Endogenous Endophthalmitis Research Articles

Disseminated nocardiosis in a patient with alcoholic liver cirrhosis: a case report

BackgroundNocardia are Gram-positive, aerobic, filamentous bacteria that can cause localized or disseminated infections. Immunocompromised patients are at a higher risk of developing Nocardia infection and further dissemination of the disease. To date, limited data have documented the relationship between nocardiosis and alcoholic liver disease.Case presentationWe report the case of a 47-year-old man with a known history of alcoholic liver cirrhosis. The patient presented to our emergency department with redness, swelling in the left eye, and diminished bilateral vision. Fundus examination of the left eye was obscured, while that of the right eye was consistent with subretinal abscess. Therefore, endogenous endophthalmitis was suspected. Imaging revealed two ring-enhancing lesions in the brain, and multiple bilateral small cystic and cavitary lung lesions. Unfortunately, the left eye eventually eviscerated due to the rapid progression of the disease. Cultures from the left eye were positive for Nocardia farcinica. The patient was started on imipenem, trimethoprim/sulfamethoxazole, and amikacin based on culture sensitivity. The patient’s hospitalization course was complicated by his aggressive and advanced condition, which led to his death.ConclusionsAlthough the patient’s condition initially improved with the recommended antibiotic regimens, it led to death owing to the patient’s advanced condition. Early detection of nocardial infection in patients with typical or atypical immunosuppressive conditions may improve overall mortality and morbidity. Liver cirrhosis disrupts cell-mediated immunity and may increase the risk of Nocardia infection.

Endogenous listeria monocytogenes endophthalmitis in a cirrhotic patient

AbstractEndogenous endophthalmitis caused by listeria monocytogenes is rare and serious, which is easily misdiagnosed initially. We present one case of endogenous endophthalmitis due to listeria monocytogenes in a cirrhotic patient, whose diagnosis was delayed 17 days after admission.

Endogenous Endophthalmitis in a Patient with Colorectal Cancer: A Case Report

A 58 year-old woman with a history of diabetes mellitus and rectal Adenocarcinoma presented with acute loss of vision and pain in the left eye with hypopyon with no systemic symptoms at presentation. Diagnosis of endogenous endophthalmitis was made. Treatement was medical by topical, intravitreal and systemic antibiotics, with poor visual outcome. This case reminds ophthalmologists that endogenous endophthalmitis might be associated with underlying malignancy.

A rare case of pyelonephritis-associated endogenous endophthalmitis

Endogenous endophthalmitis (EE) is the inflammation of the inner layers of the eye occurring due to intraocular colonisation of microorganisms from a pre-existing systemic septic foci. It is relatively rare and is most often associated with diabetes mellitus, liver disease, cardiac disease, malignancy, in-dwelling catheters and intravenous drug abuse. We report here a rare association of EE and pyelonephritis in a young male. The clinical condition and visual acuity improved first with topical, systemic and periocular corticosteroids, broad spectrum antibiotics, later by pars plana vitrectomy and ultimately with ureteric stenting. Prompt and multidisciplinary management along with accurate clinical history, thorough examination, and microbiological and radiological corroboration can help to prevent visual handicaps.

Endogenous Endophthalmitis at a Tertiary Referral Center in China: A Retrospective Study Over Three Decades

ABSTRACT Purpose To investigate the etiology, pathogens, treatment, and prognosis of endogenous endophthalmitis (EE). Methods Patients diagnosed with EE over three decades at Peking Union Medical College Hospital were retrospectively reviewed and analyzed. Results A total of 97 eyes from 81 patients were included. Diabetes was the most common predisposing medical condition (34.6%). Klebsiella pneumoniae (31.3%) and Candida albicans (32.8%) were the most common pathogens. Liver abscess (20.6%) was the predominant cause EE due to liver abscess had a worse initial visual acuity (P < 0.05). Patients who initially underwent pars plana vitrectomy (PPV)+silicone oil tamponade underwent fewer total treatments (P < 0.05). In the past 10 years, the proportion of Gram-positive cocci, Gram-negative bacilli, and Candida showed an upward trend. Over the past 15 years, EE after liver abscess and immunosuppression has increased, while EE from genitourinary systems has decreased. Conclusion EE was a devastating intraocular disease with a poor visual prognosis. The initial condition and prognosis of EE after liver abscess were the worst. PPV+silicone oil tamponade as an initial treatment may reduce additional therapy.

