Keratitis with <b><i>Kocuria palustris</i></b> and <b><i>Rothia mucilaginosa</i></b> in Vitamin A Deficiency

Abstract

Purpose: To present a case of unusual corneal infection early in the course of peripheral ulcerative keratitis in a patient with severe vitamin A deficiency. Method: Single observational case report in urban USA. Case Presentation: An alcoholic patient with pancreatitis, chronic diarrhea, and vitamin A deficiency presented with a marginal corneal ulcer from which two bacteria of the family Micrococcaceae were cultured and identified by genome sequence analysis, namely Kocuria palustris and Rothia mucilaginosa. Soon after, severe bilateral peripheral ulcerative keratitis developed, later accompanied by eyelid cellulitis of one lid. These conditions improved with antibiotics, treatment of the underlying gastrointestinal conditions, and treatment of the vitamin deficiency. Conclusion: Susceptibility to keratitis with unusual bacteria of the Micrococcaceae family can occur in the setting of alcoholism-related gastrointestinal disease with severe vitamin A deficiency. To our knowledge, K. palustris is a species not previously identified in any human disease, and the Kocuria genus has not previously been reported as a participant in eye infection. Documented cases of R. mucilaginosa in ocular disease are rare. These unusual infections heralded the onset of severe marginal corneal melts.

Atopic keratoconjunctivitis complicated by Kocuria koreensis keratitis: the first case

“…Hence, we described the cornea as having a “coral-like appearance” in this case. A case of Kocuria keratitis reported by Mattem et al [5] exhibited corneal opacity with a coral-like appearance, similar to our case. Therefore, this coral-like appearance may be considered a useful diagnostic sign.…”

“…Identification of Kocuria spp. has been performed previously using an automated instrument for identification and antibiotic susceptibility testing (VITEK ® 2 system) [13] or 16S ribosomal DNA sequencing [5]. In our diagnostic method for bacterial keratitis, an abrasion sample of infected cornea is applied directly to chocolate agar and cultured, and species of isolated bacteria are identified using MALDI-TOF/MS.…”

“…Kocuria spp. are also unusual causative organisms in ocular infectious diseases, and there are a small number of reports on Kocuria keratitis [5, 6]. …”

Detection of Potentially Pathogenic Non-Tuberculous Mycobacteria in Artisanal Coalho Cheese from the State of Paraiba, Northeast Brazil

“…The species K. rhizophila and K. palustris are part of the microbiota of the skin and oropharynx, being isolated from samples of environmental and animal origin. Clinical cases of infections by K. rhizophila and K. palustris are increasingly being described: identified K. palustris in a patient with peripheral ulcerative keratitis while [21] and in duodenal mucosa from a patient with Celiac Disease [22]; identified K. rhizophila in a central catheter of a child with sepsis [23].…”

Complete Genome Sequence of Kocuria palustris MU14/1

“…Kocuria palustris is one of 18 described species in a lineage that was formerly assigned membership to the genus Micrococcus ( 1 ). K. palustris is an aerobic coccus that was originally recovered from plant rhizoplanes ( 2 ), but that has since been isolated from marine environments ( 3 ) and more recently from a human patient with keratitis ( 4 ). Genomic information of the species is limited to that of a single isolate, K. palustris PEL ( 5 ), for which a draft genome of 55 contigs is available (GenBank accession no.…”