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Infectious crystalline keratitis induced by Citrobacter.

Zeba Khanam¹, Gaganjeet Singh Gujral¹, Shariq Wadood Khan²

¹Institute of Ophthalmology, J. N. Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.

GMS Ophthalmology Cases

|June 14, 2021

Summary

This case study highlights a rare infection of microbial keratitis caused by Citrobacter koseri. Prompt antimicrobial susceptibility testing and targeted levofloxacin treatment successfully restored the patient's vision.

Keywords:

Citrobacter crystalline keratopathy levofloxacin microbial keratitis

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Area of Science:

Ophthalmology
Microbiology

Background:

Microbial keratitis presents a significant threat to vision due to emerging resistant organisms.
Home remedies may delay effective treatment for serious eye infections.

Observation:

A 30-year-old female used rose nectar for presumed ocular ailment, leading to delayed presentation.
Infective keratitis was diagnosed in the left eye, initially treated empirically.

Findings:

Microbiological examination identified a rare gram-negative bacillus, Citrobacter koseri, as the causative agent.
Antimicrobial susceptibility testing guided a shift from moxifloxacin to levofloxacin eye drops.
The patient's vision improved from 20/120 to 20/30 with targeted 1.5% levofloxacin treatment over 3 months.

Implications:

Accurate diagnosis via corneal scrapings and susceptibility testing is crucial for effective microbial keratitis management.
Targeted antibiotic therapy based on sensitivity results is vital to prevent vision loss and combat antimicrobial resistance.
Avoiding empirical polypharmacy in eye infections is essential to prevent further resistance and vision deterioration.