Clinical profile and outcomes of pediatric endogenous endophthalmitis: A report of 11 cases from South India

Endogenous Endophthalmitis in Children: A 5-Year Retrospective Study in Vietnam

PURPOSE

To describe the findings and outcomes in pediatric endogenous endophthalmitis cases over a 5-year period in Vietnam.

METHODS

All cases of pediatric endogenous endophthalmitis seen at Vietnam National Eye Hospital from 2016 to 2020 (n = 157) were retrospectively studied. Data on epidemiology, microbiology, clinical manifestations, ultrasound findings, and outcomes were collected and analyzed. Success was defined as visual acuity of counting fingers at 1 meter or better if visual acuity testing could be done, and a fully attached retina, controlled intraocular pressure, and no phthisis bulbi.

RESULTS

The mean patient age was 6.0 ± 3.8 years. Gram-positive cocci were the most common causative agents (45.2%), followed by Gram-negative bacilli (10.8%). Among 31 cases in which both vitreous and aqueous specimens were collected, 17 (54.8%) showed discordant microbiological results. The overall treatment success rate was 38.2%. An initial visual acuity better than light perception was associated with a higher success rate (45.8% vs 16.7%, P < .05). Children presenting with ultrasound grade 3 vitreous opacity had a lower success rate compared to those with grades 1 and 2 combined (38.1% vs 69.6%, P < .05).

CONCLUSIONS

Gram-positive cocci were the most frequently identified pathogens in children with endogenous endophthalmitis in Vietnam. The low agreement between smear stain and culture results indicates that using both methods could enhance diagnostic accuracy. Initial visual acuity at admission and the degree of vitreous opacity were recognized as important prognostic factors for treatment outcomes. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

Pediatric endogenous endophthalmitis: Clinical features and treatment outcomes

CONTEXT

Forty-eight pediatric patients treated for endogenous endophthalmitis were analyzed. Redness and vitritis were the common symptom and sign, respectively; infection with Gram-negative bacilli was frequent. Children under 5 and with systemic illness had poorer visual prognosis.

PURPOSE

To Analyze the demographics, clinical-microbiological profiles, and treatment outcomes of pediatric patients with endogenous endophthalmitis.

METHODS

We conducted a retrospective analysis of electronic medical records covering 8 years from 2016 to 2023 at a tertiary eye care center in India, focusing on patients of age <18 years diagnosed with endogenous endophthalmitis. Data extraction included demographic variables, clinical presentations, microbiological analyses, therapeutic interventions, and visual outcomes.

RESULTS

The analysis included 48 patients with an average age of 5.4 ± 4.98 years and an equal gender ratio. During the study period, 48 children with endogenous endophthalmitis were treated; it was 5% (48 of 961) of all endophthalmitis patients and 20.8% (48 of 231) of pediatric endophthalmitis patients. Common symptoms included redness (62.5%), reduced vision (20.8%), leucocoria (27.08%), pain (22.91%), and watering/discharge (29.16%). Clinical signs included vitritis (89.58%) and anterior chamber exudates/hypopyon (47.91%). Vitreous culture positivity was 54.05%; common isolates were Gram-negative bacilli (35%), Gram-positive cocci (25%), and Gram-positive bacilli and fungi (20% each). Systemic infection was present in 72.9% (35 of 48) of patients, with respiratory tract infection being the most common (39.5%). All eyes received intravitreal antibiotic injections, and 28 (75.7%) received vitrectomy. Children under 5 with systemic illness had a worse visual prognosis. Unfavorable outcomes were associated with Gram-positive bacilli and fungal infection. Approximately 45% of eyes worsened to phthisis.

CONCLUSIONS

Any redness in a child with systemic infection warrants prompt ophthalmic evaluation. Children under 5 with systemic illness are associated with a worse visual prognosis. Unfavorable outcomes are linked to Gram-positive bacilli and fungal infection.

Pediatric Endophthalmitis Over the Last Five Decades: A Case Report and Systematic Review

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.

Microbiological Landscape and Epidemiology of Endophthalmitis in Children and Adolescents in a Multi-Tier Ophthalmology Network in India: An Electronic Medical Record-Driven Analytics Report

PURPOSE

To study the epidemiology and microbiological landscape in patients (≤21 yrs) diagnosed with endophthalmitis across a multi-tier ophthalmology network in India.

METHODS

This cross-sectional hospital-based study included 1,041 patients (≤21 yrs) diagnosed with endophthalmitis, between April 2012 and May 2022. The data were collected using an electronic medical record system.

RESULTS

Bacteria (24%) was the most common etiology followed by fungus (2%). The majority of the patients were male (66%) with a mean age of 8.37 ± 5.99 years. The most common age group was middle childhood (6-11 years) with 365 (35.06%) patients. The patients were more commonly from the lower socio-economic status (60.81%) and urban geography (49%). The common cause of endophthalmitis was trauma (59.33%) and amongst the 279 culture positive eyes, the predominant bacteria isolated was Streptococcus pneumoniae followed by Bacillus species and fungus included predominantly Aspergillus and Candida species. The most common surgical intervention performed was intraocular antibiotics (74%) followed by pars plana vitrectomy (52%).

