Candida glabrata as an aetiological factor of the fulminant course of panophthalmitis

INTRODUCTION

The role of fungi in infections in immunocompromised patients is a growing problem in both diagnosis and treatment. Candida species are the most common cause of fungal, endogenous endophthalmitis and infections of the cornea.

CASE STUDY

A patient was admitted to hospital due to acute inflammation of the tissue of the left orbit, 1.5 years after the corneal penetrating transplantation of the left eye with intracapsular extraction of lens and simultaneous anterior vitrectomy. The microbiological system identified: Streptococcus pyogenes, Staphylococcus aureus, and Candida glabrata in the patient.

CONCLUSIONS

The factors conducive to fungal infections are: patient's old age, immune disorders and diabetes, as well as the presence of a necrotic tissue or a foreign body. All these parameters were met in this case. Only antibiotic therapy and long-term antifungal therapy, together with surgical debridement of the site of the ongoing infection produces clinical effects in such severe cases.

Panophthalmitis caused by Streptococcus dysgalactiae subsp. equisimilis: A case report and literature review

Lancefield group G β-hemolytic Streptococcus dysgalactiae subspecies equisimilis (SDSE) has become a leading causative pathogen of invasive streptococcal infection. In this report, we describe a case of disseminated SDSE infection complicated by endogenous endophthalmitis, resulting in panophthalmitis and blindness. A 65-year-old man who underwent mitral valve replacement surgery two months previously was hospitalized due to high fever and right visual loss. A systemic investigation revealed endophthalmitis complicated by mediastinal abscess, prosthetic infective endocarditis, cerebral emboli and hemorrhage, and multiple arthritis. The patient underwent various surgeries, including vitrectomy, mediastinal lavage, mitral valve replacements, joint lavages, as well as an intensive antibiotic treatment. His general condition gradually improved, but the ocular infection developed to panophthalmitis, which ultimately required ophthalmectomy. A literature review regarding Group G-associated endogenous endophthalmitis suggested that the disease occurs in elderly people, is frequently complicated with endocarditis, and yields poor visual prognosis regardless of appropriate antibiotic treatment and surgical therapies. In this aging society, invasive infections with SDSE should be much more recognized among medical practitioners in order to improve patient prognosis.

Prevention of Evisceration or Enucleation in Endogenous Bacterial Panophthalmitis with No Light Perception and Scleral Abscess

Panophthalmitis is the most extensive ocular involvement in endophthalmitis with inflammation in periocular tissues. Severe inflammation of the anterior and posterior segments is frequently accompanied by corneal opacity, scleral abscess, and perforation or rupture. Enucleation or evisceration was the only remaining viable treatment option when all options to salvage the eye had been exhausted. The purpose of this retrospective study is to examine the outcomes of patients with endogenous bacterial panophthalmitis, no light perception and scleral abscess who were treated with multiple intravitreal and periocular injections of antibiotics and dexamethasone. Evaluation included spreading of infection to contiguous or remote sites, following evisceration or enucleation, and sympathetic ophthalmia. Eighteen patients were diagnosed with EBP, with liver abscesses in eight patients, retroperitoneal infection in four, pneumonia in two, infective endocarditis in one, cellulitis in one, drug abuse in one, and mycotic pseudoaneurysm in one. Culture results were positive for Klebsiella pneumoniae in 12 patients, Streptococcus spp. in three, Pseudomonas aeruginosa in one, Escherichia coli in one, and Staphylococcus aureus in one. The average number of periocular injections was 2.2, and the average number of intravitreal injections was 5.8. No eye required evisceration or enucleation and developed the spreading of infection to contiguous or remote sites during the follow-up. No sympathetic ophthalmia was observed in the fellow eye of all patients. Prevention of evisceration or enucleation in patients with EBP, NLP and scleral abscess can be achieved by multiple intravitreal and periocular injections of antibiotics and dexamethasone.

Bilateral endogenous bacterial panophthalmitis

We present a case of meningitis with bilateral endogenous bacterial panophthalmitis in a previously healthy individual. The management of this ocular condition is unclear, and the prognosis is poor. The patient was admitted to the Clinic of Eye Diseases after a 9-day treatment with systemic antibiotics with a complete systemic recovery but impaired vision of both eyes. Functional vision was restored in the better eye with intravitreal vancomycin and pars plana vitrectomy. Nevertheless, after the removal of silicone oil, phthisis bulbi began to develop. Better outcomes could be expected if bacteremic patients were examined routinely by an ophthalmologist and, in case of endogenous bacterial endophthalmitis, treated with intravitreal antibiotics.

