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A Bacteriological Study of Dacryocystitis in a Tertiary Care Hospital

Sivakrishna A , Jithendhra K, Sreenivasulu Reddy P, Avinash G, P. Vasundhara, T. Deepa, T. Ravikumar, M. Prasad Naidu
American Journal of Microbiological Research. 2018, 6(2), 38-41. DOI: 10.12691/ajmr-6-2-1
Published online: March 14, 2018

Abstract

Dacryocystitis is an inflammation of the lacrimalsac and duct. It is an important cause of ocular morbidity both in children and adults. The study was conducted in Narayana Medical College Nellore. Demographic data of all patients like Age, Sex, Occupation and Socio economic status of patient, nature, duration of symptoms and other aspects mentioned in the proforma was included. Patients who had received either topical or systemic antibiotics for the past one week from their visit to the hospital were excluded. In the present study a total of 100 samples of patients were included in the study based up on inclusion criteria. Out of 100 cases under the study it is observed that the females affected were 51.43% in comparison with males 48.57%. Out of 100 cases which were obtained over a period of one year, 70 samples were culture positive and 30 samples were culture negative. Right eye involvement was noticed among 22 males (64.70%), and left eye 12 (35.30%), in females right eye involvement 12 (33.34%) and left eye involvement 24 (66.66%) was noticed. All cases or forms of Polymicrobial growth were observed in dacryocystitis. The commonest organism in acquired dacryocystitis was Staphylococcus aureus (42.8%) followed by Staphylococcus epidermidis (37.4%) and enterococci (8.57%). Escherichia coli was the common organism (8.57%) followed by pseudomonas aeruginosa (2.85%). Dacryocystitis was most common in females than men. Females of middle age and above had higher incidence of dacryocystitis. Left eye was involved more than right eye. Staphylococcus species were the most common pathogen followed by Escherichia coli in daryocystitis. Vancomycin, Amikacin, Imipenem and co-trimoxazole are suitable therapeutic option in dacryocystitis.

1. Introduction

Dacryocystitis is one of the most common diseases of the eye. It is an important cause of ocular morbidity both in children and adults. 1 Dacryocystitis is an inflammation of the lacrimalsac and duct. It may be congenital and acquired. Acquired dacryocystitis occurs in two forms: Acute and Chronic. 2

Acute dacryocystitis is heralded by the sudden onset of pain and redness in medial canthal region which is caused by lacrimalsac distension and inflammation of less than 2 weeks duration. Obstruction of the nasolacrimal duct leading to stagnation of tears in pathologically closed lacrimal drainage system can results in dacryocystitis. 3 Obstruction of nasolacrimal duct may be an “idiopathic inflammatory stenosis (primary acquired nasolacrimal duct obstruction)” or may be secondary to trauma, infection, inflammation, neoplasm (or) mechanical obstruction (secondary acquired lacrimal drainage obstruction). Dacryocystitis is a common problem, yet there are relatively few studies describing the microbiological characteristics of lacrimal sac infection. 4 The microbiology of dacryocystitis may differ in acute and chronic infections. Acute dacryocystitis is often caused by gram negative rods. 5 In chronic dacryocystitis, mixed bacterial isolates are common with the predominance of staphylococcus species and streptococcus pneumoniae. 5, 6 Fungal infections caused by candida albicans and aspergillus species occurs infrequently. During the past 20 years there have been only a few studies on the bacteriology of dacryocystitis. According to them “CONS” and Staphylococcus aureus are the most frequently isolated organisms in lacrimalsac infections. 7 Chronic dacryocystitis may be present with a variety of symptoms including unilateral tearing and intermittent milky discharge that accumulates in the inner canthus. A non tender mass in the medial canthus that is reducible by finger –pressure is a common complaint. Definitive treatment of chronic dacryocystitis is achieved with “dacryocystorhinostomy”. 8

2. Material and Methods

The present study on dacryocystitis was carried out in Department of Microbiology, Narayana medical college Nellore, over a period of one year. The study was approved by Ethical Committee. Demographic and clinical data of all the patients like age, sex, occupation, socioeconomic status of patient, nature, duration of symptoms and other aspects mentioned in the proforma were collected. After clinical diagnosis of dacryocystitis by ophthalmologist, specimen was collected with the help of ophthalmologist.

Specimen Collection: The surrounding area was aseptically cleaned to avoid contamination from the surface micro-organisms and samples were collected in two sterile swabs from lacrimalsac. It was collected either by applying pressure over the lacrimalsac and allowing the purulent material to reflux through the lacrimal punctum (or) by irrigating the lacrimal-drainage system with sterile swab and lacrimal syringing.

