Endogenous endophthalmitis caused by Citrobacter koseri originating from a renal abscess

The Unusual Suspect: Citrobacter Infection as a Rare Cause of Renal Abscess

Citrobacter infections have emerged as now a common nosocomial pathogen. Most of the infections manifest in patients with underlying medical conditions. The features of infection can range from infections in the lower urinary tract, respiratory tract, gastrointestinal disease, or bacteremia, however renal abscesses remain uncommon. Here we present the case of a 48-year-old female with medical history of diabetes that presented with a right renal abscess secondary to Citrobacter koseri infection managed with drainage and antimicrobial treatment.

Endogenous endophthalmitis caused by urinary tract infection: A case report

RATIONALE

Endogenous endophthalmitis is a vision-threatening intraocular infection caused by hematogenous spread of infectious organisms from distant sites.

PATIENT CONCERNS

A 71-year-old man with a history of fever and dysuria 5 days prior to presentation presented with sudden loss of vision in his left eye. The patient had no history of ocular surgery or trauma, and ocular examination revealed a large amount of exudative plaque covering the pupil. Therefore, fundus examination was not feasible. B-scan ultrasonography revealed a dome-shaped subretinal mass with an exudative retinal detachment.

DIAGNOSIS

Endogenous endophthalmitis was diagnosed on the basis of these findings.

INTERVENTIONS

The patient underwent pars plana vitrectomy and the early postoperative course was favorable.

OUTCOMES

Vitreous cultures grew gram-negative bacilli, identified as Klebsiella pneumonia. Urinalysis revealed white blood cells (++) and urinary tract infection was the only identifiable risk factor for endogenous endophthalmitis.

LESSONS

Urinary tract infection is an independent risk factor for endogenous endophthalmitis.

Citrobacter koseri: A Cause of Silicone Oil Related Endophthalmitis after Post Pars Plana Vitrectomy

Purpose. We present a rare case of Citrobacter koseri culture-positive endophthalmitis in a postvitrectomy silicone oil-filled eye. Case report. A 64-year-old male patient presented to our ophthalmology emergency room with representative symptoms of acute endophthalmitis. He underwent a plana vitrectomy oil-filled tamponade previously. Preoperative and postoperative findings of the case were reported. Results. Culture tests of aqueous, silicone oil, and vitreous taps were positive for Citrobacter koseri. Conclusions. Culture-positive endophthalmitis in a silicone oil-filled eye has very rarely been in the literature. The described cases were caused by acute inflammatory reactions to silicone oil and were culture-negative. The postvitrectomy culture-positive endophthalmitis caused by Citrobacter is a very rare condition, and its management is not so smooth. Approaching with silicone oil removal, intraoperative intravitreal antibiotic injection, and silicone oil reinjection was performed in our case with good outcomes.

A case of Citrobacter koseri renal abscess and review of the literature

Citrobacter species are anaerobic gram-negative bacteria that are known to cause infections in immunocompromised hosts, particularly in hospital settings. Their opportunistic nature and tendency to develop antibiotic resistance make Citrobacter species challenging to treat. Renal or perinephric abscess formation as a result of Citrobacter infection is uncommon, having only previously been reported in four cases. We present a case of a 70-year-old man with diabetes and prostate cancer who was diagnosed with an 18 cm perinephric and a 10 cm perihepatic abscess caused by Citrobacter koseri. The patient required drains and re-positioning of the drains multiple times in addition to a prolonged course of antibiotics to achieve complete radiographic resolution. This case highlights the challenges in treating renal and perinephric abscess, as it required drain re-placements two additional times after the initial placement and an additional 4 weeks of antibiotics. Successful treatment for larger abscesses usually requires a two-arm approach, with antibiotics in combination with either percutaneous or surgical abscess drainage.

Complete genome sequencing and comparative analysis of Citrobacter koseri CKNJ, a strain isolated from patient with endogenous endophthalmitis

Citrobacter koseri is an opportnistic pathogen can cause a variety of diseases. Though the mortality rate of C. koseri infections is high but there is a paucity of clinical information on them. Furthermore, the genomic features of this species are poorly studied. Herein, we presented a patient with endogenous endophthalmitis secondary to septicaemia, and collected a C. koseri isolate, CKNJ, from the blood of the patient. Whole genome sequencing revealed that the CKNJ harbors no plasmid and codes for 67 putative virulence factors. Whole genome SNP-based phylogenetic analysis revealed that strain CKNJ was close to the strains with same isolation sites. Compared to the other sequenced C. koseri chromosomes, CKNJ contains several strain-variable regions, including one prophage and two large genomic islands. The sequencing of the first complete genome of a clinical strain from China should reinforce our understanding of the genomic features and pathogenicity of this invasive infection-causing C. koseri with clinical significance.