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. 1996 Nov;80(11):962–968. doi: 10.1136/bjo.80.11.962

Non-tuberculous mycobacterial keratitis: a study of 22 cases.

S C Huang 1, H K Soong 1, J S Chang 1, Y S Liang 1
PMCID: PMC505672  PMID: 8976722

Abstract

AIM: To investigate causes and clinical findings of non-tuberculous mycobacterial keratitis, and to study its response to topical antibiotic therapy and surgical extirpative keratectomy. METHOD: A single centre, retrospective review of 22 patients with non-tuberculous mycobacterial keratitis seen in a 3 year period. Laboratory diagnoses were established with Ziehl-Nielsen acid fast staining and Löwenstein-Jensen cultures. RESULTS: In 20 patients (91%), there was an antecedent history of foreign body eye trauma (18 patients) or elective surgery (two patients). There were 19 cases of Mycobacterium chelonei, and three of M fortuitum. Clinical signs included epithelial defects, satellite or ring stromal infiltrates, crystalline keratopathy, and hypopyon. For topical antibiotic therapy, 20 patients received amikacin, while one patient received rifampin and another received ciprofloxacin, each in accordance with the results of the in vitro drug sensitivities. An extirpative keratectomy was performed in 15 cases; four of these cases additionally required a temporary conjunctival flap in order to finally eradicate the infection. At the end of the follow up period (median 18 months; range 3 months to 3 years) all eyes were stable and free of infection, with 19 (86%) having final visual acuities of 20/200 or better. CONCLUSION: Early clinical recognition and prompt laboratory diagnosis, together with aggressive topical antibiotic therapy and early keratectomy, may shorten morbidity and improve the clinical outcome of non-tuberculous mycobacterial keratitis.

