Evaluation of conjunctival bacterial flora in patients with Stevens-Johnson Syndrome

Frizon, Luciana; Araújo, Marília Cavalcante; Andrade, Luciana Segura de; Yu, Maria Cecília Zorat; Wakamatsu, Tais Hitomi; Höfling-Lima, Ana Luísa; Gomes, José Álvaro Pereira

doi:10.6061/clinics/2014(03)04

Cited by 30 publications

(32 citation statements)

References 13 publications

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“…as the prominent species in SJS patients. Frizon, et al 21 also found coagulase-negative staphylococci and Corynebacterium spp. as the prominent species in SJS group.…”

Section: Discussionmentioning

confidence: 94%

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Comparison of the ocular microbiome between chronic Stevens-Johnson syndrome patients and healthy subjects

Kittipibul

Puangsricharern

Chatsuwan

2020

Sci Rep

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Stevens -Johnson syndrome (SJS) has manifestation through the exfoliation of epidermis and mucosaltissue. Ocular surface is usually affected in acute and chronic stage. The patients are usually suffered from chronic ocular sequelae including symblepharon, limbal stem cell deficiency, etc. Furthermore, ocular microbiome may also be altered in SJS. This is prospective, age and sex matched analytical study which including 20 chronic SJS patients and 20 healthy subjects for specimen collection from inferior conjunctiva for microbiome analysis by conventional cultures and next-Generation Sequencing (nGS) methods. Significant higher proportion of positive-cultured specimen was demonstrated in SJS group (SJS group 60%, healthy 10%, p-value = 0.001). In addition, NGS which providing high-throughput sequencing has demonstrated the greater diversity of microbial species. the higher proportion of pathogenic microorganisms including Pseudomonas spp., Staphylococcus spp., Streptococcus spp., Acinetobacter spp. was shown in SJS group. ocular surface in SJS is usually occupied by more diverse microorganisms with increased proportion of pathogenic species. This condition may affect chronic inflammation and opportunistic infections in SJS group. In order to prevent and treat infection in these patients, appropriate antibiotics based on bacterial examination should be considered as the first-line treatment in the SJS patients.Stevens -Johnson syndrome (SJS) is an abnormal immune-mediated responses stimulated by medications such as sulfonamides, allopurinol, cold medicines including paracetamol 1 and systemic infections caused by virus and mycoplasma. Incidence of SJS is 1.2-6 out of 1,000,000 persons per year 2 . Although the incidence of diseases is low, the mortality rate is high ranging from 1% to 5% 2 . Patients usually present with severe, acute blistering disorders that affect the skin and mucous membranes involving oral mucosa and ocular surface 3 . Ocular involvement has been reported in 25-75% of SJS patients 2 . In the acute phase, patients usually develop conjunctivitis, corneal abrasion, and pseudo-membrane formation. While chronic ocular sequelae develop in 35% of cases, including eyelid irregularity, symblepharon formation, limbal stem cell deficiency (LSCD), and keratinization, leading to poor vision 2 .Recent interests are focused in the change of ocular microbiomes in this devastating disease. Several studies reported alteration of the ocular microbiomes in SJS patients, compared to healthy subjects. In healthy eyes, the most common microorganisms are Staphylococcus coagulase negative, Corynebacterium, and Propionibacterium 4,5 which are mainly gram-positive bacteria colonized in the ocular surface. In SJS, more pathogenic species are found including gram-negative bacteria. Frizon, et al. reported different compositions of microorganisms in SJS patients consisting of 55% of gram-positive cocci, 19% of gram-positive bacilli, and 25% of gram-negative bacilli 4 . They also found that these pathogenic organisms showed...

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“…as the prominent species in SJS patients. Frizon, et al 21 also found coagulase-negative staphylococci and Corynebacterium spp. as the prominent species in SJS group.…”

Section: Discussionmentioning

confidence: 94%

“…Frizon, et al reported the increase of bacterial diversity in SJS group 21 . In this study, several analyses were performed to compare the α-diversity in SJS and healthy groups.…”

Section: Scientific Reports |mentioning

confidence: 96%

Comparison of the ocular microbiome between chronic Stevens-Johnson syndrome patients and healthy subjects

Kittipibul

Puangsricharern

Chatsuwan

2020

Sci Rep

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“…A better understand of microbial flora is important to develop appropriate health and preventive measures, particularly for children. Although there are a number of studies reporting the presence of bacteria in the conjunctival sac, these works were conducted in patients suffering from various eye diseases, such as Stevens -Johnson syndrome and cataracts [5,6]. These works show that the microbial flora may change as a result of surgery [7,8], use of antibiotics [9] and even seasonal change.…”

