Open Access Case report

Nocardia transvalensis keratitis: an emerging pathology among travelers returning from Asia

Elodie Trichet1, Stéphan Cohen-Bacrie2, John Conrath1, Michel Drancourt2 and Louis Hoffart1*

Author Affiliations

1 Service d'ophtalmologie, Hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France

2 Pôle des Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille; Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UMR CNRS 6236, IRD 3R 198, Université de la Méditerranée, IFR 48, Faculté de Médecine, Marseille, France

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BMC Infectious Diseases 2011, 11:296  doi:10.1186/1471-2334-11-296

Published: 31 October 2011

Abstract

Background

The incidence rate of Nocardia keratitis is increasing, with new species identified thanks to molecular methods. We herein report a case of Nocardia transvalensis keratitis, illustrating this emerging pathology among travellers returning from Asia.

Case presentation

A 23-year-old man presented with a 10-week history of ocular pain, redness, and blurred vision in his right eye following a projectile foreign body impacting the cornea while motor biking in Thaïland. At presentation, a central epithelial defect with a central whitish stromal infiltrate associated with pinhead satellite infiltrates was observed. Identification with 16S rRNA PCR sequencing and microbiological culture of corneal scraping and revealed N. transvalensis as the causative organism. Treatment was initiated with intensive topical amikacin, oral ketoconazole and oral doxycycline. After a four-week treatment period, the corneal infiltrate decreased so that only a faint subepithelial opacity remained.

Conclusion

Nocardia organisms should be suspected as the causative agent of any case of keratitis in travelers returning from Asia. With appropriate therapy, Nocardia keratitis resolves, resulting in good visual outcome.

Keywords:
Nocardia keratitis; amikacin; infectious keratitis