[Clinical case of the month. Acute post-traumatic panophthalmitis]

Panophtalmitis is an intra-ocular and intra-orbital rare infection, but its consequences are often horrendous, with loss of both function and anatomy of the eye. The surgical approach and the antibiotherapy should be given as soon as possible, both by intra-vitreal and intra-venous injections. We report the case of a 49-year-old man who developed a Bacillus cereus panophtalmitis. A delay in the diagnosis lead to the loss of vision and the evisceration of the sick eye. Bacillus cereus panopthalmitis should be suspected in all cases of post-traumatic endophtalmitis with a soiled metallic foreign body, in patients with important local inflammatory signs as well as systemic signs. Vitrectomy, surgical extraction of the foreign body, intra-vitreal and systemic antibiotherapies should be given as soon as possible, even before the results of the bacteriological analysis.

Endogenous Klebsiella panophthalmitis: atypical presentation

Endogenous endophthalmitis caused by K. pneumoniae was considered to be a rare cause of endogenous endophthalmitis. Most of the patients had prior medical conditions, and diabetes is the most common underlying condition. Patients with a K. pneumoniae liver abscess are at risk of developing endogenous Klebsiella pneumoniae endophthalmitis (EKE). Clinical manifestation of K. pneumoniae endophthalmitis are unique with posterior chamber becomes full of pus while anterior segment seem quiet. The authors presented a case of extremely rare presentation of endogenous bacterial endophthalmitis, who presented with choroidal mass. After receiving pars plana vitrectomy and intravitreal antibiotic injection, clinical condition improved. Despite aggressive treatment, the final visual outcome was generally poor.

[Endogenous postpartum panophthalmitis induced by sphingomonas paucimobili]

Endogenous panophthalmitis is a rare eye disease with purulent necrosis of all the ocular structures. It is a rare but serious condition that occurs when bacteria cross the blood-ocular barrier and multiply within the eye. Although rare, endogenous panophthamitis is a potentially devastating intraocular infection resulting in a poor visual and anatomic prognosis. We present a 39-year-old woman, without any previous history, who developed a endogenous panophthalmitis in the left eye secondary to a puerperal endomyometritis secondary to infection with Sphingomonas paucimobilis. Despite systemic antibiotic therapy and intraocular injections, there was an evolution to purulent corneal melting.

Lupus vulgaris with endopthalmitis--a rare manifestation of extrapulmonary tuberculosis in India

We report a case of 17-year-old girl who presented with gradual destruction of the nose along with endopthalmitis and loss of vision of the left eye. On nasal examination, left alae nasi and nasal cartilage was destroyed. Left eye showed signs of endopthalmitis with pthisis bulbi with complete loss of vision. Skin biopsy, FNAC of the lymph nodes were suggestive of tubercular etiology. However, patient did not have any evidence of pulmonary TB. We report this case due to the rare clinical features. The importance of a high index of suspicion and prompt treatment in such atypical forms to prevent morbidity cannot be over-emphasised.

[Endogenous Clostridium septicum panophthalmitis associated with gastrointestinal malignancy]

Endogenous panophthalmitis due to Clostridium septicum (C. septicum) is a rare, but life-threatening condition. There is a known association between infection and malignancy. Our patient presented with panophthalmitis - with visual loss, proptosis, raised intraocular pressure and air bubble in the anterior chamber. C. septicum was found in cultures of pus. He was treated with antibiotics and surgery, and recovered. Further investigations showed carcinoma of the colon. This case stresses the need for urgent treatment and subsequent investigation for occult malignancy.

Severe Candida albicans panophthalmitis treated with all available and potentially effective antifungal drugs: fluconazole, liposomal amphotericin B, caspofungin, and voriconazole

A severe case of Candida albicans panophthalmitis, probably prompted by an underlying diabetes mellitus, is reported. The course was prolonged (more than 16 weeks), although favourable after treatment with several antifungal agents, all with a predictable activity in this ocular complication and with proven susceptibility in the present case: fluconazole, liposomal amphotericin B, caspofungin, and voriconazole.

