Sharma Neharika, O'Hagan Stephen
Cairns Base Hospital, 165 The Esplanade, Cairns, Queensland, 4870, Australia.
James Cook University, 1 James Cook Drive, Townsville City, 4811, Queensland, Australia.
J Ophthalmic Inflamm Infect. 2016 Dec;6(1):23. doi: 10.1186/s12348-016-0091-2. Epub 2016 Jun 21.
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.
A 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.
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.
嗜皮诺卡菌是诺卡菌属中较新发现的菌种之一。嗜皮诺卡菌性角膜炎较为罕见，此前仅有8例报道。其中1例报道病例与使用半透性硬性隐形眼镜有关。我们报告首例与长戴型软性隐形眼镜相关的嗜皮诺卡菌性角膜炎病例，并推荐一种新的治疗方案。
一名47岁女性在连续佩戴长戴型软性隐形眼镜5周后出现右眼角膜炎。无外伤史，也未戴隐形眼镜游泳。经验性使用环丙沙星和妥布霉素滴眼液时，因滴眼后眼表刺激而无法耐受；取而代之的是，经验性治疗采用氯霉素和强化的1.5%庆大霉素滴眼液。角膜刮片在3周后培养出嗜皮诺卡菌，该菌对阿米卡星和复方新诺明敏感。治疗改为使用2.5%阿米卡星滴眼液，角膜浸润部分消退。由于培养出的药敏结果以及复方新诺明的高眼内渗透性，加用口服复方新诺明160/800mg，每日2次，效果良好，右眼最终最佳矫正视力为6/5。
在接触镜相关性角膜炎的鉴别诊断中应考虑嗜皮诺卡菌性角膜炎。我们报告首例与长戴型软性隐形眼镜相关的病例。诺卡菌属可类似真菌性和棘阿米巴性角膜炎。此前未报道过使用口服复方新诺明进行治疗。该病例表明，根据培养出的药敏结果，复方新诺明在治疗嗜皮诺卡菌性角膜炎中具有作用。
