Review of Endogenous Endophthalmitis Caused by Salmonella Species Including Delayed Onset Salmonella Typhi Endophthalmitis

Endogenous endophthalmitis is a rare but serious condition that occurs when bacteria cross the blood–ocular barrier and multiply within the eye. We provide a literature review of Salmonella endogenous endophthalmitis by reviewing eight reported cases and integrating this with our experience of one case in which a four-year-old child presented with acute endophthalmitis of four days duration. He had suffered typhoid fever two months back. Vitreous biopsy revealed Salmonella typhi. Despite aggressive surgical and medical treatment, the eye developed retinal necrosis, detachment, and phthisis. Blood, aqueous, and vitreous cultures were the most frequent means of establishing the diagnosis in the reported cases. The visual outcome in most cases of endogenous Salmonella endophthalmitis is blindness in the affected eye, which has not improved since its first report in 1979. Endogenous endophthalmitis due to Salmonella typhi should be incorporated into standard literature on complications of acute and relapse phases of typhoid fever.     

Culture Proven Endogenous Bacterial Endophthalmitis in Apparently Healthy Individuals

Purpose: To report 7 eyes of 7 patients who were diagnosed as the cases of endogenous endophthalmitis and proved by culture reports. Though in most of the previously published series, one or more predisposing factors were present in the patients of endogenous endophthalmitis, the authors are presenting a case series of culture-proven endogenous endophthalmitis in apparently healthy and immunocompetent individuals.

Design: Retrospective noncomparative case series. All patients were diagnosed as endogenous bacterial endophthalmitis with positive vitreal culture. Variables studied were demographic characteristics, microbiology, therapeutic interventions done, final visual and anatomical outcome.

Results: Streptococcus pneumoniae was the most frequent isolate 43% (3 out of 7 eyes) followed by Staphylococcus aureus and E. coli in equal frequency 29% ( 2 each out of 7 eyes). The median time between the onset of symptoms and presentation with features of endophthalmitis to hospital was 7 days. The presenting visual acuity was less than HM (hand motions) in all cases except one, which had VA of 20/200. No single underlying predisposing condition was identifiable in any of the cases. All the cases were given intravitreal therapeutic agents (one or more doses of antibiotics and steroid) and pars plana vitrectomy was performed in 2 cases. The final visual acuity was not better than presenting VA except in 1 case, which had final VA of 20/40. Intraocular pressure was on the lower side (mean IOP 7?mmHg compared to 12?mmHg in the fellow eye). No eye was enucleated or eviscerated.

Conclusion: Though in most of the previously published literature endogenous endophthalmitis has been a metastatic ocular infection, the present study describes a series of endogenous bacterial endophthalmitis de novo in onset, without any identifiable predisposing factors. The overall age of presentation was in a younger population than in previously published series. The overall visual outcome was poor, probably due to the serious nature of disease itself and the relatively late presentation.     

Endogenous Endophthalmitis in the American and Korean Population: An 8-year Retrospective Study

Purpose: To study the clinical features of endogenous endophthalmitis (EE) in sample patient populations from the USA and South Korea over an 8-year period.

Methods: We reviewed data from 128 eyes of 60 American and 48 Korean patients diagnosed with EE and compared their clinical characteristics.

Results: Fungemia and liver abscess were the most common extraocular infection sources among American (26.7%) and Korean patients (33.3%), respectively. Klebsiella pneumoniae and Candida species were the most common pathogens of EE in the Korean and the American patients, respectively. Endophthalmitis caused by fungi had a better visual prognosis than that caused by bacteria (p = 0.001). Vitrectomy was beneficial for eyes with EE due to virulent bacteria presenting with worse than counting finger vision.

Conclusions: The predisposing conditions and responsible organisms for EE vary in different regions of the world. The visual prognosis was strongly influenced by the underlying pathogen.     

Salmonella Typhi Associated Endogenous Endophthalmitis: A Case Report and a Review of Literature

Aim: To report a rare case of Salmonella typhi associated endogenous endophthalmitis in an immunocompetent male and to review the available literature.

Methods: Retrospective chart review.

