Endogenous E. coli endophthalmitis

Bilateral endogenous endophthalmitis complicated by scleral perforation: an unusual presentation

Endogenous endophthalmitis complicated by necrotising scleritis has rarely been reported in the literature. We, hereby, report a case of bilateral scleral perforation with endogenous endophthalmitis in an 87-year-old female patient with diabetes who presented as bilateral orbital cellulitis. Systemic workup ruled out autoimmune aetiology. The culture and sensitivity of exudates exuding from the scleral perforation showed Escherichia coli The Patient was managed conservatively with parenteral and topical antibiotics along with steroid, but the vision could not be salvaged. The report emphasizes on atypical presentation of endogenous endophthalmitis. In old and immunosuppressed individuals presenting with a clinical picture of bilateral orbital cellulitis with profound vision loss, endogenous endophthalmitis should be ruled out.

Two cases of differentiation syndrome with ocular manifestations in patients with acute promyelocytic leukaemia treated with all-trans retinoic acid and arsenic trioxide

Purpose

To describe two cases of differentiation syndrome presenting with ocular manifestations including bilateral chorioretinopathy in patients with acute promyelocytic leukaemia treated with all-trans retinoic acid and arsenic trioxide differentiation therapy.

Observations

This observational case series identifies two patients at a single tertiary institution diagnosed with differentiation syndrome with associated ophthalmic involvement. Both patients reported bilateral reduction in visual acuity at days fourteen and ten respectively following initiation of differentiation therapy in addition to developing other systemic manifestations of differentiation syndrome. Both patients received the same chemotherapeutic regimen including both all-trans retinoic acid and arsenic trioxide as well as ten days of routine differentiation syndrome prophylaxis with oral prednisolone. Case 1 presented with bilateral pale yellow sub-retinal lesions concentrated at the posterior poles with ocular coherence tomography (OCT) evidence of bilateral multifocal areas of focal RPE elevation and adhesion to the thickened outer retina with interspersed sub-retinal fluid. Fluorescein angiography revealed areas of early hyperflouresence corresponding to the yellow chorioretinal lesions with late diffuse leakage of fluid into the subretinal space. Case 2 presented with a similar characteristic retinal findings on fundoscopy and optical coherence tomography. Both patients experienced rapid improvement in the visual symptoms and marked resolution of the sub-retinal fluid within seven to fourteen days of onset with excellent long-term visual outcome. Both patients achieved molecular remission after induction and received standard consolidation and maintenance therapy without visual disturbance.

Conclusion and importance

Ocular manifestations of differentiation syndrome have been only recently recognised. We present a case series of two patients with differentiation syndrome with ocular involvement. Common to both presentations was the presence of bilateral reduction in visual acuity with multifocal serous retinal detachment secondary to chorioretinopathy. The visual outcome from both presentations was excellent with rapid normalisation of visual acuity and resolution of the sub-retinal fluid with only the first case having their differentiation therapy temporarily withheld during the acute phase of illness.

CHORIORETINAL BIOPSY FOR THE DIAGNOSIS OF ENDOGENOUS ENDOPHTHALMITIS DUE TO ESCHERICHIA COLI

PURPOSE

To describe the novel use of a chorioretinal biopsy technique to confirm the microbiological diagnosis of endogenous Escherichia coli (E. coli) endophthalmitis, when other investigations have been proven nondiagnostic.

METHODS

Case report of an 82-year-old white man with endogenous endophthalmitis without a clearly identifiable source of infection.

RESULTS

After systemic cultures and multiple aqueous and vitreous samples were unable to identify a causative organism, chorioretinal biopsy of a subretinal abscess was used to confirm the microbiological diagnosis. This ensured appropriate ophthalmic and systemic treatment of infection.

CONCLUSION

Endogenous E. coli endophthalmitis is a rare and aggressive condition usually seen in patients with insulin-dependent diabetes with concurrent urinary tract infection. This case demonstrates chorioretinal biopsy to be a viable and effective method of establishing a firm microbiological diagnosis in cases of culture-negative endophthalmitis.