Clinical and Microbiological Manifestations of Endogenous Endophthalmitis in Tertiary Care Hospital, Northern Thailand

ABSTRACT Purpose To determine the characteristics, primary sources, pathogens, risk factors, and visual outcomes in patients with endogenous endophthalmitis (EE). Methods We performed a retrospective cohort study of 61 consecutive patients with EE (74 affected eyes) and reported on prevalence, clinical courses, prognostic factors and visual outcomes. Results Prevalence of EE was 5% of all patients with endophthalmitis. Among culture-positive cases (89%), Gram-positive species dominating (69%) followed by Gram-negative with 22% and fungal species with 9%. Regarding to visual outcomes, the mean visual acuity (VA, ETDRS letters) at baseline, 3-months, 6-months and 1-year follow-up was 0.85, 9, 8 and 9, respectively. Initial VA of hand movement or better (P 0.007) and bilateral infection (P 0.004) were associated with better visual outcome. Conclusion The prognosis for EE remained poor despite aggressive and immediate treatment. The high suspicion, early diagnosis and prompt treatment are important factors that might lead to the better outcome.

Endogenous Endophthalmitis in COVID-19 Patients: A Case Series and Literature Review

ABSTRACT Purpose To report outcomes in cases of endogenous endophthalmitis (EE) following COVID-19 infection. Material and methods In a retrospective study, patients with EE, who had a recent history of COVID-19 infection requiring hospital admission were recruited. Necessary demographic details, details of ocular examination, and microbiological details were collected. Results Six patients (10 eyes), with a mean age of 48 + 19.80 years were included. The mean duration of onset of ocular symptoms from the time of diagnosis of COVID was 28.16 + 16.15 days. 8 eyes required surgical intervention, whereas 2 eyes were managed conservatively. Three patients were positive for Candida albicans, two patients were positive for Aspergillus fumigatus, and one patient was a presumed bacterial EE. The majority of the eyes had favorable functional and anatomical outcomes during the post-operative period. Conclusion High-dose corticosteroid therapy in the management of moderate and severe COVID-19 infection may be associated with EE, predominantly fungal.

Optical coherence tomography findings in fungal uveitis.

The purpose of the study was to describe the vitreal, retinal, and choroidal features of eyes affected by endogenous endophthalmitis (EE) and evaluate the effects of systemic antifungal drug treatment and pars plana vitrectomy by using spectral domain optical coherence tomography (SD-OCT). Medical records and SD-OCT images of eyes diagnosed with EE at a single uveitis tertiary referral center in Brazil were acquired at the time of diagnosis, after 7 days of high-dose antifungal drug treatment, and at follow-up assessments performed 30days after resolution. Thirteen eyes were enrolled in the study. All patients showed hyperreflective round-shaped lesions on SD-OCT and pre-retinal aggregates. Five eyes responded to antifungal systemic oral drugs despite showing vitreous opacity. The response to treatment was observable on optical coherence tomography (OCT) images. Fungal endophthalmitis showed typical features on SD-OCT, facilitating early diagnosis and treatment despite the absence of vitreous culture or biopsy. This study suggests that OCT images can be used to support diagnosis by physicians who do not have access to vitreoretinal surgery.

Endogenous Endophthalmitis From a Klebsiella pneumoniae Liver Abscess: The Incidence, Risk Factors, and Utility of Imaging