Results: A 28-year-old immunocompetent male presented with a 3-day-old history of pain, redness and diminished vision in his left eye. Conjunctival chemosis, corneal haze, and hypopyon were noted and yellowish exudates filled the vitreous cavity. A detailed elicitation of history revealed that patient had been treated for enteric fever that presented with diarrhea and fever, two weeks prior to current presentation. Blood and vitreous cultures grew Gram negative bacilli, identified as S. typhi. Despite intensive intravitreal and systemic antibiotic therapy, an evisceration had to be performed.

Conclusions: Endogenous endophthalmitis can be one of the rare sequelae of enteric fever and may present in the acute and relapsing phases and often times have a rapidly fulminant course with poor visual outcomes.     

Endogenous Endophthalmitis in Patients with MRSA Septicemia: A Case Series and Review of Literature

Purpose: To report the presentation, predisposing factors, clinical features and outcome in 6 eyes of 3 patients with endogenous endophthalmitis secondary to methicillin resistant staphylococcus aureus (MRSA) septicaemia.

Methods: Retrospective review of case records of 3 patients who were treated for endogenous endophthalmitis secondary to MRSA septicaemia in a tertiary referral institution.

Results: All three patients had systemic predisposition to endogenous endophthalmitis (diabetes, urosepsis). Two patients presented within 1 week of onset of visual symptoms and the third after 3 months. Blood culture was positive for MRSA in all patients. Visual and anatomical improvement was noted in two patients who presented early. The third patient’s visual outcome despite early treatment with intravitreal antibiotics and vitrectomy was not satisfactory.

Conclusion: Endogenous endophthalmitis by MRSA is a rare but serious condition. Early and specific therapy based on reliable detection of the underlying microorganism is needed for good anatomical and functional outcome.     

Culture-Positive Endogenous Endophthalmitis: An Eleven-Year Retrospective Study in the Central Region of Thailand

Purpose: To report the characteristics of infection and prognostic factors of endogenous endophthalmitis (EE) over an 11-year period.

Methods: The clinical records of 41 eyes of 36 patients diagnosed with culture-proven EE at the Rajavithi Hospital were retrospectively reviewed.

Results: Median age at presentation was 58 years. Liver abscess (19%) and urinary tract infections (19%) were the most common sources of infection. The most common causative agents were gram-negative organisms (48%). The most commonly isolated microorganism was Klebsiella pneumoniae (26.8%). Worse initial visual acuity and severe intraocular inflammation at first presentation were equally associated with poor visual outcome in the multivariate model (adjusted odds ratio, 20.32; 95% confidence interval [1.12–357.45]; P = 0.040).

Conclusions: Endogenous endophthalmitis usually has a poor visual prognosis. Liver abscess and urinary tract infections are common primary sites of infection. Poor initial visual acuity and severe intraocular inflammation at the initial presentation are predictors of poor visual outcome.     

Endogenous Endophthalmitis Caused by Carbapenem-Resistant Hypervirulent Klebsiella Pneumoniae: A Case Report and Literature Review

Purpose: To report a rare case of endogenous endophthalmitis caused by carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP).

Methods: A retrospective chart review was conducted. The isolates were characterized by hypermucoviscosity, resistance genes, virulence genes, and multilocus sequence typing.

Results: A 47-year-old diabetic woman acquired carbapenem-resistant K. pneumoniae (CRKP) nosocomial pneumonia. Metastatic endophthalmitis occurred in the right eye a week after the occurrence of CRKP bloodstream infection (BSI). Visual acuity decreased to light perception within 3 days. Although vitrectomy relieved ocular pain, endophthalmitis deteriorated due to uncontrollable BSI, and developed to corneal perforation. The strains isolated from bronchoalveolar lavage fluid, blood, and intraocular pus originated from the same clone. The pathogen was hypermucoviscous, belonged to sequence type 11, harbored resistance genes bla_KPC-2, bla_TEM, bla_SHV, rmtB, and virulence genes rmpA2, iucABCD, iroBCD.

Conclusions: Endogenous endophthalmitis caused by CR-hvKP has emerged, which is a treatment challenge for both ophthalmologists and physicians.     

Endophthalmitis: A review of recent trends

Endophthalmitis is a feared complication of trauma, surgical procedures and septicemia. Although uncommon, its potential for significant visual loss is well recognized. Especially over the past decade, complicated surgeries and medical techniques have increased and seriously ill patients are being sustained in ever increasing numbers. New pathogens are being recognized and known ones reclassified thanks to advances in molecular analysis. Continuously evolving PCR methodologies also add a new dimension to the diagnosis of infectious endophthalmitis. As well, medical literature is now truly international, encompassing studies from around the world that expand our understanding of ocular infectious disease. This report reviews some of these changes as they relate to endophthalmitis and particularly to the spectrum of organisms involved.     