The diabetic ocular environment facilitates the development of endogenous bacterial endophthalmitis

PURPOSE

We tested the hypothesis that changes in the diabetic ocular environment facilitate the development of endogenous bacterial endophthalmitis (EBE).

METHODS

C57BL/6J mice were rendered diabetic with streptozotocin (STZ) for 1, 3, or 5 months' duration. Diabetic and age-matched nondiabetic mice were tail vein-injected with 10(8) CFU of Klebsiella pneumoniae, a common cause of EBE in diabetics. After either 2 or 4 days postinfection, the EBE incidence was assessed by electroretinography, histology, bacterial counts, and myeloperoxidase ELISAs. Blood-retinal barrier (BRB) permeability in uninfected diabetic mice also was determined.

RESULTS

No cases of EBE were observed among the 1-month diabetic group. Extending the time from diabetes induction to 3 months resulted in a 23.8% EBE incidence after 2 days, and a 22% incidence after 4 days. The incidence of EBE increased to 27% in the 5-month diabetic group. Infected eyes had an average 8.01 × 10(2) and 6.19 × 10(4) CFU/eye for the 3- and 5-month diabetic groups, respectively. There was no significant difference in BRB permeability between control and 1-month uninfected diabetic mice. However, 3- and 5-month diabetic mice had significantly greater BRB permeability than control mice. These results suggested that increasing the time from STZ diabetes induction to 3 and 5 months resulted in an ocular environment more conducive to the development of EBE.

CONCLUSIONS

These results demonstrated a correlation between an increase in BRB permeability and an increase in EBE incidence, supporting the hypothesis that diabetic ocular changes contribute to the development of EBE.

Uncommon ophthalmologic disorders in intensive care unit patients

Ophthalmologic complications are frequently encountered in intensive care unit (ICU) patients (Grixti et al. Ocul Surf 2012;10(1):26-42). However, eye care is often overlooked in the critical care setting or just limited to the ocular surface because treatment is focussed on the management of organ failures. Lack of awareness about other less common intraocular sight-threatening conditions may have a devastating effect on the patient's vision. To identify specific, frequently missed uncommon ocular disorders in ICU, a literature review using the keywords "Intensive Care," "Eye care," "ITU," "ICU," "Ophthalmological disorders," "Eye disorders" was performed. The databases of CINAHL, PuBMed, EMBASE, and Cochrane library were searched. The higher quality studies are summarized in the table with statements of methodology to clarify the level of evidence. The most prevalent ophthalmologic disorders identified in critically ill subjects include exposure keratopathy, chemosis, and microbial keratitis. In addition, uncommon eye disorders reported in ICU include metastatic endogenous endophthalmitis, acute primary angle closure, ischemic optic neuropathy, pupil abnormalities, vascular occlusions, and rhino-orbital cerebral mucormycosis. Early diagnosis and effective treatment will help to prevent visual loss.

Endogenous endophthalmitis: a 10-year review of culture-positive cases in northern China

PURPOSE

The aim of this study was to report the clinical features and treatment outcomes in a series of patients with endogenous endophthalmitis treated over a 10-year period in a single hospital in northern China.

METHODS

The authors conducted a retrospective chart review of 19 patients (23 eyes) treated for culture-proven endogenous endophthalmitis at the First Hospital of China Medical University between 1998 and 2007.

RESULTS

Patients were followed up for a mean of 15.9 months (range: 0.5-41 months). The main systemic predisposing risk factors were diabetes mellitus (52.6%), immunosuppressive therapy (36.8%), and malignancies (31.6%). Fungal isolates were present in 14 eyes (60.9%), gram-positive isolates in 8 eyes (34.8%), and gram-negative isolates in 1 eye (4.3%). All patients received intravenous antibiotics or antifungal agents, and other treatments included injection of intravitreal medication in 7 eyes (30.4%) and pars plana vitrectomy with injection of intravitreal medication in 14 eyes (60.9%). Final visual outcomes were obtainable for 21 eyes (one patient died 15 days after diagnosis). Ten (47.6%) of these 21 eyes achieved a visual acuity of 20/400 or better, and 11 (52.4%) achieved a visual acuity worse than 20/400, including 5 that were eviscerated. The median visual acuity was counting fingers (range: 20/25 to no light perception). Eyes with endophthalmitis caused by Candida species tended to have better visual outcomes than did eyes with bacterial and Aspergillus causes.