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Selected References

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  1. Aylward G. W., Stacey A. R., Marsh R. J. Mycobacterium chelonei infection of a corneal graft. Br J Ophthalmol. 1987 Sep;71(9):690–693. doi: 10.1136/bjo.71.9.690. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bullington R. H., Jr, Lanier J. D., Font R. L. Nontuberculous mycobacterial keratitis. Report of two cases and review of the literature. Arch Ophthalmol. 1992 Apr;110(4):519–524. doi: 10.1001/archopht.1992.01080160097041. [DOI] [PubMed] [Google Scholar]
  3. Dalovisio J. R., Pankey G. A., Wallace R. J., Jones D. B. Clinical usefulness of amikacin and doxycycline in the treatment of infection due to Mycobacterium fortuitum and Mycobacterium chelonei. Rev Infect Dis. 1981 Sep-Oct;3(5):1068–1074. doi: 10.1093/clinids/3.5.1068. [DOI] [PubMed] [Google Scholar]
  4. Dugel P. U., Holland G. N., Brown H. H., Pettit T. H., Hofbauer J. D., Simons K. B., Ullman H., Bath P. E., Foos R. Y. Mycobacterium fortuitum keratitis. Am J Ophthalmol. 1988 Jun 15;105(6):661–669. doi: 10.1016/0002-9394(88)90061-x. [DOI] [PubMed] [Google Scholar]
  5. Gangadharam P. R., Lanier J. D., Jones D. E. Keratitis due to Mycobacterium chelonei. Tubercle. 1978 Mar;59(1):55–60. doi: 10.1016/0041-3879(77)90026-5. [DOI] [PubMed] [Google Scholar]
  6. Gorovoy M. S., Stern G. A., Hood C. I., Allen C. Intrastromal noninflammatory bacterial colonization of a corneal graft. Arch Ophthalmol. 1983 Nov;101(11):1749–1752. doi: 10.1001/archopht.1983.01040020751018. [DOI] [PubMed] [Google Scholar]
  7. Helm C. J., Holland G. N., Lin R., Berlin O. G., Bruckner D. A. Comparison of topical antibiotics for treating Mycobacterium fortuitum keratitis in an animal model. Am J Ophthalmol. 1993 Dec 15;116(6):700–707. doi: 10.1016/s0002-9394(14)73469-5. [DOI] [PubMed] [Google Scholar]
  8. Hu F. R. Extensive lamellar keratectomy for treatment of nontuberculous mycobacterial keratitis. Am J Ophthalmol. 1995 Jul;120(1):47–54. doi: 10.1016/s0002-9394(14)73758-4. [DOI] [PubMed] [Google Scholar]
  9. Hu F. R. Infectious crystalline keratopathy caused by Mycobacterium fortuitum and Pseudomonas aeruginosa. Am J Ophthalmol. 1990 Jun 15;109(6):738–739. doi: 10.1016/s0002-9394(14)72451-1. [DOI] [PubMed] [Google Scholar]
  10. Kent H. D., Cohen E. J., Laibson P. R., Arentsen J. J. Microbial keratitis and corneal ulceration associated with therapeutic soft contact lenses. CLAO J. 1990 Jan-Mar;16(1):49–52. [PubMed] [Google Scholar]
  11. Knapp A., Stern G. A., Hood C. I. Mycobacterium avium-intracellulare corneal ulcer. Cornea. 1987;6(3):175–180. doi: 10.1097/00003226-198706030-00004. [DOI] [PubMed] [Google Scholar]
  12. Laflamme M. Y., Poisson M., Chéhadé N. Mycobacterium chelonei keratitis following penetrating keratoplasty. Can J Ophthalmol. 1987 Apr;22(3):178–180. [PubMed] [Google Scholar]
  13. Lauring L. M., Wergeland F. L., Sack G. E. Anonymous mycobacterium keratitis. Am J Ophthalmol. 1969 Jan;67(1):130–133. doi: 10.1016/0002-9394(69)90017-8. [DOI] [PubMed] [Google Scholar]
  14. Lazar M., Nemet P., Bracha R., Campus A. Mycobacterium fortuitum keratitis. Am J Ophthalmol. 1974 Sep;78(3):530–532. doi: 10.1016/0002-9394(74)90246-3. [DOI] [PubMed] [Google Scholar]
  15. Levenson D. S., Harrison C. H. Mycobacterium fortuitum corneal ulcer. Arch Ophthalmol. 1966 Feb;75(2):189–191. doi: 10.1001/archopht.1966.00970050191007. [DOI] [PubMed] [Google Scholar]
  16. Lin R., Holland G. N., Helm C. J., Elias S. J., Berlin O. G., Bruckner D. A. Comparative efficacy of topical ciprofloxacin for treating Mycobacterium fortuitum and Mycobacterium chelonae keratitis in an animal model. Am J Ophthalmol. 1994 May 15;117(5):657–662. doi: 10.1016/s0002-9394(14)70074-1. [DOI] [PubMed] [Google Scholar]