Endogenous Serratia marcescens Endophthalmitis with Dark Hypopyon: A Case Report and Review

A case of endogenous Serratia marcescens endophthalmitis in a patient with diabetes, end-stage renal disease, and an indwelling venous catheter is reported. The patient presented with a tan hypopyon and elevated intraocular pressure. Diagnosis was established by positive blood, vitreous, conjunctival, and catheter tip cultures. After a deteriorating course the eye was enucleated. Gross and histopathologic examination revealed the presence of a dark hypopyon with iris necrosis and pigment dispersion and possible spontaneous globe perforation. This is the eleventh reported case of endogenous Serratia endophthalmitis. Previous association of a pink hypopyon and of pigmented vitreous fluid and Serratia endophthalmitis has been reported. This is the first case of dark hypopyon in endogenous Serratia marcescens endophthalmitis reported in the medical literature. Previous entities associated with dark hypopyon have been limited to intraocular melanoma and Listeria monocytogenes endophthalmitis. Dark hypopyon in the appropriate clinical setting may be useful in aiding diagnostic and therapeutic decisions.     

Bilateral Endogenous Endophthalmitis Associated with Methicillin Sensitive Staphylococcus aureus (MSSA) Related Tenosynovitis: Case Report

Endogenous endophthalmitis is a rare, devastating intraocular infection associated with poor outcome often from late diagnosis. We present a case report of acute onset bilateral endogenous endophthalmitis caused by Methicillin Sensitive Staphylococcus Aureus causing tenosynovitis of carpometacarpal joint in a 64 year old man with Type II Diabetes Mellitus. To the best of our knowledge, this is the first case report of endogenous endophthalmitis following tenosynovitis. This case also highlights the fact that prompt diagnosis and treatment is the key for good outcome.     

Culture-Proven Candida Albicans Endogenous Endophthalmitis in a Patient with Onychomycosis

ABSTRACT

Purpose: To report a case of Candida albicans endogenous endophthalmitis in an immunocompetent patient with onychomycosis.

Methods: Retrospective case report.

Results: A 40-year-old man with onychomycosis presented with C. albicans subretinal abscess in the left eye. Systemic and intravitreal injections did not prevent further progression of the infection. The patient underwent pars plana vitrectomy. One month after surgery, the intraocular inflammation gradually subsided. However, his visual acuity stayed at counting fingers as a result of macular scarring.

Conclusion: The aim of this case presentation is to emphasize that endogenous fungal endophthalmitis can be seen in an immunocompetent patient. The use of systemic steroids in the past was the main reason for the progression of the disease in this case. In these situations, when the clinical findings suggest a fungal etiology, it should keep in mind that endogenous candida endophthalmitis can be a result of fungal infections from distant sites such as the toenails and systemic steroids should not be started before definite diagnosis.     

Causes of Uveitis in a Tertiary Center in Chile: A Cross-sectional Retrospective Review

Abstract

Purpose: To describe the pattern of uveitis in a tertiary center in Santiago, Chile.

Methods: We reviewed all of the case records with a presumptive diagnosis of uveitis from patients referred to the Uveitis Department of Hospital del Salvador between 2002 and 2012. Initial assessment was standardized. We tested for association among causes, gender, and age groups.

Results: Anterior uveitis was the leading anatomical location of the inflammation (40.4%). A specific etiology was demonstrated in 59% of cases (28.7% infectious). Vogt-Koyanagi-Harada syndrome (VKH) was the most frequent cause of uveitis (17.2%). We found association between idiopathic intermediate uveitis, toxocariasis, juvenile idiopathic arthritis, VKH, toxoplasmosis, diabetes mellitus (DM)-associated uveitis, tuberculosis, and idiopathic anterior uveitis and age groups. VKH, DM-associated uveitis, and syphilis-associated uveitis were associated with gender.

Conclusions: Our sample shows a distribution of causes of uveitis similar to those in developed countries. The prevalence of VKH is higher than expected.     

Ocular Involvement in Hospitalized Patients with Candidemia: Analysis at a Boston Tertiary Care Center

Purpose: To study the prevalence, microbial profile, and risk factors for ocular involvement in patients with candidemia.

