Application of Polymerase Chain Reaction-Based Restriction Fragment Length Polymorphism in Typing Ocular Rapid-Growing Nontuberculous Mycobacterial Isolates From Three Patients With Postoperative Endophthalmitis

Palani, Deepa; Kulandai, Lily Therese; Naraharirao, Madhavan Hajib; Guruswami, Sitalakshmi; Ramendra, Bakshi

doi:10.1097/ico.0b013e318060ac3a

Cited by 27 publications

(22 citation statements)

References 38 publications

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“…M. abscessus , while initially categorized as a subspecies of M. chelonae , was determined to be a separate species in 1992 after DNA hybridization studies 2. Given the many biochemical similarities between M. abscessus and M. chelonae , clinical laboratories often fail to distinguish between these organisms at the species level with standard biochemical testing 6–8.…”

Section: Discussionmentioning

confidence: 99%

“…PCR is a rapid, specific, and cost-effective means of identification of RGNTM to the species level that can be performed in parallel with standard biochemical tests;2,6,7 however, it often requires outsourcing to validated laboratories, requiring additional time and resources. Gene sequencing also serves as an effective option for identification of RGNTM 6.…”

Section: Discussionmentioning

confidence: 99%

“…Rapidly-growing nontuberculous mycobacteria (RGNTM) include bacteria such as Mycobacterium chelonae, Mycobacterium abscessus , and Mycobacterium fortuitum 1,2. These atypical mycobacteria can be acquired from the natural environment and nosocomially.…”

Section: Introductionmentioning

confidence: 99%

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Recurrent nontuberculous mycobacterial endophthalmitis: a diagnostic conundrum

Venkateswaran

Yeaney

Chung

et al. 2014

OPTH

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ObjectiveTo report a case of recurrent nontuberculous mycobacterial endophthalmitis in the context of neurotrophic keratopathy secondary to herpes zoster ophthalmicus that had an atypical presentation and complex course, and highlights the challenges of causative organism identification and therapeutic interventions in this condition.MethodsA retrospective chart review was conducted to determine the visual outcomes of the patient.ResultsA 68-year-old pseudophakic male with long-standing neurotrophic keratopathy and perforated descemetocele managed with cyanoacrylate glue and a contact bandage lens in the left eye, began experiencing recurrent episodes of endophthalmitis after undergoing a penetrating keratoplasty. Several therapeutic procedures including an anterior chamber washout, two pars plana vitrectomies, explantation of the posterior chamber intraocular lens and capsular bag, and multiple intravitreal antimicrobial injections, were performed to which he has ultimately responded favorably, with no signs of infection to date and stable visual acuity. The causative organism of his recurrent infections was initially identified as Mycobacterium abscessus through biochemical testing and 16S ribosomal ribonucleic acid gene sequencing; however, repeat polymerase chain reaction (PCR) and sequencing of the 65 kDa heat shock protein (hsp65) gene for experimental purposes confirmed the accurate identification of the organism to be Mycobacterium chelonae. Given the greater reliability of PCR and sequencing of the hsp65 gene over traditional biochemical tests and culture techniques, M. chelonae was likely the infectious agent all along, and the organism was originally misidentified on the basis of less accurate tests.ConclusionRecurrent atypical mycobacterial endophthalmitis requires expedient identification and management to prevent poor visual outcomes. Standard biochemical testing can identify the causative organism but is limited by the inability to distinguish between nontuberculous species reliably. We recommend the use of PCR in conjunction with sequencing of the hsp65 gene for reliable differentiation of M. chelonae and M. abscessus in atypical mycobacterial ocular infections. Minimum inhibitory concentration antibiotic susceptibility tests on cultured strains are the best guide to antibiotic selection, given the rapidly rising resistance to antimicrobials in atypical mycobacterial species.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Recurrent nontuberculous mycobacterial endophthalmitis: a diagnostic conundrum

Venkateswaran

Yeaney

Chung

et al. 2014

OPTH

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“…Culture of vitreous fluid for toxoplasmosis using viral media has been reported to be possible in cases of extensive, diffuse infections. 44 Tuberculous chorioretinitis 45 is potentially confirmable by PCR testing, although higher copy numbers seem to be required than exist in ocular specimens that have not been grown out in culture. 46 PCR protocols optimized for the confirmation of Mycobacterium tuberculosis from cultures rather than from biologic fluids are not efficient diagnostic tools and yield false negatives when applied to ocular specimens.…”

Section: Ancillary Testing To Confirm the Working Diagnosismentioning

confidence: 99%

Diagnostic dilemmas in retinitis and endophthalmitis

Davis

2011

Eye

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“…Molecular PCR-based technology has been developed to detect AMB infections, which are relatively faster and more specific compared to traditional microbiological methods 53 . Primers targeting the heat shock protein 65 (hsp65) have been utilized to detect M. fortuitum in postoperative endophthalmitis patients 54 .…”

mentioning

confidence: 99%

Atypical Mycobacterial Keratitis: A Negligent and Emerging Thread for Blindness

Aung¹,

Beuerman²

2018

J Rare Dis Res Treat

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Atypical mycobacteria are wide spread in the environment; they are now known to be a cause of a variety of infections including corneal infections especially after refractive surgery. The diagnosis and clinical management are often unsatisfactory due to misdiagnosis and requirement of prolonged combination of antibiotics. Evolving drug resistance is known to be a unique feature in managing atypical mycobacterial keratitis due to the propensity for the development of biofilms. In this article, we provide an etiology of atypical mycobacterial keratitis, mycobacterial biofilm pathogenesis, and the importance of mycobacterial biofilm matrix component (extracellular DNA) in maintaining mycobacterial biofilm matrix maintenance. Current treatment options for atypical mycobacterial keratitis are summarized and suggestions are made for the new treatment strategies targeting on the mycobacterial biofilm pathogenesis pathway.

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Application of Polymerase Chain Reaction-Based Restriction Fragment Length Polymorphism in Typing Ocular Rapid-Growing Nontuberculous Mycobacterial Isolates From Three Patients With Postoperative Endophthalmitis

Abstract: A clinical suspicion of infection by RGNTM in delayed-onset postoperative endophthalmitis should be considered when resistance to standard therapy is encountered.

Cited by 27 publications

References 38 publications

Recurrent nontuberculous mycobacterial endophthalmitis: a diagnostic conundrum

Recurrent nontuberculous mycobacterial endophthalmitis: a diagnostic conundrum

Diagnostic dilemmas in retinitis and endophthalmitis

Atypical Mycobacterial Keratitis: A Negligent and Emerging Thread for Blindness

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