Endogenous Bacterial Endophthalmitis Research Articles

Bacterial endogenous endophthalmitis in Vietnam: a randomized controlled trial comparing vitrectomy with silicone oil versus vitrectomy alone.

Background/aimsTo compare treatment outcomes with and without silicone oil tamponade in patients undergoing pars plana vitrectomy (PPV) for severe endogenous bacterial endophthalmitis (BEE).MethodsOne hundred and eight consecutive patients with severe BEE (defined by the absence of pupil red reflex at presentation and/or dense vitreous opacity on ultrasound and no improvement after 24–36 hours of medical treatment) were randomly assigned to two treatment groups: Group 1, standard PPV with intravitreal antibiotics; and Group 2, PPV with intravitreal antibiotics and silicone tamponade. Overall success was defined as: a visual acuity ≥ count fingers at 1 meter, with an attached retina, and no intraocular oil.ResultsFifty three patients were randomized to Group 1 and 55 patients to Group 2. The mean age of study subjects was 32 years and baseline clinical characteristics were similar in both groups. At the final follow-up visit at 9 months, the overall success rate of Group 2 (67.3%) was significantly better than Group 1 (43.4%; P=0.01). There were also fewer devastating complications (such as inoperable retinal detachment, phthisis bulbi) in Group 2 compared with Group 1 (21.8% versus 43.4%; P=0.01).ConclusionThe outcome at 9 months of patients with BEE treated by vitrectomy with silicone oil was better than those treated by vitrectomy alone.

Endogenous endophthalmitis caused by Enterococcus faecalisin a cat

A three‐year‐old male neutered domestic shorthair cat was presented for loss of vision associated with hyperthermia, lethargy and anorexia. Ophthalmic examination revealed a bilateral panuveitis. Cytological examination of aqueous and vitreous humours was performed and revealed a suppurative inflammation associated with numerous cocci. Enterococcus faecalis was identified by bacterial culture from aqueous and vitreous humour. No primary infection site was identified. Active uveitis resolved after systemic antibiotic therapy, but the vision loss was permanent. To the authors’ knowledge, this is the first reported case of endogenous bacterial endophthalmitis secondary to E. faecalis infection in a cat.

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.

The roles of non-T-cells in infectious uveitis

Immune responses against uveitis are broadly divided into innate immune response and adaptive immune response. The group of inflammatory cells that induce innate immunity against uveitis comprises the “non-lymphocytes” such as neutrophils, macrophages and dendritic cells. Among the uveitis in which innate immunity plays a central role, infectious uveitis is the most important. Particularly in endophthalmitis and acute retinal necrosis that have poor visual prognosis, delay in diagnosis directly impacts visual function; therefore early diagnosis and treatment are important to obtain good visual outcome. Neutrophils are the inflammatory cells involved in the earliest pathology of infectious uveitis, causing ocular tissue damage which may result in irreversible visual function impairment. In representative infectious uveitis such as endogenous bacterial or fungal endophthalmitis, a characteristic cytokine profile has been identified; apart from cytokines promoting neutrophil migration, production and activation, other cytokines that enhance neuropathy and intraocular proliferation have also been detected. Although Behcet's disease has been considered to be a uveitis involving adaptive immunity, since the hypopyon observed in this disease is composed of neutrophils, inflammatory cells of the innate immune system are also involved in its pathology. However, considering also the fact that T cell infiltration features prominently in retinal vasculitis of Behcet's disease, innate immunity and adaptive immunity do not act individually, but function simultaneously and form an innate immunity-adaptive immune cycle, contributing to the persistence and chronicity of uveitis. Rec.6/30/2013, Acc.9/30/2013, pp269-273

The Diabetic Ocular Environment Facilitates the Development of Endogenous Bacterial Endophthalmitis

