Pseudomonas oryzihabitans corneal ulcer: A rare case

Tripti Choudhary; Anchal Thakur; Amit Gupta; Archana Angrup; Supriya Dhar

doi:10.4103/ijo.IJO_3059_21

CASE REPORT

Year : 2022 | Volume : 2 | Issue : 3 | Page : 665-666

Pseudomonas oryzihabitans corneal ulcer: A rare case

Tripti Choudhary¹, Anchal Thakur¹, Amit Gupta¹, Archana Angrup², Supriya Dhar¹
¹ Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
² Department of Microbiology, PGIMER, Chandigarh, India

Date of Submission	15-Dec-2021
Date of Acceptance	15-Feb-2022
Date of Web Publication	16-Jul-2022

Correspondence Address:
Dr. Amit Gupta
Professor, Cornea and Refractive Services, Room No- 123, Advanced Eye Centre, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh - 160 012
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_3059_21

Abstract

We report clinical features, culture-sensitivity profile and outcomes of infectious keratitis caused by Pseudomonas oryzihabitans. A 70 year-old male presented with acute pain, redness and diminution of vision in left eye since 6 days. Clinically, was diagnosed as infectious keratitis and microbiology revealed gram-negative bacilli. Culture showed Pseudomonas oryzihabitans growth. Initiation of appropriate antibiotics with steroids led to the resolution of keratitis. Pseudomonas oryzihabitans causes fulminant keratitis with rapid deep stromal involvement. However, timely intervention with appropriate topical anti-bacterials with steroids may lead to successful outcomes.

Keywords: Fulminant keratitis, keratitis, pseudomonas, pseudomonas oryzihabitans

How to cite this article:
Choudhary T, Thakur A, Gupta A, Angrup A, Dhar S. Pseudomonas oryzihabitans corneal ulcer: A rare case. Indian J Ophthalmol Case Rep 2022;2:665-6

How to cite this URL:
Choudhary T, Thakur A, Gupta A, Angrup A, Dhar S. Pseudomonas oryzihabitans corneal ulcer: A rare case. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Aug 13];2:665-6. Available from: https://www.ijoreports.in/text.asp?2022/2/3/665/351169

Infectious keratitis is a commonly encountered condition in most ophthalmology clinics. It is a potentially blinding ocular condition, if not treated at early stage can cause severe visual loss. Pseudomonas oryzihabitans

is a nonfermenting, oxidase-negative, catalase-positive, gram-negative bacillus. We will discuss the presentation, microbiology assessment and treatment strategies of keratitis caused by this organism in our case.

Case Report

A 70-year-old-male presented with sudden onset of pain, redness, and progressive diminution of vision in the left eye for the past 6 days. There was no history of any antecedent trauma. He was a known diabetic and a case of primary open-angle glaucoma and underwent phacoemulsification and trabeculectomy in both eyes 15 years back. On examination, the visual acuity was hand movements in the right eye and perception of light (PL) with an inaccurate projection of rays in the affected left eye. Slit-lamp examination revealed diffuse conjunctival congestion and presence of central epithelial defect measuring 7 mm × 6 mm along with patchy stromal infiltrates, corneal edema, and hypopyon measuring 3.5 mm [Figure 1]a. Ultrasonography showed an echo-free posterior segment, ruling out endophthalmitis.

Figure 1: (a) Day 1: Slit-lamp image of the left eye showing intense conjunctival congestion with corneal epithelial defect (7 mm × 6 mm) with diffuse corneal edema and a hypopyon measuring 3.5 mm. (b) Day 3: Slit-lamp image of the left eye showing a 4 mm × 5 mm corneal epithelial defect and a streak hypopyon. (c) After 3 weeks of treatment, the slit-lamp image of the left eye showing well-defined corneal opacity with vascularization

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Corneal scrapings revealed gram-negative bacilli and growth of non-lactose fermenting dry colonies on MacConkey agar and yellowish, wrinkled, adherent colonies on blood agar. The colonies were consistent with the growth of Pseudomonas oryzihabitans and were confirmed by MALDI-TOF MS (Bruker Daltronik, GmbH Germany) with a reliable score of >2, important to differentiate it from various other non-aeruginosa species.

The isolate was sensitive to amikacin, ceftazidime, ciprofloxacin, imipenem, meropenem, and piperacillin-tazobactam. The patient was initiated on topical ceftazidime 1% and amikacin 2.5% hourly with oral ciprofloxacin 500 mg twice a day. Significant improvement was seen within 48 h in the symptoms, and the epithelial defect decreased to 4 mm × 5 mm with a streak hypopyon [Figure 1]b. We initiated topical prednisolone (1%) drops four times a day, with the existing antimicrobial therapy, leading to marked improvement. After 3 weeks, at final follow-up, there was complete resolution of epithelial defect with a vascularized corneal opacity with hand movement vision [Figure 1]c.

Discussion

Virulent keratitis caused by Pseudomonas aeruginosa is a well-known entity; however, keratitis caused by other species is rare.^[1] Pseudomonas (Flavimonas) oryzihabitans is mainly a saprophytic organism, isolated from both natural and hospital settings.^[2] Systemically, the infection presents as bacteraemia and peritonitis in immuno-compromised. Patients with foreign bodies such as intravenous indwelling catheters are predisposed to infection by this organism.^[3]

There are very few cases of ocular involvement presenting as chronic and acute postoperative endophthalmitis reported in the literature caused by P. oryzihabitans.^[4],[5] We present the first report describing Pseudomonas oryzihabitans as a cause of bacterial keratitis, causing acute, rapidly progressive (deep stromal involvement) fulminant keratitis with profound inflammation.

Non-aeruginosa species of Pseudomonas are susceptible to most anti-pseudomonal antibiotics and trimethoprim-sulfamethoxazole (except most P. fluorescens/putida isolates). Some species, such as P. oryzihabitans, may be more resistant to aztreonam and ticarcillin-clavulanate. Thus, with increasing reports of resistance among these non-aeruginosa species, a reliable identification method and evidence-based treatment, that is, based on the antimicrobial susceptibility report is very important for better patient management as in the present case.

Conclusion

Timely diagnosis and treatment by susceptible antibiotics along with initiation of steroids led to a favorable outcome in keratitis caused by Pseudomonas oryzihabitans. Knowledge of the presentation, microbiological culture, and sensitivity profile of this rare organism will guide ophthalmologists to suspect and treat this fulminant keratitis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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3.	Papakonstantinou S, Dounousi E, Ioannou K, Tsouchnikas I, Kelesidis A, Kotzadamis N, et al. A rare cause of peritonitis caused by flavimonas oryzihabitans in continuous ambulatory peritoneal dialysis (CAPD). Int Urol Nephrol 2005;37:433–6.
4.	Yu EN, Foster CS. Chronic postoperative endophthalmitis due to pseudomonas oryzihabitans. Am J Ophthalmol 2002;134:613–4.
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