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Nocardia infection following ocular surface surgery
Jingting Wang1,2,3, Xiuhai Lu1,2,3, Jungang Wang1,2,3
1Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Eye Institute of Shandong First Medical University, No. 372, Jingsi Road, Huaiyin District, Jinan, China.
Objective:
To investigate the clinical characteristics and treatment outcomes of Nocardia infection after ocular surface surgery.
Methods:
This is a retrospective study. Eight cases of culture-proven Nocardia infection, which developed within 1 month after ocular surface surgery were included. Demographics and clinical history of patients were investigated.
Results:
There were 8 eyes (2 left and 6 right) of 8 patients (5 males and 3 females), aged 27-65, with a median age of 52.9 years. Three cases underwent pterygium excision, three were subjected to conjunctival flap covering, and two were treated with lamellar corneal transplantation. The time interval between previous surgery and the onset of symptoms varied from 7 to 28 days (mean = 20.5 ± 7.13 days). All the cases presented grey-white infiltrates at the surgical incision site while appearing with six corneal ulcers and two conjunctival ulcers. Filaments of Nocardia were founded by confocal microscopy in two of the five cases. All responded poorly to medical therapy. Seven of the eight cases were treated with reoperation. Nocardia infection recurred in three cases after reoperation, and one was eviscerated.
Conclusions:
Surgical trauma is a risk factor for ocular Nocardia infection. Nocardia infection should be suspected when secondary infection occurs in a surgical incision with an atypical clinical presentation. The use of corticosteroids may influence the efficacy of drugs. Complete removal of lesions may lower the recurrence of Nocardia infection with poor drug treatment effects.
Insights
Ocular Nocardia infection can occur after eye surgery. Prompt surgical removal of infected tissue is crucial for managing Nocardia infection, as medical treatments are often ineffective.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Ocular surface surgery can predispose patients to secondary infections.
- Nocardia species are opportunistic pathogens that can cause severe infections.
Purpose of the Study:
- To investigate the clinical characteristics of Nocardia infection following ocular surface surgery.
- To evaluate the treatment outcomes for these infections.
Main Methods:
- Retrospective study of eight culture-proven Nocardia infection cases.
- Analysis of patient demographics, clinical history, and surgical procedures.
- Review of treatment strategies and outcomes.
Main Results:
- Nocardia infection occurred within one month post-surgery in patients aged 27-65.
- Common procedures included pterygium excision, conjunctival flap covering, and lamellar keratoplasty.
- Infections presented as infiltrates at surgical sites, corneal, or conjunctival ulcers.
- Medical therapy was largely ineffective; reoperation was required in seven cases.
- Recurrence was noted in three cases post-reoperation, with one eye requiring evisceration.
Conclusions:
- Surgical trauma is a significant risk factor for ocular Nocardia infection.
- Atypical presentations of secondary infections post-surgery warrant suspicion for Nocardia.
- Corticosteroid use may impact treatment efficacy.
- Complete surgical debridement is vital for reducing recurrence, especially with poor response to medical treatment.
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