Elizabethkingia meningoseptica and Contact Lens Use

Abstract

RESUMODoente de 47 anos, sexo masculino, recorreu ao serviço de urgência por início súbito de dor ocular e hiperemia conjuntival no olho esquerdo. Os antecedentes oftalmológicos incluíam o uso de lente de contacto semi-rígida e glaucoma primário de ângulo aberto. O exame na lâmpada de fenda revelou uma pequena úlcera de córnea central associada a infiltrado inflamatório estromal. A zaragatoa da base da úlcera de córnea permitiu a identificação de colónias de Elizabethkingia meningoseptica. O doente foi empiricamente tratado com levofloxacina colírio 0,5% e pomada de gentamicina 0,3%, tendo a infecção resolvido após cinco semanas. CASE REPORTA 47-year-old caucasian man presented to the ophthalmology emergency department of the Centro Hospitalar São João (Porto, Portugal) in August 2013 with a two day history of increasing pain and redness of his left eye (OS). He had no relevant systemic antecedents but he was regularly followed in the outpatient department due to primary open-angle glaucoma (treated with topical latanoprost, brimonidine, timolol and brinzolamide) and pathological myopia. Right eye visual acuity (VA) was hand movement due to terminal glaucoma. Ophthalmological antecedents also included the use of semi-rigid contact lens in the left eye. On our first examination, left eye visual acuity was 20/32 and biomicroscopy revealed a stromal keratitis with ill-defined borders and a small epithelial defect measuring 0.5 mm x 0.5 mm (Fig. 1). Scrapings from corneal ulcer and lower conjunctival fornix were sent for microbiological testing and topical empiric treatment (0,5% levofloxacin drops 1/1 hour and 0,3% gentamicin ointment 4/4 hours for 3 days) was prescribed. Evaluation 72 hours later showed loose re-epithelialization of the ulcer and ABSTRACTA 47-year-old man presented to our emergency department complaining of acute ocular pain and redness of his left eye. Ophthalmological antecedents included use of semi-rigid contact lens and primary open-angle glaucoma. Slit-lamp examination revealed a small central corneal ulcer associated with stromal inflammatory infiltrate. Scraping from the corneal ulcer was positive for Elizabethkingia meningoseptica. He was empirically treated with topical 0.5% levofloxacin and 0.3% gentamicin, and five weeks later the infection had resolved. In this case report we describe the uncommon association between contact lens and Elizabethkingia meningoseptica. Despite possible serious complications associated with this atypical agent, prompt diagnosis and adequate treatment lead to good visual prognosis.

Ocular Manifestation of Elizabethkingia Meningoseptica

“…Elizabethkingia is an important saprophyte that has grown much attention in recent years due to its ability to cause clinically signi cant infections and resistance to multiple anti-microbial agents [1][2][3][4]. Limited cases of ocular Elizabethkingia infections have been reported, where contact lens use, trauma, previous ocular surgery and ocular surface disorders appeared to be important risk factors [8][9][10][11][12]. We present the largest series of Elizabethkingia infection that has manifested in eyes.…”

“…Elizabethkingia is known to cause a variety of nosocomial human infections and has emerged as a clinically important pathogen because of its resistance to multiple anti-microbial agents [4][5][6][7]. Ophthalmological related Elizabethkingia infections are increasingly being reported where use of contact lens, trauma, ocular surgery and ocular surface disorders were associated [8][9][10][11]. Standardized management, choice of anti-microbial treatment and prognosis of Elizabethkingia ocular infections are lacking due to paucity of cases.…”

Clinical Characteristics of Elizabethkingia meningoseptica Ophthalmic infections

“…Elizabethkingia is known to cause a variety of nosocomial human infections and has emerged as a clinically important pathogen because of its resistance to multiple anti-microbial agents [4][5][6][7]. Ophthalmological related Elizabethkingia infections are increasingly being reported where use of contact lens, trauma, ocular surgery and ocular surface disorders were associated [8][9][10][11].…”