We tested the hypothesis that changes in the diabetic ocular environment facilitate the development of endogenous bacterial endophthalmitis (EBE). C57BL/6J mice were rendered diabetic with streptozotocin (STZ) for 1, 3, or 5 months' duration. Diabetic and age-matched nondiabetic mice were tail vein-injected with 10(8) CFU of Klebsiella pneumoniae, a common cause of EBE in diabetics. After either 2 or 4 days postinfection, the EBE incidence was assessed by electroretinography, histology, bacterial counts, and myeloperoxidase ELISAs. Blood-retinal barrier (BRB) permeability in uninfected diabetic mice also was determined. No cases of EBE were observed among the 1-month diabetic group. Extending the time from diabetes induction to 3 months resulted in a 23.8% EBE incidence after 2 days, and a 22% incidence after 4 days. The incidence of EBE increased to 27% in the 5-month diabetic group. Infected eyes had an average 8.01 × 10(2) and 6.19 × 10(4) CFU/eye for the 3- and 5-month diabetic groups, respectively. There was no significant difference in BRB permeability between control and 1-month uninfected diabetic mice. However, 3- and 5-month diabetic mice had significantly greater BRB permeability than control mice. These results suggested that increasing the time from STZ diabetes induction to 3 and 5 months resulted in an ocular environment more conducive to the development of EBE. These results demonstrated a correlation between an increase in BRB permeability and an increase in EBE incidence, supporting the hypothesis that diabetic ocular changes contribute to the development of EBE.

Bilateral anterior uveitis in a patient with bacterial meningitis

We report a case of bilateral iridocyclitis accompanied by bacterial meningitis in an immunocompetent patient. Case report. A 48 year-old healthy female visited our hospital with strong headache, fever, bilateral hyperemia, and blurred vision in both eyes. A slit-lamp examination revealed moderate cells and flare in the anterior chamber of both eyes, with fine keratoprecipitates. There were no obvious inflammatory changes in the vitreous, retina, and optic disc of both eyes. Elevation of peripheral blood white blood cells, C-reactive protein, and an elevated number of cerebrospinal fluid (CSF) cells suggested bacterial meningitis. The patient was admitted to our hospital and received intravenous antibiotics. Finally, a CSF culture revealed infection with gram-positive rods, suspected Listeria monocytogenes, confirming bacterial meningitis. For iridocyclitis, we prescribed betamethasone eyedrops and 0.5 % tropicamide eyedrops with intravenous adminstration of systemic antibiotics. 3 days later, her headache and bilateral hyperemia disappeared. This case is better described as sterile reactive uveitis rather than endogenous bacterial endophthalmitis, because bilateral anterior uveitis was resolved without chronic uveitis, iris atrophy, and vitreous opacity. When clinicians see patients with meningitis and bilateral anterior uveitis, sterile reactive uveitis should be considered in the differential diagnosis of uveitis.

Early intravitreal treatment of endogenous bacterial endophthalmitis

There are currently no standardized treatment guidelines for endogenous bacterial endophthalmitis. We report the long-term outcomes of early intravitreal treatment of endogenous bacterial endophthalmitis, defined as intravitreal and systemic antibiotics administered within 24 h of diagnosis, with conservative use of pars plana vitrectomy. Interventional retrospective case series. Consecutive patients treated for culture-proven endogenous bacterial endophthalmitis between 2001 and 2008 at the Weill Cornell Medical Center. The clinical records of 18 eyes from 13 patients were reviewed. Visual acuity. Mean age at presentation was 61 (25-85) years. All patients had underlying medical conditions. Extraocular infectious foci were identified in nine (69%) patients, with endocarditis being the most common. Gram-positive organisms were identified in 12 (92%) patients, including five with methicillin-resistant Staphylococcus aureus. No cases were misdiagnosed. Final visual acuities of better than 6/120 and counting fingers were achieved in 6 (55%) and 7 (64%) of 11 eyes, respectively. Longer time between onset of ocular symptoms and intravitreal antibiotic injection correlated with worse visual outcomes (P < 0.05) and was associated with mortality (P < 0.05). Mortality was also associated with methicillin-resistant S. aureus infection (P < 0.05). Of those with follow up longer than 1 year, retinal detachment developed in 3 of 10 eyes (30%) after the acute infection, and cataract developed in 6 of 9 (67%) phakic eyes. Mean follow up was 146 (4-313) weeks. Intravitreal antibiotics for endogenous bacterial endophthalmitis administered within 24 h to supplement immediate systemic antibiotics may provide a relatively favourable visual prognosis.