Nocardial endophthalmitis and subretinal abscess: CT and MR imaging features with pathologic correlation: a case report

Ocular nocardiosis is a rare but potentially aggressive process. Clinically, it can mimic other disease entities, including neoplasia and other types of infection. We present a case of nocardial panophthalmitis progressing to subretinal abscess and emphasize the radiologic and clinical features.

First case of Arthrographis kalrae ethmoid sinusitis and ophthalmitis in the People's Republic of China

We present here the first case in the People's Republic of China of human disease caused by the fungus Arthrographis kalrae. The male patient had fungal panophthalmitis and invasive sinusitis involving the maxillary and ethmoid sinuses. He was an apparently healthy man before receiving trauma to his left eye. He complained of pain and loss of visual acuity in the injured eye, which displayed redness and edema and eventually discharged pus. His symptoms became more severe after he was treated with steroids and several antibacterial agents. A computed tomography scan of the left eye revealed that the maxillary and ethmoid sinuses were involved. A smear of purulent material from the left eye orbit revealed fungal elements, and cultures of the material grew a fungus. The isolate was identified as A. kalrae based on gross and microscopic morphologies, biochemical assays, and DNA sequence analysis. The patient received amphotericin B intravenously, itraconazole orally, and atomized allitridum by nebulizing allitridum therapy. The patient's wound healed following surgical intervention, but the patient lost the use of his left eye. This case should remind ophthalmologists and other clinicians to consider the possibility of infections being fungal when antibacterial agents have no effect and the patient's condition worsens.

Case report of tuberculous panophthalmitis

BACKGROUND

Although tuberculosis is very common in the Indian sub-continent, tuberculous panophthalmitis has not been reported from this region so far. We report a case of a young girl with tuberculous panophthalmitis.

CASE REPORT

A 12-year-old female child presented with painless progressive loss of vision in the right eye of two months' duration. Examination revealed diffuse corneal haze with deep vascularization, iris nodules, and scleral necrosis. Histopathological examination of the enucleated eye revealed necrotizing granulomatous inflammation, multiple epitheloid cell granulomas, and Langhan's giant cells, along with large areas of caseous necrosis. Chest X-ray revealed right hilar lymphadenopathy with right lower zone infiltration and a small pleural effusion. Considering the clinical picture, histopathology and chest findings, a diagnosis of disseminated tuberculosis was made, and standard four-drug anti tubercular treatment was started. At 2 months follow up there was radiological resolution of the lung lesions and pleural effusion.

CONCLUSIONS

Clinical features suggestive of tubercular panophthalmitis are absence of pain, presence of nodules on or within the eyeball, and spontaneous perforation. We would like to emphasize that in all susceptible individuals presenting with clinical suspicion of ocular tuberculosis it would be prudent to start early anti-tubercular therapy to prevent progression to panophthalmitis. A complete systemic workup to look for any other possible focus of tubercular involvement must be done.

Panophthalmitis due to clostridium septicum

PURPOSE

To describe patient survival in a rare case of endogenous Clostridium septicum sepsis with panophthalmitis.

DESIGN

Observational case report.

METHODS

Both eyes of a female patient were examined in a hospital setting.

RESULTS

A 68-year-old woman had right orbital pain, proptosis, panophthalmitis, mental confusion and fever for 2 days. Blood cultures were significant for Clostridium septicum. The patient did not improve after treatment with intravenous broad-spectrum antibiotics and the right eye was enucleated. The patient survived the acute infection and extensive systemic evaluation revealed an undiagnosed colon carcinoma that may have been responsible for colonization and vascular dissemination of Clostridium septicum.

CONCLUSIONS

Clostridium septicum panophthalmitis and sepsis can be the presenting sign in patients with unsuspected malignancies, particularly colon cancer. Patients can survive the infection with aggressive therapy with systemic antibiotics combined with removal of the infected tissue.

