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Year : 2009  |  Volume : 27  |  Issue : 2  |  Page : 168--170

Nocardia puris endophthalmitis

D Papaventsis, N Siafakas, L Kondyli, M Akritidou, P Pantazi, E Perdikari, G Bethimoutis, G Chatzakis, L Zerva 
 Hellenic Red Cross Hospital and Attikon University General Hospital, Athens, Greece

Correspondence Address:
D Papaventsis
Hellenic Red Cross Hospital and Attikon University General Hospital, Athens

How to cite this article:
Papaventsis D, Siafakas N, Kondyli L, Akritidou M, Pantazi P, Perdikari E, Bethimoutis G, Chatzakis G, Zerva L. Nocardia puris endophthalmitis.Indian J Med Microbiol 2009;27:168-170

How to cite this URL:
Papaventsis D, Siafakas N, Kondyli L, Akritidou M, Pantazi P, Perdikari E, Bethimoutis G, Chatzakis G, Zerva L. Nocardia puris endophthalmitis. Indian J Med Microbiol [serial online] 2009 [cited 2020 Sep 27 ];27:168-170
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Full Text

Dear Editor,

Nocardiosis is a localized or disseminated infection caused by soil-borne aerobic actinomycetes. The genus Nocardia currently contains more than 50 species that have not been subjected to the same level of analysis by phenotypic and molecular methods. [1] New species recently characterized have been reported as human pathogens. [2] An 80-year-old man with a history of scleral buckle surgery for retinal detachment in 1986 in Vienna, Austria, was referred to our hospital in May 2007, after a period of 21 years with no symptoms. The patient presented with a 4-week history of severe inflammatory reaction in the anterior chamber and vitreous body of the right eye. Fundus examination revealed no scleral erosion by the silicone sponge explant. However, signs of explant inflammation were present. The sponge was removed and sent to the laboratory where pus formation was found. The microbiological diagnosis of a Nocardia spp. was made by conventional identification procedures (Gram stain, modified Kinyoun stain, colony morphology, nitrate reductase and urease production and esculin hydrolysis). The patient was treated with oral moxifloxacin hydrochloride (400 mg OD for >1 month). Topical treatment consisted of a combination therapy with antibiotics and corticosteroids. Marked improvement was seen after 10 days of therapy. There was no sign of inflammation and retinal detachment in the right eye. The patient was discharged with a visual acuity of 10/100 and was asked to visit the outpatient department for follow-up.

As molecular methods have revolutionized Nocardia taxonomy, a 16S rRNA gene sequencing and phylogenetic analysis was undertaken according to Hiraishi. [3] Analysis of the obtained 16S rRNA gene sequence with BLAST revealed that the isolate had a 98.9-99.9% sequence similarity with Nocardia puris strains. [4] The phylogram in [Figure 1] shows the close relationship of the isolate with other N. puris isolates. A discrete genetic cluster was clearly formed, supported by a bootstrap value of 1000.

To our knowledge, this is the first report of N. puris endophthalmitis. Post-operative endophthalmitis may occur weeks to years following surgery, but such a delayed infection in an immunocompetent patient was likely due to the low virulence of the organism introduced at the time of surgery. The 16S rRNA gene sequence results must be interpreted with caution and almost always in combination with phenotypic identification. Surgical therapy remains the cornerstone of therapy; however, newer fourth generation fluoroquinolones seem to play an important role in clinical recovery. [5]


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