Short communication
Delayed-onset bleb-related endophthalmitis caused by Moraxella nonliquefaciens
Endoftalmitis de inicio tardío asociada a ampolla de filtración por Moraxella nonliquefaciens
Read
10
Timeswas read the article
1
Total PDF
9
Total HTML
Share statistics
array:24 [ "pii" => "S2173579420301079" "issn" => "21735794" "doi" => "10.1016/j.oftale.2020.05.004" "estado" => "S300" "fechaPublicacion" => "2020-11-01" "aid" => "1718" "copyright" => "Sociedad Española de Oftalmología" "copyrightAnyo" => "2020" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2020;95:559-64" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S036566912030188X" "issn" => "03656691" "doi" => "10.1016/j.oftal.2020.05.012" "estado" => "S300" "fechaPublicacion" => "2020-11-01" "aid" => "1718" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2020;95:559-64" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Comunicación corta</span>" "titulo" => "Endoftalmitis de inicio tardío asociada a ampolla de filtración por <span class="elsevierStyleItalic">Moraxella nonliquefaciens</span>" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "559" "paginaFinal" => "564" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Delayed-onset bleb-related endophthalmitis caused by Moraxella nonliquefaciens" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1514 "Ancho" => 1505 "Tamanyo" => 238972 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Imagen del ojo derecho al diagnóstico. A) Imagen de la ampolla de filtración del ojo derecho al diagnóstico con material purulento en su interior, lo que indica la presencia de blebitis. B) Erosión de la ampolla de filtración con tinción con fluoresceína positiva pero con fenómeno de Seidel negativo. C) Imagen de polo anterior del ojo derecho con pliegues en la membrana de Descemet, hipopion en cámara anterior e importante hiperemia conjuntival.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Díaz Barrón, J.M. Hervás Hernandis, L. Sanz Gallen, A. López Montero, I. Gil Hernández, A.M. Duch-Samper" "autores" => array:6 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Díaz Barrón" ] 1 => array:2 [ "nombre" => "J.M." "apellidos" => "Hervás Hernandis" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Sanz Gallen" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "López Montero" ] 4 => array:2 [ "nombre" => "I." "apellidos" => "Gil Hernández" ] 5 => array:2 [ "nombre" => "A.M." "apellidos" => "Duch-Samper" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173579420301079" "doi" => "10.1016/j.oftale.2020.05.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579420301079?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S036566912030188X?idApp=UINPBA00004N" "url" => "/03656691/0000009500000011/v2_202108180554/S036566912030188X/v2_202108180554/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173579420301675" "issn" => "21735794" "doi" => "10.1016/j.oftale.2020.04.018" "estado" => "S300" "fechaPublicacion" => "2020-11-01" "aid" => "1713" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2020;95:565-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Ocular surface analysis in patients diagnosed with X-linked ichthyosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "565" "paginaFinal" => "568" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Análisis de superficie ocular en pacientes diagnosticados de ictiosis X" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 695 "Ancho" => 1007 "Tamanyo" => 69200 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Display of stromal corneal opacities in slit lamp.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F.B. Domínguez-Serrano, M. Caro-Magdaleno, B. Mataix-Albert, P. Molina-Solana, J. Montero-Iruzubieta, E. Rodríguez-de-la-Rúa" "autores" => array:6 [ 0 => array:2 [ "nombre" => "F.B." "apellidos" => "Domínguez-Serrano" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Caro-Magdaleno" ] 2 => array:2 [ "nombre" => "B." "apellidos" => "Mataix-Albert" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Molina-Solana" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Montero-Iruzubieta" ] 5 => array:2 [ "nombre" => "E." "apellidos" => "Rodríguez-de-la-Rúa" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669120301830" "doi" => "10.1016/j.oftal.2020.04.023" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669120301830?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579420301675?idApp=UINPBA00004N" "url" => "/21735794/0000009500000011/v1_202011010626/S2173579420301675/v1_202011010626/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173579420301560" "issn" => "21735794" "doi" => "10.1016/j.oftale.2020.05.017" "estado" => "S300" "fechaPublicacion" => "2020-11-01" "aid" => "1725" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2020;95:555-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Pseudoxanthoma elasticum in childhood in patient with β-thalassaemia" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "555" "paginaFinal" => "558" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pseudoxantoma elástico infantil en paciente con β-talasemia" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 939 "Ancho" => 1333 "Tamanyo" => 137390 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">a) Multicoloured image showing the diffuse granular mottling of the <span class="elsevierStyleItalic">peau d'orange</span> retinal pigment epithelium. b) Small whitish subretinal lesions at the peripapillary level compatible with colloid and crystalloid bodies. c) Colloid bodies in comet wake (infrared image). d) Colloid bodies visualized with autofluorescence. e) Colloid bodies visualized by infrared. f) Optical coherence tomography on colloid bodies.