Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong.
Cornea. 2019 Oct;38(10):1328-1331. doi: 10.1097/ICO.0000000000001997.
Tsukamurella is an important and emerging organism that causes opportunistic human infection. We present the largest case series of Tsukamurella species-associated ophthalmic infections, with an emphasis on clinical spectrum, risk factors, treatment, and outcome.
A case series of culture-positive Tsukamurella species in ocular microbiological specimens was identified retrospectively from 2005 to 2018. Tsukamurella species were identified by phenotypic, molecular, and genotypic methods. Diagnoses were clinical and were supplemented by microbiological findings. Treatment including antibiotic type, number of antibiotics, treatment duration, and clinical outcome was documented.
Eleven cases of culture-positive Tsukamurella ocular infection were identified. Of these 54.5% (6/11) of cases resulted in conjunctivitis, 18% (2/11) of cases resulted in keratitis, and 9% (1/11) of cases resulted in blepharitis. One case of canaliculitis and 1 case of postenucleation ocular implant-related infection were reported, which were both novel findings. The presence of ocular implant and preexisting ocular surface diseases such as exposure keratopathy and ectropion were thought to be predisposing factors. We have demonstrated that treatment of Tsukamurella ocular conjunctivitis, keratitis, and blepharitis was effective using a combination therapy of 2 antibiotics (fluoroquinolone, fusidic acid, or chloramphenicol). Canaliculitis and ocular implant infection required further addition of oral antibiotics (macrolide or doxycycline), canaliculotomy, and removal of the infected implant for satisfactory management.
Tsukamurella tyrosinosolvens and Tsukamurella pulmonis were found to be the predominant species that caused ocular infection. Ocular manifestation of Tsukamurella has a wider spectrum than that previously reported. A high-level of suspicion and a low threshold for microbiological sampling in cases with prolonged ocular surface infection are recommended to diagnose Tsukamurella infections.
土拉弗朗西斯菌是一种重要且新兴的机会致病菌，可导致人类感染。我们报告了最大的土拉弗朗西斯菌相关眼部感染病例系列，重点介绍了其临床谱、危险因素、治疗和结局。
我们回顾性地从 2005 年至 2018 年确定了眼部微生物标本中培养阳性的土拉弗朗西斯菌病例系列。通过表型、分子和基因方法鉴定土拉弗朗西斯菌。诊断是临床诊断，并通过微生物学发现进行补充。记录了包括抗生素类型、抗生素数量、治疗持续时间和临床结局在内的治疗情况。
共确定了 11 例培养阳性的土拉弗朗西斯菌眼部感染病例。其中，54.5%（6/11）的病例为结膜炎，18%（2/11）的病例为角膜炎，9%（1/11）的病例为睑炎。报告了 1 例泪小管炎和 1 例眼球摘除后眼内植入物相关感染病例，这两种都是新发现的病例。我们认为，眼内植入物的存在以及先前存在的眼表面疾病，如暴露性角膜炎和睑外翻，是诱发因素。我们已经证明，使用 2 种抗生素（氟喹诺酮类、夫西地酸或氯霉素）的联合治疗对土拉弗朗西斯菌眼部结膜炎、角膜炎和睑炎有效。泪小管炎和眼内植入物感染需要进一步添加口服抗生素（大环内酯类或强力霉素）、泪小管切开术和移除感染的植入物，以进行满意的管理。
我们发现，土拉弗朗西斯菌酪氨酸亚种和土拉弗朗西斯菌肺炎亚种是引起眼部感染的主要病原体。与先前报道的相比，土拉弗朗西斯菌眼部表现的谱更宽。对于存在长时间眼表面感染的患者，建议提高对土拉弗朗西斯菌感染的怀疑水平，并降低微生物采样的门槛。
