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Case Reports
. 2023 Oct 6;14(1):507-512.
doi: 10.1159/000533906. eCollection 2023 Jan-Dec.

A Case of Nocardia africana-Related Keratitis

Winai Chaidaroon  1 , Prangchanok Sawetwong  1 , Sirinya Manochomphu  2
Affiliations
Case Reports

A Case of Nocardia africana-Related Keratitis

Winai Chaidaroon et al. Case Rep Ophthalmol. .

Abstract

Nocardia spp. are gram positive, aerobic, weakly acid-fast bacteria. Nocardia spp. keratitis is a rare ocular infection classically described following corneal injury or vegetative and soil exposure. However, keratitis caused by Nocardia africana had never been reported in the literature. We first reported a 70-year-old male who had a traumatic ocular injury to his left eye a month ago. With his complaint of left eye pain, reduced vision, and light sensitivity, the slit-lamp biomicroscopy showed the superficial multi-lobulated epithelial infiltration located at the inferior cornea with a positive fluorescein stain. Microscopic workup from corneal specimens demonstrated dry and chalky white colonies on blood agar and Lowenstein-Jensen media resembling Nocardia spp. The MALDI-TOF MS analyses using VITEK® MS exhibited N. africana. The corneal lesion was treated with 2% amikacin topical eye drops and responded well. The careful history-taking, precise clinical examinations, and meticulous microscopic assessment were the cornerstones of diagnosis. Definite diagnosis and timely treatment were essential to prevention of ocular morbidity in N. africana.

Keywords: Corneal ulcer; Keratitis; Nocardia africana.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1.
Fig. 1.
Photographs of the left eye before and after treatment. a At the first visit, superficial multi-lobulated epithelial infiltration of 4 × 4 mm located at the inferior cornea. An irregular epithelial surface, mild anterior chamber inflammation with a small hypopyon, and moderate conjunctival injection were noted. b Slit beam biomicroscopy revealed irregular multi-lobulated superficial corneal infiltration (arrow). c Fluorescein stain picture showed positive fluorescein epithelial staining at the irregular surface of the lower cornea. d After 3 weeks of medical treatment, the edge of lesions became flat and well demarcated, with an irregular superficial corneal epithelial healing.
Fig. 2.
Fig. 2.
a, b Numerous dry and chalky white colonies of Nocardia spp. grew up on blood agar and Lowenstein-Jensen agar. c Gram-positive bacilli with filamentous branching found in Gram stain ×100. d modified acid-fast stain demonstrated partial eosinophilic filamentous pathogens ×100.
See this image and copyright information in PMC

References

    1. Rodríguez-Lozano J, Armiñanzas Castillo C, Ruiz de Alegría Puig C, Ventosa Ayarza JA, Fariñas MC, Agüero J, et al. . Post-traumatic endophthalmitis caused by Nocardia nova. JMM Case Rep. 2019;6(2):e005175. 10.1099/jmmcr.0.005175. - DOI - PMC - PubMed
    1. Soleimani M, Masoumi A, Khodavaisy S, Heidari M, Haydar AA, Izadi A. Current diagnostic tools and management modalities of Nocardia keratitis. J Ophthalmic Inflamm Infect. 2020;10(1):36. 10.1186/s12348-020-00228-w. - DOI - PMC - PubMed
    1. Hamid ME, Maldonado L, Sharaf Eldin GS, Mohamed MF, Saeed NS, Goodfellow M. Nocardia africana sp. nov., a new pathogen isolated from patients with pulmonary infections. J Clin Microbiol. 2001;39(2):625–30. 10.1128/JCM.39.2.625-630.2001. - DOI - PMC - PubMed
    1. Chaidaroon W, Tantayakom T. Nocardia keratitis in a human immunodeficiency virus patient. Jpn J Ophthalmol. 2004;48(3):272–5. 10.1007/s10384-003-0046-7. - DOI - PubMed
    1. Sharma D, Mathur U, Gour A, Acharya M, Gupta N, Sapra N. Nocardia infection following intraocular surgery: report of seven cases from a tertiary eye hospital. Indian J Ophthalmol. 2017;65(5):371–5. 10.4103/ijo.IJO_564_16. - DOI - PMC - PubMed

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