Methods: The records of all inpatient consultations requested at the Brigham and Women’s Hospital from October 2009 to June 2011 to evaluate for ocular involvement in patients with candidemia were retrospectively reviewed.

Results: Forty-nine consults were requested to rule out ocular involvement in patients with candidemia. The mean patient age was 55 years. In decreasing frequency, the organisms isolated were Candida albicans (42%), Candida parapsilosis (23%), Candida glabrata (17%), Candida tropicalis (8%), Candida dublinensis (5%), Candida krusei (3%), and Candida lusitaniae (3%). All patients were on antifungal treatment at the time of their initial ophthalmologic examination. One patient had evidence of chorioretinitis, and 3 patients had nonspecific fundus findings. Common risk factors included presence of an intravenous catheter, malignancy, and abdominal surgery.

Conclusions: Ocular involvement is rare among patients with systemic Candida infection.     

Bacterial spectrum and resistance patterns in corneal infections at a Tertiary Eye Care Center in South China

AIM: To investigate the spectrum and antibiotic susceptibility of bacteria isolated from patients with suspected corneal infections in Zhongshan Ophthalmic Center in South China over the past four years retrospectively. METHODS: Totally 1943 corneal scrapes from patients with corneal infections from 2010 to 2013 were cultured and processed using standard microbiological procedures to identify bacterial isolates. Simultaneously, the bacterial isolates were tested for antibiotic susceptibility to 8 antibiotics (ceftazidime, cefuroxim, cefazolin, levofloxacin, ofloxacin, neomycin, tobramycin, chloramphenicol) using the Kirby-Bauer disc diffusion technique. RESULTS: Of the total 1943 scrapes, 397 (20.43%) were culture-positive, of which 294 (74.06%) were gram-positive (GP) and 103 (25.94%) were gram-negative (GN) bacteria. Of the GP organisms, the most prevalent genera were Staphylococcus spp. (56.17%, n=223), Kocuria spp. (5.29%, n=21) and Micrococcus spp. (1.26%, n=5). On the other hand, the most prevalent genera were Pseudomonas spp. (12.85%, n=51), Burkholderia spp. (2.02%, n=8) and Acinetobacter spp. (1.51%, n=6) for the GN organisms. Among five antibiotics that have eye drop products, the resistant to neomycin of GP (7.82%, 95% CI: 4.72%-10.92%) and GN isolates (9.71%, 95% CI: 4.01%-15.41%) was lowest, while the resistant to chloramphenicol was highest (GP: 34.35%, 95% CI: 28.92%-39.78%; GN: 60.19%, 95% CI: 50.74%-69.64%). CONCLUSION: Staphylococcus spp. was the most common bacterial pathogens isolated from patients with corneal infections in this setting. High percentages of GP and GN bacteria were mostly susceptible to neomycin and highly resistant to chloramphenicol.     

Endogenous fungal endopthalmitis treated with intravitreal caspofungin in a COVID-19 recovered patient: A case report

We present a case of endogenous fungal endophthalmitis in a nondiabetic, nonhypertensive patient who recovered from COVID-19 infection. Endogenous fungal endophthalmitis in an immunocompetent individual is quite uncommon. The organism in our patient was resistant to amphotericin and voriconazole and was successfully treated with intravitreal caspofungin. The rarity of an opportunistic nosocomial infection in an immunocompetent person with a drug-resistant organism prompted us to write this report.     

Endogenous endophthalmitis: 10-year experience at a tertiary referral centre

Purpose

Endogenous endophthalmitis (EE) is a sight-threatening emergency and the aetiology is often multifactorial. Delayed diagnosis may exacerbate the poor visual prognosis. We describe the management and visual outcomes of EE presenting to a tertiary referral centre.

Patients and methods

A prospective consecutive case series of 64 patients presenting with presumed EE from 1997 to 2007 to the Royal Victorian Eye and Ear Hospital were included. All data were collected in a standardized manner. Outcome measures included: visual acuity, microbial profiles, and vitrectomy rate.

