The combination of Demodex folliculorum and Aerobic Bacteria in the Etiopathogenesis of Chronic Blepharitis

Öz

Abstract Aims: This study was conducted to investigate the presence of thecombination of Demodex folliculorum and aerobic bacteria in patients with chronic blepharitis. Material and Methods: Seventy-one patients diagnosed with chronic blepharitis were evaluated for the presence of D. folliculorumby light microscope examination of samples prepared from eyelashes collected by eyelash epilation. Culture samples were also obtained from patients’ eyelid margins. Bacterial strainsamong the predominant bacterial colonies grown in cultures were identified using the BD Phoenix identification system (BD Diagnostic Systems, Sparks, USA). Patients were divided into two groups, Demodex-positive and Demodex-negative,and compared according to bacterial production and bacterial strains produced. Results: D. folliculorumwas identified in 42 (59.1%) patients. Comparison between Demodex-positive and -negative groups revealeda statistically significant increase in Demodex positivity with age.There was no significant relationship between gender and Demodex positivity.The Demodex-positive group showed a statistically significantly higher bacterial growth in the culture samples than the Demodex-negative group.Both groups exhibited a predominance ofStaphylococcus epidermidis. S.epidermidis (38.1% vs. 31.0%), Staphylococcus aureus (19.0% vs. 10.3%), and Corynebacterium spp.(16.7% vs. 6.9%) were detected at higher rates in the Demodex-positive group than in the Demodex-negative group. There was no statistically significant difference between both groups regarding the presence of these bacterial species. Conclusions: Patients with chronic blepharitis could have a mixedinfection site with the combination of D. folliculorumand aerobic bacteria found in the normal eyelid flora.

Anahtar Kelimeler

• Chronic blepharitis
• Demodex folliculorum
• aerobic bacteria
• etiopathogenesis

Kaynakça

1. Referans1. Liu J, Sheha H, Tseng SC. Pathogenic role of Demodex mites in blepharitis. Curr.Opin. Allergy Clin. Immunol. 2010; 10:505–510.
2. Referans2. Nutting WB, Green AC. Hair follicle mites (Acari: Demodicidae) from Australian aborigines. Aust. J. Dermatol.1974; 15:10–14.
3. Referans3. Kheirkhah A, Casas V, Li W, Raju VK, Tseng SC. Corneal manifestations of ocular demodex infestation. Am. J.Ophthalmol. 2007; 143:743–749.
4. Referans4. Luo X, Li J, Chen C, Tseng S, Liang L. Ocular demodicosis as a potential cause of ocular surface inflammation. Cornea. 2017; 36:9–14.
5. Referans5. Bhandari V, Reddy JK. Blepharitis: always remember demodex. Middle East Afr. J.Ophthalmol. 2014; 21:317–320.
6. Referans6. Kanski JJ, Bowling B. Clinical ophthalmology: A systematic approach. Elsevier Health Sciences. 2011.
7. Referans7. Baima B, Sticherling M. Demodicidosis revisited. Acta Derm.Venereol. 2002; 82:3–6.
8. Referans8. Groden LR, Murphy B, Rodnite J, Genvert GI. Lid flora in blepharitis. Cornea, 1991; 10:50–53.