Exclusion Criteria: Patients who had received either topical or systemic antibiotics for the past one week from their visit to the hospital were excluded. The specimens were processed immediately in the following manner as, direct smear examination, culture on dried plates of maconkey’s agar at 37°C for 18 to 24 hours and on 5% sheep blood agar and chocolate agar with 5-10% CO2 atmosphere at 37°C for 24-48 hours. The identification of the bacteria was done by microscopy and biochemical tests using standard laboratory guidelines. The bacterial inoculums conforming by 0.5% macfarland’s standard and antibiogram was performed on muller-hinton agar, by Kirby-bauer disc diffusion test and the zone of inhibition was measured and reported as susceptible (or) resistant.

3. Results

In the present study a total of 100 cases were included based up on inclusion criteria. Out of 100 cases which were obtained over a period of one year, 70 were culture positive and 30 were culture negative. Majority of single eye involvement was noticed in this study. Out of 100 cases under the study it was observed that the females were 51.43% and males 48.57%. Out of 100 cases pure growth was seen in majority of cases. Data of the study shows 30-60 years as the most common age group in dacryocystitis.

Table 1 shows out of total 100 study cases 70 [70%] were positive for acquired dacrocystitis among which 51.43% were females and 48.57 % were males.

Out of the 100 samples in study period, 70 samples were culture positive and 30 negative.

Bacteriological analysis of the study was done. A total of 70 isolates were grown from 70 culture positive cases. Single isolate was recovered from all cases. All cases of polymicrobial growth were observed in dacryocystitis. The gram positive pathogens (62) were more common than gram negative pathogens (08). The commenst organism in acquired dacryocystitis was staphylococcus aureus as the most gram positive pathogen (42.8%) followed by staphyloccus epidermidis (37.4%) in dacryocystitis. Escherichia coli was the common organism (pathogen) (8.57%) followed by pseudomonas aeruginosa (2.85%) in gram negative pathogens. The antibiogran of the isolates was performed as per CLSI guidelines. The gram positive isolates were most sensitive to Vancomycin, Linezolid, Azithromicin, Amikacin (100%). Escherichiacoli showed maximum sensitivity to Imipenem (100%), Gentamicin (66.66%), Amikacin (66.66%) and Maximum resistance was exhibited to Ampicillin (0%) and Amoxy+CLAV (33.33). The analysis of the Antibiotic sensitivity clearly indicated Vancomycin and Linezolid as choice of drug for common pathogens encountered in dacryocystitis.

4. Discussion

Dacryocystitis is one of the most common diseases of the eye. It is important cause of ocular morbidity both in children and adult. Hence it requires special attention regarding the initiation of appropriate treatment. In the present study 100 clinically diagnosed cases of dacryocystitis attending ophthalmology outpatient department at Narayana Medical College Hospital, Nellore were studied.

Distribution of dacryocystitis cases shows that the infection is common in females 36 (51.43%) in comparison with males 34 (48.57%) which correlated the studies of Machin SJ et al 9 Badhu b et al, 10 predilection in females may be due to the smaller Nasolacrimal cannal diameter in females than men. 11

Distribution of dacryocystitis cases according to gender and eye affected; In present study the involvement of eye is mainly unilateral either right or left. These correlates well with the study of Brook I et al. 12 There is a relatively high incidence of disease on left side as compared to right side these correlates well with Brook I et al 12 in Usha k et al 13 study right lacrimal sac was involved in 76 (40%) patients and left lacrimal sac in 60 (33%). Distribution of dacryocystitis cases according to number of organisms; In this study out of 100 samples, 70 samples were obtained, single organism were isolated 68 (98%) of the cases and mixed organisms in 02 (2%) which correlates with studies of Kundu Pk et al 14 82.5%) and (10.5%).

Distribution of various organisms in dacryocystitis; In acquired dacryocystitis most common gram positive isolate is (Staphylococus aureus) (42.8%) and most common gram negative isolate is Escherichia coli (8.57) out of 70 isolates. This correlates with studies of Huber spitzy V et al 15 (50%) and (11,.7%).

Antibiogram pattern of organisms isolated from dacryocystitis cases: The antimicrobial sensitivity pattern varies from community to community. This is because of emergence of resistant strains as a result for indiscriminate use of antibiotics. The gram positive isolate were more sensitive to Vancomycin and Linezolid (100%) followed by Clindamicin (86%). The gram negative organisms were most sensistive to Imipenem, Co-trimoxazole 100% followed by Amikacin (66.66%) and Gentamicin (66.66%). Briscoe D et al 16 revealed that gram negative isolates were sensitive to Ceftazidime in 95% Ciprofloxacin in 86% and Cefuroxime in 50% with a sensitivity of less than 30% of Cefalexin and Ampicillin. In Usha K et al 13 study gram positive organisms exhibited a high rate of sensitivity to Vancomycin, Chloramphenicol and Ofloxacin.