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Hernández Bel, A. Esteve Martínez, R. Rodríguez López, C. Monferrer Adsuara, M.L. Hernández Garfella, E. Cervera Taulet" "autores" => array:6 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Hernández Bel" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Esteve Martínez" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Rodríguez López" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Monferrer Adsuara" ] 4 => array:2 [ "nombre" => "M.L." "apellidos" => "Hernández Garfella" ] 5 => array:2 [ "nombre" => "E." "apellidos" => "Cervera Taulet" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669120301969" "doi" => "10.1016/j.oftal.2020.05.018" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669120301969?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579420301560?idApp=UINPBA00004N" "url" => "/21735794/0000009500000011/v1_202011010626/S2173579420301560/v1_202011010626/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Delayed-onset bleb-related endophthalmitis caused by <span class="elsevierStyleItalic">Moraxella nonliquefaciens</span>" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "559" "paginaFinal" => "564" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Díaz Barrón, J.M. Hervás Hernandis, L. Sanz Gallen, A. López Montero, I. Gil Hernández, A.M. Duch-Samper" "autores" => array:6 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Díaz Barrón" "email" => array:1 [ 0 => "andrea.dazbarrn9@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J.M." "apellidos" => "Hervás Hernandis" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "L." "apellidos" => "Sanz Gallen" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "López Montero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "I." "apellidos" => "Gil Hernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "A.M." "apellidos" => "Duch-Samper" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Facultad de Medicina, Universidad de Valencia, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Endoftalmitis de inicio tardío asociada a ampolla de filtración por <span class="elsevierStyleItalic">Moraxella nonliquefaciens</span>" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1514 "Ancho" => 1505 "Tamanyo" => 238972 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Image of right eye at diagnosis. A) Right eye filtration bleb at diagnosis containing purulent material, indicating the presence of blebitis. B) Filtration bleb erosion with positive fluorescein stain but with negative Seidel phenomenon. C) Right eye anterior pole with folds in Descemet membrane, hypopion in anterior chamber and important conjunctival hyperemia.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Endophthalmitis associated with filtration blebs has an incidence of between 0.4 and 6.9%<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and is usually produced by virulent organisms, such as streptococci or gram-negative bacteria.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Streptococci of the <span class="elsevierStyleItalic">viridans</span> and <span class="elsevierStyleItalic">S. pneumoniae</span> group are isolated in more than one third of cases. Other common microorganisms in this type of infection are <span class="elsevierStyleItalic">Staphylococcus aureus, Haemophilus influenzae</span> and enterococci.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The main risk factor is the fragility of the conjunctiva, which is observed by a thin-walled cystic filtration bleb with absence of vascularization, normally produced by the use of antimitotics.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a> The presence of a positive Seidel test in the filtration bleb also increases the risk of endophthalmitis.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Microorganisms colonize the eye by transconjunctival route and initially cause blebitis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Moraxella spp</span>. is a genus of short bacillus-shaped aerobic gram-negative bacteria, cocobacillus or diplococci. Its prevalence in endophthalmitis is low,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5</span></a> although it is higher in endophthalmitis associated with filtration blebs.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a><span class="elsevierStyleItalic">Moraxella nonliquefaciens</span> inhabits the nasal cavity, upper respiratory tract and eye.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> It has been associated with eye infections such as bacterial keratitis and conjunctivitis, of which only 10 cases of endophthalmitis have been reported in the literature,<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,6–10</span></a> most associated with late-onset blebitis.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,6,8,9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Although endophthalmitis due to <span class="elsevierStyleItalic">Moraxella nonliquefaciens</span> presents severe inflammation at diagnosis,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4,6–9</span></a> its visual prognosis with effective diagnosis and appropriate treatment is usually good.