Contact Lens-Related Infectious Keratitis with White Plaque Formation Caused by Corynebacterium propinquum

Abstract

We report the first case of Corynebacterium propinquum keratitis in the compromised cornea of a diabetic patient wearing therapeutic contact lenses. The strain was identified to the species level based on sequencing of the 16S rRNA gene and RNA polymerase ␤-subunit-encoding gene (rpoB). Ophthalmologists should be aware of nondiphtherial corynebacterial infection of compromised corneas. CASE REPORT This case consisted of a 44-year-old woman with a history of type 1 diabetes, hemodialysis due to diabetic nephropathy, vitrectomy in both eyes due to proliferative diabetic retinopathy, and cataract surgery in both eyes. She complained of decreased vision of the left eye without any irritation and was referred to our department because of a persistent corneal epithelial defect. The corrected vision was 0.02 in the right eye, with hand motion detectable by the left eye. Intraocular pressure was 14 mm Hg in both eyes. She had disturbance on blinking and exhibited epithelial damage in the area of the palpebral fissure in both eyes. Slit-lamp examination showed epithelial defect, pannus formation, and white plaque without obvious injection in the left cornea (Fig. 1A). To treat her left cornea, the white plaque was removed and punctal plugs were inserted; the patient was provided with therapeutic bandage contact lenses, and 0.1% hyaluronic acid was administered six times per day in both eyes. After 3 weeks, the corneal epithelial defect of the left eye improved, and the left vision recovered to 0.03. However, after an additional 3 days, hypopyon and corneal infiltration had developed in the left eye (Fig. 1B). We suspected infectious keratitis and removed the contact lens. A corneal scraping was obtained, subjected to Gram staining, and observed by light microscopy. The smear revealed numerous coryneform Gram-positive rods with phagocytosis by polymorphonuclear leukocytes (PMNs) (Fig. 1C). We suspected nondiphtherial Corynebacterium keratitis and switched the eye drops to gatifloxacin (GAT) and cefmenoxime administered (separately) six times per day each. Complete eye closure with eye patch was added because of poor reepithelialization, and systemic intravenous ampicillin also was added. The epithelial defect gradually healed, but complete epithelialization took about 2 months (Fig. 1D). The final visual acuity recovered to 0.02. Bacterial culture yielded Corynebacterium species.Bacterial species identification. The genus of the bacterial isolate, designated MGJ001, was shown to be Corynebacterium by microscopic observation and biochemical tests. Identification of the isolate to the species level, performed by biochemical testing using API Coryne (1) (bioMérieux SA, Lyon, France), indicated that the strain was Corynebacterium pseudodiphtheriticum. The DNA sequence of the 16S rRNA gene, which was amplified by PCR with the primer pair 10F (5=-GTTTGATCCTGGCTCA-3=) and 800R (5=-TACCAGGGTATCTAATCC-3=), showed 99% homology with both C. pseudodiphtheriticum and C. propinquum by the Basic Local Alignment Search Tool (BLAST). To ...

Current Evidence for Corynebacterium on the Ocular Surface

“…However, in immunocompromised patients, many recent reports have demonstrated that Corynebacterium species can be potentially pathogenic when present on the ocular surface [ 7 , 8 , 9 , 10 ], as this infection has been associated with cases of endocarditis of the aortic and mitral valves [ 11 ], granulomatous mastitis [ 12 ], and pelvic osteomyelitis [ 13 ]. Many reports have been based on the case series [ 7 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. Therefore, the frequency of occurrence of various Corynebacterium species on the ocular surface compared to other organs is not well characterized, and the mechanism by which Corynebacterium species function as pathogenic organisms is also unclear.…”

The trend of resistance to antibiotics for ocular infection of Staphylococcus aureus, coagulase-negative staphylococci, and Corynebacterium compared with 10-years previous: A retrospective observational study

“…aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci (MR-CNS) are highly resistant to various antibiotics [ 2 , 4 – 7 ]. It has recently been reported that Corynebacterium can cause ocular surface infection, even though it is considered to be a non-pathogenic organism [ 8 – 12 ], and fluoroquinolone-resistant Corynebacterium has become a growing issue of concern [ 9 , 13 ].…”

Corynebacterium propinquum Keratitis Identified Using MALDI-TOF

“…These include skin abscesses, endocarditis, bacteremia, and infections of the lower respiratory system. 7 Several conjunctival 3,8 and corneal 3,9 isolates are mentioned in the microbiological literature. The clinical details were given for 1 corneal infection involving a diabetic woman who wore bandage contact lenses.…”

“…The clinical details were given for 1 corneal infection involving a diabetic woman who wore bandage contact lenses. 9 The isolate was identified as C. pseudodiphtheriticum in biochemical testing but as C. propinquum in rpoB gene sequencing. The patient was treated with intravenous ampicillin and topical gatifloxacin and cefmenoxime.…”