Jenna
Tucker
–
Medical
Microbiology
–
Dr.


Rusceh
–
Spring
2011

Pathogens
of
the
Eye


Introduc=on
 Moraxella lacunata 
The
eye
is
the
very
complex
and
interes=ng
visual
organ
of
the
body.
The
eye
detects
 Moraxella lacunata is
a
pus‐producing
obligate
aerobe.
It
is
a
gram
nega3ve
rod
proteobacteria
that
does
not
produce
acid
from
carbohydrates,
is
oxidase
posi=ve,

light,
which,
aDer
entering
the
pupil,
hits
the
lens
of
the
eye
and
is
then
focused
onto
the
 penicillin
suscep=ble,
and
infects
the
mucous
membranes
of
humans
and
other
mammals.
M. lacunata can
cause
bacterial
conjunc3vi3s
(inflamma=on
of
the

re=na,
sending
a
message
through
the
op=c
nerve
to
the
brain.
Although
the
eye
is
 conjunc=va,
which
is
the
outermost
layer
of
the
eye
and
the
inner
surface
of
the
eyelids).

con=nuously
exposed
to
various
pathogens,
infec=ons
occur
when
its
normal
defenses

are
compromised.
Infec=ons
of
the
eye
can
come
from
many
sources,
ranging
from
local
 Virulence
factors:

h3p://en.wikipedia.org/wiki/

areas
like
the
eyelid
to
more
remote
regions
of
the
body
like
the
sinuses.
Addi=onally,
 ‐evasion
of
the
complement
system
that
allows
Moraxella to
survive
in
the
mucosa


File:Swollen_eye_with

infec=ons
can
result
from
trauma,
eye
surgery,
contact
lens
wear,
immune
deficiencies,
or
 ‐increasing
protease
ac=vity
to
destroy
=ssue
and
thus
promote
bacterial
a3achment

_conjunc=vi=s.jpg

other
diseases
causing
bacterial
growth
or
viral
exposure.

The
surface
=ssues
of
the
eye
are
colonized
by
normal
flora
such
as
Streptococcus,
Staphylococcus,
and
Corynebacterium
strains.
Altera=ons
in
the
host
defense
or
in

the
species
of
bacteria
can
lead
to
infec=on.
An
altera=on
in
the
flora
can
occur
by
external
contamina=on,
by
spread
from
adjacent
sites,
or
via
a
blood‐borne

pathway.
M. lacunata is
usually
a
harmless
parasite
of
humans
and
other
warm‐blooded
animal
mucosal
membranes
and
is
generally
considered
not
to
be
highly

Diagram
of
the
eye.


 pathogenic.
However,
it
is
an
opportunis3c
pathogen
in
predisposed
or
debilitated
hosts.

h3p://www.eyecancer.com/Images/eyeDiagram2.gif
  Candida albicans


 
 
 
A
healthy
conjunc3va
is
necessary
for
the
maintenance
of
a
healthy
cornea
and
thus
the
visual


 
 
 
acuteness
of
the
eye.
The
conjunc=va
contributes
to
the
tear
film,
which
consists
of
three

Candida albicans
is
a
fungus
that
causes
endophthalmi3s,
an
inflammatory
condi=on
of
the
intraocular
cavi=es
(such
as


 
 
 
layers:

the
aqueous
or
vitreous
humor).
There
are
two
types
of
endophthalmi=s:
endogenous,
which
results
from
the
spread
of

h3p://www.optometric.com/archive%5C2008%
 
 
 
 
 
‐Inner:
mucous
–
adherence
to
the
cornea
(from
the
conjunc=va)

organisms
from
a
distant
source
of
infec=on,
and
exogenous,
which
results
from
direct
contact
such
as
from
eye
surgery,

5CJuly%5Cimages/OM_July_A08_Fig02.jpg
 
 
 
 
 
‐Middle:
aqueous
–
wehng
agent

foreign
bodies,
or
ocular
trauma.
Endogenous
endophthalmi=s
occurs
when
growth
of
C. albicans
proceeds
unhindered
by


 
 
 
 
‐Outer:
oil
‐
preven=on
of
evapora=on


other
bacteria
that
usually
exist
in
a
compe==ve
balance
in
the
body.
C. albicans normally
resides
in
the
human
body
and
 
 

















is
found
in
the
female
genital
tract,
the
gastrointes=nal
tract,
and
the
respiratory
tract.
However,
when
the
fungus
grows
 
 
 
 
Infec=ons
of
the
conjunc=va
can
spread
to
the
cornea
and
can
cause
a
perfora=on.
 

unchecked,
it
can
travel
to
other
parts
of
the
body
through
the
blood
stream.
 

