Patel Ravi, Sise Adam, Al-Mohtaseb Zaina, Garcia Noel, Aziz Hassan, Amescua Guillermo, Pantanelli Seth M
*Department of Ophthalmology, Penn State Hershey Medical Center, Hershey, PA; †Bascom Palmer Eye Institute, University of Miami, Miami, FL; and ‡Cullen Eye Institute, Baylor College of Medicine, Houston, TX.
Cornea. 2015 Dec;34(12):1617-9. doi: 10.1097/ICO.0000000000000634.
To describe 2 cases of Nocardia keratitis resistant to topical compounded amikacin therapy.
A 24-year-old woman presented with a corneal infiltrate. Cultures were taken, and topical moxifloxacin was administered. Corneal biopsy was performed when clinical status deteriorated, which confirmed infection with Nocardia. The patient was administered topical compounded amikacin. When clinical status further deteriorated, she was switched to compounded trimethoprim-sulfamethoxazole, which resulted in rapid resolution. Separately, a 22-year-old woman presented with contact lens-related keratitis that grew Nocardia asteroides. Corneal cultures and drug sensitivity testing revealed a strain of N. asteroides resistant to amikacin and imipenem, but sensitive to tobramycin. After a protracted clinical course, the keratitis ultimately responded to topical tobramycin leaving the patient with a pericentral corneal scar.
Nocardia keratitis is an atypical infection for which standard management algorithms exist. However, atypical cases require that these patients be followed closely for the response to therapy.
描述2例对局部应用复方阿米卡星治疗耐药的诺卡菌性角膜炎病例。
一名24岁女性出现角膜浸润。进行了培养，并给予局部莫西沙星治疗。临床状况恶化时进行了角膜活检，证实感染诺卡菌。该患者接受了局部复方阿米卡星治疗。当临床状况进一步恶化时，改用复方甲氧苄啶 - 磺胺甲恶唑，病情迅速缓解。另外，一名22岁女性出现与隐形眼镜相关的角膜炎，培养出星形诺卡菌。角膜培养和药敏试验显示一株对阿米卡星和亚胺培南耐药但对妥布霉素敏感的星形诺卡菌。经过漫长的临床病程，角膜炎最终对局部妥布霉素产生反应，患者留下角膜中央周边瘢痕。
诺卡菌性角膜炎是一种非典型感染，存在标准的治疗方案。然而，非典型病例需要密切观察这些患者对治疗的反应。