5. Conclusion

A total of 100 clinically diagnosed cases of dacryocystitis were processed in the present study among these 70 cases were culture positive and 30 cases were culture negative. Dacryocysttis was most common in women than men. Females of middle age and above had higher incidences of dacryocystitis. Left eye was involved more than right eye. In majority of cases the most common complaints was watering of eye associated with purulent discharge. The most common organism in acquired dacryocytitis was (Staphylococus aureus) followed by Staphylococus epidermidis (cons). The gram positive isolates were most sensitive to Vancomycin, Linezolid, followed by Clindamycin and less sensitive to Pencillin. The gram negative organism were most sensitive to Imipenem, Co-trimoxazole followed by Amikacin and Gentamicin.

Conflict of Interest

None declared.

Acknowledgements

Cooperation with Dept of Microbiology, Narayana Medical college and Hospital, Chinthareddy palem, Nellore, 524003, Andhra Pradesh, India.

References

[1]  Ghoses, Nayak n, Satpathy G eta al current microbial correlates of the eye and nose in dacryocystitis their clinical significance. AIOC Proceedings 2005; 437-439.
In article      
 
[2]  Gupta AK, Raina UK, Gupta A. The lacrimal apparatus. In text book of ophthalmology. Ist edn. New delhi, B I Churchill livingstone 1999; 275-277.
In article      
 
[3]  Huber spitzy V, Stein Kogler Fj, et al Acquired dacryocystitis; Microbiology and conservative therapy act a. Opthalmology. 1992; 70.
In article      View Article
 
[4]  Mills DM, Bodeman MG, Meyer DR, Marton A.D, Asoprs Dacryocystitis study group ophthalmology plastic reconstructive surgery; 2007: 23 (4).
In article      
 
[5]  Illiff nT. Infections of the lacrimal drainage system in Peopre JS, Holland GN, Ocular infections and immunity Mos by: St loismo, 1996. pp-1346-1355.
In article      
 
[6]  Hritikainen J, Lentonen OP, Saari KM. Bacteriology of lacrimal duct obstruction in adults (BOP) -1997, 81: pp37-40.
In article      View Article
 
[7]  Terrencep O Brein. Periocular infections. In mandel, Douglas, Bennet. Eds. Principles and practice of infectious diseases 5th ed. Newyork, Churchill living stone 2000: 1274-1277.
In article      
 
[8]  Chandler JW, Sugar J, Edelhauser HF. In: Podos SM, Yanoff M.Eds. Text book of Opthalmology Volume 8, Chapter 14; lacrimal system Dry eye states and other conditions.
In article      
 
[9]  Machin SJ et al lacrimal duct obstruction treated with lacrimonasal stent. Arch Soc Esp opthalomol 2003; 78(6); 315-318.
In article      View Article
 
[10]  Badhu B et al Epidemiology of chronic dacryocystitis and success rate of external dacryocystorhinostosis in Nepal orbit 2005; 24(2): 79-82.
In article      View Article
 
[11]  Rao VA Anatomy and diseases of lacrimal apparatus. In text book of disease of the eye 2nd ed madaras 1996: 41-48.
In article      
 
[12]  Brook I, Frazier EH. Aerobic and anaerobic microbiology of dacryocystitis AMJ opthalomol 1998; 12594: 552-554.
In article      View Article
 
[13]  Usha K et al spectrum nd the suspectibilities of microbial isolates in case of congenital nasolacrimal duct obstruction JAAPOS 2006; 10(5): 469-478.
In article      View Article  PubMed
 
[14]  Khurana A.K et al disease of lacrimal apparatus, ophthalmology 3rd edn. New Age publishers 2003; 342-346.
In article      
 
[15]  Huber–spitzy V, Stein kogler FJ, Huber E, Arocker-mettinger E Acquired dacryocystitis; Microbiology and conservative therapy Acta optihalmol (copench)1992; 70(6): 745-749.
In article      View Article
 
[16]  Briscoed, Rubowitz A, Assia EI. Changingh bacterial isolates and antibiotics sensitivities of purulent dacyocystitis orbit 2001; 24(2): 95-98.
In article      View Article
 

Published with license by Science and Education Publishing, Copyright © 2018 Sivakrishna A, Jithendhra K, Sreenivasulu Reddy P, Avinash G, P. Vasundhara, T. Deepa, T. Ravikumar and M. Prasad Naidu

