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Kasem Ali Sliman R, Khoury L, Shehadeh S. Pediatric Endophthalmitis Over the Last Five Decades: A Case Report and Systematic Review. Pediatr Infect Dis J 2024; 43:997-1003. [PMID: 38899988 DOI: 10.1097/inf.0000000000004419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
INTRODUCTION Pediatric infectious endophthalmitis is a rare, severe ocular infection that can have devastating consequences. It may be exogenous or endogenous, with exogenous endophthalmitis being more common. Current data on the etiology, microbiology, antibiotic treatments and outcomes in pediatric cases is limited. PURPOSE To summarize the etiology, microbiology, visual outcomes and management of pediatric endophthalmitis. METHODS A literature review was conducted on cases of pediatric endophthalmitis published from 1980 to 2022, identified through searches of PubMed, Medline, Web of Science and Google Scholar databases. RESULTS A total of 796 patients were included. Ocular trauma was the most common cause with 623 patients (78.3%), followed by posteye surgery with 100 patients (12.6%) and endogenous endophthalmitis with 67 patients (70 eyes) (8.4%). Among culture-positive cases, gram-positive microorganisms predominated. Treatment involved pars plana vitrectomy in 608 patients (76%) and intraocular antibiotics in 590 patients (74%). Favorable visual acuity (≥20/200) was achieved in 30.5% of patients, 20% had no light perception and 12.5% developed poor anatomical outcomes with phthisis bulbi. CONCLUSION Our review provides insights into the etiology, epidemiology, microbiology, treatment and visual outcomes of pediatric endophthalmitis based on available literature worldwide.
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Affiliation(s)
| | - Lana Khoury
- From the Department of Pediatrics, Carmel Medical Center, Haifa, Israel
| | - Shereen Shehadeh
- From the Department of Pediatrics, Carmel Medical Center, Haifa, Israel
- B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Pediatric Infectious Unit, Carmel Medical Center, Haifa, Israel
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Yoshimiya M, Shimbashi S, Hyodoh H. Postmortem changes in the eye on computed tomography images. Leg Med (Tokyo) 2024; 70:102477. [PMID: 38936142 DOI: 10.1016/j.legalmed.2024.102477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/24/2024] [Accepted: 06/22/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Ocular tension decreases with increasing postmortem interval (PMI) and eyes collapse with extreme progression of postmortem change; however, time-related changes in postmortem computed tomography (PMCT) findings have not been clarified. This study aimed to quantitatively evaluate the vitreous volume and CT values of the vitreous body to clarify time-related changes in PMCT. METHODS We retrospectively reviewed PMCT images of the eyes of subjects who underwent autopsy at our institution between July 2023 and February 2024. They were classified into four PMI groups: PMI-1: < 1 day, PMI-2: 1-2 days, PMI-3: 3-6 days, PMI-4: ≥ 7 days. The vitreous volumes and mean CT values of the vitreous chambers were measured. Additionally, the presence of intraocular gas and crystalline lens dislocation was observed. RESULTS The PMCT images of 131 eyes of 66 patients (41 males, 25 females) were analyzed. The mean age was 63.7 (22-99) years. The volume of the vitreous cavity was significantly decreased at PMI-3 and PMI-4, which indicated scleral depression. Intraocular gas appeared in PMI-4. Lens dislocation began at PMI-3 and was more frequently observed at PMI-4 and in the higher-temperature environment group. CONCLUSION Ocular findings on PMCT are useful for estimating the time of death.
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Affiliation(s)
- Motoo Yoshimiya
- Department of Forensic Medicine, University of Fukui School of Medical Sciences, Japan.