CONCLUSION

The most common etiology of endophthalmitis in children is bacterial and traumatic in nature and presented from the lower socio-economic status. A half of the eyes warranted a vitreo-retinal surgical intervention.     .

Endogenous endophthalmitis as a severe complication following a Streptococcus pyogenes infection

The diagnosis of endogenous endophthalmitis is challenging. We report a pediatric case of endogenous endophthalmitis due to Streptococcus pyogenes angina. A previously healthy 33-month-old child presented to the emergency department with a history of fever and fatigue related to bacterial angina. On physical examination, an opalescent cornea was noticed and the diagnosis of endogenous endophthalmitis was confirmed by the pediatric ophthalmologist. Streptococcus pyogenes was found in blood culture and in the anterior chamber fluid. There was an adverse outcome with posterior vitrectomy and eye atrophy. Since endogenous endophthalmitis can lead to a poor visual outcome, urgent therapeutic management is necessary.

Etiology, microbiological isolates, and antibiotic susceptibilities in culture-proven pediatric endophthalmitis: a 9-year review

Purpose

To analyze the etiology, microbiological isolates, and antibiotic susceptibilities of endophthalmitis in pediatric patients.

Methods

Patients aged < 18 years with culture-positive endophthalmitis in Zhongshan Ophthalmic Center between January 2010 and December 2018 were included retrospectively.

Results

A total of 127 patients (127 eyes) were included, and 108 (85%) had posttraumatic endophthalmitis. Streptococcus (21.4%), coagulase-negative Staphylococcus (14.5%), Aspergillus (6.9%), and Bacillus cereus (5.3%) were the common organisms. The proportion of Streptococcus decreased with age (40.0% in 0–3 years, 16.3% in 4–12 years, and 6.3% in 13–17 years), while coagulase-negative Staphylococcus increased from 5.7% to 18.8%. Overall, fluoroquinolones achieved the highest antibiotic susceptibility rate (> 95%), while the susceptibility of isolated bacteria to tobramycin and cefazolin was only 60.2% and 59.4%, respectively. The susceptibility rates of Gram-positive cocci to cephalosporins were nearly 90%. For Gram-negative bacilli, susceptibility to neomycin was 91.3%.

Conclusion

Trauma was the main etiology for pediatric endophthalmitis. Although Streptococcus was the most prevalent organism in general, the dominant pathogen varied with age, which merits clinical attention. Fluoroquinolones showed the highest antibiotic efficacy; however, commonly used antibiotics tobramycin and cefazolin showed relatively low antibiotic susceptibility. Thus, antibiotic resistance in pediatric populations merits clinical attention.

Favourable outcome in paediatric endogenous endophthalmitis secondary to Neisseria meningitidis following pars plana vitrectomy

Paediatric endogenous endophthalmitis is an uncommon but potentially devastating intraocular infection which should not be missed. Often cases present to the accident and emergency department. Accurate and prompt assessment is key in saving sight and life. We present one such case and how it was surgically managed.

Endogenous endophthalmitis in children and adolescents: Case series and literature review

Purpose:

To study the clinical and microbiological profile, treatment modalities, and anatomical and functional outcomes among children and adolescents with endogenous endophthalmitis (EE) at a tertiary eye care centre in India.

Methods:

Medical records of subjects <18 years, presenting with EE from 1997 to 2007 were reviewed. Cases where the causative organism was identified were included. Treatment regimen included systemic antibiotics, vitrectomy, intravitreal antibiotics, and enucleation. Systemic evaluation to identify the source of infection was done by an internist. Microbiological analysis of blood, urine, and ocular specimens was done. The favorable anatomical outcome was defined as the attached retina, with controlled intraocular pressure and clear media at the last follow up. The favorable functional outcome was defined as vision >3/60 on the final follow up. Univariate regression analysis was done to identify factors predicting functional outcome.

Results:

Thirty eyes of 30 subjects (23 (77%) males) were studied. The mean age at presentation was 6.8 years (range=1–16 years). Fever was evident in four (13%) and blood culture was negative in all cases. Gram-positive organisms were identified in 11 (37%) eyes, fungi in 3 (10%), and toxocara in 8 (27%) eyes. Twenty-three (77%) eyes underwent vitrectomy. Favorable functional and anatomical outcomes were achieved in 9 (30%) and 12 (40%) eyes, respectively. Eyes undergoing vitrectomy showed significant correlation with good functional outcome (P = 0.05).

Conclusion:

EE is under-reported and not well studied in children. The absence of systemic features may be evident in a developing country with over the counter availability of antibiotics. Gram-positive infections are common and vitrectomy is a beneficial modality of treatment.