Results

In total, 64 cases of EE were identified over the study period with a mean age of 57.5 years, and 53.5% were male. Presenting acuities ranged from Snellen 6/6 to no perception of light (NPL). Identifiable risk factors were present in 78.1%, with the majority related to intravenous drug abuse. A 64.1% culture positivity rate was recorded. A vitrectomy rate of 57, 56, and 21% was recorded in documented bacterial, fungal, and no growth cases, respectively. Final Snellen acuities ranged from 6/6 to NPL. A total of 5 out of 64 eyes were enucleated, of which 3 identified Klebsiellaspecies. Better visual outcome was documented in fungal cases.

Conclusion

EE is a serious ocular condition and has a varied aetiology. Visual outcomes are often poor, irrespective of the method of management. Fungal aetiology often confers a better prognosis, and vitrectomy is advocated for bacterial proven cases.     

Endogenous Cryptococcal Endophthalmitis in Immunocompetent Host: Case Report and Review of Multimodal Imaging Findings and Treatment

Purpose: To describe a case of bilateral endogenous cryptococcal endophthalmitis in an immunocompetent host and to review adjunctive ophthalmic imaging patterns and treatment.

Methods: A retrospective case report.

Results: A 45-year-old female patient with two distinct presentations of endogenous cryptococcal endophthalmitis in each eye presented initially with progressive blurred vision in the left eye, beginning more than 10 years after a craniotomy with ventriculoperitoneal shunt. Complete ophthalmic imaging was conducted and compared with data from previous literature. Administration of amphotericin-B had poorly responded; however, consolidation of fluconazole resulted in disease stabilization.

Conclusions: Bilateral intraocular cryptococcal infection can present with two distinct patterns of posterior segment findings. A review of ophthalmic imaging patterns found consistency in some characteristics of A-scan ultrasonogram and fundus fluorescein angiogram. Besides conventional treatment, voriconazole is likely to play an important role in the management of cryptococcal endophthalmitis.     

Endogenous endophthalmitis secondary to Burkholderia cepacia: A rare presentation

Burkholderia cepacia (previously known as Pseudomonas cepacia) is low virulent, gram negative bacilli, known to cause infections in immunocompromised hosts. There are reports about this organism causing keratitis, acute or delayed postoperative, or post traumatic endophthalmitis. Persistence of infection and poor visual outcome are well known complications of infection caused by this organism. Endogenous endophthalmitis due to Burkholderia cepacia is rare. There is no such case report available of endogenous endophthalmitis caused by these bacteria in the literature, where it is presented as retinal abscess and retinal vasculitis. Our aim is to report such a rare case from our hospital, which was treated with systemic and intravitreal antibiotics, with control of infection.     

Five-Year Retrospective Review of Cases with Benign Essential Blepharospasm and Hemifacial Spasm Presenting in a Tertiary Eye Care Center in North India

Retrospective analysis of epidemiological and clinical characteristics of patients diagnosed with benign essential blepharospasm and hemifacial spasm who reported to the oculoplasty clinic of a tertiary eye care center in north India between January 2010 and April 2015 was carried out. Dry eye, as well as all the local factors that can cause blepharospasm or hemifacial spasm, was ruled out. Systemic evaluation was done to rule out any neurological disorder. A detailed history was taken to rule out any associated psychiatric disorders as well as use of any medication which could be responsible for dystonic movements. In every patient of hemifacial spasm, magnetic resonance imaging (MRI) of the brain was done for any facial nerve compression or tumor involving posterior fossa. Botulinum type A injections were given after assessing their requirements on the basis of guidelines given by Jankovic et al.     

Endogenous candida endophthalmitis in South Taiwan: A 10-year retrospective study

PurposeTo investigate the clinical manifestations and the results of the management of endogenous candida endophthalmitis (ECE) at our hospital.MethodsThis study was a retrospective chart review conducted between September 2002 and September 2012.ResultsOur study included 24 eyes of 14 patients. The culture results revealed Candida albicans in 11 cases and Candida tropicalis in three cases. Diabetes mellitus, cancer, and intravenous catheter implantation were the most important risk factors for ECE. A systemic antifungal agent combined with intravitreal injection or vitrectomy was our method for treating these cases and the complications. The outcomes were generally poor, with a final visual acuity (VA) of better than 0.1 in 10 cases, counting finger to 0.1 in six cases, light perception to hand motion in six cases, and no light perception in two cases.ConclusionUnsatisfactory visual outcome in ECE is related to poor initial VA and complications. Early diagnosis and prompt treatment are necessary for these patients.