CONCLUSIONS

Similar to the findings of previous studies, this study showed that fungi, especially Candida species, were the most common causative organisms of endogenous endophthalmitis. Endogenous endophthalmitis is generally associated with poor visual acuity outcomes, particularly when caused by more virulent species of fungi, such as Aspergillus.

Uveal inflammation in septic newborn foals

BACKGROUND

Septicemia in humans is described as a leading cause of uveitis, which eventually can induce blindness.

HYPOTHESIS/OBJECTIVES

Uveal inflammatory findings could be related to sepsis severity in newborn foals and might be used as an indirect indicator for survival.

ANIMALS

Seventy-four septic foals, 54 nonseptic foals, and 42 healthy foals.

METHODS

Prospective observational clinical study. A detailed blinded, ophthalmic examination was performed by boarded ophthalmologists on all admitted newborn foals. Foals were grouped as septic (when blood culture resulted positive or the sepsis score was > or =14), nonseptic, and controls. Based on blood culture results, the septic group was subdivided into bacteremic and nonbacteremic foals.

RESULTS

Blood culture was performed in 62/74 septic foals, from which 35 (56%) were bacteremic and 27 (44%) were non-bacteremic. Anterior uveitis was diagnosed in a significantly (P < .005) higher number of septic/bacteremic foals (14/35, 40%) than in septic/nonbacteremic foals (5/27, 19%), nonseptic foals (4/54, 7%), and control foals (0%). Anterior chamber fibrin was only observed in 4/14 (29%) septic/bacteremic foals with anterior uveitis. Anterior uveitis was also associated with posterior uveitis in 6/35 (19%) septic/bacteremic foals. The diagnosis of uveitis was related to nonsurvival (P = .001, odds ratio = 6.2, 95% confidence interval = 2.1-18.2).

CONCLUSIONS AND CLINICAL IMPORTANCE

Anterior uveitis is highly prevalent in septic newborn foals, especially in those with a positive blood culture, and it should be considered as a survival prognostic factor.

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.

A case of endogenous bacterial endophthalmitis caused by Streptococcus bovis

BACKGROUND

Streptococcus bovis is a gram-positive streptococcus present as normal flora in the digestive tracts of herbivores. It is occasionally isolated from the human intestine and may act as a causative organism of infectious endocarditis, urinary infections and meningitis. This report describes a rare case of a patient that underwent surgical treatment for endogenous endophthalmitis caused by S. bovis complicated by bacteremia and suppurative spondylitis.

METHODS

Endophthalmitis of the right eye occurred in a 76-year-old man accompanied by hypopyon and prominent vitreous opacity complicated by suppurative spondylitis. The visual acuity of the right eye consisted of light perception. Lensectomy and vitrectomy were performed immediately using a perfusate containing antibiotics. Antibiotics were administered by intravenous infusion following surgery.

RESULTS

S. bovis was detected in the cultures of blood and vitreous fluid collected during surgery. The visual acuity was 20/160 at 11 months after surgery.

CONCLUSIONS

Reports of endogenous endophthalmitis in human caused by S. bovis have not been found to date in a search of the MEDLINE database. This is the first report of acute endogenous endophthalmitis caused by S. bovis.

A 10-year comparison of endogenous endophthalmitis outcomes: an east Asian experience with Klebsiella pneumoniae infection

PURPOSE

To evaluate the infection sources and causative organisms in cases of endogenous endophthalmitis and review the outcomes for patients with Klebsiella pneumoniae infection during a 10-year period.

METHODS

All cases of endogenous endophthalmitis treated at one Taiwanese hospital from July 1992 to June 2002 were retrospectively reviewed (n = 74; 86 eyes). The study was divided into two 5-year periods, with patients stratified into Group F or Group L according to onset date within the first or last of these periods, respectively. The outcomes of cases of K. pneumoniae infection in Group L (21 eyes) and Group F (32 eyes) were compared.

