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July 1990, Vol 108, No. 7 >
ARTICLE | July 1990

Coryneform Endophthalmitis: Title and subTitle BreakTwo Case Reports FREE

James W. McManaway, III, MD; Robert S. Weinberg, MD; Philip E. Coudron, PhD
[+] Author Affiliations

Accepted for publication March 28, 1990.

Reprint requests to Department of Ophthalmology, Hershey Medical Center, PO Box 850, Hershey, PA 17033 (Dr McManaway).


Arch Ophthalmol. 1990;108(7):942-944. doi:10.1001/archopht.1990.01070090044036
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• Recent clinical studies have emphasized the importance of diphtheroids, previously regarded as nonpathogenic bacteria or contaminants, as causes of ocular disease. We encountered two patients with endophthalmitis following cataract extraction and anterior chamber intraocular lens implantation. Both patients had previously been treated with subconjunctival and/or oral corticosteroids for presumed sterile endophthalmitis. Vitreous cultures in each case yielded pure growth of a diphtheroid that was subsequently identified as coryneform group A-4. The clinical response to standard intraocular therapy with gentamicin and cefazolin was delayed, although both patients eventually had restoration of functional vision. A comparison of the antibiotic minimum inhibitory and minimum bactericidal concentrations of the isolates may help to explain the delayed response to therapy seen in these two patients.

REFERENCES

1 +
Coyle MB, Hollis DG, Groman NB.  Corynebacterium spp and other coryneform organisms . In: Lennette EH, Balows A, Hausler WJ Jr, Shadomy HJ, eds. Manual of Clinical Microbiology . 4th ed. Washington, DC: American Society for Microbiology; 1985;:193-204.
2 +
Chandler JW, Milam DF.  Diphtheria corneal ulcers . Arch Ophthalmol . 1978;;96:53-56.
3 +
Friedman E, Peyman GA, May DR.  Endophthalmitis caused by Propionibacterium acnes . Can J Ophthalmol . 1978;;13:50-52.
4 +
Beatty RF, Robin JB, Trousdale MD, Smith RE.  Anaerobic endophthalmitis caused by Propionibacterium acnes . Am J Ophthalmol . 1986;;101:114-116.
5 +
Jaffe GJ, Whitcher JP, Biswell R, Irvine AR.  Propionibacterium acnes endophthalmitis seven months after extracapsular cataract extraction and intraocular lens implantation . Ophthalmic Surg . 1986;;17:791-793.
6 +
Meisler DM, Palestine AG, Vastine DW, et al.  Chronic Propionibacterium acnes endophthalmitis after extracapsular cataract extraction and intraocular lens implantation . Am J Ophthalmol . 1986;;102:733-739.
7 +
Roussel TJ, Culbertson WW, Jaffe NS.  Chronic postoperative endophthalmitis associated with Propionibacterium acnes . Arch Ophthalmol . 1987;;105:1199-1201.
8 +
Meisler DM, Zakov ZN, Bruner WE, Plorde JJ.  Endophthalmitis associated with sequestered intraocular Propionibacterium acnes . Am J Ophthalmol . 1987;;104:428-429.
