Abstract
BackgroundTo report three cases of nontuberculous mycobacterial (NTM) endophthalmitis following multiple ocular surgeries and to review previous literature in order to study the clinical profile, treatment modalities, and visual outcomes among patients with NTM endophthalmitis.MethodsClinical manifestation and management of patients with NTM endophthalmitis in the Department of Ophthalmology, Faculty of Medicine, Siriraj hospital, Mahidol University, Bangkok, Thailand were described. In addition, a review of previously reported cases and case series from MEDLINE, EMBASE, and CENTRAL was performed. The clinical information and type of NTM from the previous studies and our cases were summarized.ResultsWe reported three cases of NTM endophthalmitis caused by M. haemophilum, M. fortuitum and M. abscessus and a summarized review of 112 additional cases previously published. Of 115 patients, there were 101 exogenous endophthalmitis (87.8%) and 14 endogenous endophthalmitis (12.2%). The patients’ age ranged from 13 to 89 years with mean of 60.5 ± 17.7 years with no gender predominance. Exogenous endophthalmitis occurred in both healthy and immunocompromised hosts, mainly caused by cataract surgery (67.3%). In contrast, almost all endogenous endophthalmitis patients were immunocompromised. Among all patients, previous history of tuberculosis infection was identified in 4 cases (3.5%). Rapid growing NTMs were responsible for exogenous endophthalmitis, while endogenous endophthalmitis were commonly caused by slow growers. Treatment regimens consisted of macrolides, fluoroquinolones or aminoglycosides, which were continued for up to 12 months. Initial and final vision were generally worse than 6/60.ConclusionsNTM endophthalmitis is a serious intraocular infection that leads to irreversible loss of vision. The presentation can mimic a chronic recurrent or persistent intraocular inflammation. History of multiple intraocular surgeries or immune-deficiency in patient with chronic panuveitis should raise the practioner’s suspicion of NTM endophthalmitis. Appropriate diagnosis and treatment are important to optimize visual outcome.
Highlights
To report three cases of nontuberculous mycobacterial (NTM) endophthalmitis following multiple ocular surgeries and to review previous literature in order to study the clinical profile, treatment modalities, and visual outcomes among patients with NTM endophthalmitis
We searched in MEDLINE, EMBASE, and CENTRAL for related articles by using the search terms “atypical mycobacteria”, “non-tuberculous mycobacteria”, “endophthalmitis”, and “intraocular infection”
Up to October 2020, there were 112 cases from 51 case reports and case series (Additional files 1 and 2) of culture positive NTM endophthalmitis reported in the literature apart from three cases of this current study [1, 5,6,7, 14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58]
Summary
To report three cases of nontuberculous mycobacterial (NTM) endophthalmitis following multiple ocular surgeries and to review previous literature in order to study the clinical profile, treatment modalities, and visual outcomes among patients with NTM endophthalmitis. The scotochromogens (Runyon group II) grow over 2–4 weeks and produce yellow-orange pigment They include M. scrofulaceum, M. szulgai, M. gordonae, M. xenophi and M. flavescens. The Rapid growers (Runyon group IV) include 3 subgroups; the M. fortuitum group, the M. chelonae/abscessus group, and the M. smegmatis group. They colony within 5 days and do not produce pigment [2]. NTM ocular infections were first reported in a case of M. fortuitum keratitis after corneal foreign body removal in 1965. Rapid growers especially M. chelonae, M. fortuitum and M. abscessus are the most common causes of ocular infections and generally associated with poor visual outcomes [4,5,6,7,8,9,10,11]
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