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Ocular Infection: Microbiological and Clinical Aspects

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: closed (30 December 2021) | Viewed by 33307

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Special Issue Editors

Dr. Francesco Aiello

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Guest Editor

Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
Interests: corneal diseases; anterior segment diseases; corneal transplant; ocular infections; cataract surgery; refractive surgery

Dr. Marco Ciotti

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Guest Editor

Virology Unit, Laboratory of Clinical Microbiology and Virology, Polyclinic Tor Vergata Foundation, 00133 Rome, Italy
Interests: HPV and cervical cancerogenesis; human polyomavirus reactivation in immunocompromised patients; virological molecular diagnostics; validation of diagnostic kits
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Special Issue Information

Dear Colleagues,

It is widely accepted that ocular infections represent one of the major acquired causes of blindness worldwide, especially in developing countries. However, the management of ocular infectious diseases is becoming increasingly challenging even in the more developed areas of the world, mainly due to increasing drug resistances.

Undoubtedly, the application of new technologies has made the diagnostics of ocular infections more reliable and the therapeutic approach more effective, thus providing patients with better visual outcomes and quality of life.

Nonetheless, especially in the case of “neglected” pathogenic agents (i.e., protozoa, fungi), our knowledge still provides far from a comprehensive view of molecular biology, pathogenic mechanisms, and both clinical and surgical management in the field of ocular microbiology today. Furthermore, new pathogens such as SARS-CoV-2 have shown ocular tropism, even though it is unclear whether the visual system is merely colonized by SARS-CoV-2 or if the novel coronavirus is able to invade and replicate within it.

This Special Issue aims at creating a wide forum of discussion on ocular microbiology, in order to deepem our knowledge of pathophysiological, clinical, diagnostic, and therapeutic aspects across every form of ophthalmic infection. The published papers will describe new developments in these areas.

High-quality articles containing original research results as well as review articles of exceptional merit will be warmly accepted.

Dr. Francesco Aiello
Dr. Marco Ciotti
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Conjunctivitis
Keratitis
Endophthalmitis
Microbial keratitis
Acanthamoeba keratitis
COVID-19 conjunctivitis
COVID-19 ocular involvement
Diagnosis
Viral infection
Microbial infection

Published Papers (12 papers)

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Research

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7 pages, 236 KiB

Open AccessArticle

The Role of Topical Povidone-Iodine in the Management of Infectious Keratitis: A Pilot Study

by Emilio Pedrotti, Erika Bonacci, Raphael Kilian, Camilla Pagnacco, Adriano Fasolo, Marco Anastasi, Gessica Manzini, Francesca Bosello and Giorgio Marchini

J. Clin. Med. 2022, 11(3), 848; https://doi.org/10.3390/jcm11030848 - 5 Feb 2022

Cited by 4 | Viewed by 2094

Abstract

The aim of this prospective explorative study was to evaluate the safety and the effectiveness of topical polyvinylpyrrolidone-iodine (PVP-I) administered during the time-to-results period for pathogen identification and susceptibility testing in patients with infectious keratitis (IK). A corneal swab (CS) for antimicrobial evaluation was performed at enrollment (T0) and topical 0.66%-PVP-I was administered until the laboratory results were available (T1). Ulcer and infiltrate areas and infiltrate depths were compared between T0 and T1 (i.e., time-to-result period). Patients were then shifted to a specific antimicrobial therapy and followed up until resolution of their infiltrates (Tlast-TL). Twenty-five eyes were enrolled, and none showed clinical worsening leading to protocol withdrawal. At T1, ulcer and infiltrate areas showed significant improvement in Gram-positive IK (n = 13–52%; p = 0.027 and p = 0.019, respectively), remained stable in fungal IK (n = 5–20%; both p = 0.98) and increased in those with Gram-negative bacteria (n = 4–16%; p = 0.58 and p = 0.27). Eyes with negative cultures (n = 3–12%) showed complete resolution at T1 and did not initiate any additional antimicrobial therapy. The administration of 0.66% PVP-I during the time-to-result period seems to be a safe strategy in patients with IK while often sparing broad-spectrum antimicrobial agents. In addition, it showed to be effective in eyes with a Gram-positive bacterial infection. Full article

(This article belongs to the Special Issue Ocular Infection: Microbiological and Clinical Aspects)

19 pages, 4707 KiB

Open AccessArticle

Influence of Cytokines on Inflammatory Eye Diseases: A Citation Network Study

by Beatriz G. Gálvez, Clara Martinez-Perez, Cesar Villa-Collar, Cristina Alvarez-Peregrina and Miguel Ángel Sánchez-Tena

