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Goyal S, Hardin J, Uwaydat SH, Ellabban AA, Warner DB, Sallam AB. Review and update of cataract surgery in the diabetic eye. EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1351296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Sunali Goyal
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Cornea and External Diseases, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Joshua Hardin
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sami H. Uwaydat
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Retina, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - David B. Warner
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Cornea and External Diseases, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ahmed B Sallam
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Retina, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Abstract
Endophthalmitis is a severe eye infection that may result in permanent loss of useful vision in the affected eye. Most cases are exogenous and occur as a complication of cataract surgery, an intravitreal injection, or penetrating ocular trauma. Endogenous endophthalmitis results from hematogenous seeding of the eye by bacteria or fungi, but bacteremia or fungemia may be transient and patients may present without symptoms of systemic infection. Nearly all endophthalmitis patients present with decreased vision, and some also have eye pain. Eye examination usually reveals a hypopyon and intraocular inflammation. Diagnosis is clinical, supported by cultures of the vitreous and/or aqueous or by blood cultures in some endogenous cases. Molecular diagnostic techniques have been used in research laboratories for pathogen identification in endophthalmitis and offer the possibility of rapid diagnosis, including in culture-negative cases. Intravitreal injection of antibiotics is the most important component of treatment; some cases also benefit from surgical debridement of the vitreous by a vitrectomy. The visual outcome depends partly on the pathogen: coagulase-negative staphylococcal endophthalmitis has a better prognosis than does streptococcal endophthalmitis, for example. Endophthalmitis is a medical emergency, and prompt diagnosis and treatment are essential for saving vision.
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Affiliation(s)
- Marlene L Durand
- Departments of Medicine and Ophthalmology, Harvard Medical School, and Infectious Disease Service, Massachusetts Eye and Ear Infirmary, and Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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van Crevel R, van de Vijver S, Moore DAJ. The global diabetes epidemic: what does it mean for infectious diseases in tropical countries? Lancet Diabetes Endocrinol 2017; 5:457-468. [PMID: 27499355 PMCID: PMC7104099 DOI: 10.1016/s2213-8587(16)30081-x] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 02/06/2023]
Abstract
Tropical countries are experiencing a substantial rise in type 2 diabetes, which is often undiagnosed or poorly controlled. Since diabetes is a risk factor for many infectious diseases, this increase probably adds to the large infectious disease burden in tropical countries. We reviewed the literature to investigate the interface between diabetes and infections in tropical countries, including the WHO-defined neglected tropical diseases. Although solid data are sparse, patients with diabetes living in tropical countries most likely face increased risks of common and health-care-associated infections, as well as infected foot ulcers, which often lead to amputation. There is strong evidence that diabetes increases the severity of some endemic infections such as tuberculosis, melioidosis, and dengue virus infection. Some HIV and antiparasitic drugs might induce diabetes, whereas helminth infections appear to afford some protection against future diabetes. But there are no or very scarce data for most tropical infections and for possible biological mechanisms underlying associations with diabetes. The rise in diabetes and other non-communicable diseases puts a heavy toll on health systems in tropical countries. On the other hand, complications common to both diabetes and some tropical infections might provide an opportunity for shared services-for example, for eye health (trachoma and onchocerciasis), ulcer care (leprosy), or renal support (schistosomiasis). More research about the interaction of diabetes and infections in tropical countries is needed, and the infectious disease burden in these countries is another reason to step up global efforts to improve prevention and care for diabetes.
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Affiliation(s)
- Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, Netherlands.
| | - Steven van de Vijver
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam Medical Center, University of Amsterdam, Netherlands
| | - David A J Moore
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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Hosseini SM, Ahmadabadi A, Tavousi SH, Rezaiyan MK. Endogenous Endophthalmitis after Severe Burn: A Case Report. J Ophthalmic Vis Res 2017; 12:228-231. [PMID: 28540018 PMCID: PMC5423380 DOI: 10.4103/jovr.jovr_144_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: This report describes a rare ocular complication in a burned patient. Case Report: A 12-year-old girl was admitted to our burn center because of full thickness burn of 46% of her total body surface area. On the 23rd day of her stay, she complained of pain and decreased visual acuity in the right eye. Examination of this eye revealed panuveitis, dense vitritis, and a large chorioretinal abscess in the macular area; her best corrected visual acuity (BCVA) in this eye was hand motion. The left eye was completely normal. A smear and culture of the vitreous biopsy revealed the presence of Candida albicans. With a diagnosis of endogenous endophthalmitis due to fungal infection, the patient was treated with systemic fluconazole, intravitreal injection of Amphotericin B, and pars plana deep vitrectomy. After 6 months, the patient's final ocular examination revealed BCVA of counting fingers at two meters, a large macular scar, and quiescence of the intraocular infection. Conclusion: Burn patients treated with broad-spectrum antibiotics are at risk of candidemia and its complications, including endogenous endophthalmitis. Early diagnosis of endogenous endophthalmitis in high risk patients could prevent visual loss.
