Nocardia transvalensis keratitis: an emerging pathology among travelers returning from Asia

Abstract

BackgroundThe incidence rate of Nocardia keratitis is increasing, with new species identified thanks to molecular methods. We herein report a case of Nocardia transvalensis keratitis, illustrating this emerging pathology among travellers returning from Asia.Case presentationA 23-year-old man presented with a 10-week history of ocular pain, redness, and blurred vision in his right eye following a projectile foreign body impacting the cornea while motor biking in Thaïland. At presentation, a central epithelial defect with a central whitish stromal infiltrate associated with pinhead satellite infiltrates was observed. Identification with 16S rRNA PCR sequencing and microbiological culture of corneal scraping and revealed N. transvalensis as the causative organism. Treatment was initiated with intensive topical amikacin, oral ketoconazole and oral doxycycline. After a four-week treatment period, the corneal infiltrate decreased so that only a faint subepithelial opacity remained.ConclusionNocardia organisms should be suspected as the causative agent of any case of keratitis in travelers returning from Asia. With appropriate therapy, Nocardia keratitis resolves, resulting in good visual outcome.

Diversity and frequency of Nocardia spp. in the soil of Isfahan province, Iran

“…So far, more than 50 species in the genus Nocardia are described among which Nocardia asteroids (N. asteroids) complex, Nocardia brasiliensis (N. brasiliensis), Nocardia transvalensis (N. transvalensis), Nocardia otitidiscaviarum (N. otitidiscaviarum), Nocardia farcinica and Nocardia pseudobrasiliensis are more pathogenic in humans [2] . These organisms are found in sludge, soil, contaminated soils water, plants, spoiled material and plant and cause opportunistic infections in humans and animals [3][4][5][6][7][8][9][10] .…”

“…Sampling locations in cities included squares, boulevards, sidewalk, area offices, coastal and forest parks, rivers, waterfall and samples were collected in villages from corral livestock and domestic animals, nests, farm land, fruit gardens, garden houses, etc. Soil samples to the amount of 100-200 g for each sample were collected from superficial layer with depth not exceeding [2][3][4][5] cm. The samples were placed in sterile polyethylene bags, transported immediately to the laboratory and were stored at low temperature (4 曟 ) until tested.…”

Pathogenic Nocardia cyriacigeorgica and Nocardia nova Evolve To Resist Trimethoprim-Sulfamethoxazole by both Expected and Unexpected Pathways

“…emerging or have been historically underestimated, nocardial infections are being recognized as an emerging public health problem (11,12).…”

Nocardia spp.: A Rare Cause of Pneumonia Globally

“…are uncommon and typically seen in subtropical/tropical climates (e.g., India, Asia, and the South Pacific). [212][213][214][215][216][217][218] Nocardia keratitis may complicate ocular trauma, 214,219 ocular surgery, 217,[220][221][222][223] or contact lens use. 216,224,225 Lin et al evaluated >6,000 cases of infectious keratitis in southeast India from 2006 to 2009; Nocardia spp.…”