliations

Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31246677

Citation

Leung, Kai Ching Peter, et al. "Ophthalmic Manifestation of Tsukamurella Species: a Case Series and First Report of Ocular Implant Infection After Enucleation." Cornea, vol. 38, no. 10, 2019, pp. 1328-1331.
Leung KCP, Au SCL, Ko TCS. Ophthalmic Manifestation of Tsukamurella Species: A Case Series and First Report of Ocular Implant Infection After Enucleation. Cornea. 2019;38(10):1328-1331.
Leung, K. C. P., Au, S. C. L., & Ko, T. C. S. (2019). Ophthalmic Manifestation of Tsukamurella Species: A Case Series and First Report of Ocular Implant Infection After Enucleation. Cornea, 38(10), pp. 1328-1331. doi:10.1097/ICO.0000000000001997.
Leung KCP, Au SCL, Ko TCS. Ophthalmic Manifestation of Tsukamurella Species: a Case Series and First Report of Ocular Implant Infection After Enucleation. Cornea. 2019;38(10):1328-1331. PubMed PMID: 31246677.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ophthalmic Manifestation of Tsukamurella Species: A Case Series and First Report of Ocular Implant Infection After Enucleation. AU - Leung,Kai Ching Peter, AU - Au,Sunny Chi Lik, AU - Ko,Tak Chuen Simon, PY - 2019/6/28/pubmed PY - 2019/6/28/medline PY - 2019/6/28/entrez SP - 1328 EP - 1331 JF - Cornea JO - Cornea VL - 38 IS - 10 N2 - PURPOSE: Tsukamurella is an important and emerging organism that causes opportunistic human infection. We present the largest case series of Tsukamurella species-associated ophthalmic infections, with an emphasis on clinical spectrum, risk factors, treatment, and outcome. METHODS: A case series of culture-positive Tsukamurella species in ocular microbiological specimens was identified retrospectively from 2005 to 2018. Tsukamurella species were identified by phenotypic, molecular, and genotypic methods. Diagnoses were clinical and were supplemented by microbiological findings. Treatment including antibiotic type, number of antibiotics, treatment duration, and clinical outcome was documented. RESULTS: Eleven cases of culture-positive Tsukamurella ocular infection were identified. Of these 54.5% (6/11) of cases resulted in conjunctivitis, 18% (2/11) of cases resulted in keratitis, and 9% (1/11) of cases resulted in blepharitis. One case of canaliculitis and 1 case of postenucleation ocular implant-related infection were reported, which were both novel findings. The presence of ocular implant and preexisting ocular surface diseases such as exposure keratopathy and ectropion were thought to be predisposing factors. We have demonstrated that treatment of Tsukamurella ocular conjunctivitis, keratitis, and blepharitis was effective using a combination therapy of 2 antibiotics (fluoroquinolone, fusidic acid, or chloramphenicol). Canaliculitis and ocular implant infection required further addition of oral antibiotics (macrolide or doxycycline), canaliculotomy, and removal of the infected implant for satisfactory management. CONCLUSIONS: Tsukamurella tyrosinosolvens and Tsukamurella pulmonis were found to be the predominant species that caused ocular infection. Ocular manifestation of Tsukamurella has a wider spectrum than that previously reported. A high-level of suspicion and a low threshold for microbiological sampling in cases with prolonged ocular surface infection are recommended to diagnose Tsukamurella infections. SN - 1536-4798 UR - https://www.unboundmedicine.com/medline/citation/31246677/Ophthalmic_Manifestation_of_Tsukamurella_Species:_A_Case_Series_and_First_Report_of_Ocular_Implant_Infection_After_Enucleation L2 - http://dx.doi.org/10.1097/ICO.0000000000001997 DB - PRIME DP - Unbound Medicine ER -