Abstract
Endogenous endophthalmitis (EE) is a rare but devastating infection that occurs secondary to seeding of the intraocular cavity from an extraocular focus. Recent reports suggest the increasing prevalence and incidence of Klebsiella pneumoniae as a causative organism in Asian countries. Analysis of the largest cohorts published to date suggests that K. pneumoniae endogenous endophthalmitis (KPEE) is 10 to 15 times more prevalent than other causes of EE. The incidence of KPEE among patients with systemic Klebsiella infection appears to be >100-fold more common than other causes of EE. The exact reason for these observations is not clear, but a number of studies now suggest that Klebsiella serotypes K1 and K2 have virulence factors that enhance their survival in diabetic patients and increase their pathogenicity. Here, we report two cases of KPEE in the USA. We also review the recent clinical and basic science literature on the prevalence, incidence, and pathophysiology of this emerging and devastating infection.
Highlights
Endogenous endophthalmitis (EE) is a relatively uncommon but severe infection that comprises 2% to 15% of all cases of endophthalmitis [1-3]
In this case series and review, we report two cases of systemic Klebsiella infection that resulted in EE within the USA
We have previously described an atypical case of K. pneumoniae endogenous endophthalmitis (KPEE) [26] that presented with bilateral intraocular inflammation without hypopyon, and systemic evaluation revealed a widely disseminated infection
Summary
Endogenous endophthalmitis (EE) is a relatively uncommon but severe infection that comprises 2% to 15% of all cases of endophthalmitis [1-3]. In addition to numerous case series from Asia, a growing body of basic scientific research has begun to elucidate the pathophysiology of this particular infection. In this case series and review, we report two cases of systemic Klebsiella infection that resulted in EE within the USA. Jackson et al reported a series of 21 eyes in 19 patients with EE from England over a 17-year period, and only one case was secondary to Klebsiella (5% prevalence) [1]. Okada et al reviewed all cases of EE admitted to the Massachusetts Eye and Ear
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