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

Cite this article:

Normal Style
Sivakrishna A, Jithendhra K, Sreenivasulu Reddy P, Avinash G, P. Vasundhara, T. Deepa, T. Ravikumar, M. Prasad Naidu. A Bacteriological Study of Dacryocystitis in a Tertiary Care Hospital. American Journal of Microbiological Research. Vol. 6, No. 2, 2018, pp 38-41. http://pubs.sciepub.com/ajmr/6/2/1
MLA Style
A, Sivakrishna, et al. "A Bacteriological Study of Dacryocystitis in a Tertiary Care Hospital." American Journal of Microbiological Research 6.2 (2018): 38-41.
APA Style
A, S. , K, J. , P, S. R. , G, A. , Vasundhara, P. , Deepa, T. , Ravikumar, T. , & Naidu, M. P. (2018). A Bacteriological Study of Dacryocystitis in a Tertiary Care Hospital. American Journal of Microbiological Research, 6(2), 38-41.
Chicago Style
A, Sivakrishna, Jithendhra K, Sreenivasulu Reddy P, Avinash G, P. Vasundhara, T. Deepa, T. Ravikumar, and M. Prasad Naidu. "A Bacteriological Study of Dacryocystitis in a Tertiary Care Hospital." American Journal of Microbiological Research 6, no. 2 (2018): 38-41.
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[1]  Ghoses, Nayak n, Satpathy G eta al current microbial correlates of the eye and nose in dacryocystitis their clinical significance. AIOC Proceedings 2005; 437-439.
In article      
 
[2]  Gupta AK, Raina UK, Gupta A. The lacrimal apparatus. In text book of ophthalmology. Ist edn. New delhi, B I Churchill livingstone 1999; 275-277.
In article      
 
[3]  Huber spitzy V, Stein Kogler Fj, et al Acquired dacryocystitis; Microbiology and conservative therapy act a. Opthalmology. 1992; 70.
In article      View Article
 
[4]  Mills DM, Bodeman MG, Meyer DR, Marton A.D, Asoprs Dacryocystitis study group ophthalmology plastic reconstructive surgery; 2007: 23 (4).
In article      
 
[5]  Illiff nT. Infections of the lacrimal drainage system in Peopre JS, Holland GN, Ocular infections and immunity Mos by: St loismo, 1996. pp-1346-1355.
In article      
 
[6]  Hritikainen J, Lentonen OP, Saari KM. Bacteriology of lacrimal duct obstruction in adults (BOP) -1997, 81: pp37-40.
In article      View Article
 
[7]  Terrencep O Brein. Periocular infections. In mandel, Douglas, Bennet. Eds. Principles and practice of infectious diseases 5th ed. Newyork, Churchill living stone 2000: 1274-1277.
In article      
 
[8]  Chandler JW, Sugar J, Edelhauser HF. In: Podos SM, Yanoff M.Eds. Text book of Opthalmology Volume 8, Chapter 14; lacrimal system Dry eye states and other conditions.
In article      
 
[9]  Machin SJ et al lacrimal duct obstruction treated with lacrimonasal stent. Arch Soc Esp opthalomol 2003; 78(6); 315-318.
In article      View Article
 
[10]  Badhu B et al Epidemiology of chronic dacryocystitis and success rate of external dacryocystorhinostosis in Nepal orbit 2005; 24(2): 79-82.
In article      View Article
 
[11]  Rao VA Anatomy and diseases of lacrimal apparatus. In text book of disease of the eye 2nd ed madaras 1996: 41-48.
In article      
 
[12]  Brook I, Frazier EH. Aerobic and anaerobic microbiology of dacryocystitis AMJ opthalomol 1998; 12594: 552-554.
In article      View Article
 
[13]  Usha K et al spectrum nd the suspectibilities of microbial isolates in case of congenital nasolacrimal duct obstruction JAAPOS 2006; 10(5): 469-478.
In article      View Article  PubMed
 
[14]  Khurana A.K et al disease of lacrimal apparatus, ophthalmology 3rd edn. New Age publishers 2003; 342-346.
In article      
 
[15]  Huber–spitzy V, Stein kogler FJ, Huber E, Arocker-mettinger E Acquired dacryocystitis; Microbiology and conservative therapy Acta optihalmol (copench)1992; 70(6): 745-749.
In article      View Article
 
[16]  Briscoed, Rubowitz A, Assia EI. Changingh bacterial isolates and antibiotics sensitivities of purulent dacyocystitis orbit 2001; 24(2): 95-98.
In article      View Article