RESULTS

The major source of infection (liver abscess) and the causative organism (K. pneumoniae) did not change throughout the 10-year review period; however, outcomes for Group L appeared superior. The interval from onset of ocular symptoms to ophthalmic consultation was shorter for Group L; however, a statistically significant difference was not demonstrated by between-group comparison. Patients with good final vision typically had good initial vision in cases of K. pneumoniae infection.

CONCLUSION

The authors' experience with endogenous endophthalmitis has confirmed the findings of analogous East Asian studies, with liver abscess as the major source of infection and K. pneumoniae as the causative organism. Superior outcome may be achieved with more comprehensive and collaborative management, ideally through the combined efforts of multiple medical subspecialties.

Endogenous bacterial endophthalmitis: a 17-year prospective series and review of 267 reported cases

Endogenous bacterial endophthalmitis is a rare but serious condition that occurs when bacteria cross the blood-ocular barrier and multiply within the eye. We provide an overview of endogenous bacterial endophthalmitis by reviewing 267 reported cases and integrating this with our experience of an additional 19 cases. The majority of patients with endogenous bacterial endophthalmitis are initially misdiagnosed and many have an underlying disease known to predispose to infection. This condition is often previously undiagnosed. Blood cultures are the most frequent means of establishing the diagnosis. The most common Gram positive organisms are Staphylococcus aureus, group B streptococci, Streptococcus pneumoniae,and Listeria monocytogenes. The most common Gram negative organisms are Klebsiella spp., Escherichia coli, Pseudomonas aeruginosa, and Neisseria meningitidis. Gram negative organisms are responsible for the majority of cases reported from East Asian hospitals, but Gram positive organisms are more common in North America and Europe. The visual outcome is poor with most cases leading to blindness in the affected eye. Many patients have extraocular foci of infection, with an associated mortality rate of 5%. The outcome of endogenous bacterial endophthalmitis has not improved in 55 years and clinicians need to have a high level of awareness of this commonly misdiagnosed condition.

Retinal lesions as clues to disseminated bacterial and candidal infections: frequency, natural history, and etiology

Invasive bacterial and candidal infections are known to involve the retina, but the natural history of the retinal lesions and the utility of ophthalmologic consultation in the critical care setting as a diagnostic tool are not well understood. We 1) performed weekly funduscopic examinations on 77 medical and surgical patients in intensive care units (ICUs), 2) analyzed results of serial ocular examinations in 180 non-neutropenic patients with candidemia, and 3) reviewed the English literature on the association of retinal lesions with disseminated bacterial or candidal infection (DBCI). We found that 15 (19%) of the ICU patients had retinal lesions consistent with DBCI. Of these 15, 1 had clearly sepsis-related retinal lesions, while 13 (87%) had 1 or more systemic disease that could have explained their retinal findings (6 diabetic retinopathy; 2 human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) retinopathy; 2 hypertensive retinopathy; 1 hemolytic uremic syndrome, and 1 leukemia). Multivariate analysis revealed that systemic disease (odds ratio 8.37, 95% confidence intervals: 3.24-21.56) independently correlated with the presence of retinal lesions while DBCI, trauma, hyperalimentation, and transfusion of blood products were not independently predictive in any analysis. Twenty of the 180 (15%) candidemic patients had retinal lesions. Two (1%) had classic 3-dimensional white lesions with vitreal extension, and 5 (2.7%) had chorioretinal lesions without vitreal haziness. Notably, 10% of patients had superficial retinal hemorrhages and/or cotton wool spots that could have been due to either candidemia or a systemic disease (diabetes, hypertension, renal failure, closed head trauma). Concurrent bacteremia occurred in 3 of the 27 patients with eye lesions. Retinal lesions resolved in a mean of 33 days. None of the patients had symptoms at the time of the retinal finding. We found 3 studies that prospectively assessed retinal lesions in bacteremic patients. The frequency of retinal lesions in these series varied from 12% to 26%, with the most common lesions being cotton wool spots followed by superficial retinal hemorrhages. White-centered hemorrhages were seen in about 15% +/- 2 of bacteremic patients. Five studies prospectively evaluated candidemic patients for Candida endophthalmitis. These studies observed rates from 0% to 78% for lesions consistent with candidal endophthalmitis. Most studies performed recently found that nonspecific lesions such as cotton wool spots or superficial retinal hemorrhages occurred with a frequency of 11% to 20%. The availability of less toxic antifungal agents, more frequent use of empirical therapy, and the trend to early treatment may be altering the frequency of this complication. Observation of a classic 3-dimensional retina-based vitreal inflammatory process is virtually diagnostic of endogenous endophthalmitis due to Candida spp., but such lesions are relatively uncommon. Conversely, nonspecific lesions that could be due to bacterial or candidal endophthalmitis (cotton wool spots, retinal hemorrhages, and Roth spots) are seen frequently. These lesions are most often due to an underlying systemic disease rather than an infection. Serial examinations provide the best evidence that a given lesion is due to an intercurrent infection. The current low rate of vitreal extension of retinal process appears to be due to the high rate of empirical or therapeutic use of antifungal agents in high-risk patient groups. Ophthalmoscopy should be performed in patients with known candidemia. However, ophthalmoscopic examination seems to have little value in assisting with the discovery of occult disseminated candidiasis or bacterial infection.