Section: Introductionmentioning

confidence: 99%

Bacteriological profiles and drug susceptibility of Streptococcus isolated from conjunctival sac of healthy children

Zhang

Zhou

et al. 2020

BMC Pediatr

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Background: To investigate bacterial flora and antibiotics susceptibility of Streptococcus pneumoniae isolated from the conjunctival sac of heathy children. Methods: Bacteria were isolated from the secretions of conjunctival sac of healthy children between 2015 and 2018. Antimicrobial susceptibility of isolated S. pneumoniae strains were determined using microbroth dilution method. Results: The sac secretions were collected from a total of 6440 children. 1409 samples presented bacterial growth, accounting for 21.8% of the samples. Among the 22 bacterial species isolated, 528 samples presented Grampositive Staphylococcus spp. growth, accounting for 37.4% of the isolates, followed by Corynebacterium spp., counting for 30% of the isolates and Streptococcus pneumoniae, counting for 21.4% of the isolates. Antibiotics susceptibility tests showed that the majority of S. pneumoniae isolates were sensitive to most antibiotics tested. However, 72.8 and 81.2% of the isolates were resistant to erythromycin and tetracycline, respectively, and over 10% of them were resistant to gentamicin, tobramycin and rifampicin. Conclusions: The bacterial flora of healthy children is mainly consisted of Gram-positive bacteria belonging to Corynebacterium spp. and Streptococcus spp.; most of S. pneumoniae isolates were sensitive to antibiotics except erythromycin and tetracycline.

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“…A study of conjunctival bacterial flora in ocular SJS eyes showed a positive bacterial yield in 95% of the eyes with Gram-positive cocci, Gram-positive bacilli, and Gram-negative bacilli accounting for 55.5%, 19%, and 25.5% of the microbial organisms isolated, respectively. [3] Patients with ocular SJS have a diverse pathogenic conjunctival flora distribution with >50% of these patients noted to have multiple bacterial species in their flora. [3]…”

Section: Introductionmentioning

confidence: 99%

Ocular surface microbial flora in patients with chronic limbal stem cell deficiency undergoing cultivated oral mucosal epithelial transplantation

Gunasekaran

Dhiman

Vanathi

et al. 2019

Middle East Afr J Ophthalmol

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PURPOSE: The purpose of this study is to analyze the ocular surface microbial flora in patients with chronic limbal stem cell deficiency (LSCD) due to Stevens–Johnson Syndrome (SJS) and ocular chemical injury undergoing cultivated oral mucosal epithelial transplantation (COMET). METHODS: Patients of SJS and chemical injury who had bilateral total LSCD planned for COMET were studied. Conjunctival swab was taken before surgery. Parameters evaluated were organism cultured, sensitivity pattern, frequency of positive culture, and clinical impact on management strategy. RESULTS: Thirteen patients were included in which nine were males and four females. All patients had positive conjunctival swab culture. Most common organism isolated was Staphylococcus epidermidis , followed by Staphylococcus aureus and Pseudomonas aeruginosa . The staphylococcal species isolated were sensitive to all the conventional antibiotics while Pseudomonas cultured showed resistance to cefuroxime, ceftriaxone, and ceftazidime. Repeat conjunctival swab sent after a week of topical antibiotic therapy yielded positive culture of the same organism twice in 25% (3/12), thrice in 58.3% (7/12), and four times in 16.6% (2/12) of the patients. One patient had a polymicrobial flora with positive yield of S. aureus (thrice), S. epidermidis (twice), and P. aeruginosa (twice) in consecutive conjunctival swab culture in the absence of clinical infection. Two patients with persistent positive cultures had to undergo repeat oral mucosal harvesting as the transplantation of the cultivated explants had to be deferred. CONCLUSION: Ocular surface in LSCD patients yielded pathogenic organisms on culture. Poor ocular surface with absent tear film could be the contributing factors. It is important to perform the conjunctival swab culture before COMET surgery.

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Evaluation of conjunctival bacterial flora in patients with Stevens-Johnson Syndrome

Cited by 30 publications

References 13 publications

Comparison of the ocular microbiome between chronic Stevens-Johnson syndrome patients and healthy subjects

Comparison of the ocular microbiome between chronic Stevens-Johnson syndrome patients and healthy subjects

Bacteriological profiles and drug susceptibility of Streptococcus isolated from conjunctival sac of healthy children

Ocular surface microbial flora in patients with chronic limbal stem cell deficiency undergoing cultivated oral mucosal epithelial transplantation

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