 
 

 
 
Conjunc3vi3s
is
characterized
by
griSness
and
irrita3on
of
the
eye
and
a
stringy,
opaque,


 













 
 

greyish
or
yellowish
discharge
that
may
cause
the
lids
to
s=ck
together.
Addi=onally,
 

C. albicans is
responsible
for
most
cases
of
endophthalmi=s.  
 h3p://www.virtualmedicalcentre.com/

 
 
bacterial
conjunc=vi=s
can
cause
severe
crus=ng
of
the
infected
eye
and
the
surrounding


 uploads/VMCDiseaseImages2134_


 
 
skin.
Moraxella lacunata
causes
an
angular
conjunc3vi3s
with
a
whi3sh
discharge
at
the


Virulence
factors
of
C. albicans
include:
 
 dry_eye_label_v4_450_noredeye.jpg


 
 
outer
canthus.
It
usually
affects
only
one
eye
but
may
spread
easily
to
the
other
eye.
 

‐Surface
molecules
that
permit
adherence
of
the
organism
to
other
 
 
Epidemiology:
 
 
 
However,
it
is
dormant
in
the
eye
for
three
days
before
the
pa=ent
shows
signs
of
symptoms.

structures


Bacterial
conjunc=vi=s
is
a
common
condi=on
in
all
areas
of
the
United
States.

Several
studies
demonstrate
that
bacterial
conjunc=vi=s
represents

‐Acid
proteases
and
phospholipases
that
aid
in
penetra=on
and


25‐50%
of
all
causes
of
conjunc=vi=s.


damage
of
cell
envelopes


Treatment:

‐Ability
to
convert
to
a
hyphal
form
(long,
branching
filamentous


Conjunc=vi=s
is
a
self
limi=ng
disease.
In
most
instances
the
disease
will
respond
if
the
secondary
causes
are
treated
and
a
broad‐spectrum

structure
of
a
fungus).
Hyphae
are
the
main
mode
of
vegeta=ve


an3bio3cs
and
eye
drops
are
used.

growth
for
fungus.


Table
taken
from
Candida Endophthalmi2s   h3p://webvision.med.utah.edu/imageswv/pupil.jpeg

h3p://www.doctorfungus.org/mycoses/human/candida/Endophthalmi2s.php%5C 
Loa
loa


 
Loiasis,
which
is
caused
by
the
African
eyeworm,
is
a
microfilarial
infec=on.
Loiasis
is

Endogenous
endophthalmi3s:

Immunosuppression
alone
is
not
the
cause
of
fungi
entering
the
bloodstream.
The
growth
of C. albicans is
can
also
be

Type
1
Herpes
Simplex
Virus
 
 
an
important
cause
of
parasi=c
ocular
disease.
The
agent
of
loiasis
is
Loa
loa,
a


 
nematode
worm.
Infec=on
is
acquired
by
humans
through
the
bite
of
the
tabanid

promoted
by
the
administra=on
of
massive
doses
of
various
an=bio=cs
that
suppress
the
normal
bacterial
flora,
which
 
 
flies,
including
the
mango
fly
and
horsefly
of
the
genus
Chrysops
(Chrysops silicea
and

usually
keep
fungal
growth
in
check.
Once
endogenous
endophthalmi=s
spreads
via
the
blood
stream
to
the
eye,
infec=on
 The
type
1
herpes
simplex
virus
(HSV‐1)
is
usually
associated
with
infec=ons
of
the



 
C. dimidiata).
When
humans
are
bi3en,
larvae
pass
from
the
fly
to
the
human.
The

probably
starts
in
the
choroid
and
spreads
to
the
re3na
and
vitreous
(the
eye's
clear
internal
jelly).


