Correspondence Address:
Shalini Malhotra
Department of Microbiology, Guru Nanak Eye Centre, Maharaja Ranjit Singh Marg, New Delhi - 110 002
India

Full Text

Sir,

Pseudomonas stutzeri (P. stutzeri) is an aerobic nil fermenting gram negative rod with a polar flagella. It is a ubiquitous saprophyte found in soil, water, and hospital environments. [1] In humans, P. stutzeri is generally considered a contaminant that becomes a pathogen if the host immunity is compromised.

A 66-year-old male patient presented to our center with complaints of purulent discharge and diminished vision in the left eye for the past 3 days; the eye had been operated on for cataract with a polymetha methyl acrylate (PMMA) intraocular lens implant 2 weeks earlier. The patient had been on treatment for dry eyes (tear supplements) for 3 years and had bilateral healed corneal perforation with adherent leucoma. On slit lamp examination, a spontaneous healed quiet corneal perforation was noted adjacent to a preexisting adherent leucoma. A conjunctival swab was taken from the left eye for culture and sensitivity (c/s) and the patient was empirically put on topical antibiotics, steroids, and freshly prepared autologous serum, which was instituted at one-hour intervals along with tear supplements. In the conjunctival swab culture, a gram negative organism was isolated that was buff colored, catalase+, and oxidase+. Based on standard identification methods, [2] it was identified as P. stutzeri. An antibiotic susceptibility pattern revealed sensitivity to ciprofloxacin, ofloxacin, ceftizoxime, and ceftazidime while resistance was observed against chloramphenicol, tobramycin, cefazolin, neomycin, and netilmycin. The patient responded to empiric therapy, which correlated well with the in vitro susceptibility report. Ocular discharge disappeared after 1 week. The corneal perforation sealed completely. The patient was followed for 6 months and is still using tear supplements for the treatment of dry eye.

A repeat swab from the left eye revealed no growth after 24 hours of aerobic incubation at 37°C, thus establishing the pathogenic role of P. stutzeri in this eye.

P. stutzeri is an aerobic nil fermenting, gram negative bacteria that is rarely associated with human disease. Isolated case reports of P. stutzeri -associated community acquired pneumonia [1] and meningitis etc. are available in literature. Ocular isolation of P. stutzeri has been reported in cases of delayed onset endophthalmitis [3] and bleb related panophthalmitis. [4] Conjunctival infection in humans caused by this bacterium has not been reported till date though it has been implicated as a pathogenic bacterium from conjunctiva of bustards with ocular discharge. [5] In humans, P. stutzeri is generally considered a contaminant and it becomes an opportunistic pathogen when the host's defense mechanisms are weakened. In this case, it might have also served as an opportunistic pathogen in a preexisting dry eye with a healed corneal perforation with adherent leucoma. This bacteria is highly sensitive to routine antibiotics and clinical response to treatment with antibiotics for other gram negative bacteria is generally good. Our patient also showed a good clinical response to ciprofloxacin. Thus, we report here the first human case of conjunctivitis associated with P. stutzeri from a symptomatic patient of dry eye with healed corneal perforation with adherent leucoma.

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