J. Clin. Med. 2022, 11(3), 661; https://doi.org/10.3390/jcm11030661 - 27 Jan 2022

Cited by 5 | Viewed by 2178

Abstract

Background: The main objective of this study was to use citation networks to analyze the relationship between different publications on the impact of cytokines at an ocular level and their authors. Furthermore, the different research areas will be identified, and the most cited publications determined. Methods: A search was performed in the Web of Science (WoS) database using the following keywords: “cytokine”, “inflammatory”, and “eye disease” for the period from 1990 to October 2021. The Citation Network Explorer and the CiteSpace software were then used to analyze the different publications. Results: 3127 publications with 8955 citations generated on the web were found. The largest number of publications on this topic emerged in 2018 and the authors with the largest number of publications addressing this area of research were Peizeng Yang (1.4%), Aize Kijlstra (1.3%), and Stephen C. Pflugfelder (1.2%). Conclusions: the citation network has provided a comprehensive and objective analysis of the main studies on the influence of cytokines in ocular inflammatory diseases. Full article

(This article belongs to the Special Issue Ocular Infection: Microbiological and Clinical Aspects)

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8 pages, 438 KiB

Open AccessArticle

An Evaluation of a Simplified Impression Membrane Sampling Method for the Diagnosis of Microbial Keratitis

by Tobi F. Somerville, Rose Herbert, Timothy Neal, Malcolm Horsburgh and Stephen B. Kaye

J. Clin. Med. 2021, 10(23), 5671; https://doi.org/10.3390/jcm10235671 - 30 Nov 2021

Cited by 6 | Viewed by 1550

Abstract

The purpose of this study was to compare bacterial isolation rate using a corneal impression membrane (CIM) and a sharp instrument for obtaining corneal samples from patients with suspected microbial keratitis (MK). Data was retrospectively collected for all patients that had corneal samples taken for presumed MK between May 2014 and May 2020. Prior to May 2017 samples were collected by scraping the edges of the ulcer with a blade. From May 2017, samples were collected by placing a CIM (Millicell cell culture insert) against the ulcer. All corneal samples were processed using the same conventional diagnostic culture method. A total of 3099 corneal samples were included, of which 1214 (39.2%) were corneal scrapes and 1885 (60.9%) CIMs. Microorganisms were isolated from 235 (19.4%) and 1229 (65.2%) cases using a corneal scrape and CIM, respectively (p < 0.001). Of routinely described pathogenic microorganisms, there were significant increases in the isolations of S. aureus (2.4% to 11.3%) and Serratia (0.5% to 1.7%) using the CIM and no significant changes in the isolations of S. pneumoniae and P. aeruginosa. No significant differences were seen between the isolation rates of fungi or Acanthamoeba species. There was a significant increase in the isolation rates of other Streptococcal species (0.7% to 6.9%) and CNS species, specifically, S. epidermidis (2.1% to 26.2%), S. capitis (0.4% to 2.6%) and S. warneri (0.3% to 1.6%) using the CIM. The simplified CIM sampling method is an effective method for collecting corneal samples from patients with presumed MK in clinical practice. Full article

(This article belongs to the Special Issue Ocular Infection: Microbiological and Clinical Aspects)

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9 pages, 243 KiB

Open AccessArticle

Post-Mortem RT-PCR Assay for SARS-CoV-2 RNA in COVID-19 Patients’ Corneal Epithelium, Conjunctival and Nasopharyngeal Swabs

by Francesco Aiello, Marco Ciotti, Gabriele Gallo Afflitto, Maria Cristina Rapanotti, Bartolo Caggiano, Michele Treglia, Sandro Grelli, Sergio Bernardini, Silvestro Mauriello, Carlo Nucci, Luigi Tonino Marsella and Raffaele Mancino