9 +
Lipsky BA, Goldberger AC, Tompkins LS, et al.  Infections caused by nondiphtheria corynebacteria . Rev Infect Dis . 1982;;4:1220-1235.
10 +
Kaplan K, Weinstein L.  Diphtheroid infections of man . Ann Intern Med . 1969;;70:919-929.
11 +
Locksley RM.  The lowly diphtheroid: nondiphtheria corynebacterial infections in humans . West J Med . 1982;;137:45-52.
12 +
Riley PS, Hollis GB, Utter DG, Weaver RE, Baker CN.  Characterization and identification of 95 diphtheroid (group JK) cultures isolated from clinical specimens . J Clin Microbiol . 1979;;9:418-424.
13 +
Rubinfeld RS, Cohen EJ, Arentsen JJ, Laibson PR.  Diphtheroids as ocular pathogens . Am J Ophthalmol . 1989;;108:251-254.
14 +
Brinser JH.  Ocular bacteriology . In: Tabbara KF, Hyndiuk RA, eds. Infections of the Eye . Boston, Mass: Little Brown & Co Inc; 1986;:129-130.
15 +
Hanscom T, Maxwell WA.  Corynebacterium endophthalmitis: laboratory studies and report of a case treated by vitrectomy . Arch Ophthalmol . 1979;;97:500-502.
16 +
Margo CE, Pavan PR, Groden LR.  Chronic vitritis with macrophagic inclusions: a sequela of treated endophthalmitis due to a coryneform bacterium . Ophthalmology . 1988;;95:156-161.
17 +
Perkins RE, Kundsin RB, Pratt MV, Abrahamsen I, Leibowitz HM.  Bacteriology of normal and infected conjunctiva . J Clin Microbiol . 1975;;1:147-149.
18 +
Forster RK.  Etiology and diagnosis of bacterial postoperative endophthalmitis . Ophthalmology . 1978;;85:320-326.
19 +
Forster RK.  Endophthalmitis . In: Duane TD, ed. Clinical Ophthalmology . New York, NY: Harper & Row Publishers Inc; 1986;;4:1-20.
20 +
Coudron PE, Harris RC, Vaughan MG, Dalton HP.  Two similar but atypical strains of coryneform group A-4 isolated from patients with endophthalmitis . J Clin Microbiol . 1985;;22:475-477.
21 +
Sanford JP. Guide to Antimicrobial Therapy 1989 . West Bethesda, Md: Antimicrobial Therapy Inc; 1989;:100.
22 +
Kane A, Barza M, Baum J.  Intravitreal injection of gentamicin in rabbits: effect of inflammation and pigmentation on half-life and ocular distribution . Invest Ophthalmol Vis Sci . 1981;;20:593-597.
23 +
Fisher JP, Civiletto SE, Forster RK.  Toxicity, efficacy, and clearance of intravitreally injected cefazolin . Arch Ophthalmol . 1982;;100:650-652.
24 +
Leopold IH.  Intravitreal penetration of penicillin and penicillin therapy of infections of the vitreous . Arch Ophthalmol . 1945;;33:211-216.
25 +
Martin DF, Ficker LA, Aguilar HA, Gardner SK, Wilson LA, Meredith TA.  Vitreous cefazolin levels after intravenous injection: effects of inflammation, repeated antibiotic doses, and surgery . Arch Ophthalmol . 1990;;108:411-414.
26 +
Cummins CS, Johnson JL.  Genus Propionibacterium . In: Sneath PH, Mair NS, Sharpe ME, Holt JG, eds. Bergey's Manual of Systematic Bacteriology . Baltimore, Md: Williams & Wilkins; 1986;:1346-1353.