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–5,7</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical case</span><p id="par0025" class="elsevierStylePara elsevierViewall">The case of a 90-year-old woman with polymyalgia rheumatica is presented. The patient visited the ophthalmology emergency room with one-week evolution with painful right eye (RE) with secretions. She had history of chronic open-angle glaucoma in both eyes and had undergone surgery for cataracts in boths and for glaucoma in RE 10 years previously, by means of trabeculectomy with scleral mat from 5 × 4 mm, conjunctival flap at the base of the fornix and application of 0.2 mg/mL of mitomycin C by peroperative topical route for 2 min.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Examination showed visual acuity in the RE of hand movement and 20/30 in the LE.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In biomicroscopy, the filtration bleb was observed to have purulent material (blebitis) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A) and positive fluorescein erosion, although without Seidel phenomenon (negative Seidel) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). The cornea was edematous, with Descemet folds, lower endothelial keratic precipitates, 1 mm height hypopion in anterior chamber (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C), grade 2 flare and grade 4 Tyndall. Intraocular pressure (IOP) was 21 mmHg (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In the fundus no structure could be observed due to marked vitritis (grade 4).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Aqueous humor and smears were taken from the filtration vial for bacterial culture.</p><p id="par0045" class="elsevierStylePara elsevierViewall">An intravitreal injection 1 mg of vancomycin in 0.1 ml and 2 mg of ceftazidime in 0.1 ml was given, prescribing reinforced eye drops of 5% ceftazidime and 5% vancomycin every hour, together with cycloplegic and dexamethasone eye drops every 8 h. Oral ciprofloxacin 500 mg every 12 h and linezolid 600 mg every 12 h were prescribed. In addition, the patient was on oral treatment with 7.5 mg a day of prednisone due to rheumatic polymyalgia.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The following day the patient maintained the same visual acuity, although reporting improvement in pain. In addition, less hypopia was observed. Tyndall had decreased to grade 2, but grade 4 vitritis persisted, so it was decided to continue the same oral treatment.</p><p id="par0055" class="elsevierStylePara elsevierViewall">After a week, there was no hypopion and persistence of blebitis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A), Descemet folds (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B), Tyndall and grade 1 flare, and the bleb erosion had been re-epithelialized (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C). A marked grade 4 vitritis persisted in the fundus, so it was decided to inject a new injection of intravitreal ceftazidime.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The result of the culture of the conjunctival smear was negative for bacteria and fungi.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The result of the aqueous humor culture was <span class="elsevierStyleItalic">Moraxella nonliquefaciens.</span></p><p id="par0070" class="elsevierStylePara elsevierViewall">It was not possible to determine the antimicrobial sensitivity, which would have allowed the implantation of a directed antimicrobial treatment, and it was decided to establish empirical antibiotic therapy, according to the pattern of sensitivity described in our environment for this microorganism, with 0.3% ciprofloxacin eye drops plus 250 mg of azithromycin orally.</p><p id="par0075" class="elsevierStylePara elsevierViewall">On day 13 after the first visit (3 days after the second intravitreal injection) RE visual acuity was finger-counting. The fundus showed grade 2 vitritis, which allowed visualization of the papilla and large vessels, and no blebitis was observed.</p><p id="par0080" class="elsevierStylePara elsevierViewall">In successive controls a progressive decrease in vitritis until complete resolution was observed on the 29th day after infection. Visual acuity of RE was 20/200 (similar to the previous one). A pale and cystic bleb was observed without blebitis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A). The fundus was normal, without vitritis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B). The cornea was transparent, with no inflammatory signs in the anterior chamber (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>C). IOP was from 10 mmHg. Treatment was suspended in its entirety.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">The incidence of endophthalmitis associated with the filtration bleb ranges from 0.4 to 6.9%.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The prevalence of <span class="elsevierStyleItalic">Moraxella spp</span>. in endophthalmitis of any etiology varies between 1.35 and 6.5%,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> depending on the series. The difference lies in the fact that in the second series <span class="elsevierStyleItalic">Moraxella spp</span>. was detected by aqueous humor PCR, with aqueous humor and vitreous humor cultures being negative in almost all cases, while in the first series only aqueous and vitreous humor cultures were performed. Aqueous humor PCR increased the identification rate of <span class="elsevierStyleItalic">Moraxella spp</span>.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The prevalence of <span class="elsevierStyleItalic">Moraxella spp</span>. in endophthalmitis associated with the filtration bleb increased to 50%.