Mycobacterium chelonae keratitis: elucidation of diagnosis through evaluation of smears of fluid from patient's contact lens care system.
OBJECTIVE
To describe the microbiologic diagnosis of putative Mycobacterium chelonae keratitis in a soft contact lens wearer by initial evaluation of Gram- and Kinyoun (acid fast)-stained smears of fluid from patient's contact lens care system.


METHODS
Corneal ulcer of suspected Acanthamoeba etiology developed in a 28-year-old soft contact lens wearer. After corneal scrapings were negative, microbiologic consultation led to evaluation of stained smears and culture of fluid from patient's contact lens care system.


RESULTS
Gram stain of smears showed a polymicrobic flora distinguished by numerous gram-positive, beaded, tightly banded, "diphtheroid-like" bacilli strongly suggestive of a rapidly growing mycobacterial species. Kinyoun-stained smears revealed innumerable acid-fast bacilli singly and in tightly woven bundles (cords), which culturally proved to be M. chelonae. Treatment with ciprofloxacin and amikacin resolved the ulcer.


CONCLUSIONS
Diagnosis of M. chelonae keratitis in contact lens wearers is often delayed or even overlooked. Additionally, in the absence of overt corneal injury, eg, trauma or surgery, a source for the infecting mycobacterial species in the setting of contact lens wear has not been identified. If searched for, however, as in the present case, the patient's contact lens care system may serve as the reservoir for the microorganism. Staining for acid-fast bacilli is further recommended when smears of contact lens care solution of a patient with a corneal ulcer shows the presence of gram-positive "diphtheroid-like" organisms.
Bottone
Edward J
EJ
Division of Infectious Diseases, The Mount Sinai Hospital, New York, NY 10029, USA. edward.bottone@mssm.edu
Cho
Ka Wing
KW
D000328:Adult; D000583:Amikacin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002939:Ciprofloxacin / Q000008:administration & dosage; D018639:Contact Lens Solutions / Q000009:adverse effects*; D003261:Contact Lenses / Q000382:microbiology*; D003315:Cornea / Q000382:microbiology; D003320:Corneal Ulcer / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D015818:Eye Infections, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D008297:Male; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D016926:Mycobacterium chelonae / Q000302:isolation & purification*; D009883:Ophthalmic Solutions; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D018639:Contact Lens Solutions; D009883:Ophthalmic Solutions; D002939:Ciprofloxacin; D000583:Amikacin