PDF(Sci-hub)
Abstract：
Nocardia farcinica is one of the more recently identified species of the Nocardia genus. Nocardia farcinica keratitis is a rare occurrence, with only eight previously reported cases. Semi-permeable rigid contact lens use was associated with one of these reported cases. We report the first case of an extended wear soft contact lens-related Nocardia farcinica keratitis and recommend a new treatment regime. A 47-year-old lady presented with a right eye keratitis after wearing her extended wear soft contact lenses for five continuous weeks. There was no history of trauma or swimming with contact lenses in. Empirical ciprofloxacin and tobramycin eye drops were not tolerated due to ocular surface irritation on application, and instead, empirical treatment was with chloramphenicol and fortified gentamicin 1.5 % eye drops. Corneal scrapings grew Nocardia farcinica after 3 weeks-sensitive to amikacin and co-trimoxazole. Treatment was changed to amikacin 2.5 % eye drops, resulting in partial resolution of the corneal infiltrates. Oral co-trimoxazole 160 mg/800 mg BD was added, due to cultured drug sensitivity and its high ocular penetration, with good results and a final right eye best-corrected visual acuity of 6/5. Nocardia farcinica keratitis should be considered in the differential diagnosis of contact lens-related keratitis. We report the first case occurring in association with extended wear soft contact lenses. Nocardia species can mimic fungal and acanthamoeba keratitis. Treatment with oral co-trimoxazole has not been previously reported. This case demonstrates the role of co-trimoxazole in treating Nocardia farcinica keratitis based on cultured drug sensitivities.
摘要：
诺卡氏菌是最近鉴定的诺卡氏菌属物种之一。诺卡氏菌角膜炎是一种罕见的发生，以前报道的病例只有8例。半渗透性刚性隐形眼镜的使用与这些报道的病例之一有关。我们报告了第一例与长期佩戴软性隐形眼镜相关的诺卡氏菌角膜炎，并建议采用新的治疗方案。一名47岁的女士在连续五周佩戴长期佩戴的软性隐形眼镜后出现右眼角膜炎。没有外伤或隐形眼镜游泳的病史。经验性环丙沙星和妥布霉素滴眼液由于眼表刺激而无法耐受，相反，经验性治疗是氯霉素和强化的庆大霉素1.5％滴眼液。对阿米卡星和复方新诺明敏感3周后，角膜刮片生长。治疗改为阿米卡星2.5%滴眼液，导致角膜浸润的部分分辨率。口服复方新诺明160mg/800mgBD，由于培养的药物敏感性及其高的眼部穿透性，效果良好，最终右眼最佳矫正视力为6/5。在隐形眼镜相关性角膜炎的鉴别诊断中应考虑诺卡氏菌角膜炎。我们报告了第一例与长期佩戴软性隐形眼镜有关的病例。诺卡氏菌可以模仿真菌和棘阿米巴角膜炎。以前没有报道口服复方新诺明的治疗。此病例根据培养的药物敏感性证明了复方新诺明在治疗诺卡氏菌角膜炎中的作用。