J. Clin. Med. 2021, 10(18), 4256; https://doi.org/10.3390/jcm10184256 - 20 Sep 2021

Cited by 12 | Viewed by 2400

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease has been described to possibly be associated with ocular surface disturbances. However, whether the virus could invade ocular tissues still remains elusive. In the present study, we tried to investigate the post-mortem presence of SARS-CoV-2 RNA in corneal epithelium gathered by patients with an ante-mortem confirmed diagnosis of Coronavirus disease-19 (COVID-19). Cadavers with an ante-mortem confirmed diagnosis of moderate to severe COVID-19 were examined. Clinical and demographic features were retrieved from hospital patients’ notes. For each cadaver, corneal scrapings, conjunctival swabs (CS) and nasopharyngeal swabs (NPS) were collected to perform real-time reverse transcriptase polymerase chain reaction ((RT)-PCR) for SARS-CoV-2. Fourteen consecutive cadavers with an ante-mortem confirmed diagnosis of moderate to severe COVID-19 were examined. The last NPS performed ante-mortem confirmed SARS-CoV-2 infection in 12/14 (85.7%) patients. The mean death-to-swab time (DtS) was 3.15 ± 0.5 (2.10–5.1) h. The post-mortem NPS and CS found positive for SARS-CoV-2 RNA were 9/14 (64.3%) and 3/28 (10.7%), respectively. None of the corneal epithelium scrapes tested positive to RT-PCR for SARS-CoV-2 RNA. These data promote the SARS-CoV-2 as not able to contaminate the post-mortem corneal epithelium, while it can persist in different other structures of the ocular surface (i.e., the conjunctiva). It is reasonable to assume that such a contamination can occur ante-mortem too. Full article

(This article belongs to the Special Issue Ocular Infection: Microbiological and Clinical Aspects)

22 pages, 3869 KiB

Open AccessArticle

Impact of COVID-19 at the Ocular Level: A Citation Network Study

by Miguel Ángel Sánchez-Tena, Clara Martinez-Perez, Cesar Villa-Collar and Cristina Alvarez-Peregrina

J. Clin. Med. 2021, 10(7), 1340; https://doi.org/10.3390/jcm10071340 - 24 Mar 2021

Cited by 8 | Viewed by 2252

Abstract

Background: The main objective of this study was to use citation networks to analyze the relationship between different publications on the impact of COVID-19 at an ocular level and their authors. Furthermore, the different research areas will be identified, and the most cited publication will be determined. Materials and Methods: The publications were searched within the Web of Science database, using “ocular”, “SARS-CoV-2”, “ophthalmology”, “eyesight”, and “COVID-19” as keywords for the period between January 2020 and January 2021. The Citation Network Explorer and the CiteSpace software were used to analyze the different publications. Results: A total of 389 publications with 890 citations generated on the web were found. It must be highlighted that July was the month with the largest number of publications. The most cited ones were “Characteristics of Ocular Findings of Patients with Coronavirus Disease 2019 (COVID-19) in Hubei Province, China” by Wu et al., which was published in May 2020. Three groups covering the different research areas in this field were found using the clustering functions: ocular manifestations, teleophthalmology, and personal protective equipment. Conclusions: The citation network has shown a comprehensive and objective analysis of the main studies on the impact of COVID-19 in ocular disease. Full article

(This article belongs to the Special Issue Ocular Infection: Microbiological and Clinical Aspects)

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9 pages, 3220 KiB

Open AccessArticle

Urgent Vitrectomy with Vancomycin Infusion, Silicone Oil Endotamponade, and General Antibiotic Treatment in Multiple Cases of Endophthalmitis from a Single Day of Intravitreal Injections—Case Series

by Agata Pietras-Baczewska, Ewa Jasińska, Mario Damiano Toro, Vincenza Bonfiglio, Michele Reibaldi, Teresio Avitabile, Katarzyna Nowomiejska and Robert Rejdak

J. Clin. Med. 2021, 10(5), 1059; https://doi.org/10.3390/jcm10051059 - 4 Mar 2021

Cited by 7 | Viewed by 2480

Abstract

The aim of this study was to report on the anatomical and functional results of surgical management of seven cases of endophthalmitis related to a single day of intravitreal aflibercept injections. Patients with signs of endophthalmitis who underwent aflibercept injections (seven eyes) performed on the same day were retrospectively evaluated. The data of visual acuity and optical coherence tomography (OCT) within nine months of the follow-up and the treatment and results of microbiological cultures are reported. Four of the total seven cases had a positive bacterial culture outcome (Streptococcus mitis). All patients underwent vitrectomy combined with phacoemulsification when the eyes were not pseudophakic, vancomycin infusion, and silicone oil tamponade within 24 h; additionally, systemic antibiotics were administered intravenously. The final best-corrected visual acuity (BCVA) after the treatment was finger counting or light perception in all cases, and all eyes were saved with disruption of the inner retinal layers and stabilization of the retina in regard to changes related to the wet age-related macular degeneration (AMD). Although the retinal anatomy was mostly preserved, most of the patients affected by Streptococcus mitis-induced endophthalmitis did not regain baseline vision after the therapy. Full article

