Conjunctival infection by Streptomyces spp: clinical case and follow up

Purpose Streptomyces is the largest genus of Actinobacteria belonging to Streptomycetaceae family, a group of ubiquitous Gram‐positive bacteria, which are part of the soil saprophyte flora and involved in environmental organic matter decomposition. Over 500 species of Streptomyces bacteria have been described. It is well known its capacity of production of antibiotics, antifungals and immunomodulating drugs (e.g., Streptomycin, Vancomycin, Chloramphenicol, Amphotericin B, Tetracycline, Tacrolimus and Bleomycin). Methods a 4‐year‐old male who suffered an accidental plant prick on temporal bulbar conjunctiva of the right eye during an Indian trip. He was only diagnosed of a hyposphagma by an ophthalmologist. From that time, it was progressively forming a granulomatous lesion on the affected area. He was treated with several broad‐spectrum antibiotic eye‐drops for about three months without improvement. Hence, it was decided to perform a conjunctival biopsy. The sample was sent to the National Institute of Microbiology to be processed. The bacteriological results concluded that it was a colony of the genus Streptomyces spp. After getting the antibiogram, he started with oral and topic trimetropim‐sulfamethoxazole. Results Three months after starting that regimen, the lesion completely disappeared. He is currently under regular controls being off of any treatments. Conclusion Streptomyces spp systemic infection is very rare, and eye involvement, exceptional. In fact there are not cases with conjunctival involvement published in literature. Mostly patients systemically infected by these bacteria present certain degree of compromised immune system. Thus, cases in immunocompetent patients are, at least, exceptional.