We investigated the rate of ophthalmologic examinations to detect endogenous endophthalmitis in patients with pyogenic liver abscesses (PLAs) and the incidence and risk factors of endophthalmitis from a PLA caused by Klebsiella pneumoniae (PLA-K). A retrospective case series METHODS: A total of 536 patients admitted to a university hospital in Korea, to treat PLAs during 2012-2022 were primarily included. The proportion of patients who were referred for ophthalmologic examinations was investigated and the incidence of endophthalmitis in 248 patients with PLA-K was calculated. Univariate and multivariate logistic regression analyses were performed to define risk factors including demographic characteristics, underlying diseases, radiological findings, and systemic conditions. A comprehensive ophthalmologic examination was performed in 73.7% of all patients with PLAs, and the incidence of endophthalmitis from a PLA-K was 7.3%. A liver abscess larger than 5 cm in size increased the incidence of endogenous endophthalmitis 4-fold compared to smaller abscesses (OR=4.01, 95% CI=1.02 - 15.78, P=.047), and portal or hepatic vein thrombophlebitis increased the incidence approximately 4-fold (OR=4.04, 95% CI=1.10 - 14.83, P=.036). Acute cholangitis was approximately 8-fold (OR=8.33, 95% CI=1.25 - 55.71, P=.029), and disseminated intravascular coagulation (DIC) was approximately 6-fold (OR=5.76, 95% CI=1.22 - 27.21, P=.027) more related to prevalence of endophthalmitis. Other extrahepatic infections increased the incidence approximately 43-fold (OR=43.06, 95% CI=10.14 - 182.90, P < .001). . Clinicians should consider the risk of endogenous endophthalmitis when PLA-K patients have large liver abscesses (> 5 cm), acute cholangitis, portal or hepatic vein thrombophlebitis, DIC, or other extrahepatic infections.

Endogenous Fungal Endophthalmitis following COVID-19 Hospitalization: Evidence from a Year-Long Observational Study

To describe cases of endogenous fungal endophthalmitis (EFE) post-recovery from or hospitalization for coronavirus disease 2019 (COVID-19). This prospective audit involved patients with suspected endophthalmitis referred to a tertiary eye care center over a one-year period. Comprehensive ocular examinations, laboratory studies, and imaging were performed. Confirmed cases of EFE with a recent history of COVID-19 hospitalization±intensive care unit admission were identified, documented, managed, followed up, and described. Seven eyes of six patients were reported; 5/6 were male, and the mean age was 55. The mean duration of hospitalization for COVID-19 was approximately 28days (14-45); the mean time from discharge to onset of visual symptoms was 22days (0-35). All patients had underlying conditions (5/6 hypertension; 3/6 diabetes mellitus; 2/6 asthma) and had received dexamethasone and remdesivir during their COVID-related hospitalization. All presented with decreased vision, and 4/6 complained of floaters. Baseline visual acuity ranged from light perception (LP) to counting fingers (CF). The fundus was not visible in 3 out of 7 eyes; the other 4 had "creamy-white fluffy lesions" at the posterior pole as well as significant vitritis. Vitreous taps were positive for Candida species in six and Aspergillus species in one eye. Anti-fungal treatment included intravenous amphotericin B followed by oral voriconazole and intravitreal amphotericin B. Three eyes underwent vitrectomy; the systemic health of two patients precluded surgery. One patient (with aspergillosis) died; the others were followed for 7-10months - the final visual outcome improved from CF to 20/200-20/50 in 4 eyes and worsened (hand motion to LP) or did not change (LP), in two others. Ophthalmologists should maintain a high index of clinical suspicion for EFE in cases with visual symptoms and a history of recent COVID-19 hospitalization and/or systemic corticosteroid use - even without other well-known risk factors.

Clinical Features and Possible Origin of Preretinal Deposits in Different Ocular Diseases and Events: A Narrative Review.

Preretinal deposits (PDs) are a rare condition among fundus diseases. We found that preretinal deposits have some features in common that can provide clinical information. This review affords an overview of PDs in different but related ocular diseases and events, and summarizes the clinical features and possible origin of PDs in related conditions, providing diagnostic clues for ophthalmologists when facing PDs. A literature search was performed using three major electronic databases (PubMed, EMBASE, and Google Scholar) to identify potentially relevant articles published on or before June 4, 2022. Most of the cases in the enrolled articles had optical coherence tomography (OCT) images to confirm the preretinal location of the deposits. Thirty-two publications reported PD-related conditions, including ocular toxoplasmosis (OT), syphilitic uveitis, vitreoretinal lymphoma, human T-cell lymphotropic virus type 1 (HTLV-I) associated uveitis or HTLV-I carriers, acute retinal necrosis, endogenous fungal endophthalmitis, idiopathic uveitis, and exogenous materials. Based on our review, OT is the most frequent infectious disease to exhibit PDs, and silicone oil tamponade is the most common exogenous cause of preretinal deposits. PDs in inflammatory diseases are highly suggestive of active infectious disease and are preferentially accompanied by a retinitis area. However, PDs will largely resolve after etiological treatment in either inflammatory or exogenous conditions.

