title: Dual infection by streptococcus and atypical mycobacteria following Ahmed glaucoma valve surgery.
abstract: OBJECTIVE
  To report a case of late postoperative endophthalmitis caused by Streptococcus pneumoniae and conjunctival necrosis by Streptococcus pneumoniae and Mycobacterium fortuitum following Ahmed glaucoma valve (AGV) surgery in a young patient.
  
  
  METHODS
  Case report of a 13-year-old boy with purulent exudates and extensive conjunctival necrosis two months following amniotic membrane graft and conjunctival closure (for conjunctival retraction post AGV for secondary glaucoma).
  
  
  RESULTS
  The conjunctiva showed extensive necrosis causing exposure of the tube and plate associated with frank exudates in the area adjoining the plate and anterior chamber mandating explantation of the plate along with intravitreal antibiotics. The vitreous aspirate grew Streptococcus pneumoniae while Streptococcus pneumoniae with Mycobacterium fortuitum was isolated from the explanted plate. Despite adequate control of infection following surgery, the final visual outcome was poor owing to disc pallor.
  
  
  CONCLUSIONS
  Conjunctival necrosis and retraction post-AGV can cause late postoperative co-infections by fulminant and slow-growing organisms. A close follow-up is therefore essential in these cases to prevent sight-threatening complications.
authors.affiliation: LV Prasad Eye Institute, Patia , Bhubaneswar, Orissa, India. aparna@lvpei.org
authors.forename: Aparna
authors.initials: A
authors.lastname: Rao
authors.forename: Batriti
authors.initials: B
authors.lastname: Wallang
authors.forename: Tapas Ranjan
authors.initials: TR
authors.lastname: Padhy
authors.forename: Ruchi
authors.initials: R
authors.lastname: Mittal
authors.forename: Savitri
authors.initials: S
authors.lastname: Sharma
mesh_terms: D000293:Adolescent; D000583:Amikacin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002437:Cefazolin / Q000627:therapeutic use; D003228:Conjunctiva / Q000473:pathology; D004359:Drug Therapy, Combination; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005901:Glaucoma / Q000601:surgery; D020327:Glaucoma Drainage Implants; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D019907:Mycobacterium fortuitum / Q000187:drug effects / Q000302:isolation & purification; D009336:Necrosis; D011008:Pneumococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D011183:Postoperative Complications; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification; D014822:Vitreous Body / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents; D000583:Amikacin; D002437:Cefazolin