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Query: UMLS:C0022568 (keratitis)
 5,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Antibiotics have been the mainstay of therapy for infectious diseases since their origins in the 1940s. As microorganisms changed and resistance developed, more advanced antibiotics were ultimately needed to provide adequate coverage and spectrum. By selecting optimal antibiotics and dosing regimens, clinicians can avoid treatment failures and adverse events and can help prevent the emergence of further antibiotic resistance. The fourth-generation ophthalmic fluoroquinolones include moxifloxacin (VIGAMOX, Alcon Laboratories, Inc., Fort Worth, TX) and gatifloxacin (Zymar, Allergan, Irvine, CA), and they are now approved for the treatment of bacterial conjunctivitis. This review highlights four scientific methods that compare and rank antibiotic potencies and predict their clinical efficacy and their propensity to develop resistance: 1) in vitro assay for minimum inhibitory concentrations, 2) in vivo models for pharmacokinetic and pharamacodynamic properties, 3) therapeutic index or inhibitory quotient, and 4) in vitro assay for mutant prevention concentration. The fourth-generation ophthalmic fluoroquinolones perform well in these assays. Both antibiotics have better in vitro activity against gram-positive bacteria than ciprofloxacin or ofloxacin. Moxifloxacin penetrates better into ocular tissues than gatifloxacin and older fluoroquinolones; in vitro activity of moxifloxacin and gatifloxacin against gram-negative bacteria is similar to that of older fluoroquinolones. Moxifloxacin also has better mutant prevention characteristics than other fluoroquinolones. These findings support the use of the newer fluoroquinolones for the prevention and treatment of serious ophthalmic infections (e.g., keratitis, endophthalmitis) caused by susceptible bacteria.
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PMID:Overview of the potency of moxifloxacin ophthalmic solution 0.5% (VIGAMOX). 1625 13

We report a case of intrastromal keratitis in a 42-year-old male with underlying human immunodeficiency virus-1 infection. Numerous microsporidial spores were found from corneal biopsy. Ultrastructural studies of corneal tissues revealed dimorphic sporophorous vesicles containing characteristic spores belonging to Trachipleistophora anthropopthera. Infection could be controlled by penetrating keratoplasty but not by topical fumagillin and systemic albendazole per se. This is the first report of human keratitis caused by this organism.
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PMID:Keratitis caused by Trachipleistophora anthropopthera. 1629 Dec 86

A case of Nocardia asteroides keratitis occurring 3 weeks after laser in situ keratomileusis (LASIK) in a nontraumatized eye is reported. The patient presented with decreased vision, inflammation, and stromal melting of the LASIK flap, discrete infiltrates, and an anterior chamber cellular reaction. Cultures for acid-fast bacteria grew Nocardia asteroides after 5 days. Infection progressed despite treatment with topical antibiotics and eventually required penetrating keratoplasty (PKP). Postoperatively, the patient was placed on moxifloxacin, a fourth-generation flouroquinolone. The patient experienced a recurrence of Nocardia keratitis at the graft-host interface 2 months after the PKP. This eventually resolved with a combination of topical moxifloxacin and imipenem therapy.
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PMID:Nocardia keratitis after laser in situ keratomileusis: clinicopathologic correlation. 1633 76

Infection and inflammation during contact lens wear is often associated with microbial contamination of lenses. Several different types of microbes that colonize lenses can lead to infection and inflammation, but the most common cause of infection (microbial keratitis; MK) remains the Gram-negative bacterium Pseudomonas aeruginosa. P. aeruginosa has a battery of cell-associated and extracellular virulence factors it can use to initiate and maintain infection. Its ability to produce proteases, to either invade or kill corneal cells, and to coordinate expression of virulence factors via quorum-sensing have been shown to be important during MK. Another important factor that contributes to the destruction of the cornea during MK is excessive activation of the host defense system. P. aeruginosa can activate several pathways of the immune system during MK, and activation often involves receptors on the corneal epithelial cells called toll-like receptors (TLRs). These TLRs recognize e.g., lipopolysaccharide or flagella from P. aeruginosa and activate the epithelial cells to produce inflammatory mediators such as cytokines and chemokines. These cytokines or chemokines recruit white blood cells, predominantly polymorphonuclear leukocytes, to the infection in order that they can phagocytose and kill the P. aeruginosa. However, continued recruitment and presence of these polymorphonuclear neutrophils and other white blood cells in the corneal tissue leads to destruction of corneal cells and tissue components. This can ultimately lead to scarring and vision loss.
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PMID:Pseudomonas aeruginosa infection and inflammation during contact lens wear: a review. 1743 10

Free-living amoebae (FLA) occur ubiquitously in many aquatic habitats and humid soils as well as in "artificial" water samples. In addition to their role as pathogens, FLA are known to serve as natural hosts and vehicles of transmission for various intracellular organisms. An otherwise healthy 24-year-old female patient presented with keratitis in her inflamed left eye. She was a contact lens wearer and had no history of corneal trauma. No acanthamoebae could be determined by culture methods. A Vannella strain (called VanAun0) isolated from corneal scrapings showed intracellular aggregating organisms. Within 1-2 days, the host amoebae ruptured, and numerous coccoid organisms (called Kaun1) were released. We succeeded in detecting the mechanisms of infection and intrusion of this eukaryotic organism, growing within the nucleus of the FLA, by light and electron microscopy. It could be shown that the spores at the cell membrane of strain KAun1 resemble Microsporidia and were taken up into the Amoeba by phagocytosis after adhesion of the spores and food cup formation (infective phase). The spores were transported into the cytoplasm of the vannellae in food vacuoles. Phase contrast microscopy revealed early stages of the parasites moving through the cytoplasm into the nucleus of the host amoeba. Electron microscopy showed the proliferation of polymorphic stages within the karyoplasm. The life cycle of these microsporidian-like organisms ended up with a sporogenic phase in which a terminal differentiation took place and numerous spores were released by rupture of the host cell wall. With the rupture of the host amoeba's cell membrane, the cycle started again from the beginning, the released infectious spores being ingested by other host amoebae. In particular, the morphology of the organelles made visible by electron microscopy finally allowed us to classify the endocytobionts as a microsporidan-like organism. Infection of Vannella sp. with the microsporidia-like organism strain KAun1 is a suitable model for studying the host-parasite relations of organisms using their hosts as so-called Trojan horses.
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PMID:Mechanism of intrusion of a microspordian-like organism into the nucleus of host amoebae (Vannella sp.) isolated from a keratitis patient. 1757 85