Bilateral Aspergillosis endogenous endophthalmitis in post COVID-19 recovered patient; A clinical case report

Bilateral Aspergillosis endogenous endophthalmitis in post COVID-19 recovered patient; A clinical case report

Clinical outcome of bacterial endogenous endophthalmitis in 15 patients

Dear Editor, Endophthalmitis refers to the inflammation of the ocular cavities and their immediate adjacent structures without extension beyond the sclera, usually secondary to infection. Endogenous endophthalmitis (EE) results from haematogenous spread of microorganisms in patients with bacteraemia or fungaemia into the eye and represents 2–15% of endophthalmitis cases.1-3 The last study conducted on the

Subretinal and Liver Abscesses in Klebsiella Endophthalmitis

A 40-year-old Hispanic male presented to the ophthalmology emergency department with 1-day of blurred vision in his left eye. He reported fevers the week prior. Examination of the left eye (A) was remarkable for a subretinal abscess with hemorrhage, vasculitis, and a preretinal hypopyon. A vitreous sample was taken, and intravitreal antibiotics were administered in the left eye. He was admitted for a systemic work-up of endogenous endophthalmitis. Blood cultures were positive for Klebsiella pneumoniae. CT scan of the abdomen (B) demonstrated a 7.3×4.5×4.5 cm hypoattenuating lesion with septations in the right lobe of the liver. Klebsiella endophthalmitis is most commonly seen in Asia and has poor visual outcomes when associated with an endogenous source. Diagnosis should prompt abdominal imaging as liver abscesses are associated. The patient was treated with IV antibiotics and the liver abscess was drained by interventional radiology (Fig. 1).

Refractory Choledocholithiasis Causing Endogenous Endophthalmitis: A Case Report.

BACKGROUND Endogenous bacterial endophthalmitis is caused by a breach of the blood-ocular barrier by pathogens originating from distant infective foci. Here, we report a case of endogenous endophthalmitis due to cholangitis complicated by common bile duct stones, which is a rare source of infection. CASE REPORT A 73-year-old man with type II diabetes mellitus underwent endoscopic choledocholithotripsy 20 years ago and laparoscopic cholecystectomy 18 years ago. He had choledocholith-related cholangitis 6, 5, and 1 years previously and 4 times in the last year and underwent endoscopic choledocholithotripsy each time. Three days after the last surgery, the patient developed right endogenous endophthalmitis and vitrectomy was performed. Four months later, the patient relapsed with cholangitis and required surgery for recurrent endophthalmitis. Roux-en-Y choledochojejunostomy was performed with curative intent, and the patient was followed up for 5 years without recurrence of choledocholith, cholangitis, or endophthalmitis. CONCLUSIONS The recommended treatment strategy for patients diagnosed with common bile duct stones or choledocholithiasis is stone extraction. Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic intervention is a widely accepted procedure. However, in cases of recurrent choledocholithiasis, the rate of recurrence increases and the interval between ERCP becomes shorter in proportion to the number of recurrences. In such intractable cases requiring numerous sessions of endoscopic stone removal, bypass Roux-en-Y choledochojejunostomy should be performed to prevent possible rare complications such as endogenous bacterial endophthalmitis.

A retrospective study of endogenous endophthalmitis-related pyogenic liver abscess: An increasing complication in North Vietnam.