 lips,
mouth,
and
face.
It
is
the
most
common
herpes
simplex
virus
and
many
people


 
larvae
develop
over
1
year
into
mature
adult
worms,
which
live
up
to
15
years,
and

The
posterior
segment
lesions
that
occur
in
the
eye
are
usually
caused
by
invasion
through
the
choriocapillaries,
crossing
 develop
it
in
childhood.
By
adulthood,
30
‐
90%
of
people
will
have
an=bodies
to

 The
Mango
Fly


 
then
migrate
through
cutaneous
and
deep
connec3ve
3ssue.
During
this
process,
they

the
pigment
epithelium
to
affect
the
re=na,
although
invasion
of
the
eye
may
also
be
gained
via
the
re=nal
vessels.
The
 HSV‐1.
HSV‐1
is
usually
acquired
orally
during
childhood,
but
may
also
be
sexually
 

h3p://www.stanford.edu/group/para


 
become
microfilariae.
Microfilaria
is
a
stage
in
the
life
cycle
of
parasi=c
nematodes
in

organism
may
then
pass
into
the
vitreous
cavity
from
the
re=na.
If
the
organism
penetrates
the
internal
membrane
of
the
 transmi3ed.

 sites/ParaSites2001/loiasis/loafly.gif


 
the
family
Onchocercidae
(like
Loa
loa).
Loa
loa
adult
worms
live
in
the
circulatory

re=na
and
gains
access
to
the
vitreous
cavity,
it
finds
medium
and
space
for
growth
that
drugs
penetrate
poorly.

 Type
1
herpes
simplex
virus
(HSV‐1)
is
an
enveloped,
double
stranded,
linear
DNA


system
of
their
host
while
their
early
larvae
develop
in
blood‐feeding
arthropod
vectors
(ie.
the
tabanid
flies).
The

Destruc3on
of
intraocular
3ssues
can
be
due
to
both
direct
invasion
by
the
organism
and
the
inflammatory
response
of
 Virus.
HSV‐1
and
‐2
are
transmi3ed
from
contact
with
an
infec=ous
area
of
the
skin

migra=on
of
adult
worms
is
generally
painless
but
may
cause
a
3ngling
sensa3on
when
occurring
on
the
bridge
at
the

the
immune
system.
 during
reac=va=ons
of
the
virus.
Although
less
likely,
the
herpes
viruses
can
be

nose,
the
conjunc=va,
and
the
eyelid.
An
intense
atopic
reac=on
may
occur,
leading
to
localized,
rapid
swelling.


 
 
The
infec=on
results
in
one
or
more
creamy
white,
usually
round
and
some=mes transmi3ed
during
latency.
Transmission
is
likely
to
occur
during
symptoma=c

Ocular
disease
may
be
due
to
both
the
presence
of
microfilaria
and
the
presence
of
the
adult
worm.
The
presence
of


 
elevated,
re=nal
lesions
of
various
size,
mainly
in
the
posterior
pole
of
the
eye.
If

 reac=va=on
of
the
virus
that
causes
visible,
typical
sores.


the
worm
is
associated
with
conjunc=val
injec=on
and
pain
with
movement
of
the
eye
and
may
affect
vision
transiently.

the
vitreous
is
involved,
mul=ple
clumps
(puff
balls)
may
be
formed
within
it
that
are
 Addi=onally,
adult
worms
have
been
found
in
the
vitreous,
eyelid,
and
anterior
chamber.
Re3nal
hemorrhages
may
occur

oDen
connected
by
thread
like
strands
(a
“string
of
pearls”).
The
lesions
can
cause
 Virulence
factors
of
HSV‐1:

as
a
result
of
microfilariae
traveling
through
the
bloodstream
to
involve
the
re=na
and
choroidal
vessels.

blurred
vision
and
pain.
 ‐Interference
with
MHC
class
I
presenta=on
of
an=gen
on
the
cell
surface.