An outbreak of Pasteurella pneumotropica in genetically modified mice: treatment and elimination

A closed breeding colony comprising genetically engineered, wild-type, and stock mice presented with varying degrees of bilateral mucopurulent conjunctivitis and panophthalmitis. The one mouse with unilateral corneal ulceration, a knockout animal, was submitted for necropsy, and bacterial culture samples were obtained from the affected eye and uterus. In addition, ocular swabs from another 12 clinically affected animals, consisting of knockout, transgenic, wild-type, and stock mice, were submitted for bacterial culture analysis. All samples revealed pure cultures of Pasteurella pneumotropica. At the time of the outbreak, there were approximately 600 mice in the affected colony, with the majority of clinical cases (58 of 79) involving knockout mice and the remainder (21 of 79) in the other strains. Treatment consisted of enrofloxacin in the drinking water at 85 mg/kg daily for 14 days. Within 7 days of initiation of treatment, all existing clinical cases had resolved and no new clinical cases developed. Four weeks after completion of treatment, two groups of mice were submitted for multiple organ bacteriological analyses. One group of mice represented those animals which had complete resolution of clinical signs, and the second group of mice represented those individuals which had remained asymptomatic throughout the outbreak. All post treatment bacterial culture samples were negative for Pasteurella pneumotropica. By using the oral enrofloxacin suspension in the drinking water rather than the parenteral counterpart, concerns regarding the pharmacokinetics, specifically drug bioavailability via the oral route, problems with aqueous immiscibility and drug degradation within an aqueous medium were not potentially confounding variables. The clinical management, ease of administration, and efficacy of using an oral antibiotic formulation for the treatment and eradication of Pasteurella pneumotropica from a large mouse colony are presented in this paper.

Ocular manifestations of tuberculosis

OBJECTIVE

To present the clinical and histopathologic findings in five cases of tuberculosis (TB) with various ocular manifestations.

DESIGN

Observational case series.

METHODS

Retrospective review of clinical findings, course, and treatment of five patients. Diagnostic techniques, including biomicroscopic, histopathologic, and molecular biologic test results, are presented.

MAIN OUTCOME MEASURES

Visual acuity, slit-lamp biomicroscopy, indirect ophthalmoscopy, and fluorescein angiography results.

RESULTS

The ocular manifestations of TB in our patients included panophthalmitis, endophthalmitis, posterior uveitis with choroidal tubercles, keratitis, and a lid mass. Mycobacterium tuberculosis was identified in four cases in ocular specimens using acid-fast bacilli microscopy and in three cases by culture. Rapid diagnosis using polymerase chain reaction was obtained in one case. Extraocular foci of TB were identified in three cases with an intraocular infection at presentation. No patients had the human immunodeficiency virus (HIV) and none were immunocompromised. Two eyes could not be saved using antituberculous treatment because of delayed diagnosis and treatment.

CONCLUSIONS

In this age of the HIV pandemic, TB is becoming more common. Because it is curable, heightened awareness and better understanding of the disease's ocular manifestations should be of concern to all ophthalmologists.

Panophthalmitis due to rhizopus in an AIDS patient: a clinicopathological study

Various opportunistic infections in the eye have been reported earlier in AIDS. We report a case of panophthalmitis in an AIDS patient where the eviscerated tissue on histopathologic and microbiologic examination showed the fungus Rhizopus.

Lactococcus garvieae and Streptococcus iniae infections in rainbow trout Oncorhynchus mykiss: similar, but different diseases

Clinical and macroscopic findings (anorexia, lethargy, loss of orientation and exophthalmia) indicate that Streptococcus iniae and Lactococcus garvieae infections of trout share some common features, but histopathology reveals notable differences between the 2 diseases. Meningitis and panophthalmitis are the main lesions among S. iniae infected trout, whereas L. garvieae infection results in a hyperacute systemic disease. Differences in the LD50s of the 2 pathogens and the sudden onset of signs and death correlate with the histopathological findings, indicating the severity of L. garvieae infection of trout.

[Panophthalmitis and results of HIV tests. Experience at the Cocody University Hospital Center in Abidjan, Ivory Coast]

PURPOSE

We assessed the frequency of panophthalmitis in HIV-infected patients.

MATERIALS AND METHODS

Thirty-seven cases of panophthalmitis were screened out of 420 hospitalized patients of ophthalmology department of Cocody Teaching University Hospital, Abidjan, Ivory Coast, from January to October 1995. HIV-tests were performed in 11 patients.

RESULTS

Mean age was 40 years (from 10 months to 75 years). Four patients (36.4% of tested patients) were infected by HIV. Contrary to seronegative patients, panophthalmitis cases in HIV-infected patients occurred spontaneously without any apparent exogenous cause (foreign bodies). Most of patients were young (from 18 to 47 years old).

CONCLUSION

We draw the attention of eye specialists of the frequency of panophthalmitis without exogenous apparent cause in HIV patients. It would be interesting to perform a transvitreal needle biopsy in order to search for intraocular toxoplasmosis that should be the first cause.