| | - Shogo Shimbashi
- Department of Forensic Medicine, University of Fukui School of Medical Sciences, Japan
| | - Hideki Hyodoh
- Department of Forensic Medicine, University of Fukui School of Medical Sciences, Japan
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Alias NSAQ, Abu-Bakar MF, Rosli AH, Jabbari AJ. A Retrospective Review of Endogenous Endophthalmitis: Three Years of Experience at Sultan Ahmad Shah Medical Centre at International Islamic University Malaysia. Cureus 2024; 16:e63175. [PMID: 39070347 PMCID: PMC11273178 DOI: 10.7759/cureus.63175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/30/2024] Open
Abstract
Introduction Endogenous endophthalmitis is characterized by severe intraocular inflammation caused by the invasion of microorganisms into the anterior and posterior chambers of the eye. It results from hematogenous spread from distant foci of infection. This, in turn, leads to potential vision loss and blindness due to reduced anatomical and functional outcomes. The latest reported prevalence of endogenous endophthalmitis accounts for at least 2-8% of cases of general endophthalmitis which is fairly significant. Purpose This study aimed to analyze the clinical profile of endogenous endophthalmitis presented in the Ophthalmology Clinic, Sultan Ahmad Shah Medical Centre at International Islamic University Malaysia (SASMEC@IIUM). This study includes the patients' demographics, clinical manifestations, causative organism, treatment, and final visual outcome. Methods This is a retrospective case series of endogenous endophthalmitis patients from January 2020 to June 2023. The data were obtained from the patients' medical records in SASMEC@IIUM. Results A total of six patients (six eyes) were diagnosed with endogenous endophthalmitis from January 2020 to June 2023. Four patients (66.6%) were female, with a mean age of 51.6 ± 17.5 years. Presenting visual acuity ranged between 6/21 to hand movement (HM). Five patients (83.3%) presented with reduced vision, while one presented with eye redness (16.6%). Ocular signs included vitritis and retinitis (five eyes, 83.3%), hypopyon (five eyes, 83.3%), injected conjunctiva (five eyes, 83.3%), and eyelid swelling (one eye, 16.6%). The most common primary infection seen was intraabdominal sepsis (three patients, 50%), septic arthritis, hospital-acquired pneumonia (HAP), and urinary tract infection (UTI). Vitreous biopsy was only positive in two patients (33.3%) However, five out of the six patients (83.3%) had positive blood cultures (two Staphylococcus aureus, two Klebsiella pneumoniae and one Pseudomonas aeruginosa). All patients received intravitreal injections and intravenous antibiotics. Only one patient underwent subsequent trans pars plana vitrectomy (TPPV). Final visual acuity ranged from 6/6 to no light perception (NPL). Conclusion In this case series of six patients, we observed a variety of outcomes with similar presentations despite standardized treatment in all patients. Five out of six patients showed poorer visual outcomes and only one patient showed a final visual acuity of 6/6. Therefore, further study with a larger sample size is needed to evaluate the factors associated with the final visual outcome in endogenous endophthalmitis.
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Affiliation(s)
| | - Mohd-Fadzil Abu-Bakar
- Ophthalmology, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, MYS
| | - Abdul-Hadi Rosli
- Ophthalmology, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, MYS
| | - Aidila Jesmin Jabbari
- Ophthalmology, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, MYS
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Leong E, Cifuentes-González C, Hu Y W J, Perumal Samy R, Khairallah M, Rojas-Carabali W, Putera I, de-la-Torre A, Agrawal R. Clinical Insights: Antimicrobial Therapy for Infectious Uveitis. Ocul Immunol Inflamm 2024:1-21. [PMID: 38759216 DOI: 10.1080/09273948.2024.2345848] [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: 08/09/2023] [Accepted: 04/16/2024] [Indexed: 05/19/2024]
Abstract
Infectious uveitis is a major global cause of vision impairment. Despite the eye's immune privilege, afforded by the blood-ocular barrier that restricts microbial entry, several pathogens such as bacteria, viruses, fungi, and parasites can still infiltrate and cause ocular infections and complications. Clinicians often encounter significant challenges in treating infectious uveitis due to limited or ineffective treatment options. Modern molecular techniques and imaging can aid in diagnosing and assessing intraocular infections. Various antimicrobial therapies exist, spanning topical and systemic treatments, but these are constrained by issues like drug concentration, penetration, effective duration, toxicity, and side effects. Treatment approaches also differ based on the infection's etiology. This review provides recent updates on antimicrobial therapies from a clinical perspective, covering topical, systemic, and regional treatments for infectious uveitis.
