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2008 OMIG, Abstract 4

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Nocardia Scleritis and Keratitis: A Case Series.
Mark D. Ewald, MD, Elisabeth J Cohen MD (sponsor), Peter R Laibson MD, Christopher J Rapuano MD, Kristin M Hammersmith MD
Cornea Department, Wills Eye Hosptial, Jefferson Univeristy

Purpose:          To compare the presentation, diagnosis, treatment and outcome of patients with scleritis and keratitis due to culture positive Nocardia infections.
Design:            Retrospective, comparative, non-interventional case series.
Participants:    A total of four eyes in four patients, followed for 4-27 months after presentation.
Methods:         Patients presented to a single referral-based corneal practice for further investigation and treatment of atypical scleritis or keratitis.  After presentation and examination, cultures were taken, and patients were treated using a broad-based antimicrobial approach.  Once the infecting organism was identified, antimicrobial treatment was tailored to treat Nocardia.
Results:           Two eyes presented with keratitis, and two eyes presented with sclero-keratitis.  All four eyes were treated initially for bacterial-related infections with topical anti-bacterial solutions.  In addition, two eyes were also covered for possible herpes simplex virus infections with oral anti-viral medications, and one eye was also treated for possible fungal keratitis with topical anti-fungal drops.  All four eyes were cultured either on presentation or once initial treatment did not appear to be curbing the infection.  Initial cultures for all four eyes grew Gram positive, filamentous bacteria.  Once the growth was identified as Nocardia species, antibacterial medications were changed to topical sulfacetamide 10% solution for keratitis or sulfacetamide 10% solution and Bactrim DS for scleritis.  Resolution of the infection and inflammation ranged from 14 to 27 days.
Conclusion:     Nocardia is an uncommon ocular infection, however it must be considered in atypical scleritis and keratitis if initial treatment is ineffective.  Cultures are necessary in identifying Nocardia.  By changing the anti-bacterial regimen to include sulfacetamide 10% drops for keratitis or sulfacetamide 10% drops plus systemic Bactrim DS for scleritis, ocular Nocardia infections can be effectively treated.

There is no grant or financial support for this investigation.
Disclosure code: N

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