Neisseria meningitidis Endogenous Endophthalmitis with Meningitis in an Immunocompetent Child

Abstract

Neisseria meningitidis is a major cause of childhood morbidity and mortality worldwide. We describe an exceptional case of an immunocompetent 15-month-old child presenting with a unilateral anterior uveitis, hypopyon, and sepsis. Anterior chamber aspirate demonstrated gram-negative cocci before Neisseria meningitidis was identified in blood and cerebrospinal fluid. Meningococcal endophthalmitis presents variably with sepsis, meningitis, or isolated ocular symptoms. Diagnosis is a clinical challenge, requiring diagnostic sampling and treatment from both pediatricians and ophthalmologists. Delayed or incorrect treatment risks blindness, disability, or death. Simultaneous invasion of meningococcus across intact blood–brain and blood–ocular barriers in this child suggests antigenic correlates between meningeal and ocular endothelial interfaces. Meningococcus is an exclusively human pathogen; research is hampered by the lack of animal models. This clinical observation suggests the potential of a novel in vitro experimental approach of using ocular tissue from eye banks to further elucidate the meningococcal–endothelial interaction that underpins meningococcal disease.     

灌注液中庆大霉素对白内障患者结膜囊细菌的作用

目的:分析白内障手术灌注液中庆大霉素对白内障患者结膜囊细菌的作用,为制定围手术期眼内炎预防措施提供依据。方法:采集200例白内障患者结膜囊拭子标本,进行细菌培养鉴定和药物敏感试验,观察检出细菌对20 μg/mL、40 μg/mL、80 μg/mL庆大霉素和2 μg/mL左氧氟沙星敏感率。结果:结膜囊细菌培养阳性检出率为62%,其中以表皮葡萄球菌为主,耐甲氧西林金黄色葡萄球菌（MRSA）检出率为3.22%,耐甲氧西林表皮葡萄球菌（MRSE）检出率为28.2%;全部检出细菌对20 μg/mL、40 μg/mL、80 μg/mL庆大霉素和2 μg/mL左氧氟沙星敏感率分别为79.84%、95.16%、97.58%、78.23%,中高浓度庆大霉素和左氧氟沙星比较,差异有统计学意义（均P<0.05）;MRSA和MRSE对20 μg/mL、40 μg/mL、80 μg/mL庆大霉素和2 μg/mL左氧氟沙星敏感率分别为69.23%、94.87%、100%、41.03%,各浓度庆大霉素和左氧氟沙星比较,差异有统计学意义（均P<0.05）。结论:白内障患者结膜囊细菌对灌注液中庆大霉素具有较高的敏感度,灌注液中加入适宜浓度庆大霉素,作为白内障围手术期眼内炎预防的措施应继续加以推广。     

Chronic endogenous fungal endophthalmitis: diagnostic and treatment challenges: A case report

Rationale:Endogenous fungal endophthalmitis (EFE) is a sight-threatening complication of systemic fungemia. As the prevalence rises, treatment remains a challenge especially when there is a failure in first-line treatment or drug-resistant fungus. This case report studies a case of chronic EFE, focusing on the diagnostic procedures, treatment options, monitoring parameters and the treatment outcomePatient concerns:A 64-year-old man with underlying well controlled diabetes mellitus was treated with 2 weeks’ course of intravenous antifungal fluconazole for pyelonephritis as his blood culture grew Candida albicans. Concurrently, he complained of 3 months of bilateral painless progressive blurring of vision. At presentation, his visual acuity (VA) was light perception both eyes. Ocular examination revealed non granulomatous inflammation with dense vitritis of both eyes.Diagnosis:He was diagnosed with EFE but the condition responded poorly with the medications.Interventions:He was treated with intravitreal (IVT) amphotericin B and fluconazole was continued. Vitrectomy was performed and intraoperative findings included bilateral fungal balls in the vitreous and retina with foveal traction in the left eye. Postoperatively, vision acuity was 6/24, N8 right eye and 2/60, N unable for left eye with extensive left macular scar and hole. Vitreous cultures were negative. He received multiple IVT amphotericin B and was started on topical steroid eye drops for persistent panuveitis with systemic fluconazole. Ocular improvement was seen after switching to IVT and topical voriconazole. Despite this, his ocular condition deteriorated and he developed neovascular glaucoma requiring 3 topical antiglaucoma agents. Panretinal photocoagulation was subsequently performed.Outcomes:At 3 months’ follow-up, his vision acuity remained at 6/24 for right eye and 2/60 for the left eye. There was no recurrence of inflammation or infection in both eyes.Lessons:Voriconazole could serve as a promising broad spectrum tri-azole agent in cases of failure in first-line treatment or drug-resistant fungus.     