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Affiliation(s)
- Evangeline Leong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Carlos Cifuentes-González
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jeremy Hu Y W
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ramar Perumal Samy
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Ocular Infections and Antimicrobial Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Moncef Khairallah
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - William Rojas-Carabali
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ikhwanuliman Putera
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Alejandra de-la-Torre
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Ocular Infections and Antimicrobial Group, Singapore Eye Research Institute, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Duke NUS Medical School, Singapore, Singapore
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He Y, Zeng W, Shi W, Chen X, Shen Y, Wang S, Cai X, Liu Y, Gao Y, Ke M. Do not stumble over the same "stone" twice: a case series of endogenous endophthalmitis secondary to severe systemic diseases. BMC Ophthalmol 2024; 24:214. [PMID: 38760776 PMCID: PMC11100056 DOI: 10.1186/s12886-024-03478-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/08/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Endogenous endophthalmitis (EE) is a rare but highly destructive eye emergency secondary to systemic infection. Acute endophthalmitis can lead to irreversible vision impairment or even loss of the whole eye, unless being diagnosed and treated promptly. CASE PRESENTATION This study reports three typical EE cases of endogenous endophthalmitis secondary to different severe systemic diseases. Patients were recruited from the Department of ophthalmology at Zhongnan hospital of Wuhan University and the Department of ophthalmology at the Second Affiliated Hospital of Fujian Medical University. Patients were followed up for up to 60 days. Among these cases, the eye symptoms is the initial manifestations while secondary to original different special systemic conditions. Patients have been treated under dynamically prompt response undergoing systemic treatment and eye treatment at the same time. Best corrected visual acuity were 20/40, 20/60 and light perception during follow-up evaluation. CONCLUSIONS Our observation suggest that prompt identification and treatment could save patients' vision from EE.
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Affiliation(s)
- Ying He
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Weijuan Zeng
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Wenjian Shi
- Department of Ophthalmology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, China
| | - Xiaomin Chen
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Yanru Shen
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Shun Wang
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Xiaojun Cai
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Yang Liu
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China
| | - Yingying Gao
- Department of Ophthalmology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, China.
| | - Min Ke
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China.
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Chen SC, Wu TT, Yin CH, Chen JS, Chen YS. Widespread Adoption of Microincision Vitrectomy Surgery Improves Visual Outcomes in Endogenous Endophthalmitis with Poor Initial Vision: A 21-Year Experience in Taiwan. Ocul Immunol Inflamm 2024:1-6. [PMID: 38691837 DOI: 10.1080/09273948.2024.2338272] [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: 11/13/2023] [Accepted: 03/28/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE To review the presentation and visual prognostic factors of patients with endogenous endophthalmitis before and after the introduction of microincision vitrectomy surgery (MIVS), at a tertiary referral hospital in Taiwan, over a 21-year period. METHODS We retrospectively analyzed medical records of patients diagnosed with endogenous endophthalmitis before and after the introduction of MIVS between January 2002 and December 2022. RESULTS Data were collected from 147 patients. Diabetes mellitus was the most common comorbidity (59.9%). Liver abscess (32.7%) was the leading source of infection, followed by urinary tract infection (15.0%), and infective endocarditis (5.4%). Klebsiella pneumoniae (50.4%) was the most common pathogen, followed by Staphylococcus aureus (13.5%), and Candida albicans (8.3%). Poor initial visual acuity worse than counting fingers (CF) (p < 0.001) and diabetes mellitus (p = 0.008) were significantly associated with poor visual outcomes. In the treatment of 98 patients with poor initial visual acuity worse than CF, the proportion of vitrectomy surgeries performed increased from 13/56 (23.2%) to 24/42 (57.1%) (p = 0.001) after the introduction of MIVS. Final visual acuity of CF or better increased from 7/56 (12.5%) to 12/42 (28.6%) after the introduction of MIVS (p = 0.046). Vitrectomy was a better prognostic factor for final visual outcome in patients with poor initial visual acuity of worse than CF (p = 0.011) than other factors. CONCLUSION In endogenous endophthalmitis patients presenting with poor initial visual acuity, vitrectomy was a better visual prognostic factor. MIVS has allowed more patients to undergo vitrectomy and improved visual outcomes.
