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The Ocular Surface Oct 2019The purpose of this study was to review the published incidence, etiology, clinical features and management of patients who developed infectious interface keratitis...
PURPOSE
The purpose of this study was to review the published incidence, etiology, clinical features and management of patients who developed infectious interface keratitis (IIK) following lamellar keratoplasty.
DESIGN
This study is a systematic literature review.
METHODS
We conducted a systematic review of published Chinese and English report through a PubMed search with the medical subject headings using the following terms: corneal transplantation, keratoplasty, anterior lamellar keratoplasty (ALK), deep anterior lamellar keratoplasty (DALK), deep lamellar endothelial keratoplasty (DLEK), Descemet membrane endothelial keratoplasty (DMEK), Descemet stripping endothelial keratoplasty (DSEK), Descemet stripping automated endothelial keratoplasty (DSAEK), infectious interface keratitis (IIK), fungal keratitis, and bacterial keratitis. Data collected included patient demographics, surgical technique, clinical signs, treatment, outcomes, and donor rim cultures. A review of the relevant literatures was also undertaken.
RESULTS
From 2007 to Feb. 2018, we identified 62 cases of IIK following lamellar corneal surgery. The mean age was 26.95 ± 8.80 years with a male/female ratio of 11:8 in DALK/ALK group and 69.65 ± 8.00 years with a male/female ratio of 17:16 in DSAEK/DSEK/DMEK group (no gender information for 10 cases). Of the 62 cases, 46 cases (75.41%) were fungal, 9 cases (14.75%) were bacterial, 2 cases (3.28%) were Actinomyces species, 1 case (1.64%) was acanthamoeba, and 4 cases (6.56%) were indeterminant. The mean onset of symptoms was postoperative day (POD) 49.47 ± 48.56 in DALK/ALK group, and 53 ± 112.01 in EK group, and 62.44 ± 50.07 for the bacterial keratitis, and 51.5 ± 102.42 for fungal keratitis. The mean postoperative follow-up period was 10.10 ± 9.36 months in DALK/ALK group and 12.37 ± 12.28 months in DSAEK/DSEK/DMEK group. Of the total 62 cases, 1 case (1.61%) with a Klebsiella pneumoniae positive donor rim cultures was associated with the same pathogen in the IIK, and 16 cases (25.81%) of fungal positive donor rim cultures were associated with the same pathogen in the IIK. Clinical signs included conjunctival injection, interface opacity, stromal edema for bacterial keratitis, and dense white infiltrates at the interface with endothelial plaques in some cases of fungal keratitis. Medical treatment included topical and oral antimicrobial agents. Surgical interventions included therapeutic keratoplasty. In 15 cases (24.19%), medical management was successful. Of the remaining 47 cases, 8 (12.90%) were managed with a repeat lamellar keratoplasty (LK) and 39 (62.90%) were unresponsive to conservative medical treatment and underwent a therapeutic keratoplasty (TKP). Post infectious best corrected visual acuity (BCVA) was logMAR 0 in 7 eyes (11.29%), better than or equal to logMAR 0.4 in 20 eyes (32.26%), less than logMAR 0.4 in 22 eyes (35.48%) and logMAR 0.7 or worse in 13 eyes (20.97%). In the rim culture negative group(n = 19), the average BCVA was logMAR 0.59 ± 0.68, with was logMAR 0.44 ± 0.74 in rim culture positive group (n = 15). There were three recurrence cases were reported after DMEK during the postoperative follow-up period.
CONCLUSIONS
Infectious interface keratitis (IIK) is an uncommon complication of lamellar keratoplasty, but it can result in a substantial loss of vision or permanent blindness. Although graft infection can occur at any time following surgery, it most commonly (87%) occurred during the first 3 months postoperatively (54/62 cases). The most commonly reported causative organism of IIK following lamellar keratoplasty was C. albicans. Positive rim culture results can provide more rapid and appropriate treatment directed to the identified organism. Therapeutic keratoplasty (TKP) was the most common surgical procedure for the management of IIK. Visual outcomes post TKP are fair with 32.26% (20/62) of patients obtaining LogMAR 0.4 or better.