白内障超声乳化手术后眼内炎4例临床分析

目的探讨白内障超声乳化手术发生术后眼内炎的危险因素及应对措施。方法分析3年来白内障手术流程中引发术后眼内炎潜在的不安全环节及防范措施。结果 3 440例白内障手术发生眼内炎4例(0.116%),3例6周内发病。其中糖尿病史者1例;伴有全身免疫性疾病长期口服糖皮质激素者1例;泪囊炎1例,术中囊膜破裂1例。结论白内障术后眼内炎是一种严重危害视力的术后并发症,白内障手术眼内炎的预防包括临床评价各种危险因素、正确的手术步骤和术前术后抗生素预防。发生白内障超声乳化手术后眼内炎只有迅速诊断和有效治疗才能成功地挽救患者的视力。     

内眼手术后感染性眼内炎的危险因素及预防措施

目的 探讨内眼手术后发生感染性眼内炎的危险因素及防范措施.方法 对2006年1月-2010年12月行内眼手术后发生感染性眼内炎的病例进行回顾性分析.结果 3887例内眼手术,术后发生感染性眼内炎15例,感染率为0.4％;其中行球内异物取出术后的最多12例,占80.0％,玻璃体切割手术后1例占6.7％,青光眼小梁手术后1例占6.7％,白内障手术后1例占6.7％;经积极抗感染球内注药及手术治疗后视力不同程度提高者12例占80.0％,视力无改善者1例占6.7％.结论 球内异物后行内眼手术,是感染性眼内炎最主要的致病因素,早期诊断、早期检测病原体确定敏感药物,早期实施玻璃体切割术联合玻璃体腔注药术,是治疗的关键,提高医务人员对内眼手术后发生感染性眼内炎重要性的认识、对内眼手术患者严密观察病情变化、强化眼部消毒处理、严格无菌操作,能防范感染性眼内炎的发生.     

ENDOPHTHALMITIS INDUCED BY MYCOBACTERIUM TUBERCULOSIS BEING MISDIAGNOSED AS NON-INFECTIOUS UVEITIS

ENDOPHTHALMITIS induced by mycobacterium tuberculosis （TB） was rarely reported. Here we present and characterize this typical case to establish the diagnosis.     

白内障术后细菌性眼内炎的早期诊断和治疗

目的　探讨白内障术后细菌性眼内炎的早期诊断和治疗。方法　分析２０１２年８月至２０１３年２月期间本院及合作中心白内障超声乳化术后７例（７眼）细菌性眼内炎的临床表现、诊断和治疗以及预后情况。结果　６眼眼内炎早期表现不典型:仅有突发性前房炎症反映,而无眼痛、明显视力下降及充血、结膜水肿,无或仅有少量前房积脓、无玻璃体积脓,但１～２ｄ后眼内炎症快速发展:前房炎症反应加重、玻璃体出现积脓;１眼早期即有急剧视力下降、明显眼痛及前房、玻璃体积脓的典型表现。４眼经球内抗生素注射、３眼行玻璃体切割联合人工晶状体取出术后炎症控制。微生物培养结果（７眼）:２眼为表皮葡萄球菌,１眼为粪肠球菌,４眼阴性。随访视力均有提高,最高达０．５。结论　白内障术后出现突发性前房渗出性炎症,即便无眼痛及明显充血、视力下降者,仍需高度警惕细菌性眼内炎。早期诊断、及时治疗与病原学检查显得尤为重要,否则一旦炎症加重则错过最佳治疗时机、导致不可逆盲甚至眼球丧失。     

开放性眼外伤并发眼内炎高危因素分析

目的:探讨开放性眼外伤并发眼内炎的高危因素。方法:回顾性分析开放性眼外伤315眼,分析不同因素对眼内炎发生率的影响。结果:在开放性眼外伤中,细长异物的穿刺伤、玻璃体异物存留及晶状体后囊破裂均可增加眼内炎的发生几率,差异有统计学意义;而缝合时间>24h可增加眼内炎的发生几率,但差异没有统计学意义;伤口增大未增加眼内炎的发生几率。结论:玻璃体内异物存留、细长异物的穿刺伤、晶状体后囊破裂是开放性眼外伤并发眼内炎的高危因素,在及时缝合的前提下,伤口的增大并不会增加眼内炎的发生率。