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Affiliation(s)
- Shih-Chou Chen
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Optometry, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Tsung-Tien Wu
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chun-Hao Yin
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Institute of Health Care Management, National Sun Yat-Sen University, Kaohsiung, Taiwan
- Department of Nursing, Meiho University, Pingtung, Taiwan
| | - Jin-Shuen Chen
- Department of Administration, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yao-Shen Chen
- Department of Administration, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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You H, Kim J. Endogenous Endophthalmitis from Urinary Tract Infection Caused by Group B Streptococcus: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:700. [PMID: 38792883 PMCID: PMC11123245 DOI: 10.3390/medicina60050700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/21/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024]
Abstract
We present a case of endogenous endophthalmitis with urinary tract infection (UTI) caused by group B Streptococcus (GBS). An 86-year-old female initially presented with ocular pain and sudden visual disturbance of the left eye. The patient did not complain of other symptoms and had no history of recent ocular surgery or trauma. Endogenous endophthalmitis was clinically diagnosed based on ophthalmic examination, history, and lab results showing systemic infection. A few days later, GBS was identified in her aqueous humor, blood, and urine cultures. Intravitreal ceftazidime and vancomycin injections, as well as fortified ceftazidime and vancomycin eye drops, were used immediately after clinical diagnosis. However, the symptoms worsened despite repeated intravitreal injections, so evisceration was performed. Endogenous endophthalmitis caused by GBS is very virulent and may present without evident systemic symptoms. The early recognition of the disease and systemic work up, followed by prompt treatment, is necessary.
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Affiliation(s)
| | - Joonhyung Kim
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Republic of Korea
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Ness T. [Bacterial endogenous endophthalmitis : Spectrum of pathogens and drug therapy]. DIE OPHTHALMOLOGIE 2024; 121:264-271. [PMID: 38438813 DOI: 10.1007/s00347-024-01995-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 03/06/2024]
Abstract
Endogenous endophthalmitis represents an ophthalmological emergency requiring immediate diagnostics and treatment. Pathogens should be detected using appropriate methods, such as the Freiburg endophthalmitis set. In bacterial endophthalmitis both Gram-positive and Gram-negative bacteria can be detected. Frequent underlying sources include endocarditis, gastrointestinal or urogenital surgery, indwelling venous catheters, liver abscesses, skin or soft tissue infections, meningitis or less commonly, intravenous drug abuse. The treatment consists of systemic and intraocular administration of antibiotics and vitrectomy. Systemic or intraocular corticosteroids can additionally be considered.
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Affiliation(s)
- Thomas Ness
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
- Albert-Ludwigs Universität Freiburg, Medizinische Fakultät, Freiburg, Deutschland.
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Carbonaro R, Menean M, Cottone G, Alessandri Bonetti M, Vaienti L, Miserocchi E, Bandello F. Endogenous Endophthalmitis Secondary to Infected Cutaneous Basal Cell Carcinoma: A Case Report. Ocul Immunol Inflamm 2024; 32:355-357. [PMID: 36696367 DOI: 10.1080/09273948.2023.2165951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/07/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Endogenous endophthalmitis (EE) is a severe intraocular infection due to hematogenous spread of bacteria from an extraocular site. Recognition of the primary source of hematogenous spread of bacteria is essential to establish an adequate therapy and avoid other major complications. Infected cutaneous tumor has never been reported as a possible source of EE. PURPOSE To describe the first case of EE due to hematogenous spread of methicillin-sensitive Staphylococcus aureus from an infected cutaneous basal cell carcinoma. Systemic antibiotic therapy and surgical excision of the cutaneous lesion were performed. CONCLUSION Severe and long-standing skin infections should be considered as a rare cause of EE.