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Endophthalmitis caused by <span class="elsevierStyleItalic">Moraxella spp</span>. is late-onset (more than 6 weeks after surgery) and is associated with the filtration bleb<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5</span></a> formed after filtrating glaucoma surgery, after cataract surgery<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> or after trauma,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5</span></a> although in these last 2 cases it occurred inadvertently.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The average appearance of endophthalmitis by <span class="elsevierStyleItalic">Moraxella spp</span>. is 41 months after filtrating surgery, 17 years after intraocular cataract surgery and 55 years after post-traumatic surgery.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In the present case it appeared 120 months after trabeculectomy, which is a later than average.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The main risk factor is fragility of the conjunctiva, which is observed by a thin-walled cystic filtration bleb with an absence of vascularization, normally produced by the use of antimitotic drugs during glaucoma surgery.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4,6</span></a> The presence of positive Seidel test in the filtration bleb also increases the risk of endophthalmitis,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> although it may not be present.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Microorganisms colonise the eye via the transconjunctival route and initially cause blebitis.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The immunosuppressive status also increases the risk,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> as well as diabetes mellitus.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Of the 10 cases of endophthalmitis produced by <span class="elsevierStyleItalic">Moraxella nonliquefaciens</span> found in the literature, one had previously undergone cataract surgery due to intraocular infection from corneal erosion by contact lens.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Of the remaining 9, 6 had been operated on for trabeculectomy and cataract and all exhibited blebitis.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,6,8,9</span></a> The other cases correspond to 3 endophthalmitis, out of a total of 107 ocular infections by <span class="elsevierStyleItalic">Moraxella spp</span>. (keratitis, conjunctivitis and endophthalmitis) collected between 1993 and 2017 in the USA, which represent 75% of all endophthalmitis cases in this series.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The present patient had blebitis at diagnosis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A) with Seidel negative phenomenon, but with filtration bleb erosion (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B) that was later re-epithelialized (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C). IOP values were always the same or below 21, although sometimes blebitis is associated with filtration bleb dysfunction due to elevated IOP.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Despite being a bacterium that forms part of the ocular flora, it is not rare for the culture of the conjunctival smear to be negative for endophthalmitis caused by <span class="elsevierStyleItalic">Moraxella nonliquefaciens</span>,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> as in this case.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Endophthalmitis associated with filtration bleb by <span class="elsevierStyleItalic">Moraxella spp</span>. has a good prognosis.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5</span></a> However, these cases usually present severe intraocular inflammation at diagnosis<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> as in this case, which began with grade 4 hypopion and vitritis, so visualization of the fundus was very poor, with no structure determined until day 13 post-infection.</p><p id="par0140" class="elsevierStylePara elsevierViewall">The visual outcome of endophthalmitis by <span class="elsevierStyleItalic">Moraxella spp</span>. can be favorable with adequate diagnosis and treatment.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5</span></a> Of the 10 cases of endophthalmitis by <span class="elsevierStyleItalic">Moraxella nonliquefaciens</span> reviewed in the literature, 3 exhibited positive visual outcomes<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,7</span></a> and 4 had a poor visual outcome.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,8,9</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">The patient's visual acuity was 20/200 on the postinfection day 29, which was good since it was similar to previous values.</p><p id="par0150" class="elsevierStylePara elsevierViewall">The mean number of intravitreal injections for endophthalmitis caused by <span class="elsevierStyleItalic">Moraxella spp</span>. is 2.7,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> which is consistent with our case, in which she was treated with an injection of vancomycin and 2 of ceftazidime.</p><p id="par0155" class="elsevierStylePara elsevierViewall">In conclusion, endophthalmitis caused by <span class="elsevierStyleItalic">Moraxella nonliquefaciens</span> is rare and is associated with late-onset blebitis (more from 6 weeks post-surgery). Diabetes and immunosuppression are risk factors. Despite presenting severe inflammation at diagnosis, the visual prognosis is usually positive.