Postmortem diagnosis of Fusarium panophthalmitis by the polymerase chain reaction

PURPOSE

We undertook this study to determine if a polymerase chain reaction-based test that we developed for the filamentary fungus, Fusarium, could be used to detect the organism in postmortem ocular tissues.

METHODS

We applied the polymerase chain reaction to amplify a target fragment of Fusarium DNA from formalin-fixed ocular tissues from a patient with endogenous Fusarium panophthalmitis.

RESULTS

By using the polymerase chain reaction-based test, we were able to amplify the target fragment of DNA from the infected eyes, but not from uninfected control eyes.

CONCLUSIONS

The technique appears to hold promise to be a sensitive, specific, and rapid method of diagnosing Fusarium infections.

Endophthalmitis and orbital cellulitis after radial keratotomy

PURPOSE

To report the findings concerning three patients with endophthalmitis and one with panophthalmitis and orbital cellulitis radial keratotomy surgery.

METHODS

One man referred with panophthalmitis and orbital cellulitis and three women referred with endophthalmitis were treated.

RESULTS

After radial keratotomy surgery, during which no microperforation or macroperforation had been reported, a severe Pseudomonas panophthalmitis and orbital cellulitis developed in the man. All vision was lost in that eye. Staphylococcus epidermidis endophthalmitis developed in one woman, Streptococcus pneumoniae endophthalmitis in the second woman and Pseudomonas endophthalmitis in the third woman, after undergoing radial keratotomy procedures during which microperforations occurred. In the latter patient, bilateral simultaneous surgery was performed, but only one eye became infected. The latter two infections resulted in light perception and hand motion vision respectively. In three cases, an initial keratitis was located in the inferior cornea.

CONCLUSIONS

Severe bacterial endophthalmitis can occur after radial keratotomy surgery, even in the absence of microperforation during the procedure. Any evidence of postoperative keratitis must be regarded seriously and treated aggressively. Despite use of this approach, the effect on final visual acuity can be devastating.

Safety of a clean air storage hood for ophthalmic instruments in the operating room

PURPOSE

Evaluation of the safety of a laminar flow clean air hood for the sterile storage of ophthalmic instruments in an operating room.

METHODS

A ten-year retrospective study of 10,524 surgical procedures performed with instruments stored in a clean air hood was conducted at the Mayo Clinic. Cases of postoperative endophthalmitis were identified through review of the diagnostic indices maintained by the ophthalmology department and the institution and through review of individual patient records.

RESULTS

The incidence of endophthalmitis in surgical cases in which instruments stored in a clean air hood were used was 0.076% (eight of 10,524 cases). No clusters of infection were identified.

CONCLUSIONS

The use of a laminar flow clean air hood provides access to surgical instruments in a high-volume operating room without exposing patients to an increased risk of endophthalmitis.

Gas gangrene panophthalmitis. A case from Greenland

A case of clostridium perfringens gas gangrene panophthalmitis developed after a penetrating eye injury. The affected eye became amaurotic, but the panophthalmitis was controlled by minimal surgical debridement and systemic antibiotic therapy with penicillin, fucidic acid and metronidazole. Elective enucleation was performed 15 days after the trauma for cosmetic reasons. The enucleated eye was examined histopathologically and showed massive retinal necrosis but no signs of bacteriae.

Clostridium bifermentans panophthalmitis after penetrating eye injury

BACKGROUND

Intraocular and orbital anaerobic infections usually result from penetrating eye injuries with soil-contaminated foreign bodies. The outcome of these infections almost always has been loss of the globe, despite appropriate antibiotic and surgical treatment. The most prevalent etiologic microbe of anaerobic panophthalmitis is Clostridium perfringens.

CASE REPORT

To the authors' knowledge, this is the first report of panophthalmitis caused by Clostridium bifermentans after penetrating eye injury. The patient had severe signs and symptoms of intraocular and orbital infection, with early total loss of visual function. Parenteral and intravitreal therapy with penicillin and clindamycin, administered according to antibiotic sensitivity studies of cultures from the anterior chamber and vitreous, did not restore vision.

CONCLUSIONS

Due to the early devastating outcome, penetrating eye injuries with soil-contaminated foreign bodies should be regarded as being at high risk for clostridial infection and should be treated promptly with vitrectomy and antibiotic therapy for aerobic and anaerobic infection.