Endogenous endophthalmitis: an 18-year review of culture-positive cases at a tertiary care center

A retrospective chart review of all patients seen at the Cleveland Clinic Foundation with infectious endogenous endophthalmitis between January 1982 and August 2000 revealed 34 affected eyes in 27 patients. During this time, the median incidence of endogenous endophthalmitis was 1.8 cases/year, and 48.1% of patients presented as outpatients. Twenty-six patients presented to an ophthalmologist, and the diagnosis was initially missed in almost half the cases. Eleven patients had an unremarkable physical exam except for eye findings. We found an equal incidence of bacterial and fungal endophthalmitis and a predominance of among the fungal etiologic agents. We did not, however, note a predominance of Gramnegative organisms seen mostly in reports from Asia. The microbiologic diagnosis was based on aqueous and vitreous cultures or positive eye histopathology stains in almost two-thirds of cases. The sensitivity of the Gram stain was poor, but its specificity and positive predictive value were excellent. The vitreous cultures obtained by vitrectomy instruments were more sensitive in making the diagnosis than the vitreous needle biopsy. Aside from blood cultures and eye specimen cultures, half the patients had an additional infectious focus, most frequently a urinary tract infection, whereas infectious endocarditis was seen in a small minority. Twelve patients had visual improvement with treatment with a final visual acuity better than 20/200 in 44% of the eyes. Good visual outcome was associated with visual acuity of 20/200 or better at diagnosis and with the absence of hypopyon.

A prospective search for ocular lesions in hospitalized patients with significant bacteremia

The purpose of this study was to determine the prevalence, risk factors, and prognostic value of ocular lesions in unselected patients with bacteremia. A total of 202 bacteremic patients, 101 nonbacteremic septic patients, and 90 nonseptic control patients were compared in a prospective, controlled, observational study. Ocular lesions related to bacteremia were found in 12% of the bacteremic group, 5% of the septic group, and 2% of the control group. Ocular lesions were significantly more frequent in the bacteremic patients than in the control patients (P=.007). The severity of the clinical condition and the presence of fungemia predict independently a higher risk of ocular lesions. Mortality rates among bacteremic patients with and without ocular lesions were, respectively, 32% and 8% (P<.01; OR, 3.99). The asymptomatic nature of most ocular lesions in patients with bloodstream infections and the impossibility of amelioration in most cases lead us to recommend ophthalmologic examination for bacteremic patients only when prognostic information is needed.

Retinal artery occlusion

A 54-year-old man presented with an acute painless loss of vision. He had a three-month history of malaise, weight loss, and episodic sweating. Physical examination showed a thin, febrile man with a petechial rash over the lower legs. Cardiac auscultation revealed an apical thrill and pansystolic murmur. Dental hygiene was poor. The diagnosis, mechanisms and treatment of retinal artery occlusion associated with bacterial endocarditis are reviewed.