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflict of interests</span><p id="par0160" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1407068" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1287299" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1407069" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1287298" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical case" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interests" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-02-04" "fechaAceptado" => "2020-05-07" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1287299" "palabras" => array:4 [ 0 => "Endophthalmitis" 1 => "Blebitis" 2 => "Bleb" 3 => "<span class="elsevierStyleItalic">Moraxella nonliquefaciens</span>" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1287298" "palabras" => array:4 [ 0 => "Endoftalmitis" 1 => "Blebitis" 2 => "Ampolla de filtración" 3 => "<span class="elsevierStyleItalic">Moraxella nonliquefaciens</span>" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Bleb-related endophthalmitis is rare and appears months or years after surgery. The causative agents are usually streptococci or gram-negative bacteria.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">There are few cases in the literature of endophthalmitis caused by <span class="elsevierStyleItalic">Moraxella nonliquefaciens,</span> and most are delayed-onset associated with blebitis after glaucoma filtration surgery.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The case is presented of a 90-year-old patient with endophthalmitis in the right eye due to <span class="elsevierStyleItalic">Moraxella nonliquefaciens</span> associated with blebitis 10 years after glaucoma surgery. After treatment, disappearance of blebitis is observed two weeks later and resolution of vitritis 29 days later, with recovery of vision to previous values (20/200).</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Endophthalmitis due to <span class="elsevierStyleItalic">Moraxella nonliquefaciens</span> is rare, and is associated with late onset blebitis after glaucoma filtration surgery. Despite the virulence of the clinical symptoms, the visual prognosis is usually favourable.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Las endoftalmitis asociadas a la ampolla de filtración tras cirugía filtrante de glaucoma son poco frecuentes, de inicio tardío y la mayoría están asociados a una blebitis. Los agentes causales suelen ser estreptococos o bacterias gram-negativas.</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Existen pocos casos descritos en la literatura de endoftalmitis causada por <span class="elsevierStyleItalic">Moraxella nonliquefaciens</span> y la mayoría están asociados a una blebitis tras cirugía filtrante de glaucoma.</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Presentamos una paciente de 90 años con endoftalmitis en ojo derecho por <span class="elsevierStyleItalic">Moraxella nonliquefaciens</span> asociada a blebitis 10 años después de la cirugía de glaucoma. Tras tratamiento se observa desaparición de la blebitis dos semanas después y resolución de la vitritis 29 días después con recuperación de la visión a valores previos (20/200).</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">La endoftalmitis por <span class="elsevierStyleItalic">Moraxella nonliquefaciens</span> es rara y está asociada a blebitis de inicio tardío tras una cirugía filtrante de glaucoma. A pesar de la virulencia del cuadro el pronóstico visual suele ser favorable.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Díaz Barrón A, Hervás Hernandis JM, Sanz Gallen L, López Montero A, Gil Hernández I, Duch-Samper AM. Endoftalmitis de inicio tardío asociada a ampolla de filtración por <span class="elsevierStyleItalic">Moraxella nonliquefaciens</span>. Arch Soc Esp Oftalmol. 2020;95:559–564.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1514 "Ancho" => 1505 "Tamanyo" => 238972 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Image of right eye at diagnosis. A) Right eye filtration bleb at diagnosis containing purulent material, indicating the presence of blebitis. B) Filtration bleb erosion with positive fluorescein stain but with negative Seidel phenomenon. C) Right eye anterior pole with folds in Descemet membrane, hypopion in anterior chamber and important conjunctival hyperemia.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1510 "Ancho" => 1505 "Tamanyo" => 307380 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Image of right eye with one week evolution. A) Right eye filtration bleb eye one week after starting treatment showing epithelial pallor and marked conjunctival hyperemia around the bleb. B) Right eye anterior pole one week after beginning treatment with persistence of folds in Descemet membrane but without hypopion.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1594 "Ancho" => 1505 "Tamanyo" => 247399 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Image of right eye on day 29 of evolution. A) Pale and cystic filtration bleb with thinned walls, with less conjunctival hyperemia around it. B) Right eye fundus 29 days after infection, showing clear vitreous, pale unexcavated papilla, healthy macula and normal retinal trajectory and diameter. C) Right eye anterior pole 29 days postinfection showing transparent cornea without folds in Descemet and without hypopion, with less conjunctival hyperemia.