9. Referans9. Kamoun B, Fourati M, Feki J, Mlik M, Karray F, Trigui A et al. Blépharite à Démodex: mytheouréalité. J. Fr.Ophtalmol. 1999; 22:525–527.
10. Referans10. English FP, Nutting WB, Cohn D. Eyelid mite nests. Aust 3 Ophthaimol. 1982; 10:187–189.
11. Referans11. Lindsley K, Matsumura S, Hatef E, Akpek EK. Interventions for chronic blepharitis. Cochrane Database Syst. Rev.2012; 5, CD005556. doi: 10.1002/14651858.CD005556.pub2
12. Referans12. Rusiecka-Ziólkowska J, Nokiel M, Fleischer M. Demodex - An old pathogen or a new one? Adv. Clin. Exp. Med. 2014; 23:295–298.
13. Referans13. Lee SH, Chun YS, Kim JH, Kim ES, Kim JC. The relationship between Demodex and ocular discomfort. Investig. Ophthalmol. Vis. Sci.2010; 51: 2906–2911.
14. Referans14. Biernat MM, Rusiecka-Ziółkowska J, Piątkowska E, Helemejko I, Biernat P, Gościniak G. Occurrence of Demodex species in patients with blepharitis and in healthy individuals: a 10-year observational study. Jpn. J. Ophthalmol. 2018; 62, 628–633.
15. Referans15. Zhao YE, Wu LP, Hu L Xu JR. Association of blepharitis with Demodex: a meta-analysis. Ophthalmic Epidemiol. 2012; 19:95–102.
16. Referans16. Eroglu S, Cakmakliogullari M, KalCakmakliogullari E. Is the presence of Demodex folliculorumincreased with impaired glucose regulation in polycystic ovary syndrome?J. Obstet. Gynaecol.2019; 1–5.
17. Referans17. Gonzalez-Hinojosa D, Jaime-Villalonga A, Aguilar-Montes G, Lammoglia-Ordiales L. Demodex and rosacea: Is there a relationship? Indian J. Ophthalmol.2018; 66:36.
18. Referans18.Patel NV, Mathur U, Gandhi A, & Singh M. Demodex blepharokeratoconjunctivitis affecting young patients: A case series. Indian J. Ophthalmol. 2020; 68:745.
19. Referans19.Wesolowska M, Knysz B, Reich A, Blazejewska D, Czarnecki M, Gladysz A et al. Prevalence of Demodex spp. in eyelash follicles in different populations. Arch. Med. Sci. 2014; 10:319–324.
20. Referans20. Arıcı KM, Sumer Z, Toker MI, Erdogan H, Topalkara A, Akbulut M. The prevalence of Demodex folliculorumin blepharitis patients and the normal population. Ophthalmic. Epidemiol. 2005; 12: 287–290.
21. Referans21. Rynerson JM, Perry HD. DEBS–a unification theory for dry eye and blepharitis. Clin. Ophthalmol.(Auckland, NZ) 2016; 10:2455.
22. Referans22. Demmler M, Möhring C, Klauss V. Blepharitis. Demodex folliculorum, associated pathogen spectrum and specific therapy. Ophthalmologe. 1997; 94:191–196
23. Referans23. Zhu M, Cheng C, Yi H, Lin L, Wu K. Quantitative analysis of the bacteria in blepharitis with demodex infestation. Front. Microbiol. 2018; 9:1719
24. Referans24. Shelley WB, Shelley ED, Burmeister V. Unilateral demodectic rosacea. ‎J. Am. Acad. Dermatol.1989; 20:915–917.
25. Referans25. Gao YY, Di Pascuale MA, Li W, Liu DT, Baradaran-Rafii A, Elizondo A, et al. High prevalence of Demodex in eyelashes with cylindrical dandruff. Investig. Ophthalmol. Vis. Sci. 2005; 46:3089–3094.
26. Referans26. Kim JT, Lee SH, Chun YS, Kim JC. Tear cytokines and chemokines in patients with Demodex blepharitis. Cytokine. 2011; 53:94–99.
27. Referans27. Messager S, Hammer KA, Carson CF, Riley TV. Assessment of the antibacterial activity of tea tree oil using the European EN 1276 and EN 12054 standard suspension tests. J. Hosp. Infect. 2005; 59:113–125.
28. Referans28. Halcón L, MilkusK.Staphylococcus aureus and wounds: a review of tea tree oil as a promising antimicrobial. Am. J. Infect. Control2004; 32:402–408.
29. Referans29. Gao YY, Di Pascuale MA, Li W, Baradaran-Rafii A, Elizondo A, Kuo CL et al. In vitro and in vivo killing of ocular Demodex by tea tree oil. Br. J.Ophthalmol. 2005; 89:1468–1473.