MDR - L. V. Prasad Eye Instituteclassroster.lvpei.org/cr/images/ARCHEIVE/2016/FEB/Dr... · Web...
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Type Grand Rounds (CMC) Date 04.02.16 MR no P855021 Presenter Dr. Maria Agustina Borrone Moderator s Dr. Muralidhar R Dr. Joveeta Joseph Clinical summary: A 22-year-old lady who presented with complaints of redness, watering associated with decreased vision in her left eye, for past 20 days. On further inquiry her symptoms commenced after a foreign body particle fell in her left eye. No similar events in the past. Slit lamp examination showed presence of a mild lid edema, circumciliary congestion, cornea showed presence of paracentral epithelial defect, grayish white suppurative dense foci of infiltrate extending upto mid to deep stromal level. Thorough scrutiny exposed distinct feathery margins with surrounding stromal edema associated cellularity with numerous radiating folds extending centrifugally, reminiscent of a ‘cracked windshield’ appearance. The characteristic morphological corneal lesion prompted us to repeat diagnostic scraping, so as to include smears for 20% AFB and inoculate in a fastidious culture media. Based on the history and examination, a presumptive clinical diagnosis of atypical mycobacterial keratitis was validated microbiologically.
Transcript of MDR - L. V. Prasad Eye Instituteclassroster.lvpei.org/cr/images/ARCHEIVE/2016/FEB/Dr... · Web...
MDR
Type
Grand Rounds (CMC)
Date
04.02.16
MR no
P855021
Presenter
Dr. Maria Agustina Borrone
Moderators
Dr. Muralidhar R
Dr. Joveeta Joseph
Clinical summary:
A 22-year-old lady who presented with complaints of redness, watering associated with decreased vision in her left eye, for past 20 days. On further inquiry her symptoms commenced after a foreign body particle fell in her left eye. No similar events in the past. Slit lamp examination showed presence of a mild lid edema, circumciliary congestion, cornea showed presence of paracentral epithelial defect, grayish white suppurative dense foci of infiltrate extending upto mid to deep stromal level. Thorough scrutiny exposed distinct feathery margins with surrounding stromal edema associated cellularity with numerous radiating folds extending centrifugally, reminiscent of a ‘cracked windshield’ appearance. The characteristic morphological corneal lesion prompted us to repeat diagnostic scraping, so as to include smears for 20% AFB and inoculate in a fastidious culture media.
Based on the history and examination, a presumptive clinical diagnosis of atypical mycobacterial keratitis was validated microbiologically.
Systematic approach in the diagnosis and management of the atypical mycobacterial infection shall be discussed.
Legends:
Fig 1 a & b: Slit lamp photographs showing pre and post treatment.
Fig 2: Photomicrograph revealing numerous acid-fast bacilli
DNB questions:
1. What is the basis for acid fast staining? When do we consider 1% Vs. 20%
2. How to distinguish different types of Mycobacteria.
3. What is microbiological significance?
4. Salient features of atypical mycobacterial keratitis
5. Importance of distinctive clinical findings of microbial keratitis
1.Ashok Kumar Reddy, Prashant Garg, K. Hari Babu, Usha Gopinathan & Savitri Sharma (2010) In Vitro Antibiotic Susceptibility of Rapidly Growing Nontuberculous Mycobacteria Isolated from Patients with Microbial Keratitis, Current Eye Research, 35:3, 225-229
2. Wajiha J. Review Article Nontuberculous Mycobacterial Ocular Infections: A Systematic Review of the Literature. BioMed Research International, Feb 2015
3.H.-S. Chu and F.-R. Hu. Non-tuberculous mycobacterial keratitis. Clinical Microbiology and Infection, Volume 19 Number 3, March 2013
