Surgical management of corneal perforation secondary to gonococcal keratoconjunctivitis

Kawashima, Motoko; Kawakita, Tetsuya; Den, Seika; Tomita, Machiko; Shimazaki, Jun

doi:10.1038/sj.eye.6703051

Cited by 36 publications

(28 citation statements)

References 22 publications

(24 reference statements)

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“…GC may be complicated by uveitis or severe keratitis, sometimes leading to corneal perforation necessitating corneal graft repair, so prompt diagnosis and treatment are essential. [6][7][8][9] There has been an increase in antibiotic resistance amongst gonococcal strains in recent years, including resistance to penicillin, fluoroquinolones, and more recently, oral cephalosporins. [10][11][12] Increasing antimicrobial resistance internationally has sparked concerns that some Neisseria gonorrhoeae strains may become pan-resistant in the near future.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of gonococcal conjunctivitis in adults and neonates

McAnena

Knowles

Curry

et al. 2015

Eye

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Purpose To report the prevalence of gonococcal conjunctivitis (GC) presenting to a tertiary referral maternity hospital (NMH) and a tertiary referral ophthalmic hospital (RVEEH) from 2011 to 2013 and describe the demographics, clinical presentation, and antibiotic susceptibility of Neisseria gonorrhoeae ocular infections. Methods Demographic, clinical, and microbiological data were collected from patients with laboratory confirmed GC. Results There were 27 556 live births at NMH during the study period, and no case of neonatal GC was identified. Fourteen cases of GC were identified at RVEEH in this period, representing a prevalence of 0.19 cases per 1000 eye emergency attendees. Antibiotic susceptibility data were available on nine cases, of which, all were ceftriaxoneand ciprofloxacin sensitive. 64.3% of patients were male, with a mean age of 18 years. The mean duration of symptoms was 3 days. All patients presented with unilateral conjunctival injection and purulent discharge. Eight cases had visual impairment at presentation and their mean visual acuity was 6/15. Corneal involvement was present in 25% of patients. Uveitis was not detected. On receipt of positive culture and/or PCR results, treatment was altered in two thirds of patients. All patients were referred for full STI screening and all patients showed a full clinical recovery 1 week posttreatment. Conclusion We observed that GC presented in young adults with a male predominance and was rare in neonates. In cases of unilateral purulent conjunctivitis, there should be a high clinical suspicion of GC, early swab for PCR and culture, and knowledge of current CDC-recommended antibiotic guidelines.

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Section: Introductionmentioning

confidence: 99%

Prevalence of gonococcal conjunctivitis in adults and neonates

McAnena

Knowles

Curry

et al. 2015

Eye

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“…El uso de norfloxacino oral en dosis de 1.200 mgr durante tres días es también una buena opción, ya que se facilita el cumplimiento del tratamiento por el paciente (5). De todos modos se han descrito resistencias del microorganismo a las quinolonas, así como a penicilinas y tetraciclinas con lo que hay es necesario elegir el antibiótico preciso de acuerdo con los test de sensibilidad de germen aislado (2).…”

Section: Discussionunclassified

Tratamiento con membrana amniótica en queratolisis secundaria a queratoconjuntivitis gonocócica del adulto

Miranda-Rollón

Sentieri-Omarrementería²,

Martínez‐Rodríguez

et al. 2009

Arch Soc Esp Oftalmol

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RESUMENCaso clínico: Varón de 46 años diagnosticado inicialmente de conjuntivitis adenovírica atípica con queratolisis marginal avanzada y riesgo de perforación ocular. El diagnóstico final fue queratoconjuntivitis gonocócica. El paciente fue tratado eficazmente con recubrimiento de membrana amniótica, ceftriaxona tópica y sistémica (50 mg/ml y 1 gr/12 h intravenosa). Discusión: La gonorrea debe ser sospechada en casos de conjuntivitis de evolución tórpida. Palabras clave:Infección gonocócica, queratoconjuntivitis, queratolisis, membrana amniótica, ceftriaxona. ABSTRACT Case report:We present a 46-year-old man diagnosed initially with atypical adenoviral conjunctivitis and advanced marginal queratolysis with risk of perforation. The final diagnosis was gonococcal keratoconjunctivitis. The patient was successfully treated with amniotic membrane transplant, topic and systemic ceftriaxone (50 mg/ml and 1 grame/12 hours intravenous). Discussion: Gonorrhea must be suspected in cases of torpid evolution conjunctivitis (Arch Soc Esp Oftalmol 2009; 84: 155-158). Key words:Gonococcal infection, queratoconjunctivitis, queratolisis, amniotic membrane, ceftriaxone.ARCH SOC ESP OFTALMOL 2009; 84: 155-158 COMUNICACIÓN CORTA INTRODUCCIÓNLa infección ocular por gonococo en el adulto es relativamente infrecuente y está asociada a actos sexuales por contacto directo con secreciones genitourinarias.El diagnóstico es difícil debido a la confusión con otras entidades que afectan a la conjuntiva como pueden ser las conjuntivitis adenovíricas sobreinfectadas en epidemias o procesos autoinmunes con queratolisis marginal.Se describe el caso de un varón joven diagnosticado de queratoconjuntivis gonocócica en nuestro servicio. CASO CLÍNICOVarón de 46 años que acude a consulta por conjuntivitis vírica en ojo derecho (OD) de diez días de

