zithromax and Eye-Infections--Parasitic

Topics: Anti-Bacterial Agents; Azithromycin; Child, Preschool; Chlamydia Infections; Chlamydia trachomatis; Eye Infections, Parasitic; Female; Humans; Incidence; Infant; Infant, Newborn; Male; Mass Drug Administration; Niger; Prevalence; Trachoma

To describe the clinical features, microbiological profile, and outcome of a series of cases of Pythium keratitis treated with topical and oral linezolid and topical azithromycin eye drops.. This was a retrospective interventional case series of microbiologically and/or histopathologically proven cases of Pythium keratitis seen between October 2016 and December 2019. All patients received a combination of topical linezolid and/or azithromycin eye drops with oral linezolid. Analysis of demographic data, predisposing risk factors, microbiological results, treatment regimen, visual acuity, surgical intervention, and final outcome was performed. A subgroup analysis of cases >6 mm in size was performed. Success was defined as complete resolution on medical management. Failure was defined as worsening of infection necessitating therapeutic penetrating keratoplasty or evisceration.. Of 21 cases, 2 were lost to follow up, 1 was diagnosed on histopathology, and 1 received only topical linezolid. Characteristic microbiological features were noted on 10% potassium hydroxide calcofluor white wet mount in 20/21 (95.23%) and Gram stain in 18/21 (85.71%). On triple drug regimen, 14/17 cases (82.35%) resolved. Average time to resolution was 87.64 ± 44.44 days. More than 60% infiltrates (13/21) were large, and 66.66% infiltrates resolved in 109.3 ± 57.06 days. Of the 5 failures, 4 needed therapeutic keratoplasty and 1 needed evisceration. All grafts failed.. The dual topical drug regimen with oral linezolid has good cure rates (over 80%) for Pythium keratitis over prolonged duration. It is recommended to persevere with medical therapy even in large infiltrates because more than two thirds resolved.

Topics: Administration, Ophthalmic; Administration, Oral; Adolescent; Adult; Aged; Anti-Bacterial Agents; Azithromycin; Child; Drug Therapy, Combination; Eye Infections, Parasitic; Female; Humans; Keratitis; Linezolid; Male; Middle Aged; Ophthalmic Solutions; Pythiosis; Retrospective Studies; Treatment Outcome

To report clinical profile and compare management options for Pythium keratitis.. Retrospective interventional study of 46 patients diagnosed as Pythium keratitis by PCR DNA sequencing from January 2014 to July 2017. Interventions were categorised into medical management (MM) (topical azithromycin and linezolid with oral azithromycin at presentation), surgery (S) (therapeutic penetrating keratoplasty, TPK), surgical adjunct (SA) (cryotherapy±alcohol with TPK) and medical adjunct (MA) (MM after TPK).. Primary treatment included MM (1 eye), SA (3 eyes) and S (42 eyes). Recurrence occurred in 27/43 eyes (MM+S group). Second surgery (S) was required in 11 eyes (TPK-2), with additional procedures (SA) in 10 eyes and evisceration in five eyes. 8/43 eyes received MA after TPK-1. One eye required TPK-3. Recurrence occured in all eyes that received MA (100%) and in 28 of 54 TPKs (51.8%) (TPK 1+2+3) in 42 eyes. Recurrence was noted in 1/14 (7.1%) that underwent SA.. The currently available and recommended treatment for Pythium keratitis is surgical by means of a TPK and in worse cases evisceration. In our study, MM/MA measures showed no benefit with recurrence or worsening of infection requiring resurgery. Almost 50% of TPKs had a recurrence requiring resurgery. However, adjunctive procedures during TPK appear to have additional benefit with low risk of recurrence and could be included as routine care.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Azithromycin; Child; Corneal Ulcer; DNA, Protozoan; Eye Infections, Parasitic; Female; Humans; Keratoplasty, Penetrating; Linezolid; Male; Middle Aged; Polymerase Chain Reaction; Pythiosis; Pythium; Retrospective Studies; Risk Factors; Treatment Outcome

