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Nocardia keratitis: A case report
S Matuska1, P Rama, A Cavallero
1Department of Ophthalmology and Visual Sciences, University Hospital San Raffaele, Milano - Italy.
European Journal of Ophthalmology
|February 22, 2017
Summary
Nocardia keratitis can be resistant to topical amikacin, potentially causing severe reactions. Combination antibiotics and cautious corticosteroid use are vital for managing this infection.
Area of Science:
- Ophthalmology
- Medical Microbiology
Background:
- Nocardia keratitis is a serious ocular infection.
- Treatment challenges include antibiotic resistance and patient tolerance.
Purpose of the Study:
- To report a case of Nocardia keratitis with amikacin resistance and adverse reactions.
- To evaluate alternative treatment strategies and the role of corticosteroids.
Main Methods:
- Diagnosis of Nocardia asteroides via smear, culture, and biochemical analysis.
- Treatment involved escalating topical amikacin, followed by a combination antibiotic therapy (chloramphenicol, tetracycline, colistin, ofloxacin).
Main Results:
- Initial 2% amikacin was ineffective; 5% amikacin caused a toxic-allergic reaction.
- Combination therapy led to rapid improvement, but infection recurred after corticosteroid use.
- Prolonged combination antibiotic treatment (3 months) was successful.
Conclusions:
- Topical amikacin may be ineffective for Nocardia keratitis.
- Fortified amikacin can cause severe reactions; combination therapy is a viable alternative.
- Topical corticosteroids pose a risk of relapse and should be used cautiously.