In the present article, the detection and the development of a parasitic endocytobiont within host amoebae (Acanthamoeba sp.) recently isolated from the contact lens and the inflamed eye of a patient with keratitis is presented. An otherwise healthy 55-year-old female patient presented with keratitis in her inflamed left eye. She was a contact lens wearer and had no history of a corneal trauma. Acanthamoebae as well as other smaller free-living amoebae could be detected from the fluid of the contact lens storage cases by culture methods. A successful therapy could be provided consequently. Two of these Acanthamoeba strains showed intracellular aggregating organisms. Within 2 to 3 days, the host amoebae ruptured, and numerous microorganisms were released. We succeeded in detecting the mechanism of infection and intrusion of this organisms by using light and electron microscopy. Infection with this endocytobiont is a suitable model for studying the host-parasite relations while the parasites use their hosts as so-called Trojan horses (see Barker, Lambert, Brown, Infect Immun 61:3503-3510, 1992).
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PMID:An extraordinary endocytobiont in Acanthamoeba sp. isolated from a patient with keratitis. 1821 Jan 54

Keratoconjunctivitis is a common infectious disease of the eye surface, which is caused by adenovirus. The chronic form is keratitis nummularis. Cyclosporin A is a calcineurin inhibitor which has been used in ophthalmology for approximately 15 years for local therapy of chronic inflammation of the eye surface. Since the 1990s this medication has proven effective for the treatment of keratitis nummularis. The indications for treatment with cyclosporin A eyedrops are given when a reduction in vision due to keratitis nummularis has not shown any improvement within 6 weeks after acute inflammation.
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PMID:[Cyclosporin A eyedrops for keratitis nummularis after adenovirus keratoconjunctivitis]. 1836 4

Infection with Herpes simplex virus type 1 (HSV-1) typically causes lesions of the mouth, face, skin, esophagus, or brain. Herpes simplex virus type 2 (HSV-2) usually causes infections of the genitals, rectum, skin, hands, or meninges. The herpes viruses are a major cause of blindness from keratitis. The usual drugs used for herpes are Vidarabine, Acyclovir, Penciclovir and Ganciclovir; they are associated with several complications. The aim of this study was to investigate if a formulation containing 2.5 mg melatonin and 100 mg SB-73 would help patients with herpes, and to compare the preparation with 200 mg Acyclovir. SB-73 is a mixture of magnesium, phosphate, fatty acids extracted from Aspergillus sp. which has anti-herpes virus properties. A single blind randomized study was performed in which 70 patients underwent treatment using the supplement cited above (group A) and 75 received treatment of 200 mg Acyclovir (group B). Sixty-seven patients of the group A (95.7%) reported a complete regression of symptoms after 7 days of treatment. By comparison, 64 subjects (85.3%) of the Acyclovir reported regression of symptoms in the same period. There was statiscally significant difference between the groups (P < 0.05).
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PMID:Regression of herpes viral infection symptoms using melatonin and SB-73: comparison with Acyclovir. 1841 May 85

Acanthamoeba species keratitis has been associated with soft contact lens wear. In the present report, an epidemiological link was established between the patient's isolate and well water from the home using molecular methods. To the authors' knowledge, this is the first case in Canada where such a link has been established. Primary care practitioners and specialists, including ophthalmologists and infectious diseases specialists, must maintain a high degree of clinical suspicion in soft contact lens wearers with keratitis unresponsive to conventional topical and systemic treatment.
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PMID:Acanthamoeba species Keratitis in a Soft Contact Lens Wearer Molecularly Linked to Well Water. 1841 87

Fungal keratitis, an important cause of corneal infectious disease, is one of the most challenging types of microbial keratitis to diagnose, isolate the etiologic fungal organism and treat successfully. Aspergillus spp. are most commonly responsible for fungal keratitis worldwide. Most cases occur in hot, humid climates. Fungi invade the ocular surface only when it is compromised and gain access into the corneal stroma through a defect in the epithelial barrier. Pathogens multiply then, and cause inflammatory reaction together with tissue necrosis. Symptoms of fungal keratitis typically are not as acute as those of other forms of microbial keratitis. On examination, both signs seen in other forms of microbial keratitis and specific features of fungal keratitis are observed. In all cases with suspected fungal keratitis, corneal smears and cultures should be performed as soon as possible. Antifungal therapy should be restricted to those cases with fungus-positive laboratory results. The use of topical corticosteroids in the treatment of fungal keratitis is contraindicated. In about one-third of patients pharmacological therapy is not successful. In those cases, surgical intervention is essential. The main goal of surgical intervention is to control infection and maintain the integrity of the globe. The most commonly performed surgery in fungal keratitis is therapeutic penetrating keratoplasty. The use of topical corticosteroids is contraindicated in early postoperative period.
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PMID:[Fungal infections of the cornea--diagnostics and management]. 1848


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