A rare case of peripartum endogenous bacterial endophthalmitis

We describe the case of a healthy, pregnant female who developed endogenous endophthalmitis at the time of delivery, and discuss the possible mechanism of infection and the management of this case. A 26-year-old Asian woman presented with a 3-week history of visual deterioration and pain in the right eye. There was no history of ocular trauma or surgery. The ocular symptoms developed one day after vaginal delivery of a healthy baby. The pregnancy had been uncomplicated until premature rupture of membranes one week prior to delivery. Right visual acuity was light perception. There was marked right anterior chamber activity with a hypopyon and fibrin. A B-scan ultrasound showed dense vitritis. Examination of the left eye was normal. Blood tests and a chest X-ray were normal. A vitreous tap was performed and bacterial culture grew Sphingomonas paucimobilis. Intravitreal antibiotics were injected (amikacin 0.4 mg/0.1 ml and vancomycin 2.0 mg/0.1 ml) and the patient was treated with oral moxifloxacin and corticosteroids. Right visual acuity improved to 6/9. This case highlights the need for clinicians to have a high level of awareness of endogenous bacterial endophthalmitis (a rare, potentially sight-threatening condition) in any patient with a painful eye or visual deterioration in the peripartum period, particularly if associated with complications such as premature rupture of membranes or perineal laceration.

Severe Acute Endogenous Endophthalmitis with Staphylococcus Epidermidis in a Systemically Well Patient

Endogenous endophthalmitis is a devastating intraocular infection caused by haematogenous spread of bacteria or fungi, usually in people with immune deficiency. This case report is unusual as a systemically well patient with normal immune function and no identifiable locus of infection rapidly developed a fulminant endogenous endophthalmitis from an organism which does not usually produce aggressive virulence determinants. Endogenous bacterial endophthalmitis is an ongoing diagnostic and therapeutic dilemma for ophthalmologists as it is relatively rare, often initially presents as uveitis, and requires a high index of suspicion for prompt diagnosis and treatment. The treatment of endogenous endophthalmitis is still controversial due to a lack of clinical trials. Potential treatments include systemic antibiotics, peri-ocular injections, intravitreal injection of antibiotics and possibly corticosteroids, pars plana vitrectomy, or a combination of some of these.

Bacterial endogenous endophthalmitis

Endogenous bacterial endophthalmitis is an uncommon disease, secondary to hematogenous spread of a septic focus. Despite advances in diagnostic and therapeutic methods, it remains a potential cause of blindness. We report a case of a diabetic patient with endogenous endophthalmitis of the right eye secondary to an Escherichia coli bacteremia of urinary origin. The evolution was torpid, with loss of visual acuity and evisceration of the right eye.

Endophtalmies endogènes bactériennes

Endogenous bacterial endophthalmitis, also called metastatic bacterial endophthalmitis, remains a diagnostic and therapeutic challenge. It is a rare and potentially sight-threatening ocular infection that occurs when bacteria reach the eye via the bloodstream, cross the blood-ocular barrier, and multiply within the eye. It usually affects immunocompromised patients and those suffering from diabetes mellitus, malignancy, or cardiac disease, but has also been reported after invasive procedures or in previously healthy people. In most cases, the ocular symptoms occur after the diagnosis of septicemia or systemic infection. Ocular symptoms include decreased vision, redness, discharge, pain, and floaters. The ocular inflammatory signs may be anterior and/or posterior. Bilateral involvement occurs in nearly 25% of cases. A wide range of microorganisms are involved, with differences in their frequency according to geography as well as the patient's age and past medical history, because of variations in the predisposing conditions and the source of the sepsis. The majority of patients are initially misdiagnosed, and ophthalmologists should be aware of this because prompt local and general management is required to save the eye and/or the patient's life.