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Affiliation(s)
- Riccardo Carbonaro
- School of Medicine, Università degli Studi di Milano, Milano, Italy
- Department of Reconstructive and Aesthetic Plastic Surgery, IRCCS Ospedale Galeazzi, Milan, Italy
| | - Matteo Menean
- School of Medicine, Vita-Salute San Raffaele. University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Cottone
- School of Medicine, Università degli Studi di Milano, Milano, Italy
- Department of Reconstructive and Aesthetic Plastic Surgery, IRCCS Ospedale Galeazzi, Milan, Italy
| | - Mario Alessandri Bonetti
- School of Medicine, Università degli Studi di Milano, Milano, Italy
- Department of Reconstructive and Aesthetic Plastic Surgery, IRCCS Ospedale Galeazzi, Milan, Italy
| | - Luca Vaienti
- School of Medicine, Università degli Studi di Milano, Milano, Italy
- Department of Reconstructive and Aesthetic Plastic Surgery, IRCCS Ospedale Galeazzi, Milan, Italy
| | - Elisabetta Miserocchi
- School of Medicine, Vita-Salute San Raffaele. University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele. University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Lizana N, Parrao D, Larrañaga M, Figueroa‐Vercellino JP, Pozo K, Bravo JC. Endogenous endophthalmitis secondary to perirenal abscess. IJU Case Rep 2023; 6:271-273. [PMID: 37667766 PMCID: PMC10475336 DOI: 10.1002/iju5.12601] [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: 03/31/2023] [Accepted: 06/09/2023] [Indexed: 09/06/2023] Open
Abstract
Introduction Endogenous Endophthalmitis is a rare ocular infection but with poor visual prognosis for most patients. Its most frequent etiology is Klebsiella spp., associated with hepatic abscesses and less frequently with perirenal abscesses. Case presentation We present a 61-year-old woman with a history of poorly controlled diabetes mellitus 2 that consulted several times for acute pyelonephritis with torpid evolution, associated with endogenous endophthalmitis in her right eye that required evisceration. Conclusion Adequate management of acute pyelonephritis can avoid local or distant complications, such as endogenous endophthalmitis, an infection with poor visual prognosis that requires high clinical suspicion for timely management with better visual outcomes and lower morbimortality.
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Affiliation(s)
| | - Diego Parrao
- Medicine SchoolUniversidad de O'HigginsRancaguaChile
| | - Matías Larrañaga
- Department of UrologyHospital Regional Libertador Bernardo O'HigginsRancaguaChile
| | | | - Karen Pozo
- Department of UrologyHospital Regional Libertador Bernardo O'HigginsRancaguaChile
| | - Juan Cristóbal Bravo
- Department of UrologyHospital Regional Libertador Bernardo O'HigginsRancaguaChile
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Xu-Yuan T, Hui-Yan L. A rare ocular complication of septicemia: a case series report and literature review. BMC Infect Dis 2023; 23:522. [PMID: 37558992 PMCID: PMC10413699 DOI: 10.1186/s12879-023-08489-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 07/27/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Septicemia that leads to ocular involvement mostly presents as endophthalmitis or panophthalmitis. Contrarily, septicemia without intraocular involvement, known as hematogenous orbital cellulitis (HOC), involves only the orbit and is an extremely rare complication of septicemia and a rare type of orbital cellulitis. CASE PRESENTATION Four male patients with septicemia presented with orbital involvement without intraocular infection were described in this study. They were 22 (case 1), 15 (case 2), 79 (case 3), and 30 (case 4) years old, with a mean age of 29.75 years. All patients were immunocompromised except for case 2. Cases 1 and 3 had a history of steroid use, whereas case 4 was in a post-chemotherapy myelosuppression phase. Septicemia in case 1 was community-acquired, cases 3 and 4 were hospital-acquired, and case 2 was secondary to acne squeezing. Blood cultures from cases 1, 2, and 3 were positive for Candida albicans, methicillin-resistant Staphylococcus aureus, and Klebsiella pneumoniae, respectively. Case 4 had negative cultures; however, next-generation sequencing reported the presence of Enterococcus faecalis and Rhizopus oryzae. Case 1 had right eye involvement, and both eyes were involved in the other three cases. According to Chandler's classification, case 1 was type 2, case 2 was type 2 (OD) and type 4 (OS), and cases 3 and 4 were type 1 orbital infections. All patients had eyelids erythema, and cases 1 and 2 had mildly decreased visual acuity, proptosis, and painful and restricted ocular motility. Hospital stays ranged from 13 to 43 days (mean, 24 days). All patients received systemic antibiotic therapy based on drug sensitivity and next-generation sequencing results, in combination with multidisciplinary treatment, resulting in complete recovery of ocular and systemic signs and symptoms; no ocular surgical interventions were performed. Extraocular muscle palsy was the last symptom to resolve. CONCLUSION HOC is predominantly seen in immunocompromised individuals with a high proportion of hospital-acquired infections and positive cultures for pathogens. Infection control using systemic antibiotics targeted at the causative organism guarantees a favorable prognosis.