A rare case of orbital mucormycosis with gas gangrene panophthalmitis

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[Panophthalmitis as a nosocomial infection]

The submitted paper deals with an epidemic of severe postoperative panophthalmitis, its development, course, causes and sequelae incl. epidemiological characteristics. The disease developed in four patients 40 hours after operation of cataract. Despite treatment all four patients developed septicaemia and therefore the affected eyeballs were eviscerated. From smears of the conjunctival sac of the affected patients and from the contents of the eviscerated eyeball Proteus mirabilis and Enterobacter cloaceae were cultivated. The authors draw attention to the epidemiological association with the eye lotion BSS which was used from which Proteus mirabilis and E. coli were cultivated and with the Ringer solution from which Enterobacter cloaceae and Klebsiella pneumoniae were cultivated. An epidemiological analysis of the epidemic was made and provisions were defined to rule out its recurrence.

Bacillus cereus panophthalmitis associated with intraocular gas bubble

It has become increasingly apparent that Bacillus cereus can cause a severe and devastating form of endophthalmitis following penetrating trauma by a metallic object. B. cereus is an uncommon aetiological agent in non-clostridial gas-forming infections. The patient studied in this single case report showed evidence of intraocular gas mimicking gas gangrene infection. The physiology of non-clostridial bacteria producing gas from anaerobic metabolic conditions is reviewed. Further intraocular and systemic complications which may be avoided by accurate and early diagnosis and the use of recommended treatment with antibiotics such as clindamycin.

Endogenous Bacillus cereus panophthalmitis

Over the past seven years we have treated three cases of drug abusers in whom endogenous Bacillus cereus endophthalmitis rapidly progressed to panophthalmitis. Ocular features of infection with this organism include severe pain, chemosis, proptosis, corneal infiltration and ring abscess, subretinal exudation, retinal hemorrhages, and perivasculitis. The process becomes fulminant in an explosive manner and may be accompanied by fever and leukocytosis. Ophthalmologists should be cognizant of the apparent susceptibility of drug abusers to Bacillus cereus infections and should consider this organism in any severe, rapidly evolving intraocular infectious process.

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.

Panophthalmitis and otitis interna in fire-bellied toads

Microbiologic and histologic studies were made of fire-bellied toads with signs of ocular and central nervous system disease. Providencia alcalifaciens, Citrobacter freundii, Aeromonas hydrophila, and other gram-negative bacilli were isolated from the eyes and multiple tissues of ill toads. The histologic evaluations revealed severe panophthalmitis and otitis interna.

Histopathology in botryomycosis-like panophthalmitis due to Staphylococcus aureus. A light microscopic and electron microscopic study. A case report

A Swedish farmer's wife aged 46 developed a unilateral panophthalmitis 6 weeks after a visit to Gambia in Africa. Vitreous puncture revealed growth of Staphylococcus aureus, but in spite of adequate treatment the eye had to be enucleated 5 weeks after the onset of symptoms. Gram-positive microorganisms in botryomycosis-like granules in the vitreal abscesses were at first suspected to be Histoplasma capsulatum. Electron microscopic examination revealed microorganisms, consistent with staphylococci. There was extensive proliferation of mesosomes, most probably due to the intense treatment. The poor nutrition and slow resorption of the dead microorganisms from the avascular vitreous did possibly also play a part in the proliferation of the mesosomes.

Panophthalmitis caused by Vibrio parahaemolyticus

We report a case of Vibrio parahaemolyticus panophthalmitis which resulted from contamination of a wound with water from a pond in inland Georgia. The pond was on the property of an oil refinery which receives crude oil from southern Mississippi. Cultures of the pond water 5 years later did not yield V. parahaemolyticus, but did yield non-O1 V. cholerae and had 0.28% sodium chloride content. V. parahaemolyticus may have been introduced into the pond along with oil transported from the Gulf of Mexico, and growth of this halophilic species may have been supported by salt from spilled crude oil.

Bacillus cereus endogenous panophthalmitis

A case of severe suppurative endogenous panophthalmitis caused by Bacillus cereus resulted from intravenously administered medications. This is the first, to our knowledge, well-documented case of endogenous endophthalmitis associated with this organism. It is recommended that if on Gram's stain of the anterior chamber fluid, Gram-positive rods are seen, chloramphenicol should be administered in addition to penicillin because of the possibility of B cereus infection.