Endophthalmitis Caused by Mycobacterium chelonae: Selection of Antibiotics and Outcomes of Treatment

Lieb, Douglas F.; Flynn, Harry W.; Dessouki, Amr; Murray, Timothy G.; Miller, Darlene

doi:10.1001/archopht.121.4.573

Cited by 31 publications

(15 citation statements)

References 11 publications

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“…M. chelonae endophthalmitis is a grave condition associated with poor visual outcomes 9–15. Causes of M. chelonae endophthalmitis include prior cataract surgery,9–12 glaucoma surgery,13 iridocyclitis,14 intravitreal steroid injections,9,15 neurotrophic cornea,9 and systemic immunosuppression 16,17.…”

Section: Discussionmentioning

confidence: 99%

“…Causes of M. chelonae endophthalmitis include prior cataract surgery,9–12 glaucoma surgery,13 iridocyclitis,14 intravitreal steroid injections,9,15 neurotrophic cornea,9 and systemic immunosuppression 16,17. The patient had several risk factors for an ocular RGNTM infection: 1) an immunosuppressed state after completion of chemotherapy during which herpes zoster infections are more common; 2) a neurotrophic cornea secondary to HZO with a non-healing ulcer and recurrent perforations; and 3) multiple diagnostic and therapeutic ocular surgeries, long-term antibiotic therapy, and steroid immunosuppression during periods of active infection.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with RGNTM endophthalmitis typically present with pain, decreased vision, and irritation 3,9,19. Nerve injury from the underlying HZO and the previous PK may have altered this classic presentation 20.…”

Section: Discussionmentioning

confidence: 99%

“…Nerve injury from the underlying HZO and the previous PK may have altered this classic presentation 20. Post-operative recovery of M. chelonae endophthalmitis often results in markedly diminished vision9–11,13,15 and enucleation9,12,14 due to delayed diagnosis and the devastating nature of the infection. Fortunately, the patient was able to achieve a highly favorable visual outcome despite his protracted clinical course.…”

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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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%

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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“…Corneal tunnel infection is a serious complication of cataract surgery and is usually caused by grampositive organisms. 15 The most common site of ocular infection associated with M chelonae is the cornea, although cases of scleritis, 12 conjunctivitis, 12 dacryocystitis, 16 granuloma formation, 17 and endophthalmitis 18 have been reported. Patients initially present with an indolent white corneal infiltrate, which may resemble a cracked windshield, but in some cases a fluffy white infiltrate appears with satellite lesions.…”

Section: Discussionmentioning

confidence: 99%

Mycobacterium chelonae–Mycobacterium abscessus complex clear corneal wound infection with recurrent hypopyon and perforation after phacoemulsification and intraocular lens implantation

Servat

Ramos-Esteban²,

Tauber³

et al. 2005

Journal of Cataract and Refractive Surgery

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We report a clear corneal wound infection occurring in a 74-year-old man caused by a member of the Mycobacterium chelonae-Mycobacterium abscessus complex, presenting as crystalline keratopathy with recurrent hypopyon. This led to perforation after phacoemulsification with posterior chamber intraocular lens implantation. Only after corneal biopsy of the incision was the causative organism isolated and found to be sensitive to clarithromycin and ciprofloxacin. Despite aggressive therapy, a full-thickness corneal perforation developed, requiring emergent cyanoacrylate glue to preserve ocular integrity. Both the difficulty and delays in obtaining a correct diagnosis led to severe ocular morbidity. Infectious lamellar keratitis limited to the clear cornea phacoemulsification incision is rare, but some unusual organisms such as atypical mycobacteria may be encountered.

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Endophthalmitis After Intravitreal Injection of Triamcinolone Acetonide

Wilhelmus¹

2003

Arch Ophthalmol

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Endophthalmitis Caused by Mycobacterium chelonae: Selection of Antibiotics and Outcomes of Treatment

Cited by 31 publications

References 11 publications

Recurrent nontuberculous mycobacterial endophthalmitis: a diagnostic conundrum

Recurrent nontuberculous mycobacterial endophthalmitis: a diagnostic conundrum

Mycobacterium chelonae–Mycobacterium abscessus complex clear corneal wound infection with recurrent hypopyon and perforation after phacoemulsification and intraocular lens implantation

Endophthalmitis After Intravitreal Injection of Triamcinolone Acetonide

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