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Affiliation(s)
- Tang Xu-Yuan
- Department of Ophthalmology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Li Hui-Yan
- Department of Ophthalmology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Gram-Negative Endogenous Endophthalmitis: A Systematic Review. Microorganisms 2022; 11:microorganisms11010080. [PMID: 36677371 PMCID: PMC9860988 DOI: 10.3390/microorganisms11010080] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/20/2022] [Accepted: 12/24/2022] [Indexed: 12/29/2022] Open
Abstract
Background: Gram-negative bacteria are causative agents of endogenous endophthalmitis (EBE). We aim to systematically review the current literature to assess the aetiologies, risk factors, and early ocular lesions in cases of Gram-negative EBE. Methods: All peer-reviewed articles between January 2002 and August 2022 regarding Gram-negative EBE were included. We conducted a literature search on PubMed and Cochrane Controlled Trials. Results: A total of 115 studies and 591 patients were included, prevalently Asian (98; 81.7%) and male (302; 62.9%). The most common comorbidity was diabetes (231; 55%). The main aetiologies were Klebsiella pneumoniae (510; 66.1%), Pseudomonas aeruginosa (111; 14.4%), and Escherichia coli (60; 7.8%). Liver abscesses (266; 54.5%) were the predominant source of infection. The most frequent ocular lesions were vitreal opacity (134; 49.6%) and hypopyon (95; 35.2%). Ceftriaxone (76; 30.9%), fluoroquinolones (14; 14.4%), and ceftazidime (213; 78.0%) were the most widely used as systemic, topical, and intravitreal anti-Gram-negative agents, respectively. The most reported surgical approaches were vitrectomy (130; 24.1%) and evisceration/exenteration (60; 11.1%). Frequently, visual acuity at discharge was no light perception (301; 55.2%). Conclusions: Gram-negative EBEs are associated with poor outcomes. Our systematic review is mainly based on case reports and case series with significant heterogeneity. The main strength is the large sample spanning over 20 years. Our findings underscore the importance of considering ocular involvement in Gram-negative infections.
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Balasoiu AT, Zlatian OM, Ghenea AE, Davidescu L, Lungu A, Golli AL, Udriștoiu AL, Balasoiu M. A Rare Case of Endophthalmitis with Rhizobium radiobacter, Soon after a Resolved Keratitis: Case Report. Antibiotics (Basel) 2022; 11:905. [PMID: 35884159 PMCID: PMC9311636 DOI: 10.3390/antibiotics11070905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Rhizobium (Agrobacterium) species are plant aerobic bacteria, which in some cases can produce endophthalmitis in humans after corneal trauma. CASE PRESENTATION A 42-year-old female patient presented in the Emergency Department of the Emergency County Hospital of Craiova, Romania, reporting pain, epiphora, and blurry vision in her right eye for about five days. This initial infectious keratitis episode was successfully resolved, but after 20 days she presented again after trauma with a leaf with corneal abscess. In the conjunctival secretion, R. radiobacter was identified. Despite antibiotherapy, the patient's state did not improve, and ultimately the eye was eviscerated. METHODS A search was performed in the ProQuest, PubMed, and ScienceDirect databases for the terms Agrobacterium, Rhizobium, radiobacter, and eye. We eliminated non-human studies, editorials and commentaries, and non-relevant content, and excluded the duplicates. RESULTS In total, 138 studies were initially obtained, and then we selected 26 studies for retrieval. After the selection process, we ended up including 17 studies in our analysis. Most studies reported R. radiobacter endophthalmitis after ocular surgical procedures or outdoor activities that involve exposure to soil. CONCLUSION R. radiobacter is a rare cause of endophthalmitis after eye trauma that generally responds well to usual antibiotherapy, but occasionally can evolve to severe, leading to the loss of the eye.
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Affiliation(s)
- Andrei Theodor Balasoiu
- Department of Ophthalmology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Ovidiu Mircea Zlatian
- Department of Bacteriology-Virology-Parasitology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Alice Elena Ghenea
- Department of Bacteriology-Virology-Parasitology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Livia Davidescu
- Department of Ophthalmology, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania;
| | - Alina Lungu
- Department of Infectious diseases, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania;
| | - Andreea Loredana Golli
- Department of Epidemiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Anca-Loredana Udriștoiu
- Faculty of Automation, Computers and Electronics, University of Craiova, 200776 Craiova, Romania;
| | - Maria Balasoiu
- Department of Bacteriology-Virology-Parasitology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
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