Clinicomicrobiological review of Nocardia keratitis.
OBJECTIVE
To present the clinical profile, laboratory results, and outcome of treatment in 16 patients with Nocardia keratitis.


METHODS
A retrospective review of 16 culture-proven cases of Nocardia keratitis was done. Clinical and microbiologic data were analyzed.


RESULTS
Nocardia constituted 1.7% of laboratory-confirmed bacterial keratitis and was seen predominantly in male subjects (13 of 16) with a mean age of 39.1 years. Although the predisposing factor was unknown in the majority, a definite history of trauma was present in four (25%) cases. Patchy stromal infiltrates were seen in 12 patients. Wreath pattern of infiltrates (six of 16) and hypopyon (nine of 16) were notable features. Nocardia was detectable in corneal scrapings of 10 patients with Gram stain and all patients with 1% acid-fast preparation (six of six). Nocardia asteroides was the causative agent in all except one (N. caviae). All isolates were sensitive to gentamicin; however, topical 30% sulfacetamide was the preferred drug for treatment. Favorable outcome (healed scar) was achieved in 11.


CONCLUSIONS
Although Nocardia keratitis is a rare condition, a high index of clinical suspicion should be kept in agricultural workers or in patients with trauma who have patchy stromal infiltrates. Sulfonamides are the initial drug of choice, and gentamicin could be an effective alternative. If recognized early, Nocardia keratitis responds to medical treatment with good visual recovery.
Sridhar
M S
MS
Sight Savers' Corneal Training Centre, Hyderabad, India.
Sharma
S
S
Reddy
M K
MK
Mruthyunjay
P
P
Rao
G N
GN
D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D015169:Colony Count, Microbial; D003315:Cornea / Q000187:drug effects / Q000382:microbiology* / Q000473:pathology; D003320:Corneal Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009617:Nocardia Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D009616:Nocardia asteroides / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification*; D009883:Ophthalmic Solutions; D012189:Retrospective Studies; D013409:Sulfacetamide / Q000008:administration & dosage / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D009883:Ophthalmic Solutions; D013409:Sulfacetamide