(This article belongs to the Special Issue Ocular Infection: Microbiological and Clinical Aspects)

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8 pages, 236 KiB

Open AccessArticle

Ophthalmic Screening in Patients with Coronavirus Disease 2019: A Prospective Cohort Study

by Anthia Papazoglou, Anna Conen, Sebastian Haubitz, Markus Tschopp, Viviane J. Guignard, Marcel N. Menke and Tim J. Enz

J. Clin. Med. 2021, 10(5), 896; https://doi.org/10.3390/jcm10050896 - 24 Feb 2021

Cited by 4 | Viewed by 2340

Abstract

Postmortem pathological examinations, animal studies, and anecdotal reports suggest that coronavirus disease 2019 (COVID-19) could potentially affect intraocular tissue. However, published evidence is scarce and conflicting. In our study, we screened 100 eyes of 50 patients hospitalized for COVID-19. Relevant medical and ophthalmological history was assessed as well as symptoms, laboratory results, specific treatments, clinical course, and outcome. Ophthalmic exams including assessment of best corrected visual acuity (BCVA), intraocular pressure (IOP), color perception, ocular motility, ophthalmoscopy as well as optical coherence tomography (OCT) of the macula and the optic disc was performed at hospital admission and 29 to 192 days later. Of the 50 patients included, 14 (28%) were female. Median age was 64.5 (range 29–90) years. COVID-19 severity was mild in 15 (30%), severe in 30 (60%), and critical in five cases (10%). At baseline, median BCVA was 0.1 (0–1.8) Logarithm of the Minimum Angle of Resolution (LogMAR) and median IOP was 16 (8–22) mmHg. At follow-up, no relevant changes in BCVA and IOP were documented. No signs of active intraocular inflammation or optic nerve affection were found and OCT findings were widely stable during the observation period. Our findings suggest that COVID-19 does not regularly affect intraocular tissue. Full article

(This article belongs to the Special Issue Ocular Infection: Microbiological and Clinical Aspects)

7 pages, 654 KiB

Open AccessArticle

Is There an Association between Herpetic Infections and Giant Cell Arteritis? A Population-Based Study

by Dong-ho Lee, Alfonso Iovieno and Claire A. Sheldon

J. Clin. Med. 2021, 10(1), 63; https://doi.org/10.3390/jcm10010063 - 27 Dec 2020

Cited by 5 | Viewed by 2155

Abstract

Recent data suggests that herpes zoster (HZ) and herpes simplex virus (HSV) may be one of the underlying immunological triggers for giant cell arteritis (GCA). However, there is limited population-based data to support this. Our goal was to determine if herpetic infections increase the likelihood of GCA in the British Columbia (BC) population. The background prevalence of GCA was compared to the prevalence of GCA in subjects with HZ and HSV using diagnostic billing code data from an online BC database (BC Data Scout^TM). BC residents ≥30 years old at the time of diagnosis from January 2000 to January 2019 were included. The relevant International Classification of Disease codes was used to identify patients with GCA, HZ, and HSV. Comparisons were made using two-sample Z tests. There were 4315 GCA diagnoses, from a total population of 3,026,005 subjects. The prevalence of GCA was 143 per 100,000 people. In terms of herpetic infections, 850 GCA cases were identified in 249,900 subjects with HZ versus 310 diagnoses of GCA in 163,170 subjects with HSV. The prevalence of GCA in subjects with HZ (0.340%) was significantly higher than the prevalence of GCA (0.143%) in the general population (p < 0.00001). The prevalence of GCA in HSV subjects (0.190%) was also significantly higher (p < 0.00001) than the population prevalence but lower than (p < 0.00001) the GCA with HZ prevalence. The likelihood of GCA appears to increase with herpetic infections, more significantly with HZ. Full article

(This article belongs to the Special Issue Ocular Infection: Microbiological and Clinical Aspects)