Culture Proven Endogenous Bacterial Endophthalmitis in Apparently Healthy Individuals

Purpose: To report 7 eyes of 7 patients who were diagnosed as the cases of endogenous endophthalmitis and proved by culture reports. Though in most of the previously published series, one or more predisposing factors were present in the patients of endogenous endophthalmitis, the authors are presenting a case series of culture-proven endogenous endophthalmitis in apparently healthy and immunocompetent individuals.Design: Retrospective noncomparative case series. All patients were diagnosed as endogenous bacterial endophthalmitis with positive vitreal culture. Variables studied were demographic characteristics, microbiology, therapeutic interventions done, final visual and anatomical outcome.Results: Streptococcus pneumoniae was the most frequent isolate 43% (3 out of 7 eyes) followed by Staphylococcus aureus and E. coli in equal frequency 29% ( 2 each out of 7 eyes). The median time between the onset of symptoms and presentation with features of endophthalmitis to hospital was 7 days. The presenting visual acuity was less than HM (hand motions) in all cases except one, which had VA of 20/200. No single underlying predisposing condition was identifiable in any of the cases. All the cases were given intravitreal therapeutic agents (one or more doses of antibiotics and steroid) and pars plana vitrectomy was performed in 2 cases. The final visual acuity was not better than presenting VA except in 1 case, which had final VA of 20/40. Intraocular pressure was on the lower side (mean IOP 7 mmHg compared to 12 mmHg in the fellow eye). No eye was enucleated or eviscerated.Conclusion: Though in most of the previously published literature endogenous endophthalmitis has been a metastatic ocular infection, the present study describes a series of endogenous bacterial endophthalmitis de novo in onset, without any identifiable predisposing factors. The overall age of presentation was in a younger population than in previously published series. The overall visual outcome was poor, probably due to the serious nature of disease itself and the relatively late presentation.

Hypermucoviscosity as a Virulence Factor in ExperimentalKlebsiella pneumoniaeEndophthalmitis

Klebsiella pneumoniae is a common cause of endogenous bacterial endophthalmitis, a disease that frequently results in a poor visual outcome. Hypermucoviscosity has been identified as a virulence factor among clinical bacteremia isolates of K. pneumoniae. In this study, an experimental murine model of K. pneumoniae endophthalmitis was established, and the role of hypermucoviscosity in its pathogenesis was analyzed. C57BL/6J mice were intravitreously injected with 100 CFU of hypermucoviscous (HMV+) or nonhypermucoviscous (HMV-) K. pneumoniae. Intraocular bacterial growth, retinal function, gross pathology, and inflammatory responses were monitored every 3 hours until the eyes lost significant (>90%) retinal function, or the infection appeared to clear. The HMV+ strain grew logarithmically in eyes until approximately 15 hours postinfection (PI), reaching a stationary phase of growth at approximately 8.0 log(10) CFU/eye. The HMV- strain grew logarithmically to approximately 7.6 log(10) by 18 hours, but bacterial count declined to approximately 6.4 log(10) CFU/eye by 21 hours PI. Eyes infected with the HMV+ strain retained approximately 35% a-wave and <10% b-wave function by 18 hours PI. These eyes also had a cumulative clinical score of 14+ by 18 hours and underwent phthisis between 21 and 24 hours. Eyes infected with the HMV- strain had a cumulative clinical score of <6 and retained >60% a-wave and >50% b-wave function throughout 21 hours. Five of 7 eyes had <100 CFU HMV- K. pneumoniae at 27 hours PI. The findings demonstrate the site-threatening consequences of K. pneumoniae endophthalmitis and the importance of the hypermucoviscosity phenotype in the pathogenesis of experimental K. pneumoniae endophthalmitis.

