Herein, we report a case of chronic endophthalmitis caused by a ceftazidime-resistant Rhizobium radiobacter strain in a 62-year-old male. The patient underwent an uneventful cataract extraction of the right eye a week prior to the appearance of symptoms (pain, redness, and blurring vision) which developed following a golf outing. Upon admission the patient received an emergency vitrectomy. The patient remained symptomatic, and R. radiobacter was isolated repeatedly from vitreous fluid cultures over a 5-month period. Ultimately, the infection responded to intravitreal gentamicin, oral ciprofloxacin, and removal of the lens implant. CASE REPORTA 62-year-old male who underwent an uncomplicated cataract extraction of the right eye in May 2001 presented with decreased visual acuity, pain, and redness of the eye 1 week later. When the patient was admitted, the visual acuity and intraocular pressure were 20/60 and 29 mm Hg, respectively, for his right eye and 20/20 and 21 mm Hg, respectively, for his left eye. Examination of the eye showed moderate conjunctival injection, anterior chamber inflammation without obvious hypopyon, and a retina that appeared flat with no sign of intraretinal inflammation. A vitreous biopsy was performed, the specimen was processed microbiologically, and the patient was treated empirically with an intravitreal injection of amikacin (0.4 mg) and vancomycin (1 mg). Culture of the vitreous biopsy specimen produced a Rhizobium radiobacter strain resistant to ceftazidime and vancomycin but susceptible to ciprofloxacin. Subsequently, the patient remained asymptomatic until he was readmitted 2 months later with an acute exacerbation of symptoms. A pars plana vitrectomy was performed with the intravitreal administration of gentamicin (0.4 mg) and a course of oral ciprofloxacin (500 mg twice daily for 10 days). Again, the vitreous fluid grew the same R. radiobacter organism. Exactly 2 months later, the patient showed worsened vision and a prominent hypopyon; he underwent another vitrectomy with removal of the intraocular lens and the capsule and was given intravitreal gentamicin (0.4 mg). His therapy was continued with the same dosage of oral ciprofloxacin for 2 weeks, and 1 drop each of 1% atropine sulfate (four times a day for 3 days), 0.2% brimonidine tartrate (twice a day for 3 days), and 1% prednisolone acetate (every 3 h for 4 days). Ultimately, the patient's chronic R. radiobacter endophthalmitis was cured by the simultaneous removal of the intraocular implant and treatment with intravitreal gentamicin and oral ciprofloxacin. Microbiological investigation. Agrobacterium species have recently been reclassified in the genusRhizobium based on comparative 16S rRNA gene analyses (7,8). Plant-pathogenic, soil inhabitant R. radiobacter is not characterized as a true human pathogen. It is an opportunistic pathogen of minor clinical significance and has been substantiated as a rare cause of bacteremia, endocarditis, and peritonitis mostly in catheterized immunocompromised patients and as a cause of uri...
Background Many cases of Fuchs’ uveitis have been associated with persistent rubella virus infection. A 73-year-old male patient with typical Fuchs’ Uveitis Syndrome (FUS) first experienced heterochromia of the left eye at the age fourteen, when rubella was endemic in the US. Objectives The purposes of this report are to describe the patient’s FUS clinical presentations and to characterize the virus detected in the vitreous fluid. Study design The patient underwent a therapeutic pars plana vitrectomy in May 2013. A real-time RT-PCR assay for rubella virus was performed on the vitreous fluid by Focus Diagnostics. Additional real-time RT-PCR assays for rubella virus detection and RT-PCR assays for generation of templates for sequencing were performed at the Centers for Disease Control and Prevention (CDC). Results The results from Focus Diagnostics were positive for rubella virus RNA. Real-time RT-PCR assays at CDC were also positive for rubella virus. A rubella virus sequence of 739 nucleotides was determined and phylogenetic analysis showed that the virus was the sole member of a new phylogenetic group when compared to reference virus sequences. Conclusions While FUS remains a clinical diagnosis, findings in this case support the association between rubella virus and the disease. Phylogenetic analysis provided evidence that this rubella virus was likely a previously undetected genotype which is no longer circulating. Since the patient had rubella prior to 1955, this sequence is from the earliest rubella virus yet characterized.
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