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V.J. Hsu, J. Affeldt, C. Blanton; Streptococcus Mitis Corneal Ulcer . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2632.
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Purpose: Streptococcus mitis is a member of the Strep. viridans group, and has been previously implicated ocular infection–wise in only a single case of crystalline keratitis. The purpose of this report is to document for the first time a case of ulcerative keratitis associated with Strep. mitis. Methods: Observation case report Results: A 39 year–old soft–contact lens–wearing female presented with a eight day history of pain and decreased vision OS. Exam revealed light perception vision, and a severe corneal ulcer exhibiting total (100%) corneal opacification and a 2.5 mm x 2.5 mm descemetoceole. Culture identified Strep. mitis sensitive (MIC's) to the following antibiotics: Gatifloxan 0.12, Moxifloxacin 0.25, Ciprofloxain >2, Levofloxacin 2, Vancomycin 0.5, and Clindamycin <0.3. Despite aggressive q1 hour treatment with topical Gatifloxacin 0.3%, the cornea perforated requiring emergency penetrating keratoplasty. BCVA at last exam was 20/200. Conclusions: Streptococcus mitis is a rarely encountered but potentially devastating ocular pathogen. Fortunately, however, it appears to be highly sensitive to the commercially available fourth–generation fluoroquinolones (Gatifloxacin and Moxifloxacin), as well as Vancomycin.
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