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  Table of Contents    
LETTER TO EDITOR  
Year : 2011  |  Volume : 54  |  Issue : 3  |  Page : 661-663
Lacrimal canaliculitis due to actinomyces: A rare entity


1 Department of Microbiology, JN Medical College, Belgaum, Karnataka, India
2 Department of Ophthalmology, JN Medical College, Belgaum, Karnataka, India

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Date of Web Publication20-Sep-2011
 

How to cite this article:
Vagarali MA, Karadesai SG, Dandur M S. Lacrimal canaliculitis due to actinomyces: A rare entity. Indian J Pathol Microbiol 2011;54:661-3

How to cite this URL:
Vagarali MA, Karadesai SG, Dandur M S. Lacrimal canaliculitis due to actinomyces: A rare entity. Indian J Pathol Microbiol [serial online] 2011 [cited 2019 Sep 18];54:661-3. Available from: http://www.ijpmonline.org/text.asp?2011/54/3/661/85147


Sir,

The fact that Actinomyces israelii can cause conjunctivitis or lacrimal canaliculitis with no generalized systemic invasion has been recognized by only a few investigators. Lacrimal canaliculitis is a relatively rare condition and is commonly undiagnosed for long periods of time. Primary chronic canaliculitis is an uncommon problem that can be overlooked, however, it may account for approximately 2% of all tearing problems. Actinomycosis may form in up to 2% of all lacrimal disease. [1]

A 35-year-old lady presented to us with complaints of watering and purulent discharge from right eye for three months, pain and swelling of the right lower eyelid for two weeks. Examination of the right eye showed swelling of the right lower eyelid which was tender. The swelling was in the medial one-third of the right lower eyelid and the neighboring part of the conjunctiva was inflamed. The punctum was found to be pouting with expression of tenacious pus on pressure over the swelling. The left eye was normal. The punctum was split under topical anesthesia taking aseptic precautions and a thick tenacious purulent material was expressed from the canaliculus [Figure 1]. The punctal discharge was collected, and examined by Gram stain, which showed Actinomyces, appearing as long Gram-positive, non-sporing bacilli and Gram-positive cocci in clusters [Figure 2]. A portion of the collected material was inoculated on sabouraud dextrose agar, 10% sheep blood agar, chocolate agar and also a deep inoculation was done in thioglycollate broth. SDA was incubated at 25°C and examined daily for up to three weeks. The remaining inoculated media were incubated at 37°C. All laboratory methods followed standard protocols. The other portion of the collected material was smeared for 10% potassium hydroxide (KOH) wet mount, and kinyoun's acid-fast staining. All direct microscopic examinations were suggestive of Actinomyces appearing as long Gram-positive, non-sporing bacilli. Aerobic culture yielded a scanty growth of Staphylococcus aureus as golden yellow, opaque, beta hemolytic circular colonies, sensitive to Penicillin, Gentamycin. Anaerobic culture yielded a growth of Actinomyces as flat, irregular, gray, non-hemolytic colonies. The isolate was further identified by negative catalase, indole, hydrogen sulphide; positive aesculin hydrolysis test; weakly positive nitrate reduction test; fermentation of glucose, lactose, sucrose, and xylose. The antimicrobial susceptibility of isolated Actinomyces israelii was determined by Kirby-Bauer disc-diffusion method and showed sensitivity to Penicillin, Ampicillin but was resistant to Gentamycin, Ceftazidime. A therapeutic triad of canaliculotomy, curettage with long-term systemic Penicillin and Sulphacetamide eye drops resulted in resolution. The patient had no purulent discharge.
Figure 1: Lacrimal canaliculitis with punctal discharge in the eye

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Figure 2: Actinomyces and Staphylococcus aureus Scientific Name Search  (Grams stain; ×1000)

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The majority of the cases reported have a clear history of trauma, either a human bite or perforating injury with contamination from outside. [2] In our case, there was no history suggesting trauma, and so the exact pathogenesis remains unclear. Concretions on the lacrimal canaliculus have been considered to be due to Candida albicans, Aspergillus niger, Fusobacterium species and most frequently Actinomyces species. [3] A primary infection of the lacrimal canaliculus is relatively uncommon. In our hospital this is the first case reported. Actinomycosis is caused by a number of facultative anaerobic Actinomycetes. Concomitant bacteria, Staphylococcus aureus favor the growth of anaerobic Actinomycetes. The presence of associated bacteria can enhance the virulence of infection and influence the mode of use of antibiotics, thereby adding to the difficulty of treating the disease. [4] Most Actinomyces strains are sensitive to a wide range of antibiotics. The present isolate was sensitive to Penicillin, Pipercillin and Ampicillin.

It is important to consider the diagnosis of lacrimal canaliculitis in any patient with chronic or recurrent conjunctivitis. Greater awareness of this condition would prevent misdiagnosis and delays in referral for definitive treatment.

 
   References Top

1.Takemura M, Yokoi N, Nakamura Y, Komuro A, Sugita J, Kinoshita S. Canaliculitis caused by Actinomyces in a case of dry eye punctual plug occlusion. Nippon GankaGakkaiZasshi 2002;106:416-9.  Back to cited text no. 1
    
2.Roy D, Roy PG, Misra PK. An interesting case of Primary cutaneous Actinomycosis. Dermatol Online J2003;9:17.  Back to cited text no. 2
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3.Bharathi MJ, Ramakrishnan R, Meenakshi R,Vasu S. Nocardia Asteroides Canaliculitis: A Case report of uncommon aetiology. Indian J Med Microbiol 2004;22:123-5.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.Bowden GH. Actinomyces propionibacterium, propionicus and Streptomyces. In: Baron S, editor. Medical Microbiology. 4 th ed. Galveston (TX): University of Texas Medical Branch at Galveston; 1996. Chapter 34. Available from: http//www.gsbs.utmb-edu/microbook.  Back to cited text no. 4
    

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Correspondence Address:
Manjula A Vagarali
Department of Microbiology, JN Medical College, Nehru Nagar, Belgaum, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.85147

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