title: Outbreak of Nocardia keratitis after photorefractive keratectomy: clinical, microbiological, histopathological, and confocal scan study.
abstract: Nocardia keratitis occurred in 4 eyes of 3 patients (2 women and 1 man) who had photorefractive keratectomy (PRK) by the same surgeon at the same center. Two eyes of the first 2 patients required lamellar keratectomy to debulk the involved stroma and obtain specimens for microbiological and histopathological evaluation. Light microscopic examination disclosed gram-positive and acid-fast filaments of Nocardia that were confirmed by the microbiological results. Diagnosis of Nocardia keratitis in the third case was not as challenging as in the first 2 cases because of a high index of suspicion. Confocal scans of all cases disclosed hyperreflective and slender, fibril-like structures in the corneal stroma. All eyes responded favorably to topical amikacin and the infection resolved without recurrence. The most probable cause of the outbreak was inadequate attention to sterility during surgery.
authors.affiliation: Labbafinejad Ophthalmic Research Center, Shaheed Beheshti Medical University, Tehran, Iran. ma_javadi@yahoo.com
authors.forename: Mohammad-Ali
authors.initials: MA
authors.lastname: Javadi
authors.forename: Mozhgan Rezaei
authors.initials: MR
authors.lastname: Kanavi
authors.forename: Siamak
authors.initials: S
authors.lastname: Zarei-Ghanavati
authors.forename: Siamak
authors.initials: S
authors.lastname: Zarei
authors.forename: Firooz
authors.initials: F
authors.lastname: Mirbabaei
authors.forename: Hosein
authors.initials: H
authors.lastname: Jamali
authors.forename: Mohamadreza
authors.initials: M
authors.lastname: Shoja
authors.forename: Manijeh
authors.initials: M
authors.lastname: Mahdavi
authors.forename: Nima
authors.initials: N
authors.lastname: Naghshgar
authors.forename: Shahin
authors.initials: S
authors.lastname: Yazdani
authors.forename: Amir
authors.initials: A
authors.lastname: Faramarzi
mesh_terms: D000328:Adult; D000583:Amikacin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004196:Disease Outbreaks; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D007492:Iran / Q000453:epidemiology; D007634:Keratitis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D008297:Male; D018613:Microscopy, Confocal; D009615:Nocardia / Q000302:isolation & purification; D009617:Nocardia Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D018903:Photorefractive Keratectomy / Q000009:adverse effects*; D014792:Visual Acuity
chemical_list: D000900:Anti-Bacterial Agents; D000583:Amikacin