Ocular nocardia infections with special emphasis on the cornea

Surv Ophthalmol. Mar-Apr 2001;45(5):361-78. doi: 10.1016/s0039-6257(00)00207-1.

Abstract

Nocardia are aerobic, gram-positive, nonmotile and branching filamentous bacteria. Corneal infection by Nocardia is rare. Trauma is the most common predisposing factor. Isolated case reports of nocardial infection associated with contact lens wear and laser in situ keratomileusis (LASIK) have been reported. The clinical picture usually consists of superficial patchy infiltrates, which may be arranged in a wreath pattern. Presence of gram-positive, branching, beaded filaments that stain with 1% acid-fast stain (using 1% sulfuric acid, modified Kinyoun's method) in smears of corneal scrapings is suggestive of nocardial infection. Nocardia grow on commonly used media as tiny, white, dry colonies. Available knowledge and clinical experience suggest that although sulfacetamide eyedrops can be tried as the initial drug, trimethoprim-sulfamethoxazole and amikacin are effective drugs. Once therapy is initiated, the infiltrate responds promptly and resolves, forming a corneal scar with or without vascularization, and good visual recovery can be expected.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-Bacterial Agents / administration & dosage*
  • Cornea / microbiology
  • Cornea / pathology*
  • Corneal Ulcer / diagnosis
  • Corneal Ulcer / drug therapy
  • Corneal Ulcer / microbiology*
  • Diagnosis, Differential
  • Endophthalmitis / diagnosis
  • Endophthalmitis / drug therapy
  • Endophthalmitis / microbiology
  • Eye Infections, Bacterial* / diagnosis
  • Eye Infections, Bacterial* / drug therapy
  • Eye Infections, Bacterial* / microbiology
  • Humans
  • Keratitis / diagnosis
  • Keratitis / drug therapy
  • Keratitis / microbiology
  • Keratoconjunctivitis / diagnosis
  • Keratoconjunctivitis / drug therapy
  • Keratoconjunctivitis / microbiology
  • Nocardia / isolation & purification*
  • Nocardia Infections* / diagnosis
  • Nocardia Infections* / drug therapy
  • Nocardia Infections* / microbiology
  • Ophthalmic Solutions
  • Prognosis
  • Sulfacetamide / administration & dosage
  • Sulfamethoxazole / administration & dosage
  • Trimethoprim / administration & dosage

Substances

  • Anti-Bacterial Agents
  • Ophthalmic Solutions
  • Sulfacetamide
  • Trimethoprim
  • Sulfamethoxazole