Topics: Corneal Transplantation; Eye Infections, Bacterial; Global Health; Graft Survival; Humans; Incidence; Keratitis; Surgical Wound Infection; Visual Acuity
PubMed: 31415815
DOI: 10.1016/j.jtos.2019.08.001 -
Medicina (Kaunas, Lithuania) Jul 2019: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impaired communication, social interaction disorder, and repetitive behavior.... (Meta-Analysis)
Meta-Analysis
: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impaired communication, social interaction disorder, and repetitive behavior. Dysbiotic gut microbiota (GM) could be a contributing factor to the appearance of ASD, as gastrointestinal (GI) symptoms are comorbidities frequently reported in ASD. As there is a lack of reviews about the role played by GM in the GI symptoms of ASD, this work aimed to carry out a systematic review of current studies comparing the GM of children with ASD and GI symptoms with those of healthy controls in the last six years. The systematic review was performed following the PRISMA guidelines. The databases chosen were Web of Science, Scopus, PubMed, and PsycINFO, and the keywords were (gut* OR intestine* OR bowel* OR gastrointestinal*) AND (microbiota* OR microflora* OR bacteria* OR microbiome* OR flora* OR bacterial* OR bacteria* OR microorganism* OR feces* OR stool*) AND (autistic* OR autism* OR ASD*). : A total of 16 articles were included. Ten articles performed correlations analysis between GI symptoms and ASD. Among those 10 articles, 7 found differences between the GI symptoms present in children with ASD and healthy controls. The most common GI symptom was constipation. Among the seven articles that found differences, three performed correlations analysis between GI symptoms and gut microbe abundance. , , , and showed higher and lower abundance, respectively, in children with ASD and GI symptoms in more than one article. , , , , , , and / ratios showed abundance discrepancies. : It is still too early to draw a conclusion about the gut microbes involved in GI symptoms of ASD. Future research should consider the relationship between ASD behavior, GM, and GI symptoms in a multidisciplinary way and homogenize sample characteristics.
Topics: Autism Spectrum Disorder; Gastrointestinal Microbiome; Gastrointestinal Tract; Humans; Syndrome
PubMed: 31357482
DOI: 10.3390/medicina55080408 -
Gynecologie, Obstetrique, Fertilite &... Dec 2018To provide national clinical guidelines focusing on intrauterine contraception.
OBJECTIVE
To provide national clinical guidelines focusing on intrauterine contraception.
METHODS
A systematic review of available literature was performed using Pubmed and Cochrane libraries. American, British and Canadian guidelines were considered as well.
RESULTS
Intrauterine contraception (IUC) displays a wide panel of indications, including adolescents, nulliparous, patients living with HIV before AIDS (Grade B) and women with history of ectopic pregnancy (Grade C). Cervical cancer screening should not be modified in women with IUC (Grade B). Bimanual examination and cervix inspection are mandatory before device insertion (Grade B). Patients should not systematically undergo screening for sexually transmitted infections (STI) before device insertion (Grade B). Screening for STI should be preferably done before insertion but it can be performed at the time of device insertion in asymptomatic women (Grade B). Routine antibiotic prophylaxis and premedication are not recommended before insertion (Grade A). A follow-up visit may be offered several weeks after insertion (Professional consensus). Routine pelvic ultrasound examination in not recommended after device insertion (Grade B). In patients with IUC, unscheduled bleeding, when persistent or associated with pelvic pain, requires further investigation to rule out complication (Professional agreement). Suspected uterine perforation warrants radiological workup to locate the device (Professional consensus). Laparoscopic approach should be preferred for elective removal of intrauterine device from abdominal cavity (Professional consensus). In case of accidental pregnancy with intrauterine device in situ, ectopic pregnancy should be excluded (Grade B). In case of viable and desired intrauterine pregnancy, intrauterine device removal is recommended if the strings are reachable (Grade C). Detection of Actinomyces-like organisms on pap smear in asymptomatic patients with intrauterine contraception does not require further intervention (Grade B). Immediate removal of intrauterine device is not recommended in case of STI or pelvic inflammatory disease (Grade B). Device removal should be considered in the absence of clinical improvement after 48 to 72 hours of appropriate treatment (Grade B).
CONCLUSION
Intrauterine contraception is a long-acting and reversible contraception method displaying great efficacy and high continuation rate. In contrast, complication rate is low. It should thus be offered to both nulliparous and multiparous women.