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“…13,14,19 Conjunctival infection with Neisseria gonorrhoeae, generally hyperacute, can progress into keratoconjunctivitis due to the bacterium's ability to penetrate intact corneal epithelium and is associated with a risk of corneal perforation. 5,20,21 Epidemics of gonococcal keratoconjunctivitis in adults have been reported. 22 Neisseria meningitidis conjunctival infections are similar in presentation to gonococcal infections; while corneal sequelae tend to be milder, N. meningitidis infections have been linked to a significant risk for meningeal or systemic infection.…”

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confidence: 99%

Clinical outcomes with besifloxacin ophthalmic suspension 0.6% in the treatment of bacterial conjunctivitis due to potentially consequential pathogens

Comstock¹,

Morris²,

Gearinger³

et al. 2014

OPTO

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Purpose: Besifloxacin is a chlorofluoroquinolone approved for use in the treatment of bacterial conjunctivitis. This study assessed the clinical efficacy of besifloxacin ophthalmic suspension 0.6% against conjunctivitis infections caused by potentially consequential pathogens. Design: Post hoc analysis of clinical outcomes for patients with conjunctival infections due to Pseudomonas aeruginosa, Serratia marcescens, Neisseria spp., methicillin-resistant Staphylococcus aureus (MRSA), and methicillin-resistant Staphylococcus epidermidis (MRSE) who were treated with besifloxacin in four multicenter, double-masked, randomized clinical trials. Methods: Minimum inhibitory concentrations (MICs) of besifloxacin against potentially consequential pathogens were pooled. Clinical outcome data for patients treated with besifloxacin with baseline infections due to these pathogens were pooled and summarized. Bacterial eradication was defined as the absence of ocular bacterial species present at or above threshold at baseline. Results: A total of 1,317 patients had culture-confirmed bacterial conjunctivitis across the four studies, and 151 infections were due to the aforementioned pathogens (P. aeruginosa n=9; S. marcescens n=10; Neisseria spp. n=16; MRSA n=35; MRSE n=81). Among MRSA and MRSE infections, 48.3% demonstrated concurrent ciprofloxacin resistance (ciprofloxacinresistant [CipR]-MRSA n=24; CipR-MRSE n=32). The MIC 90 (MIC for 90% of isolates) for besifloxacin was 1 µg/mL for S. marcescens, 0.25 µg/mL for Neisseria spp., 0.06 µg/mL for both ciprofloxacin-sensitive MRSA and ciprofloxacin-sensitive MRSE, and 4 µg/mL for both CipR-MRSA and CipR-MRSE. Against P. aeruginosa, the MIC range was 1-4 µg/mL. Bacterial eradication rates in patients treated with besifloxacin were 100% by the first follow-up visit for infections due to P. aeruginosa, S. marcescens, and Neisseria spp. and 87.8% by the second follow-up visit for infections due to MRSA and MRSE. Conclusion: The use of besifloxacin ophthalmic suspension 0.6% in the treatment of conjunctival infections due to potentially consequential pathogens resulted in high rates of bacterial eradication.

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Surgical management of corneal perforation secondary to gonococcal keratoconjunctivitis

Cited by 36 publications

References 22 publications

Prevalence of gonococcal conjunctivitis in adults and neonates

Prevalence of gonococcal conjunctivitis in adults and neonates

Tratamiento con membrana amniótica en queratolisis secundaria a queratoconjuntivitis gonocócica del adulto

Clinical outcomes with besifloxacin ophthalmic suspension 0.6% in the treatment of bacterial conjunctivitis due to potentially consequential pathogens

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