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1 +
Coyle MB, Hollis DG, Groman NB.  Corynebacterium spp and other coryneform organisms . In: Lennette EH, Balows A, Hausler WJ Jr, Shadomy HJ, eds. Manual of Clinical Microbiology . 4th ed. Washington, DC: American Society for Microbiology; 1985;:193-204.
2 +
Chandler JW, Milam DF.  Diphtheria corneal ulcers . Arch Ophthalmol . 1978;;96:53-56.
3 +
Friedman E, Peyman GA, May DR.  Endophthalmitis caused by Propionibacterium acnes . Can J Ophthalmol . 1978;;13:50-52.
4 +
Beatty RF, Robin JB, Trousdale MD, Smith RE.  Anaerobic endophthalmitis caused by Propionibacterium acnes . Am J Ophthalmol . 1986;;101:114-116.
5 +
Jaffe GJ, Whitcher JP, Biswell R, Irvine AR.  Propionibacterium acnes endophthalmitis seven months after extracapsular cataract extraction and intraocular lens implantation . Ophthalmic Surg . 1986;;17:791-793.
6 +
Meisler DM, Palestine AG, Vastine DW, et al.  Chronic Propionibacterium acnes endophthalmitis after extracapsular cataract extraction and intraocular lens implantation . Am J Ophthalmol . 1986;;102:733-739.
7 +
Roussel TJ, Culbertson WW, Jaffe NS.  Chronic postoperative endophthalmitis associated with Propionibacterium acnes . Arch Ophthalmol . 1987;;105:1199-1201.
8 +
Meisler DM, Zakov ZN, Bruner WE, Plorde JJ.  Endophthalmitis associated with sequestered intraocular Propionibacterium acnes . Am J Ophthalmol . 1987;;104:428-429.
9 +
Lipsky BA, Goldberger AC, Tompkins LS, et al.  Infections caused by nondiphtheria corynebacteria . Rev Infect Dis . 1982;;4:1220-1235.
10 +
Kaplan K, Weinstein L.  Diphtheroid infections of man . Ann Intern Med . 1969;;70:919-929.
11 +
Locksley RM.  The lowly diphtheroid: nondiphtheria corynebacterial infections in humans . West J Med . 1982;;137:45-52.
12 +
Riley PS, Hollis GB, Utter DG, Weaver RE, Baker CN.  Characterization and identification of 95 diphtheroid (group JK) cultures isolated from clinical specimens . J Clin Microbiol . 1979;;9:418-424.
13 +
Rubinfeld RS, Cohen EJ, Arentsen JJ, Laibson PR.  Diphtheroids as ocular pathogens . Am J Ophthalmol . 1989;;108:251-254.
14 +
Brinser JH.  Ocular bacteriology . In: Tabbara KF, Hyndiuk RA, eds. Infections of the Eye . Boston, Mass: Little Brown & Co Inc; 1986;:129-130.
15 +
Hanscom T, Maxwell WA.  Corynebacterium endophthalmitis: laboratory studies and report of a case treated by vitrectomy . Arch Ophthalmol . 1979;;97:500-502.
16 +
Margo CE, Pavan PR, Groden LR.  Chronic vitritis with macrophagic inclusions: a sequela of treated endophthalmitis due to a coryneform bacterium . Ophthalmology . 1988;;95:156-161.
17 +
Perkins RE, Kundsin RB, Pratt MV, Abrahamsen I, Leibowitz HM.  Bacteriology of normal and infected conjunctiva . J Clin Microbiol . 1975;;1:147-149.
18 +
Forster RK.  Etiology and diagnosis of bacterial postoperative endophthalmitis . Ophthalmology . 1978;;85:320-326.
19 +
Forster RK.  Endophthalmitis . In: Duane TD, ed. Clinical Ophthalmology . New York, NY: Harper & Row Publishers Inc; 1986;;4:1-20.
20 +
Coudron PE, Harris RC, Vaughan MG, Dalton HP.  Two similar but atypical strains of coryneform group A-4 isolated from patients with endophthalmitis . J Clin Microbiol . 1985;;22:475-477.
21 +
Sanford JP. Guide to Antimicrobial Therapy 1989 . West Bethesda, Md: Antimicrobial Therapy Inc; 1989;:100.
22 +
Kane A, Barza M, Baum J.  Intravitreal injection of gentamicin in rabbits: effect of inflammation and pigmentation on half-life and ocular distribution . Invest Ophthalmol Vis Sci . 1981;;20:593-597.
23 +
Fisher JP, Civiletto SE, Forster RK.  Toxicity, efficacy, and clearance of intravitreally injected cefazolin . Arch Ophthalmol . 1982;;100:650-652.
24 +
Leopold IH.  Intravitreal penetration of penicillin and penicillin therapy of infections of the vitreous . Arch Ophthalmol . 1945;;33:211-216.
25 +
Martin DF, Ficker LA, Aguilar HA, Gardner SK, Wilson LA, Meredith TA.  Vitreous cefazolin levels after intravenous injection: effects of inflammation, repeated antibiotic doses, and surgery . Arch Ophthalmol . 1990;;108:411-414.
26 +
Cummins CS, Johnson JL.  Genus Propionibacterium . In: Sneath PH, Mair NS, Sharpe ME, Holt JG, eds. Bergey's Manual of Systematic Bacteriology . Baltimore, Md: Williams & Wilkins; 1986;:1346-1353.

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