Topics: Adolescent; Adult; Contraception; Device Removal; Female; France; Humans; Intrauterine Devices; Pelvic Inflammatory Disease; Pregnancy; Pregnancy, Ectopic; Sexually Transmitted Diseases; Uterine Hemorrhage
PubMed: 30429071
DOI: 10.1016/j.gofs.2018.10.004 -
Practical Neurology Oct 2018A 63-year-old man presented with a 2-month history of progressive right-sided exophthalmos, painful ophthalmoplegia and fevers. As more features developed, he was... (Review)
Review
A 63-year-old man presented with a 2-month history of progressive right-sided exophthalmos, painful ophthalmoplegia and fevers. As more features developed, he was diagnosed with giant cell arteritis, then Tolosa-Hunt syndrome, and transiently responded to corticosteroids. A bland cerebrospinal fluid and highly metabolically active brain (F)-fluoro-D-glucose-positron emission tomography suggested lymphoma. Biopsy of the mass showed sulphur granules with Gram-positive filamentous bacteria with -like colonies. cavernous sinus infections are rare and indolent. They often mimic non-infective causes including other inflammatory and infiltrative conditions, vascular and neoplastic causes, particularly lymphoma. Clinicians should consider infective cavernous sinus syndromes in people with a fluctuating painful ophthalmoplegia that responds poorly to corticosteroids. The term Tolosa-Hunt syndrome is problematic and should be retired or used only with reservation.
Topics: Actinomyces; Actinomycosis; Cavernous Sinus; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Sinusitis
PubMed: 29650638
DOI: 10.1136/practneurol-2017-001844 -
Tuberculosis (Edinburgh, Scotland) Mar 2018The lung microbiota has received less attention compared to other body sites, in part because its study carries special technological difficulties related to obtaining... (Meta-Analysis)
Meta-Analysis
The lung microbiota has received less attention compared to other body sites, in part because its study carries special technological difficulties related to obtaining reliable samples as compared to other body niches. The limited number of studies on the sputum microbiota on TB patients and controls available so far have reported inconsistent, and sometimes, contradictory results. Aiming to clarify if changes in the lung microbiota composition are associated with pulmonary TB, we performed a meta-analysis of available data on microbiota of the lower respiratory tract in TB patients and healthy controls. Re-processing next generation sequencing data under uniform parameters and utilizing state-of-the-art bioinformatics analysis, we obtained distinct clusterings of microbiota between TB cases vs. controls across multiple studies. We identified Tumebacillus ginsengisoli, Propionibacterium acnes, Haemophilus parahaemolyticus as differentially abundant species signature in healthy controls while Caulobacter henricii, Actinomyces graevenitzii, Rothia mucilaginosa, in addition to Mycobacterium tuberculosis as differentially abundant species signature in TB cases, and described R. mucilaginosa as the anchoring species in a network of bacteria co-occurring with Mycobacterium tuberculosis (Mtb) infection.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacteria; Case-Control Studies; Coinfection; Female; Humans; Lung; Male; Microbiota; Middle Aged; Mycobacterium tuberculosis; Sputum; Tuberculosis, Pulmonary; Young Adult
PubMed: 29559113
DOI: 10.1016/j.tube.2018.02.006 -
Journal of the Pediatric Infectious... Sep 2015Actinomycetes are Gram-positive bacteria that can be part of the normal human flora of the gastrointestinal, pulmonary, and genital tract. Infections are rare, slowly... (Review)
Review
Actinomycetes are Gram-positive bacteria that can be part of the normal human flora of the gastrointestinal, pulmonary, and genital tract. Infections are rare, slowly progressing and most commonly affect the cervicofacial region. Actinomyces israelii is the most frequently isolated species but a number of other species may cause infection. We report the first postnatally acquired case of an actinomycosis caused by A. neuii in a child. We also provide a systematic review of all published cases of A. neuii infections. In children, there is one case report of a premature infant with perinatally acquired A. neuii sepsis. In adults 21 cases have currently been reported and A. neuii infection was associated with endophthalmitis after eye surgery, foreign material-associated infection and abscess formation in the inguinal, axillary, and mammary area. Our case highlights that a A. neuii infection is also a potential differential diagnosis in children with chronic lymphadenitis.
Topics: Actinomyces; Actinomycosis; Amoxicillin; Anti-Bacterial Agents; Cervix Uteri; Chronic Disease; Clavulanic Acid; Diagnosis, Differential; Female; Humans; Infant; Lymphadenitis
PubMed: 26407440
DOI: 10.1093/jpids/piu096 -
Journal of Clinical Neuroscience :... May 2015Brain abscesses are rare but potentially deadly complications of odontogenic infections. This phenomenon has been described mainly in the form of case reports, as... (Review)
Review
Brain abscesses are rare but potentially deadly complications of odontogenic infections. This phenomenon has been described mainly in the form of case reports, as large-scale studies are difficult to perform. We compiled a total of 60 previously published cases of such a complication to investigate the predisposing factors, microbiology, and clinical outcomes of intracranial abscesses of odontogenic origin. A systematic review of the literature using the PubMed database was performed. Men accounted for 82.1% of cases, and the mean age was 42.1 years. Caries with periapical involvement and periodontitis were the two most common intra-oral sources, and wisdom tooth extraction was the most common preceding dental procedure. In 56.4% of cases, there were obvious signs of dental disease prior to development of intracranial infection. Commonly implicated microorganisms included Streptococcus viridans (especially the anginosus group), Actinomyces, Peptostreptococcus, Prevotella, Fusobacterium, Aggregatibacter actinomycetemcomitans and Eikenella corrodens. There was an 8.3% mortality rate. Intracranial abscesses can form anywhere within the brain, and appear unrelated to the side of dental involvement. This suggests that hematogenous spread is the most likely route of dissemination.