  17. Matoba A. Mycobacterium chelonae keratitis. Am J Ophthalmol. 1987 Apr 15;103(4):595–596. doi: 10.1016/s0002-9394(14)74291-6. [DOI] [PubMed] [Google Scholar]
  18. Meisler D. M., Friedlaender M. H., Okumoto M. Mycobacterium chelonei keratitis. Am J Ophthalmol. 1982 Sep;94(3):398–401. doi: 10.1016/0002-9394(82)90368-3. [DOI] [PubMed] [Google Scholar]
  19. Mirate D. J., Hull D. S., Steel J. H., Jr, Carter M. J. Mycobacterium chelonei keratitis: a case report. Br J Ophthalmol. 1983 May;67(5):324–326. doi: 10.1136/bjo.67.5.324. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Moore M. B., Newton C., Kaufman H. E. Chronic keratitis caused by Mycobacterium gordonae. Am J Ophthalmol. 1986 Oct 15;102(4):516–521. doi: 10.1016/0002-9394(86)90083-8. [DOI] [PubMed] [Google Scholar]
  21. Newman P. E., Goodman R. A., Waring G. O., 3rd, Finton R. J., Wilson L. A., Wright J., Cavanagh H. D. A cluster of cases of Mycobacterium chelonei keratitis associated with outpatient office procedures. Am J Ophthalmol. 1984 Mar;97(3):344–348. doi: 10.1016/0002-9394(84)90634-2. [DOI] [PubMed] [Google Scholar]
  22. RUNYON E. H. Anonymous mycobacteria in pulmonary disease. Med Clin North Am. 1959 Jan;43(1):273–290. doi: 10.1016/s0025-7125(16)34193-1. [DOI] [PubMed] [Google Scholar]
  23. Robin J. B., Beatty R. F., Dunn S., Trousdale M. D., Riffenburgh R., Rao N., Smith R. E. Mycobacterium chelonei keratitis after radial keratotomy. Am J Ophthalmol. 1986 Jul 15;102(1):72–79. doi: 10.1016/0002-9394(86)90212-6. [DOI] [PubMed] [Google Scholar]
  24. Schönherr U., Naumann G. O., Lang G. K., Bialasiewicz A. A. Sclerokeratitis caused by Mycobacterium marinum. Am J Ophthalmol. 1989 Nov 15;108(5):607–608. doi: 10.1016/0002-9394(89)90449-2. [DOI] [PubMed] [Google Scholar]
  25. Stevens R. K., Holland G. N., Paschal J. F., Phinney R. B., Berlin O. G., Bruckner D. A. Mycobacterium fortuitum keratitis. A comparison of topical ciprofloxacin and amikacin in an animal model. Cornea. 1992 Nov;11(6):500–504. [PubMed] [Google Scholar]
  26. TURNER L., STINSON I. MYCOBACTERIUM FORTUITUM; AS A CAUSE OF CORNEAL ULCER. Am J Ophthalmol. 1965 Aug;60:329–331. [PubMed] [Google Scholar]
  27. Tseng S. H., Hsiao W. C. Therapeutic lamellar keratectomy in the management of nontuberculous Mycobacterium keratitis refractory to medical treatments. Cornea. 1995 Mar;14(2):161–166. [PubMed] [Google Scholar]
  28. Turner L. Atypical mycobacterial infections in ophthalmology. Trans Am Ophthalmol Soc. 1970;68:667–729. [PMC free article] [PubMed] [Google Scholar]
  29. Wallace R. J., Jr, Jones D. B., Wiss K. Sulfonamide activity against Mycobacterium fortuitum and Mycobacterium chelonei. Rev Infect Dis. 1981 Sep-Oct;3(5):898–904. doi: 10.1093/clinids/3.5.898. [DOI] [PubMed] [Google Scholar]
  30. Wallace R. J., Jr, Swenson J. M., Silcox V. A., Good R. C., Tschen J. A., Stone M. S. Spectrum of disease due to rapidly growing mycobacteria. Rev Infect Dis. 1983 Jul-Aug;5(4):657–679. doi: 10.1093/clinids/5.4.657. [DOI] [PubMed] [Google Scholar]
  31. Willis W. E., Laibson P. R. Intractable Mycobacterium fortuitum corneal ulcer in man. Am J Ophthalmol. 1971 Feb;71(2):500–504. doi: 10.1016/0002-9394(71)90126-7. [DOI] [PubMed] [Google Scholar]
  32. Wunsh S. E., Byle G. L., Leopold I. H., Littman M. L. Mycobacterium fortuitum infection of corneal graft. Arch Ophthalmol. 1969 Nov;82(5):602–607. doi: 10.1001/archopht.1969.00990020600006. [DOI] [PubMed] [Google Scholar]
  33. Zabel R. W., Mintsioulis G., MacDonald I. Mycobacterium chelonei keratitis in a soft-contact-lens wearer. Can J Ophthalmol. 1988 Dec;23(7):315–317. [PubMed] [Google Scholar]

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