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Affiliation(s)
| | - Ali Ahmadabadi
- Surgical Oncology Research Center and Burns Department of Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Hassan Tavousi
- Surgical Oncology Research Center and Burns Department of Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Khadem Rezaiyan
- Department of Community Medicine and Public Health, Mashhad University of Medical Sciences, Mashhad, Iran
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Exogenous Streptococcus pneumoniae Endophthalmitis in Diabetic Rabbits. Sci Rep 2017; 7:46196. [PMID: 28387365 PMCID: PMC5384200 DOI: 10.1038/srep46196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/10/2017] [Indexed: 12/19/2022] Open
Abstract
Diabetics are at increased risk for eye infections including bacterial endophthalmitis. It is unclear whether the severity of endophthalmitis is greater in these patients due to confounding factors such as pre-existing ocular diseases in some but not others. Therefore, we tested the hypothesis that disease severity and/or bacterial loads would be significantly higher in a Type I diabetic rabbit model of Streptococcus pneumoniae endophthalmitis. Rabbits were treated with alloxan to destroy pancreatic islet cells, or mock-treated with vehicle, and maintained for 10 days before intravitreal infection with S. pneumoniae E353. Clinical scoring of the eyes was performed 24 and 48 hours after infection, followed by euthanasia and vitreous harvest to quantitate bacterial loads. There were no significant differences in clinical scores (P ≥ 0.440) or bacterial loads (P = 0.736), however, 4/12 (33%) of the diabetic rabbits became bacteremic. This finding not only indicates a breakdown in the blood-ocular barrier, but also prompts further investigation into the exploitation of the diabetic eye by the streptococci.
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Cho H, Shin YU, Siegel NH, Yu HG, Sobrin L, Patel A, Durand ML, Miller JW, Husain D. Endogenous Endophthalmitis in the American and Korean Population: An 8-year Retrospective Study. Ocul Immunol Inflamm 2016; 26:496-503. [PMID: 27459423 DOI: 10.1080/09273948.2016.1195000] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Heeyoon Cho
- a Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Harvard Medical School , Boston , Massachusetts , USA
- b Department of Ophthalmology , Hanyang University Medical College , Seoul , Republic of Korea
| | - Yong Un Shin
- b Department of Ophthalmology , Hanyang University Medical College , Seoul , Republic of Korea
| | - Nicole H Siegel
- c Department of Ophthalmology , Boston University School of Medicine , Boston , Massachusetts , USA
| | - Hyeong Gon Yu
- d Department of Ophthalmology , Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Lucia Sobrin
- a Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Harvard Medical School , Boston , Massachusetts , USA
| | - Achal Patel
- c Department of Ophthalmology , Boston University School of Medicine , Boston , Massachusetts , USA
| | - Marlene L Durand
- a Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Harvard Medical School , Boston , Massachusetts , USA
- e Infectious Disease Unit, Department of Medicine , Massachusetts General Hospital, Harvard Medical School , Boston , Massachusetts , USA
| | - Joan W Miller
- a Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Harvard Medical School , Boston , Massachusetts , USA
| | - Deeba Husain
- a Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Harvard Medical School , Boston , Massachusetts , USA
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PROSPECTIVE TRIAL OF ENDOGENOUS FUNGAL ENDOPHTHALMITIS AND CHORIORETINITIS RATES, CLINICAL COURSE, AND OUTCOMES IN PATIENTS WITH FUNGEMIA. Retina 2016; 36:1357-63. [DOI: 10.1097/iae.0000000000000919] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Current Perspectives of Prophylaxis and Management of Acute Infective Endophthalmitis. Adv Ther 2016; 33:727-46. [PMID: 26935830 DOI: 10.1007/s12325-016-0307-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Indexed: 12/23/2022]
Abstract
Endophthalmitis is an intraocular inflammatory condition which may or may not be caused by infective agents. Noninfectious (sterile) endophthalmitis may be attributable to various causes including postoperative retained soft lens matter or toxicity following introduction of other agents into the eye. Infectious endophthalmitis is further subdivided into endogenous and exogenous. In endogenous endophthalmitis there is hematogenous spread of organisms from a distant source of infection whereas in exogenous endophthalmitis direct microbial inoculation may occur usually following ocular surgery or penetrating eye injury with or without intraocular foreign bodies. Acute infective endophthalmitis is usually exogenous induced by inoculation of pathogens following ocular surgery, open-globe injury and intravitreal injections. More infrequently the infective source is internal and septicemia spreads to the eye resulting in endogenous endophthalmitis. Several risk factors have been implicated including immunosuppression, ocular surface abnormalities, poor surgical wound construction, complicated cataract surgery with vitreous loss and certain types of intraocular lens. Comprehensive guidelines and recommendations on prophylaxis and monitoring of surgical cases have been proposed to minimize the risk of acute endophthalmitis. Early diagnosis and prompt management of infective endophthalmitis employing appropriately selected intravitreal antibiotics are essential to optimize visual outcome.