‐During
latent
infec=on,
HSV‐1
maintains
host
cells
and
preserves
a
reservoir
of
the


 Treatment:
 
 
 
Epidemiology:

virus,
which
allows
subsequent,
usually
symptoma=c,
outbreaks.
Whether
or
not

h3p://eyepathologist.com/
 
 Therapy
of
loiasis
involves
the
manual


 
 
While
rela=vely
uncommon
in
the
United
States,

recurrences
are
symptoma=c
or
not,
viral
shedding
occurs
to
produce
further


images/KL21483.jpg
 
 removal
of
adult
worms
present
in
the


 
 
loiasis
affects
an
es=mated
3
million
persons
in

h3p://www.ncbi.nlm.nih.gov/
 infec=ons.


 conjunc=va
in
addi=on
to
the
use
of
the
drug


 
 
Central
and
West
Africa.

pmc/ar=cles/PMC1293756/

Loa
loa
nematode
worm

 diethylcarbamazine
(DEC)
in
escala=ng
doses

Epidemiology:
 Eye
herpes
(ocular
herpes)
is
a
common,
recurrent
viral
infec=on
of
the
eyes.
This
type


 in
blood
smear
 
 
 

over
a
period
of
3
weeks.

 


Compared
to
previous
decades,
the
incidence
of
endogenous
endophthalmi=s
appears
to
have
increased
in
the
past
few
 of
herpes
virus
can
cause
inflamma3on
and
scarring
of
the
cornea
(cold
sore
on
the


 

h3p://en.wikipedia.org/wiki/
 
 
 
References:

decades
in
the
United
States.
Interna=onally,
fungal
endophthalmi=s
remains
rela=vely
rare.
However,
in
countries
with
 eye).
Symptoms
include
inflamma=on
of
the
cornea,
which
can
cause
an
irrita3on
or


 
 
 
 
"Candida
Endophthalmi=s."
Dr.
Fungus:
Fungi,
Fungus,
Fungal.
27
Jan.
2007.
Web.

sudden
and
severe
ocular
pain.
Also,
the
cornea
can
become
cloudy,
leading
to
blurry
 File:L_loa_whole_HBa.jpg

tropical
climates,
fungal
endophthalmi=s
is
not
infrequent.

 
 
 
 
 
26
May
2011.
<h3p://www.doctorfungus.org/mycoses/human/candida
 

vision.
 
 
 
 
 
Endophthalmi=s.php>.

Prospec=ve
studies
of
hospitalized
pa=ents
infected
with
C. albicans
reveal
that
9‐37%
of
pa=ents
developed
 Ranging
from
a
simple
infec=on
to
a
condi=on
that
can
possibly
cause
blindness,
there


 
 
 
 
Chignell,
A.H.
"Endogenous
Candida
Endophthalmi=s."
J
R
Soc
Med
85.12
(1992):

endophthalmi=s.

 are
several
forms
of
eye
herpes:
 
 
 
 

h3p://www.stanford.edu/

721‐24.




‐Herpes
kera33s
is
the
most
common
form
of
eye
herpes
and
is
a
viral
corneal

 
 
 
 
“Conjunc=vi=s(Pink
Eye)."
Web.
26
May
2011.
<h3p:// 
 


 
 
 
Treatment
of
endophthalmi3s:
 class/humbio103/


infec=on.
Ocular
herpes
in
this
form
generally
affects
only
the
top
layer
of
the
cornea
 
 
 
 
www.conjunc=vi=s.blogspot.com/>.

For
the
re=nal
phase
of
the

 
 
 
 ParaSites2006/Loiasis/

 
Dugdale,
David.
"Herpes
Simplex."
Medline
Plus.
Web.
26
May
2011.
<3p:// 

disease,
where
the
lesions

 and
usually
heals
without
scarring.
 h3p://lhsvirtualzoo.wikispaces.com/


 
 
 Images/loa_loa_eye.gif


 
www.nlm.nih.gov/medlineplus/ency/ar=cle/001324.htm>.

are
accessible
from
the
blood

 ‐Stromal
kera33s
occurs
when
the
infec=on
goes
deeper
into
the
layers
of
the
cornea.
 file/view/eye_worm_2.jpg/


 
 
 
 
Egan,
Daniel,
et
al.
"Endophthalmi=s."
Medscape.
29
Apr.
2009.
Web.
26
May
 

stream,
systemic
an3fungals

 This
can
lead
to
scarring,
loss
of
vision
and
occasionally
blindness.
Stromal
kera==s
is


 210344322/eye_worm_2.jpg


 
 
 
2011.
<h3p://emedicine.medscape.com/ar=cle/799431‐overview>.

are
used.
In
those
pa=ents
with

 most
likely
caused
by
a
late
immune
response
to
the
original
infec=on.
 
