Título

CORNEAL ULCER DUE TO MORAXELLA NONLIQUEFACIENS IN A CHILD POST-KERATOPLASTY: A CASE REPORT

Objetivo

Report a case of corneal ulcer positive for Moraxella nonliquefaciens. Eye infection caused by this genus of bacteria seems to be on the rise in the last few years, as more cases are being reported - however, most of the times the species identification is done retrospectively and there are no reports of this species causing corneal ulcers in Brazil.

Relato do Caso

We describe a case of a 5 year old child, who previously was treated for congenital glaucoma with trabeculotomy and also had a full-thickness keratoplasty performed, diagnosed with a corneal ulcer positive for M. nonliquefaciens in the left eye. Patient was with sinusitis when presented with pain and ocular secretion associated with an ulcer of chronic evolution and difficult treatment evolving to corneal melting. For the etiological diagnosis of the ulcer, a culture was performed with corneal scrapings from the ulcerated region and from the stitches removed from the transplanted cornea. Initial treatment offered was anfotericin B and gatifloxacin 0,5%. Following, fortified gentamicin was added guided by antibiogram. After outcome of the infection, despite the resolution of the ulcer, he remained with significant paracentral thinning.

Conclusão

Moraxella is a genus of Gram-negative diplobacilli that can colonize the oropharynx. It is involved in different forms of ocular infections, albeit being isolated in only around 5% of eye infection samples. Although not frequently described as an important agent for bacterial keratitis, some studies show that M. nonliquefaciens is responsible for a significant amount of Moraxella ocular infections. LaCroce SJ, et al, isolated M. nonliquefaciens in 80% of keratitis due to Moraxella.
This report should alert us that this species in corneal infections may be much bigger than what was previously thought. Therefore, attention is needed for the diagnosis of the pathogen in cases of corneal ulcer that did not respond to empirical treatment, especially in children due to susceptibility to contamination by oropharyngeal germs.