The role of oral co-trimoxazole in treating Nocardia farcinica keratitis—a case report

Abstract

Background Nocardia farcinica is one of the more recently identified species of the Nocardia genus. Nocardia farcinica keratitis is a rare occurrence, with only eight previously reported cases. Semi-permeable rigid contact lens use was associated with one of these reported cases. We report the first case of extended wear soft contact-lens-related Nocardia farcinica keratitis and recommend a new treatment regime.FindingsA 47-year-old lady presented with a right eye keratitis after wearing her extended wear soft contact lenses for five continuous weeks. There was no history of trauma or swimming with contact lenses in. Empirical ciprofloxacin and tobramycin eye drops were not tolerated due to ocular surface irritation on application; and instead, empirical treatment was with chloramphenicol and fortified gentamicin 1.5 % eye drops. Corneal scrapings grew Nocardia farcinica after 3 weeks—sensitive to amikacin and co-trimoxazole. Treatment was changed to amikacin 2.5 % eye drops, resulting in partial resolution of the corneal infiltrates. Oral co-trimoxazole 160/800 mg BD was added, due to cultured drug sensitivity and its high ocular penetration, with good results and a final right eye best-corrected visual acuity of 6/5.Conclusion Nocardia farcinica keratitis should be considered in the differential diagnosis of contact-lens-related keratitis. We report the first case occurring in association with extended wear soft contact lenses. Nocardia species can mimic fungal and Acanthamoeba keratitis. Treatment with oral co-trimoxazole has not been previously reported. This case demonstrates a role for co-trimoxazole in treating Nocardia farcinica keratitis based on cultured drug sensitivities.

Cloning, Expression, Invasion, and Immunological Reactivity of a Mammalian Cell Entry Protein Encoded by the mce1 Operon of Nocardia farcinica

“…Pulmonary disease is the most common presentation of Nocardia in immunosuppressed patients and approximately one-third of affected patients have a disseminated disease ( Ambrosioni et al, 2010 ; Kandi, 2015 ; Scorey and Daniel, 2016 ). Infection of traumatic wounds produces chronic inflammation that may lead to fistulas, abscesses, cellulitis, ulcerations, and mycetoma ( Smego and Gallis, 1984 ; Salinas-Carmona, 2000 ; Salinas-Carmona et al, 2009 ), and may extend into muscles, bones, the brain, kidneys, the prostate, cornea, heart, and adjacent organs ( De Nardo et al, 2013 ; Sirijatuphat et al, 2013 ; Kumar et al, 2014 ; Park et al, 2014 ; Sharma and O’Hagan, 2016 ). Nocordia infection of the central nervous system may be acquired by cutaneous or respiratory routes ( Smego and Gallis, 1984 ; Beaman and Beaman, 1994 ; Inamadar and Palit, 2003 ; Zakaria et al, 2008 ; Chen et al, 2016 ).…”

Successful control of scleritis caused by Nocardia farcinica: A case report

“…According to previous studies and drug susceptibility results, N. farcinica is sensitive to compound sulfamethoxazole and amikacin, and resistant to cephalosporins, tobramycin and ciprofloxacin. [ 5 , 18 , 19 ] It has been reported that vitreous body injection of amikacin may lead to macular necrosis. [ 20 , 21 ] However, there are no effective antibiotics that can control infection through anterior chamber injection.…”

“…Of the few reports of N. farcinica eye infection, the therapeutic efficacy of mild keratitis is acceptable, while the efficacy for endophthalmitis is relatively poor. [ 3 – 5 ] In this study, we report a case of infectious scleritis involving the corneal limbus, which is suspected to be caused by N. farcinica in traumatic wound infection. The diagnosis was quickly and accurately confirmed by pathogenic microorganism culture and metagenomic sequencing.…”

Current diagnostic tools and management modalities of Nocardia keratitis

“…Several antibiotics were implemented in the treatment of ocular Nocardiosis including topical chloramphenicol [27], gentamicin [42], polymyxin B sulfate/trimethoprim, amikacin, ciprofloxacin, levofloxacin, moxifloxacin, ofloxacin, gatifloxacin [28], tobramycin, and imipenem [15], and oral clarithromycin [17]. Resistance to tobramycin [43], ciprofloxacin [43], trimethoprim [44], vancomycin [19], clarithromycin [45], and amikacin [1,46] have been reported. Currently, amikacin is the treatment of choice for ocular Nocardiosis [45,46].…”