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2015 Agenda and Abstracts | < Previous | Next >

2015 OMIG Abstract 6

Staphylococcus Caprae Polymicrobial Keratitis
David J. Harris, III, MD1 and David J. Harris, Jr., MD2
1Department of Ophthalmology & Visual Sciences, University of Kentucky, Lexington, KY,
2Department of Surgery, The University of Tennessee Graduate School of Medicine, Knoxville, TN

Purpose: To describe a case of polymicrobial keratitis, caused in part by Staphylococcus caprae, an organism not previously reported as a human ocular pathogen.

Method: Retrospective case report.

Results: A 65 year-old diabetic female long-term daily contact lens wearer presented to her ophthalmologist with acute pain and decreased vision in the right eye. After 30 days of empiric treatment of the large corneal infiltrate and ulcer with topical moxifloxacin, erythromycin, natamycin, and fortified gentamicin, she was referred because of progressive stromal infiltration and thinning. Culture of corneal scrapings performed at that time rapidly grew Staphylococcus caprae, sensitive to vancomycin. The eye at first improved under treatment with topical fortified vancomycin and systemic fluconazole, but the infiltrate and hypopyon increased during the second week of treatment. Fungal cultures of the original scrapings began to grow Paecilomyces lilacanus, and a central descemetocele formed. A therapeutic penetrating keratoplasty was performed. Histopathology of the resected cornea revealed fungal elements but no bacteria. The patient had an uneventful recovery with no recurrence of keratitis and a clear graft.

Conclusions: Staphylococcus caprae, a coagulase-negative organism usually associated with goats, has rarely been reported in human bone and joint infections, but never as an eye pathogen. In this polymicrobial case, with no known exposure to goats, eradication of the bacterial component, confirmed by histopathology, probably caused transient improvement, but the fungal component necessitated a penetrating graft. This case demonstrates that failure of keratitis to respond to antibiotics may result not only from resistance, but also from a second unsuspected organism. It remains unknown whether Staphylococcus caprae can be a corneal pathogen alone.


2015 Agenda and Abstracts | < Previous | Next >