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Review

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21 pages, 9787 KiB

Open AccessReview

Endogenous Endophthalmitis—The Clinical Significance of the Primary Source of Infection

by Małgorzata Gajdzis, Kornelia Figuła, Joanna Kamińska and Radosław Kaczmarek

J. Clin. Med. 2022, 11(5), 1183; https://doi.org/10.3390/jcm11051183 - 23 Feb 2022

Cited by 8 | Viewed by 3881

Abstract

Endophthalmitis is a severe form of ocular inflammation. The source of pathogens in endogenous endophthalmitis is located inside the body, and infection spreads hematogenously. Although rare, endogenous endophthalmitis is a very serious condition, as this type of inflammation is very devastating for ocular tissues. Prognosis is very poor, and the patients are often in a serious general condition, so they require special care and an individual approach in the treatment process. Thanks to the knowledge of the risks associated with infections of individual tissues and organs as well as potential pathogens and the clinical picture, it is possible to make a correct diagnosis faster and implement the correct treatment. In the case of endogenous endophthalmitis, reaction time is absolutely crucial for prognosis. In this review, we focus primarily on the importance of the primary source of infection for the course of the disease and prognosis. Full article

(This article belongs to the Special Issue Ocular Infection: Microbiological and Clinical Aspects)

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21 pages, 29537 KiB

Open AccessReview

Fusarium Keratitis—Review of Current Treatment Possibilities

by Marek Szaliński, Aleksandra Zgryźniak, Izabela Rubisz, Małgorzata Gajdzis, Radosław Kaczmarek and Joanna Przeździecka-Dołyk

J. Clin. Med. 2021, 10(23), 5468; https://doi.org/10.3390/jcm10235468 - 23 Nov 2021

Cited by 10 | Viewed by 2300

Abstract

In many parts of the world, fungi are the predominant cause of infectious keratitis; among which, Fusarium is the most commonly isolated pathogen. The clinical management of this ophthalmic emergency is challenging. Due to the retardation of the first symptoms from an injury and the inability to differentiate fungal from bacterial infections based on clinical symptoms and difficult microbial diagnostics, proper treatment, in many cases, is postponed. Moreover, therapeutical options of Fusarium keratitis remain limited. This paper summarizes the available treatment modalities of Fusarium keratitis, including antifungals and their routes of administration, antiseptics, and surgical interventions. Full article

(This article belongs to the Special Issue Ocular Infection: Microbiological and Clinical Aspects)

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11 pages, 1574 KiB

Open AccessReview

Topical Corticosteroids and Fungal Keratitis: A Review of the Literature and Case Series

by Karl Anders Knutsson, Alfonso Iovieno, Stanislav Matuska, Luigi Fontana and Paolo Rama

J. Clin. Med. 2021, 10(6), 1178; https://doi.org/10.3390/jcm10061178 - 11 Mar 2021

Cited by 18 | Viewed by 4301

Abstract

The management of fungal keratitis is complex since signs and symptoms are subtle and ocular inflammation is minimal in the preliminary stages of infection. Initial misdiagnosis of the condition and consequent management of inflammation with corticosteroids is a frequent occurrence. Topical steroid use is considered to be a principal factor for development of fungal keratitis. In this review, we assess the studies that have reported outcomes of fungal keratitis in patients receiving steroids prior to diagnosis. We also assess the possible rebound effect present when steroids are abruptly discontinued and the clinical characteristics of three patients in this particular clinical scenario. Previous reports and the three clinical descriptions presented suggest that in fungal keratitis, discontinuing topical steroids can induce worsening of clinical signs. In these cases, we recommend to slowly taper steroids and continue or commence appropriate antifungal therapy. Full article

(This article belongs to the Special Issue Ocular Infection: Microbiological and Clinical Aspects)

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13 pages, 2110 KiB

Open AccessReview

Staphylococcus aureus Keratitis: Incidence, Pathophysiology, Risk Factors and Novel Strategies for Treatment

by Jason W. Lee, Tobi Somerville, Stephen B. Kaye and Vito Romano

J. Clin. Med. 2021, 10(4), 758; https://doi.org/10.3390/jcm10040758 - 13 Feb 2021

Cited by 16 | Viewed by 3702

Abstract

Bacterial keratitis is a devastating condition that can rapidly progress to serious complications if not treated promptly. Certain causative microorganisms such as Staphylococcus aureus and Pseudomonas aeruginosa are notorious for their resistance to antibiotics. Resistant bacterial keratitis results in poorer outcomes such as scarring and the need for surgical intervention. Thorough understanding of the causative pathogen and its virulence factors is vital for the discovery of novel treatments to avoid further antibiotic resistance. While much has been previously reported on P. aeruginosa, S. aureus has been less extensively studied. This review aims to give a brief overview of S. aureus epidemiology, pathophysiology and clinical characteristics as well as summarise the current evidence for potential novel therapies. Full article

(This article belongs to the Special Issue Ocular Infection: Microbiological and Clinical Aspects)

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