Endogenous Klebsiella endophthalmitis. Report of two cases and review of the literature

BACKGROUND

Endogenous endophthalmitis is a rare complication of gram-negative sepsis. The diagnosis often is delayed unless a high index of suspicion exists. Familiarity with the clinical setting in which endogenous Klebsiella endophthalmitis occurs will hasten diagnosis and may improve outcome.

METHODS

The authors reviewed the medical literature and describe two patients with diabetes who lost vision from endogenous Klebsiella endophthalmitis.

FINDINGS

One patient lost all vision in both eyes before the diagnosis of sepsis was clinically suspected. In the other, endophthalmitis was the only clinical sign of septicemia 8 days after hospital discharge for treatment of a Klebsiella urinary tract infection. Survey of the literature showed an increase in the number of cases of endogenous Klebsiella endophthalmitis reported over the last 12 years. Sixty-one percent of the 44 patients reported in the literature since 1981 had diabetes, 68% had suppurative liver disease, and 16% had urinary tract infection.

CONCLUSION

An important implication of these associations is that metastatic Klebsiella endophthalmitis must be considered when vitritis occurs in patients with diabetes, particularly in those with acute liver disease or a urinary tract infection, or in any patient with vitritis and suppurative liver disease.

Escherichia coli emphysematous endophthalmitis and pyelonephritis. Case report and review of the literature

Emphysematous escherichia coli endophthalmitis occurred in a 72-year-old patient as a complication of E. coli septicemia secondary to emphysematous pyelonephritis and endocarditis. This is the first reported case of endogenous emphysematous endophthalmitis secondary to E. coli septicemia.

Metastatic Serratia marcescens endophthalmitis

Metastatic endophthalmitis in a ten-day-old baby who underwent colostomy for an unperforated anus and developed septicemia to Serratia marcescens is described. Although rapid isolation of the agent enabled efficacious specific antibiotic treatment and systemic eradication of the infective agent, the ocular condition continued to deteriorate. Because of the total loss of visual functions and the fear of possible development of sympathetic ophthalmia, enucleation rather than vitrectomy or evisceration was performed. Histopathologic examination of the globe revealed massive infiltrates within the choroid and optic nerve with total destruction of the retinal architecture. The child recovered immediately after surgery and was discharged a week later.

Metastatic bacterial endophthalmitis: a contemporary reappraisal

Metastatic bacterial endophthalmitis remains a challenge to the clinician despite the success of antibiotics in reducing its frequency and severity. Controversy currently surrounds the management of this condition because of uncertainty about the value of and indications for vitreous surgery. We review 72 cases of metastatic endophthalmitis from the past decade, including five not previously published. The spectrum of causative bacteria changed significantly during this period, with displacement of meningococcus by Bacillus cereus as the most frequently reported agent and an increasing incidence of infection by organisms of low pathogenicity in immunologically compromised hosts. We propose a new classification scheme for metastatic endophthalmitis based on the location (anterior or posterior segment) and extent (focal or diffuse) of the primary intraocular infection. Focal and anterior cases appear to have a good prognosis, while posterior diffuse disease nearly always leads to blindness. Our analysis of outcomes suggests that systemic antibiotics are more valuable in metastatic than in postoperative or traumatic endophthalmitis and that intraocular antibiotic injection and vitrectomy make only a limited contribution to successful treatment in metastatic infection. We recommend a clinical approach to metastatic endophthalmitis that minimizes exposure of patients to the risks of invasive procedures.

Medical therapy of metastatic meningococcal endophthalmitis

We treated a 15-year-old girl who had meningococcal meningitis and metastatic endophthalmitis with large doses of intravenously administered penicillin G. The patient promptly improved with this therapy, and the visual axis completely cleared during the subsequent five months.

Streptococcus suis type II (group R) as a cause of endophthalmitis

A case is reported of a patient with bilateral endophthalmitis, meningitis, sensorineural deafness, labyrinthitis, and septicaemia due to Streptococcus suis type II (group R). The organism is known to produce epidemic meningitis, septicaemia, and purulent arthritis in piglets, but human infection is rare, and no other case reports of ocular infection are known. The organism was sensitive to penicillin at a minimum inhibitory concentration of 0.03 mg/1.