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Landré C, Baillif S. [Endogenous bacterial and fungal endophthalmitis at Nice University Medical Center: A 15-year case review]. J Fr Ophtalmol 2016; 39:346-54. [PMID: 27016334 DOI: 10.1016/j.jfo.2015.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 11/06/2015] [Accepted: 11/12/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate epidemiology, diagnostic and therapeutic management strategies and visual outcomes of cases of bacterial and fungal endogenous endophthalmitis managed in the Nice University Medical Center between January 2000 and June 2015. METHODS Three hundred twenty-three charts of patients with endophthalmitis treated at the Nice University Medical Center over this period were retrospectively reviewed to select the ones with endogenous endophthalmitis. Demographic characteristics, medical history, clinical presentation, diagnostic and therapeutic management, microbiology, and final outcomes were analyzed. RESULTS Twenty-two eyes of 20 patients were selected, constituting 6.20% of all cases of endophthalmitis. The mean age was 69years, and 75% of patients were male. The most common risk factors were diabetes, malignancies and cardiac diseases. Bacterial isolates were found in 16 cases (80%), fungal isolates in 3 (15%) and co-infection in 1 case. Gram-positive organisms accounted for 70.6% of cases (mostly Staphylococcus aureus [25%], Streptococcus agalactiae [25%] and Streptococcus pneumoniae [16.7%]). Candida albicans was the most common fungal organism. There was one bacterial and fungal co-infection. Two patients died, 4 eyes were enucleated or eviscerated (20%), and 4 patients (20%) attained a final visual acuity of 1/10 or better. CONCLUSION Endogenous endophthalmitis is a rare and serious condition with a poor prognosis. Gram-positive microorganisms, mostly S. aureus, were the main causative pathogens found.
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Affiliation(s)
- C Landré
- Service d'ophtalmologie, hôpital Pasteur 2, centre hospitalo-universitaire de Nice, 30, avenue de la Voie-Romaine, 06000 Nice, France
| | - S Baillif
- Service d'ophtalmologie, hôpital Pasteur 2, centre hospitalo-universitaire de Nice, 30, avenue de la Voie-Romaine, 06000 Nice, France.
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Joubert SV, Duarte MA. Cellulitis of the Knee in a 16-Month-Old Boy: A Case Report. J Chiropr Med 2016; 15:53-8. [PMID: 27069433 DOI: 10.1016/j.jcm.2016.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 08/28/2015] [Accepted: 09/08/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The purpose of this case report is to describe the presentation of cellulitis in a 16-month-old boy to a chiropractic clinic. CLINICAL FEATURES The patient presented with nontraumatic, sudden onset of nonpurulent erythema on the right knee. A plain film radiograph of the knee showed a 40-mm thickening of the anterior knee. A diagnosis of cellulitis was rendered based on the presentation of the rapidly spreading erythema and radiographically confirmed findings. INTERVENTION AND OUTCOME The patient was immediately referred to the local emergency room. The patient was hospitalized, treated with clindamycin and amoxicillin for 3 days, and then discharged. The patient's pediatrician discontinued clindamycin treatment at the posthospitalization follow-up. Two weeks after treatment was discontinued, the patient was diagnosed with recurrent cellulitis. CONCLUSION This case demonstrated that for this young patient with cellulitis of the knee, timely recognition and referral, together with patient or parent education and immediate treatment, were essential to a successful outcome.
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Affiliation(s)
- Sonia V Joubert
- Chiropractic Physician, Attending Clinician, National University of Health Sciences, Lombard, IL
| | - Manuel A Duarte
- Chiropractic Physician, Chair of Clinical Practice, National University of Health Sciences, Lombard, IL
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Chen KJ, Chao AN, Chen TL, Liu L, Hwang YS, Chen YH. Risk Factors Predictive of Endogenous Endophthalmitis Among Hospitalized Patients With Hematogenous Infections in the United States. Am J Ophthalmol 2015; 160:391-2. [PMID: 26187877 DOI: 10.1016/j.ajo.2015.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 03/24/2015] [Accepted: 04/25/2015] [Indexed: 11/26/2022]
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