Endophthalmitis: Antibacterial Activity of Precipitates of Vancomycin and Ceftazidime

We appreciate the comments by Hui et al. (3) concerning our article (1). We agree about the potential benefits of repeated intravitreal injections of antibiotics. Intravitreal antibiotics have become part of the standard treatment for endophthalmitis. The current antibiotic treatment for acute-onset bacterial endophthalmitis includes vancomycin for gram-positive coverage and either ceftazidime or an aminoglycoside for gram-negative coverage (7). However, neither ceftazidime nor an aminoglycoside can cover all the gram-negative organisms, such as many nonfermenters. Based on one in vitro study, ceftazidime precipitates in vitreous at body temperature, regardless of the presence of vancomycin (5). Because the extent of ceftazidime precipitates is less, normal saline is preferred to a balanced salt solution as a preparation medium for antibiotics for intravitreal injection (5). In infected eyes with endophthalmitis, there are several parameters, such as electrolyte concentrations, pH, inflammatory cells, and total protein contents; therefore, precipitation may not disrupt the therapeutic effects of antibiotics in bacterial endophthalmitis. Recently, there was a report that showed that the precipitate and supernatant retain significant antibacterial activity, thus confirming the efficacy of combination therapy with vancomycin and ceftazidime in the management of bacterial endophthalmitis (6). This validates that vancomycin and ceftazidime are still an excellent combination of antibiotics for the empirical treatment of bacterial endophthalmitis. In the Endophthalmitis Vitrectomy Study, there was no difference between final visual acuities with and without the use of systemic antibiotics (2). Compared with the result for exogenous postoperative endophthalmitis, the systemic antibiotics decrease the bacteria loading to the eye in endogenous endophthalmitis. However, they cannot prevent the occurrence of endophthalmitis, as in our case. Vitrectomy and lensectomy significantly shorten the half-life of ceftazidime after intravitreal injection (8). Inflammation increases clearance to a small degree in phakic and aphakic eyes (8). Repeated intravitreal injections of ceftazidime may have the potential benefit of maintaining the therapeutic level against bacterial organisms. However, infectious endophthalmitis is a sight-threatening ocular disease, especially in endogenous bacterial endophthalmitis. It causes a high possibility of loss of vision and has a significant impact on socioeconomic life. Even though intravitreal antibiotics successfully destroy the bacteria, the retina may continue to be damaged by the remaining inflammatory debris, and functional recovery is limited by potential pathologies, such as macular edema, retinal detachment, and retinal vasculitis. After 12 to 24 h of initial intravitreal antibiotics, we recommend early pars plana vitrectomy with repeated intravitreal antibiotics if there is no improvement in clinical signs and symptoms, because early vitrectomy for endophthalmitis dramatically reduces the inflammatory debris load in the vitreous cavity, provides a large specimen for diagnostic evaluation, and achieves a higher possibility of favorable visual outcome (4).

A case of endogenous bacterial endophthalmitis caused by Streptococcus bovis

Streptococcus bovis is a gram-positive streptococcus present as normal flora in the digestive tracts of herbivores. It is occasionally isolated from the human intestine and may act as a causative organism of infectious endocarditis, urinary infections and meningitis. This report describes a rare case of a patient that underwent surgical treatment for endogenous endophthalmitis caused by S. bovis complicated by bacteremia and suppurative spondylitis. Endophthalmitis of the right eye occurred in a 76-year-old man accompanied by hypopyon and prominent vitreous opacity complicated by suppurative spondylitis. The visual acuity of the right eye consisted of light perception. Lensectomy and vitrectomy were performed immediately using a perfusate containing antibiotics. Antibiotics were administered by intravenous infusion following surgery. S. bovis was detected in the cultures of blood and vitreous fluid collected during surgery. The visual acuity was 20/160 at 11 months after surgery. Reports of endogenous endophthalmitis in human caused by S. bovis have not been found to date in a search of the MEDLINE database. This is the first report of acute endogenous endophthalmitis caused by S. bovis.

