Polymicrobial Infection of the Cornea Due to Contact Lens Wear

Abstract

A 38-year-old male presented with pain and redness in his left eye. He had a history of wearing contact lenses. His ophthalmic examination revealed a large corneal ulcer with surrounding infiltrate. Cultures were isolated from the contact lenses, lens solutions, storage cases, and conjunctivae of both eyes and also corneal scrapings of the left eye. Fortified vancomycin and amikacin drops were started hourly. Culture results of conjunctivae of each eye and left cornea were positive for Pseudomonas aeruginosa; cultures from the contact lenses, lens solution and storage case of both eyes revealed Pseudomonas aeruginosa and Alcaligenes xylosoxidans. Polymerase chain reaction of the corneal scraping was positive for Acanthameoba. The topical antibiotics were changed with ones that both bacteria were sensitive to and anti-amoebic therapy was added. The patient had two recurrences following initial presentation despite intensive therapy. Keratitis occurred due to multiple pathogens; the relapsing course despite adequate therapy is potentially associated with this polymicrobial etiology.

Comparison of Culture-Positive and -Negative Microbial Keratitis

“…The demographics and microbiological profile of the disease differ, and various reports have been published through the world. 2 , 3 Shifting trends in the microbiological profile of keratitis have also been reported in some studies. 4 , 5 , 6 Therefore, regular studies of the microbial profile are essential in order to determine local microorganisms and their antimicrobial sensitivities.…”

Case Series: Unusual Presentation of Acanthamoeba Coinfection in the Cornea

“…In this cases series, perineuritis was observed in case 1, whereas epitheliitis was observed in case 2. Perineuritis and epitheliitis are known presentations in early Acanthamoeba keratitis infection, but these two presentations are relatively unusual in Acanthamoeba keratitis coinfection 1,4–7,9 . Perineuritis, a typical characteristic of Acanthamoeba keratitis, was also reported in contact lens–related microbial keratitis caused by P. aeruginosa 12 .…”

“…Depending on different stages of the disease, it may resemble herpetic, bacterial, or mycotic keratitis 2 . Because of the frequent misdiagnosis of Acanthamoeba keratitis, its clinical outcome is often unsatisfactory 4–7 …”

“…It could contribute to an even more complicated clinical picture and a further delay in diagnosis, leading to a poor clinical prognosis 9,10 . Common clinical features at the presentation of Acanthamoeba coinfection include central dense infiltrates, epithelial defects, and hypopyon 4 – 7,9 . However, these signs are often seen as late-stage changes with unpromising visual prognosis 10 …”

Current understanding and therapeutic management of contact lens associated sterile corneal infiltrates and microbial keratitis

“…106 Polymicrobial keratitis should be considered particularly in cases of MK which are slow or not healing despite receiving appropriate antimicrobial therapy or when a previously responding corneal ulcer suddenly worsens. [106][107][108] The lesion size in cases of polymicrobial keratitis was significantly bigger than monomicrobial keratitis, and polymicrobial keratitis is more likely seen with a presence with hypopyon. 106,109 Polymicrobial keratitis is more likely to have multiple risk factors (33.3%) and systemic risk factors (23.8%) when compared to monomicrobial keratitis, which has no cases with multiple or systemic risk factors.…”