Topics: Bacterial Infections; Body Piercing; Brain Abscess; Humans; Mouth Mucosa; Peptostreptococcus; Tooth Extraction
PubMed: 25800939
DOI: 10.1016/j.jocn.2014.11.015 -
PloS One 2014To date, there is no compilation of evidence-based information associating bacteremia and periodontal procedures. This systematic review aims to assess magnitude,... (Review)
Review
BACKGROUND
To date, there is no compilation of evidence-based information associating bacteremia and periodontal procedures. This systematic review aims to assess magnitude, duration, prevalence and nature of bacteremia caused by periodontal procedures.
STUDY DESIGN
Systematic Review.
TYPES OF STUDIES REVIEWED
MEDLINE, EMBASE and LILACS databases were searched in duplicate through August, 2013 without language restriction. Observational studies were included if blood samples were collected before, during or after periodontal procedures of patients with periodontitis. The methodological quality was assessed in duplicate using the modified Newcastle-Ottawa scale (NOS).
RESULTS
Search strategy identified 509 potentially eligible articles and nine were included. Only four studies demonstrated high methodological quality, whereas five were of medium or low methodological quality. The study characteristics were considered too heterogeneous to conduct a meta-analysis. Among 219 analyzed patients, 106 (49.4%) had positive bacteremia. More frequent bacteria were S. viridans, A. actinomycetemcomitans P. gingivalis, M. micros and species Streptococcus and Actinomyces, although identification methods of microbiologic assays were different among studies.
CLINICAL IMPLICATIONS
Although half of the patients presented positive bacteremia after periodontal procedures, accurate results regarding the magnitude, duration and nature of bacteremia could not be confidentially assessed.
Topics: Bacteremia; Dental Prophylaxis; Humans; Observational Studies as Topic; Periodontal Diseases; Prevalence; Research Design
PubMed: 24870125
DOI: 10.1371/journal.pone.0098271 -
Journal of Oral Pathology & Medicine :... Sep 2013Bone resorption inhibitor-related osteopathology of the jaw (BRIOJ) is a severe complication in patients treated with bisphosphonates or denosumab. However, the precise... (Comparative Study)
Comparative Study Review
BACKGROUND
Bone resorption inhibitor-related osteopathology of the jaw (BRIOJ) is a severe complication in patients treated with bisphosphonates or denosumab. However, the precise pathogenesis of BRIOJ is not yet fully understood. Recent studies discovered the presence of Actinomyces colonies in biopsy material from BRIOJ patients. The aim of this study was to analyze current knowledge concerning the impact of Actinomyces on the pathogenesis of this condition and to present data from our own patients.
METHODS
Data from 51 patients with histopathological diagnoses of BRIOJ were retrospectively analyzed. In addition, a systematic literature search for studies describing the presence of Actinomyces was performed.
RESULTS
Actinomyces was present in 86% of our cases and 63.3% of 371 cases presented in the literature. All of our patients and 85% of patients described in the literature had a clearly defined local focus in association with osteopathology. A clear picture of whether Actinomyces colonizes the previously necrotic bone or contributes to inflammation causing subsequent bone necrosis is lacking in the literature.
CONCLUSION
The pathogenesis of BRIOJ remains unknown; however, there seems to be a role for Actinomyces, and possibly other pathogens, in the development of osteopathology of the jaws, which is not exclusive to bisphosphonate therapy. This study supports the hypothesis that an infectious component is of utmost importance for the pathogenesis of BRIOJ.
Topics: Actinomyces; Actinomycosis; Adult; Aged; Aged, 80 and over; Alendronate; Antibodies, Monoclonal, Humanized; Biopsy; Bisphosphonate-Associated Osteonecrosis of the Jaw; Bone Density Conservation Agents; Denosumab; Diphosphonates; Female; Humans; Imidazoles; Male; Middle Aged; RANK Ligand; Retrospective Studies; Tooth Extraction; Zoledronic Acid
PubMed: 23369166
DOI: 10.1111/jop.12038