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A Pseudoepidemic of Postoperative Scleritis Due to Misdiagnosis

Published online by Cambridge University Press:  02 January 2015

Dale R. Burwen ,
Curtis E. Margo ,
Michael M. McNeil ,
June M. Brown ,
Gerda Tapelband ,
Robert B. Jenkins  and
William R. Jarvis
Dale R. Burwen
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services, Atlanta, Georgia
Curtis E. Margo*
Affiliation:
Watson Clinic, Lakeland, Florida
Michael M. McNeil
Affiliation:
Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services, Atlanta, Georgia
June M. Brown
Affiliation:
Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services, Atlanta, Georgia
Gerda Tapelband
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services, Atlanta, Georgia
Robert B. Jenkins
Affiliation:
Florida, and the North Florida/South Georgia Veterans Health System, Gainesville, Florida
William R. Jarvis
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services, Atlanta, Georgia
*
Watson Clinic, 1600 Lakeland Hills Blvd, Lakeland, FL 33805
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Abstract

Objective:

To describe a pseudoepidemic of infectious scleritis following eye surgery.

Methods:

Retrospective cohort study with selected procedural and laboratory investigations.

Results:

Twenty-one patients with postoperative scleritis were identified during a 2-month outbreak. Neither an infectious etiology nor a causative pre-, intra-, or postoperative exposure was found. The clinical findings, when carefully reviewed, were consistent with poor surgical-wound closure.

Conclusions:

The art of clinical diagnosis involves the subjective interpretation of clinical history, physical findings, and laboratory results. A repeated error in the interpretation of clinical findings can simulate an outbreak of disease. Clinicians may be reluctant to concede misdiagnosis

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 20 , Issue 8 , August 1999 , pp. 539 - 542
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1999

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References

1.Hagan, ME, Kotz, SA, Bartholomew, W, Potter, L, Nelson, M. A pseudoepidemic of Rhodotorula rubra: a marker for microbial contamination of the bronchoscope. Infect Control Hosp Epidemiol 1995;16:727–728.CrossRefGoogle ScholarPubMed
2.Deresinski, SC, Clemons, KV, Kemper, CA, Roesch, K, Walton, B, Stevens, DAGenotypic analysis of pseudoepidemic due to contamination of Hanks' balanced salt solution with Candida parapsilosis. J Clin Microbiol 1995;33:2224–2226.CrossRefGoogle ScholarPubMed
3.Forman, W, Axelrod, P, St John, K, Kostman, J, Khater, C, Woodwell, J, et al. Investigation of a pseudo-outbreak of orthopedic infections caused by Pseudomonas aeruginosa. Infect Control Hosp Epidemiol 1994;15:652–657.CrossRefGoogle ScholarPubMed
4.Campagnaro, RL, Teichtahl, H, Dwyer, B. A pseudoepidemic of Mycobacterium chelonae: contamination of a bronchoscope and auto-cleaner. Aust NZJ Med 1994;24:693–695.CrossRefGoogle Scholar
5.Patterson, JE, Chapin-Robertson, K, Waysott, S, Farrel, P, McGeer, A, McNeil, MM, et al. Pseudoepidemic of Nocardia asteroides associated with a mycobacterial culture system. J Clin Microbiol 1992;30:1357–1360.CrossRefGoogle ScholarPubMed
6.York, MK. Bacillus species pseudobacteremia traced to contaminated gloves used in collection of blood from patients with acquired immunodeficiency syndrome. J Clin Microbiol 1990;28:2114–116.CrossRefGoogle ScholarPubMed
7.Seine, T, Harris, AA, Levin, S, River, N, Chaplain, R. A pseudoepidemic due to atypical mycobacteria in a hospital water supply. JAMA 1987;258;809–811.Google Scholar
8.Goodman, RA, Smith, J, Kabuki, G, Dougherty, EM, Sikes, RK. Nosocomial mycobacterial pseudoinfection in a Georgia hospital. Infect Control 1984;5:573–576.CrossRefGoogle Scholar
9.Aber, RC, Appelbaum, PC. Pseudoepidemic of endocarditis in patients undergoing open heart surgery. Infect Control 1980;1:97–99.CrossRefGoogle ScholarPubMed
10.Weinstein, RA, Stamm, WE. Pseudoepidemics in hospitals. Lancet 1997;2:862–864.Google Scholar
11.Lyne, AJ, Lloyd-Jones, D. Necrotizing scleritis after ocular surgery. Trans Ophthalmol Soc UK 1997;99:146–149.Google Scholar
12.Bloomfield, SE, Becker, CS, Christian, CL, Nauheim, JS. Bilateral necrotizing scleritis with marginal corneal ulceration after cataract surgery in a patient with vasculitis. Br J Ophthalmol 1980;64:170–174.CrossRefGoogle Scholar
13.Salamon, SM, Mondino, BJ, Zaidman, GW. Peripheral corneal ulcers, conjunctival ulcers, and scleritis after cataract surgery. Am J Ophthalmol 1982;93:334–337.CrossRefGoogle ScholarPubMed
14.Mamalis, N, Johnson, MD, Haines, JM, Teske, MP, Olson, RJ. Corneal-scleral melt in association with cataract surgery and intraocular lenses: a report of four cases. J Cataract Refract Surg 1990;16:108–115.CrossRefGoogle ScholarPubMed
15.Kattan, HM, Pfugfelder, SC. Nocardia scleritis. Am J Ophthalmol 1990;110:446–447.CrossRefGoogle ScholarPubMed
16.Sainz de la Maza, M, Foster, S. Necrotizing scleritis after ocular surgery: a clinicopathologic study. Ophthalmology 1991;98:1720–1726.CrossRefGoogle ScholarPubMed
17.O'Donoghue, E, Lightman, S, Tuft, S, Watson, P. Surgically induced necro-tising sclerokeratitis (SINS—precipitating factors and response to treatment. Br J Ophthalmol 1992;76:17–21.CrossRefGoogle ScholarPubMed
18.Salacz, G. Postoperative necrotizing sclerokeratitis. Doc Ophthalmol 1992;80:167–170.CrossRefGoogle ScholarPubMed
19.Alfonso, E, Kenyon, DR, Ormerod, LD, Stevens, R, Wagoner, MD, Albert, DM. Pseudomonas corneoscleritis. Am J Ophthalmol 1987;103:90–95.CrossRefGoogle Scholar
20.Margo, CE, Pollack, FM, Hood, CI. Aspergillus panophthalmitis complicating treatment of pterygium. Cornea 1988:7:285–289.CrossRefGoogle ScholarPubMed
21.Engle, R, Davis, BJ. Medical diagnosis: present, past, and future, I: present concepts of the meaning and limitation of medical diagnosis. Arch Intern Med 1963;112:512–519.CrossRefGoogle ScholarPubMed
22.Lepe, LL. Error in medicine. JAMA 1994;272:1851–1857.CrossRefGoogle Scholar