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 Bacterial Endophthalmitis: A Five-Year Retrospective Review at a Tertiary Care Academic Center

ABSTRACT

Purpose

To better characterize the demographics and outcomes of endogenous bacterial endophthalmitis (EBE).     

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.     

儿童细菌性眼内炎的治疗

采用玻璃体切除和玻璃体内注射抗生素，治疗３０例儿童细菌性眼内炎。结果：治疗的效果与治疗时机、细菌毒力的大小、眼外伤的程度等因素有直接关系。细菌培养结果：７０％为球菌感染，３０％为杆菌感染，且８０％的细菌用庆大霉素治疗有效。     

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.     

Degenerated Intravitreal Cysticercus Cyst Masquerading as Endogenous Endophthalmitis

The authors report a case of degenerated intravitreal cysticercus cyst presenting as endogenous endophthalmitis, which has hitherto been unreported. A young adult presented with symptoms of chronic bilateral ocular inflammation, and was treated topically for endogenous endophthalmitis in the left eye. On dilated fundus examination the right eye was found to have a cystic structure in the inferior vitreous cavity. The cyst was removed by a three-port vitrectomy. On submitting the vitreous sample to histopathology it was confirmed to be degenerated cysticerus cyst with chronic inflammation.     

玻璃体切割治疗细菌性眼内炎的疗效观察

目的评估玻璃体切割治疗细菌性眼内炎的临床效果。方法收治22例细菌性眼内炎，抽吸前房水及玻璃体培养发现，常见的致病菌为葡萄球菌及枯草杆菌，采用玻璃体切割联合注药治疗眼内感染。结果治愈率为68％，总有效率为86％，3例丧失光感，占14％。结论玻璃体切割联合眼内注药是目前治疗眼内感染较为理想的方法。     

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.     

Iris Abscess as an Unusual Presentation of Endogenous Endophthalmitis after Intramuscular Injection

Purpose: To report a case of iris abscess due to endogenous endophthalmitis after an intramuscular injection complicated with gluteal abcess.

Method: A 65-year-old female presented with decreased vision and burning pain in her right eye, 2 weeks after an intramuscular injection.

Results: Iris abscess and hypopyon with a fibrinous exudate was noted in the anterior chamber of the right eye. Blood culture and anterior chamber paracentesis was positive for methicillin-sensitive Staphylococcus aureus.

Conclusions: The authors believe this to be the first case of an iris abscess due to gluteal abscess after intramuscular injection.     

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.     

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.     

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.     

Endophthalmitis

Australia and New Zealand continue to be at the forefront of endophthalmitis research. In this Clinical Controversy, an ophthalmologist from each country presents different approaches to the management of a 72-year-old patient with routine endophthalmitis following cataract surgery. Mark Elder concludes that this case needs aqueous and vitreous aspirates for culture and the initial treatment of choice is intracameral vancomycin and amikacin. The evidence for intravitreal steroids is equivocal. Systemic antibiotics are indicated if there is a possibility of a bacterial biofilm present on the intraocular lens. Nigel Morlet concludes that timely intervention with appropriate antibiotics delivered in the right concentration to the vitreous cavity is the crux of successful management of endophthalmitis. Aggressive treatment of the inflammatory response is also required to further reduce the damage to the intraocular structures. Both ophthalmologists agree that vitrectomy is not necessarily the most appropriate treatment option.     

Complications of Surgery in Glaucoma: Early and Late Bacterial Endophthalmitis Following Glaucoma Filtering Surgery

One case of “early” post-trabeculectomy endophthalmitis and five eyes with “late” endophthalmitis three to nine years after glaucoma filtration surgery are presented. Differentiation of early versus late endophthalmitis is based on the time of onset and pathogenesis. Retrospective analysis of 1100 consecutive trabeculectomies revealed an incidence of less than 0.1% for early and 0.2% for late endophthalmitis. Medical and surgical approaches are discussed. The presumed importance of identifying posterior extension into the vitreous and performing a therapeutic vitrectomy is emphasized.     

Prevention and Management of Traumatic Endophthalmitis

Twelve cases of traumatic culture-proven endophthalmitis were treated with intraocular antibiotics or in combination with vitrectomy. In 11 cases, the eyes were saved and in 10 the visual acuity was equal to or better than 20/200.     

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.     

超声乳化白内障吸出术后感染性眼内炎的治疗

目的:讨论超声乳化白内障吸出术后感染性眼内炎的原因和处理。方法:对3850例超声乳化白内障吸出术中5例感染性眼内炎患者进行前房冲洗及注药术,术后全身和局部应用抗菌素、激素及散瞳药。结果:5例感染性眼内炎均得到控制,1例需进行玻璃体切割术,4例进行前房冲洗术。除1例患者外,4例均获得满意的视功能恢复。结论:超声乳化白内障吸出术后眼内炎的发生,术中前房污染是最常见的致病菌来源,及时、彻底的前房冲洗注药术是有效的处理方法之一。眼科学报1999;15:124—126。     

白内障术后眼内炎诊治

目的:探讨白内障术后眼内炎的临床表现及诊治方法。方法:回顾性分析2005-05/2008-03我院诊治的4例白内障术后眼内炎病例,总结临床表现及治疗方法。结果:药物治疗2例,玻璃体切除手术治疗2例,全部患者感染控制,视力提高3例。结论:白内障围手术期应制定规范预防方案,严格执行,减少眼内炎发生可能。尽早发现、根据病情选择合理方式是治疗眼内炎的关键。