1. BURKHOLDERIA KERATITIS
Authors: Author 1, Author 2, Author 3, Author 4.
Hospital University Sains Malaysia, School of Medical Sciences, Kota Bharu, Kelantan
PURPOSE
Burkholderia species is an uncommon cause of corneal ulcers. We present this case to highlight the presentation and management of Burkholderia keratitis
METHODS
Case report
RESULTS
A 75-year-old Malay gentleman presented with sudden onset of painful red left eye for 4 days, associated with purulent discharge. Patient complained of a wooden particle entering his left eye while cutting grass prior to the symptoms.
Examination showed left eye best corrected visual acuity (BCVA) of 6/45 with congested conjunctiva. There was a paracentral corneal ulcer noted at 3 o’clock and the surrounding cornea was oedematous. The anterior chamber activity was 3+ and intra-ocular pressure was 24mmHg. Fundus examination was normal. The right eye was normal
Gram staining showed Gram-negative rods. Corneal scraping for culture and sensitivity revealed Burkholderia cepacia. He was treated with intensive topical ceftazidime and recovered completely after 4 weeks of treatment. A corneal scar remained. The BCVA was 6/21.
DISCUSSION
Burkholderia cepacia is an aerobic gram-negative bacillus commonly found in soil and fresh water environments. It is an organism of low virulence; thus rarely causes infection in healthy hosts[1]. Other risk factors for infection include ocular trauma involving vegetative matter. In this case, patient’s underlying poorly controlled diabetes mellitus may have contributed to low immunity and risk of infection.
A retrospective study done by Comarella JD et al reported that only 1 out of 263 cases of corneal ulcers are caused by Burkholderia cepacia[2]. The commonest gram-negative organism causing corneal ulcers in this study was Pseudomonas aeruginosa. In a report of two cases of Burkholderia spp by Franka Lestin et al[3], similar clinical features of paracentral corneal involvement with corneal edema and anterior uveitis were observed, suggesting that these features may be characteristic of infection with this organism
SAMPLE
CONCLUSION
Burkholderia keratitis is rare. Risk factors include immunocompromise and ocular trauma with vegetative matter. A high index of clinical suspicion and laboratory investigations are required for the diagnosis. Empirical therapy with fluroquinolones or third-generation cephalosporins is recommended when Gram negative bacilli are implicated.
ACKNOWLEDGEMENT -
REFERENCES
Loutet SA and Valvano MA (2011) Extreme antimicrobial peptide and polymyxin B resistance in the genus Burkholderia. Front. Cell. Inf. Microbio. 1:6. doi: /fcimb
Júlia Dutra Comarella, Patricia Grativol Costa Saraiva, Fábio Petersen Saraiva, Corneal ulcer: a retrospective study of a cases seen at the Hospital das Clínicas, Federal University of Espirito Santo, Rev Bras Oftalmol. 2015; 74 (2):
Franka Lestin, Robert Kraak, and Andreas Podbielski, Two Cases of Keratitis and Corneal Ulcers Caused by Burkholderia gladioli, Journal of Clinical Microbiology, July 2008, 2445–2449.
Kemal Ornek, Mehmet Ozdemir and Ahmet Ergin, Burkholderia cepacia keratitis with endophthalmitis, Journal of Medical Microbiology (2009), 58, 1517–1518.
Christine Segonds et al, Microbiological and Epidemiological Features of Clinical Respiratory Isolates of Burkholderia gladioli, Journal of Clinical Microbiology, May 2009, 1510–1516.
FIGURE 1 :LE CORNEAL ULCER
SAMPLE
FIGURE 3: HEALING CORNEAL ULCER