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   Table of Contents      
CASE REPORT
Year : 1982  |  Volume : 30  |  Issue : 3  |  Page : 167-168

Bilateral conjunctivitis associated with nocardia Asteroides:A case report


Department of Microbiology, H.P. Medical College, Simla, India

Correspondence Address:
M L Gupta
Department of Microbiology, H.P. Medical College, Simla - 171001
India
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Source of Support: None, Conflict of Interest: None


PMID: 6757136

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How to cite this article:
Gupta M L, Singh P, Goyal B K, Goyal A, Sharma R D. Bilateral conjunctivitis associated with nocardia Asteroides:A case report. Indian J Ophthalmol 1982;30:167-8

How to cite this URL:
Gupta M L, Singh P, Goyal B K, Goyal A, Sharma R D. Bilateral conjunctivitis associated with nocardia Asteroides:A case report. Indian J Ophthalmol [serial online] 1982 [cited 2020 Apr 4];30:167-8. Available from: http://www.ijo.in/text.asp?1982/30/3/167/28201

Nocardiosis is a generalised microbial disease in man characterised by chronic suppurative and less frequently granulomatous lesions caused by aerobic actinomycetes of the genus Nocardia. The most common site for primary lesion is the lungs although dissemina­tion to other organs is not uncommon. As far as the involvement of the eye is concerned, Nocardia is rare pathogen and it may cause conjunctivitis which may be either mucopuru­lent or granulomatous sometimes associated with development of scar tissue and an inter­stitial or superficial punctate keratitis, some­times leading to corneal ulceration. The involvement of the intraocular structures, the lids and the lacrimal glands has also been postulated.

We describe a patient with the bilateral nocardial conjunctivitis in whom infection in one eye resolved completely.


  Case report Top


A 60 years old male having a dual occupa­tion of farming and tailoring presented with the complaint of having sore eyes for the last 3 years with history of yellowish particulate discharge from both the eyes for the last 3 months. The yellowish discharge was present at the time of examination and sent for microbiological examination and patient dis­charged with the advice of using sulphaceta­mide 20% eye drops and report after a week. The discharge subsequently yielded the growth of Nocardia asteroides. Thereafter the contact with the patient was lost for about a year. When he again reported with the lesion in the right eye quietened and left eye still having active lesion with yellowish discharge in the form of flakes.

Clinically the patient was having mucopurulent type of conjunctivitis of left eye with some evidence of scarring. The scarring was evident from a depressed area present in the lower fornix. There was no other significant or relevant finding in the eye or elsewhere it the body. [Figure - 1]a.

The discharge yielded light orange colou­red growth. This came out to be Nocardia asteroides as confirmed by gram's staining, acid fast staining and biochemical reactions.

Conjunctival scrapings on H & F staining showed the presence of chronic inflammatory cells and fibrosis [Figure - 1]b. The gram staining of the tissue depicted the pre­sence of gram positive filaments at places having coccoid appearance.

The patient was put on local and oral sulphonamides and was cured.


  Discussion Top


There are a few reports of involvement of intraocular structures[1],[2], cornea[3], conjunctival[4],[5],[6],[7],[8], and sclera[9]. Involvement of lid and lacrimal gland has mostly been metastatic where as cornea and conjunctiva seemed as the primary sites where soil probably served as the source of infection.

In the present case the patient had persis­tent complaint of soreness in both the eyes.

After his first report to this hospital patient had been advised the use of sulpha eye drops, subsequently the lesion in the right eye quietened. But it continued to smolder and made the patient to present with symptoms. The follow up will reveal whether the lesion had natural waxes and wanes or not.


  Summary Top


A 60 years old male presented with bilateral chronic conjunctivitis of long duration. The microbiological and histopathological findings revealed the presence of Nocardia asteroides.

 
  References Top

1.
Burper, J.C. and Stroke, W.R., 1971, Arch, Ophthalmol. 86: 666.  Back to cited text no. 1
    
2.
Neal, A.; Sher, M.D. ; Charlotter, W.; Hill, M.D., David, E. and Bifug, M.D., 1977, Arch, Ophthalmol. 95; 1415.  Back to cited text no. 2
    
3.
Relph, R.A.; Lamp, M.A.; and Less, G. 1976; Bril, J. Ophthalmol. 60: 104.  Back to cited text no. 3
    
4.
Bakly, 1921, Tr, Ophthalmol. Soc. U. Kingdom 41,521.  Back to cited text no. 4
    
5.
Benedict, W.L. and Iverson, H.A., 1944, Arch Ophthalmol (Chicago), 32, 82.  Back to cited text no. 5
    
6.
Knapp, A, and Dwyer. J.G., 1918, Arch Ophthalmol. 47 :497.  Back to cited text no. 6
    
7.
May, C.H., 1917, Arch. Ophthalmol. 46; 171.  Back to cited text no. 7
    
8.
Lawerence, W.H., Kenneth H., William, G. M. and Walter, J.B., 1979, Brit, J. Ophthalmol. 63 : 449.  Back to cited text no. 8
    
9.
Henderson, J.W., Wellman, W. E. and Weed, L.A. 1960, Proc, Mayo. Clinic. 35 : 614.  Back to cited text no. 9
    


    Figures

  [Figure - 1]


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