 
 
 
 


heavy
infiltra=on
of
the
vitreous,
 ‐Iridocycli3s
is
a
serious
form
of
eye
herpes
where
the
iris
and
surrounding
=ssues


 "Eye
Infec=on
‐
Causes."
Solu=ons
to
Medical
Condi=ons
&
Symptoms
‐
Be3er

Medicine.
Ed.
Klasco
Rich.
Health
Grades
Inc.,
2
May
2011.
Web.
26
May
2011.

pars
plana
vitrectomy
is

 inside
the
eye
become
inflamed,
causing
severe
sensi=vity
to
light,
blurred
vision,
pain


 <h3p://www.be3ermedicine.com/ar=cle/eye‐infec=on/causes>.

performed.
Pars
plana
vitrectomy

 and
redness
 
 "Eye
Infec=ons."
Alcon.
Bayer
Healthcare,
AG.
Web.
26
May
2011.
<h3p://www.alcon.com/en/pa=ents‐family/eye‐IIinfec=ons.aspx>.


 Hidalgo,
Jose
A.,
et
Al.
"Candidiasis."
Medscape.
11
Jan.
2010.
Web.
26
May
2011.
<h3p://emedicine.medscape.com/ar=cle/213853‐overview>.

refers
to
the
group
of
opera=ons

 Eye
with
ocular
herpes
 Epidemiology:
 
 Hill,
Jessica.
"Eye
Herpes
or
Ocular
Herpes."
All
About
Vision.
Access
Media
Group
LLC.
Web.
26
May
2011.
<h3p://www.allaboutvision.com/condi=ons/ocular‐
Eye
infected
with
C. albicans
 performed
in
the
deeper
part
 h3p://dentaldad.com/dnn/
 
 herpes.htm>.

h3p://www.revophth.com/
 of
the
eye,
which
involve
removing

 The
Na=onal
Eye
Ins=tute
(NEI)
says
an
es=mated
400,000
Americans
have


Portals/0/herpes%20ocular.jpg
 
 Klotz,
Stephen
A.,
et
Al.
"Fungal
and
Parasi=c
Infec=ons
of
the
Eye."
Clin
Micrbiol
Review
13.4
(2000):
662‐85.


CMSImagesContent/2006/8/1_992_0.jpg
 some
or
all
of
the
vitreous.
 experienced
some
form
of
ocular
herpes,
with
close
to
50,000
new
and
recurring
cases


 Lich=nger,
Alejandro.
"Subconjunc=val
Loiasis."
Am
J
Trop
Med
Hyg
84.2
(2011):
183.

occurring
each
year.
 
 Marlin,
David
S.,
et
Al.
"Conjunc=vi=s,
Bacterial."
Medscape.
1
June
2009.
Web.
26
May
2011.
<h3p://emedicine.medscape.com/ar=cle/1191730‐overview>.

Treatment:
 
 "Moraxella
Lacunata."
Penn
State
College
of
Engineering.
Web.
26
May
2011.
<h3p://www.engr.psu.edu/iec/abe/database/bMoxL.htm>.

Herpes
viruses
establish
lifelong
infec=ons
and
the
virus
cannot
currently
be



 Vidakovics,
Perez,
and
K.
Riesbeck.
"Virulence
Mechanisms
of
Moraxella
in
the
Pathogenesis
of
Infec=on."
Curr
Opin
Infect
Dis
22.3
(2009):
279‐85.

eradicated
from
the
body.
Treatment
usually
involves
general‐purpose
an3viral
drugs


 Wolco3,
W.L.,
and
Suzi
Wolco3.
"Metabolic
Typing
‐‐
Candida
Albicans."
Metabolic
Typing
for
Weight
Loss,
Op=mal
Health,
Energy,
Fitness
and
Immunity.

that
interfere
with
viral
replica=on.
 
 Healthexcel,
Inc.
Web.
26
May
2011.
<h3p://www.healthexcel.com/docs/_cand1.html>.


 Wood,
Mark.
"Conjunc=vi=s:
Diagnosis
and
Management."
Community
Eye
Health
Journal
12.30
(1992):
19‐20.