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characteristics and risk factors of infections after glaucoma filtering surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.J. Poulsen" 1 => "R.R. Allingham" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00061198-200012000-00004" "Revista" => array:6 [ "tituloSerie" => "J Glaucoma." "fecha" => "2000" "volumen" => "9" "paginaInicial" => "438" "paginaFinal" => "443" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11131749" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "microbiologic identification of bleb-related delayed-onset endophthalmitis caused by Moraxella species" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.L. Cornut" 1 => "C. Chiquet" 2 => "A. Bron" 3 => "J.P. Romanet" 4 => "G. Lina" 5 => "P.O. Lafontaine" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/IJG.0b013e31816299ec" "Revista" => array:6 [ "tituloSerie" => "J Glaucoma." "fecha" => "2008" "volumen" => "17" "paginaInicial" => "541" "paginaFinal" => "545" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18854730" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.D. Díaz López" 1 => "F. García Garrote" 2 => "I. Perales Palacios" 3 => "P. Pescador Martín" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "editores" => "E.Cercenado Mansilla, R.Cantón Moreno" "titulo" => "Diagnóstico microbiológico de las infecciones oculares. 2019. 31a. Fernando García Garrote (coordinador). Procedimientos en Microbiología" "paginaInicial" => "23" "serieFecha" => "2019" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Moraxella nonliquefaciens endophthalmitis after trabeculectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T.D. Lobue" 1 => "T.A. Deutsch" 2 => "R.M. Stein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/0002-9394(85)90367-8" "Revista" => array:6 [ "tituloSerie" => "Am J Ophthalmol." "fecha" => "1985" "volumen" => "99" "paginaInicial" => "343" "paginaFinal" => "345" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3976811" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endophthalmitis caused by Moraxella species" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.M. Berrocal" 1 => "I.U. Scott" 2 => "D. Miller" 3 => "H.W. Flynn Jr" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0002-9394(01)01098-4" "Revista" => array:6 [ "tituloSerie" => "Am J Ophthalmol." "fecha" => "2001" "volumen" => "132" "paginaInicial" => "788" "paginaFinal" => "790" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11704047" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Posttrabeculectomy endophthalmitis caused by <span class="elsevierStyleItalic">Moraxella nonliquefaciens</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H. Laukeland" 1 => "K. Bergh" 2 => "L. Bevanger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/jcm.40.7.2668-2770.2002" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol." "fecha" => "2002" "volumen" => "40" "paginaInicial" => "2668" "paginaFinal" => "2770" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12089304" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endophthalmitis caused by <span class="elsevierStyleItalic">Moraxella nonliquefaciens</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.R. Ebright" 1 => "J.R. Lentino" 2 => "E. Juni" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ajcp/77.3.362" "Revista" => array:6 [ "tituloSerie" => "Am J Clin Pathol." "fecha" => "1982" "volumen" => "77" "paginaInicial" => "362" "paginaFinal" => "363" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7072642" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endophthalmitis caused by beta-iactamase-positive <span class="elsevierStyleItalic">Moraxella nonliquefaciens</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.D. Sherman" 1 => "M. York" 2 => "A.R. Irvine" 3 => "P. Langer" 4 => "V. Cevallos" 5 => "J.P. Whitcher" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0002-9394(14)71473-4" "Revista" => array:6 [ "tituloSerie" => "Am J Ophthalmol." "fecha" => "1993" "volumen" => "115" "paginaInicial" => "674" "paginaFinal" => "676" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8488926" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endophthalmitis caused by unusual gram-negative bacilli: three case report and review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.E. Schmidt" 1 => "M.A. Smith" 2 => "C.S. Levy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/clinids/17.4.686" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis." "fecha" => "1993" "volumen" => "17" "paginaInicial" => "686" "paginaFinal" => "690" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8268350" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Moraxella nonliquefaciens</span> and <span class="elsevierStyleItalic">M. osloensis</span> are important Moraxella species that cause ocular infections" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.J. LaCroce" 1 => "M.N. Wilson" 2 => "J.E. Romanowski" 3 => "J.D. Newman" 4 => "V. Jhanji" 5 => "R.M.Q. Shanks" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/microorganisms7060163" "Revista" => array:4 [ "tituloSerie" => "Microorganisms" "fecha" => "2019" "volumen" => "4" "paginaInicial" => "7" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000009500000011/v1_202011010626/S2173579420301079/v1_202011010626/en/main.assets" "Apartado" => array:4 [ "identificador" => "5812" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Short communications" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009500000011/v1_202011010626/S2173579420301079/v1_202011010626/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579420301079?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 2 | 1 | 3 |
| 2021 February | 5 | 0 | 5 |
| 2021 January | 2 | 0 | 2 |