To describe the previously unreported successful treatment of presumptive Pythium keratitis (PK) with medical therapy alone.. A 42-year-old female homemaker presented to us with a 15-day history of pain and redness in the right eye after a trivial injury. Her vision was 20/80 at presentation. Slit-lamp biomicroscopy revealed a central, dense and dry-looking, grayish-white infiltrate reaching mid stroma. The infiltrate had feathery margins and was surrounded by multiple tentacle-like lesions and peripherally expanding pinhead-sized subepithelial lesions. The contralateral eye was essentially normal. Diagnostic corneal scraping on smears revealed broad, aseptate, hyaline filaments with ribbon-like folds; very characteristic of Pythium species. Confocal imaging revealed fungal filaments. Based on corroborative evidence, a diagnosis of presumptive PK was made. She was administered a combination therapy consisting of eye drop linezolid 0.2% 1 hourly, azithromycin 1% 2 hourly, atropine sulfate 1% thrice daily, and oral azithromycin 500 mg once daily for 3 days in a week.. After initial worsening in the form of stromal expansion, regression of pinhead-sized lesions was seen with onset of scarring by as early as day 4 of intense medical therapy. The tentacle-like lesions did not worsen. On day 8, significant resolution was noted with scarring, and by the end of 2 weeks, the entire stromal lesion had scarred and complete resolution of expanding tentacles was observed in 3 weeks.. Presumptive Pythium keratitis of the patient completely resolved with antibacterial treatment alone. It is pertinent for ophthalmologists to be aware of this new treatment regimen.

Topics: Administration, Oral; Administration, Topical; Adult; Anti-Bacterial Agents; Atropine; Azithromycin; Drug Therapy, Combination; Eye Infections, Parasitic; Female; Humans; Keratitis; Linezolid; Mydriatics; Ophthalmic Solutions; Pythiosis; Pythium

Ocular toxoplasmosis may present in atypical fashion, particularly in immunosuppressed patients, and PCR is an important diagnostic tool especially when differentiating from other infectious causes.. A descriptive case-series demonstrating the use of a novel real-time PCR protocol targeting 529 bp repeat element, a multicopy and highly conserved fragment, in Toxoplasma gondii genome. This was designed and established by our microbiology service following independent, external validation.. Three immunosuppressed patients presenting to a tertiary uveitis referral centre with unilateral, severe, sight-threatening uveitis are described. One patient presented with a large focus of sight-threatening retinitis and occlusive vasculitis while on systemic immunosuppression with azathioprine and adalimumab for Crohn's disease. One patient with chronic lymphocytic leukaemia presented with severe posterior uveitis and total retinal detachment. Finally, the third patient presented with severe retinitis adjacent to the optic nerve and vitritis causing acute vision loss. HIV infection was subsequently identified. In all three cases, the cause of inflammation was not clear from clinical examination alone and prompt treatment was required to prevent permanent vision loss. Intraocular sampling and PCR testing was performed including testing for toxoplasmosis, herpesviruses and syphilis.. The novel real-time PCR assay described is more sensitive than those targeting the Toxoplasma B1 gene owing to the higher number of repeats and highly conserved sequence level. This technique can be applied in clinical practice and provides a valuable tool for the rapid diagnosis of ocular toxoplasmosis.

Topics: Aged; Azithromycin; Base Pairing; DNA Primers; DNA Probes; DNA, Protozoan; Drug Combinations; Eye Infections, Parasitic; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Prednisolone; Real-Time Polymerase Chain Reaction; Repetitive Sequences, Nucleic Acid; Toxoplasma; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination; Uveitis; Vitreous Body

Myiasis is the feeding of fly larvae on vertebrates. The sheep bot fly larva of Oestrus ovis is a mammalian parasite of the skin, nose, ears, and eyes. When the larvae infest and feed on the structures of the eye, the condition is termed ophthalmomyiasis. Most often this infestation is limited to the external structures of the eye and is referred to as ophthalmomyiasis externa. The features of this condition are severe local inflammation, positive foreign body sensation, erythema, and lacrimation. Vision may or may not be reduced, depending on involvement of the cornea. A 20-year-old white male soldier sought treatment for an inflamed eye and an irritated cornea OS. His eyelids were swollen with marked periorbital edema and conjunctival erythema OS. On slitlamp examination, small whitish organisms were viewed on the conjunctiva OS. The organisms were removed, preserved, and sent to Nova Southeastern University where they were identified as O. ovis first-stage larvae. The patient was treated with antibiotic ointment, and the inflammation resolved within 1 week. O. ovis has a worldwide distribution, and although sheep are the preferred host, humans may also serve as an intermediate host in the organism's life cycle. This case represents one of several reports of ophthalmomyiasis in the Middle East caused by O. ovis. U.S. troops stationed in Iraq and surrounding areas are vulnerable to eye infestation by fly larvae, and health care providers need to include this condition in their differential diagnosis of anterior segment inflammatory disorders.

Topics: Adult; Animals; Anti-Bacterial Agents; Azithromycin; Blepharitis; Conjunctivitis; Diptera; Edema; Erythromycin; Eye Infections, Parasitic; Humans; Iraq; Larva; Male; Military Medicine; Military Personnel; Myiasis; Orbital Diseases