Parapharyngeal abscess complicated by endophthalmitis: a rare presentation of nasopharyngeal carcinoma

We report an extremely rare case of nasopharyngeal carcinoma presenting as a lateral neck abscess complicated by endogenous bacterial endophthalmitis. Endogenous bacterial endophthalmitis complicating a neck abscess has not been reported in the recent English literature. We discuss the possible pathophysiology of neck abscess as a presenting feature of nasopharyngeal carcinoma, and the relationship between the parapharyngeal abscess and endogenous bacterial endophthalmitis. A middle-aged Chinese man presented with a left neck abscess associated with progressive vision deterioration and proptosis of the left eye. Incidentally, his random blood glucose was found to be elevated. Nasal endoscopy also revealed bilateral bogginess in the fossa of Rosenmuller. A diagnosis of left neck abscess with endogenous endophthalmitis associated with underlying diabetes mellitus was made. A computed tomography scan of the neck showed a left parapharyngeal abscess. Incision and drainage of the abscess together with biopsy of the nasopharynx was performed. Due to the non-salvageable condition of the left eye, evisceration was also performed. Pus culture studies from the neck abscess grew Klebsiella pneumoniae, and nasopharyngeal biopsy revealed undifferentiated carcinoma. Nasopharyngeal carcinoma is endemic in South East Asia and can have multiple, varied presentations. Therefore, in this setting, the clinician should have a high index of suspicion, especially in a patient from the Chinese ethnic group.

Endogenous Bacterial and Fungal Endophthalmitis

Endogenous Bacterial and Fungal Endophthalmitis

Endogenous Aeromonas Hydrophila Endophthalmitis in an Immunocompromised Patient

PurposeTo report a case of endogenous endophthalmitis due to Aeromonas hydrophila in a patient with distal common bile duct carcinoma and biliary sepsis.MethodsA 72-year-old woman with distal common bile duct carcinoma, obstructive jaundice, diabetes mellitus, and hypertension had a 1-day history of blurred vision, redness, and eye discharges in the right eye. An ophthalmic examination showed no light perception vision, increased intraocular pressure, severe corneal edema, severe anterior chamber reaction, exudative membranes on the anterior lens surface, and severe vitreal reaction. There was no ocular history of trauma, infection, or surgery in either eye.ResultsUnder the impression of endogenous bacterial endophthalmitis, immediate intraocular cultures and intravitreal antibiotic injections were performed, but the anterior chamber reaction, and the ultrasonogram findings were deteriorated. Evisceration was undertakened because of extrusion of the intraocular contents, and Aeromonas hydrophila was isolated by intraocular culture.ConclusionsEndogenous endophthalmitis due to Aeromonas hydrophila is rare, but has a rapid clinical course and a poor prognosis, despite of prompt diagnosis and management.

A Hazard of undiagnosed diabetes with benign prostatic hyperplasia: bilateral endogenous bacterial endophthalmitis

A Hazard of undiagnosed diabetes with benign prostatic hyperplasia: bilateral endogenous bacterial endophthalmitis

Pediatric Endogenous Bacterial Endophthalmitis: Case Report and Review of the Literature

A 1-year-old girl with no history of trauma or ocular surgery presented with acute eyelid swelling, conjunctival chemosis, corneal edema, hypopyon, and a white pupillary reflex in her right eye after a bout of gastrointestinal illness. Fundoscopic examination of the fellow eye revealed Coats-like disease with subretinal exudates. Retinoblastoma could not be ruled out by ultrasonography and computed tomography (CT), and enucleation of the right eye was recommended, which the family refused. Due to the possibility of endophthalmitis in the right eye, a vitreous tap was performed, with intravitreal injection of antibiotics.