Endogenous endophthalmitis-related Klebsiella pyogenic liver abscess is a rare complication of metastatic infection. In most cases, visual acuity results are often impaired, even blind, and even with aggressive treatment with topical antibiotics, the final results are unsatisfactory. The objective of this study is to retrospectively based on medical records to describe clinical features, risk factors, and visual outcomes of patients with endogenous endophthalmitis-related pyogenic liver abscesses. We reported a case series of 12 endogenous endophthalmitis-related pyogenic liver abscess patients from March 2021 to 2023. All cases of endogenous endophthalmitis were diagnosed at admission or during the hospital stay. From the medical records of 588 pyogenic liver abscess patients, we found 12 cases of endogenous endophthalmitis with 2.0%. The result showed a mean age of 61.5 ± 12.0 (41-78), diabetes mellitus (7 of 12), right lobe (7 of 12), single abscess (9 of 12), and the mean largest abscess diameter of 5.8 ± 1.7 cm (3.3-9). All patients had ocular symptoms such as eye pain (9 of 12), pus discharge (3 of 12), hypopyon (1 of 12), swollen eyelids (2 of 12), and corneal edema (2 of 12), pyogenic liver abscess before endogenous endophthalmitis (10 of 12), the median interval between endogenous endophthalmitis and pyogenic liver abscess 6.1 ± 1.9 days, ocular symptoms before diagnosis endogenous endophthalmitis 4.4 ± 2.3 days. All affected eyes were injected intravitreously with ceftazidime, amikacin, and vancomycin. Two patients underwent evisceration. Endogenous endophthalmitis has permanent morbidity, reducing visual acuity, poor quality of life, and lacks the warning signs, so it is essential for early detection of symptoms and referral to ophthalmologists.

Эндогенный эндофтальмит на фоне аутоиммунного гепатита: клиническое наблюдение

Endogenous endophthalmitis (EE) is a severe inflammatory disease resulting from hematogenous dissemination of pathogenic agents (bacteria, fungi) from the primary focus into the choroid due to impaired permeability of blood-ocular barrier. Retina, vitreous body, and anterior chamber are further involved. This paper describes a 61-year-old woman with EE associated with autoimmune hepatitis (AIH). Ocular inflammation was preceded by bacteremia. Clinical signs of EE included vitreitis, choroidal effusion, and exudative retinal detachment followed by amaurosis and phthisis bulbi. In 2008, the woman was diagnosed with AIH of unknown origin. Insulin-dependent diabetes developed secondary to treatment with prednisolone. After canceling steroids, AIH progressed to cirrhosis. Here, the development of EE was probably associated with secondary immunodeficiency in the setting of AIH. The timely diagnosis of EE is important for selecting an effective treatment strategy that involves intravitreal antibiotics and vitrectomy. Ophthalmologists should be aware of previous fever or flu-like disorder, severe ocular inflammation (hypopion, vitreitis, choroidal effusion, retinal detachment), no red reflex, and severe vision loss. KEYWORDS: endogenous endophthalmitis, autoimmune hepatitis, vitrectomy, intravitreal injections, and phthisis bulbi, hypopyon, choroid, bacteremia, cirrhosis, retinal detachment. FOR CITATION: Belov D.F., Korotkov V.G., Nikitin P.A., Terekhova I.V., Konenkova Ya.S. Endogenous endophthalmitis associated with autoimmune hepatitis: case report. Russian Journal of Clinical Ophthalmology. 2023;23(3):164–169 (in Russ.). DOI: 10.32364/2311-7729- 2023-23-3-9.

A case of hemodialysis vascular access-related infection with endogenous bacterial endophthalmitis

A case of hemodialysis vascular access-related infection with endogenous bacterial endophthalmitis

Bilateral endogenous endophthalmitis in a patient after Intensive Care Unit hospitalization for acute respiratory failure due to Covid-19 pneumonia

Bilateral endogenous endophthalmitis in a patient after Intensive Care Unit hospitalization for acute respiratory failure due to Covid-19 pneumonia

Candida Lusitaniae Endophthalmitis: A Brief Literature Review with a Focus on Treatment Options

Intraocular fungal infections are uncommon. They may originate either exogenously, as occurs with penetrating trauma and postoperative infections, or endogenously, through hematogenous spread. Patients at the highest risk of endogenous endophthalmitis are those with central venous catheters, total parenteral nutrition, and active intravenous drug use, as well as those who are immunosuppressed [1]. Candida species are the most common fungi identified from endogenous sources related to the above. Although the incidence of ocular involvement is unclear, a few studies provide a range of 2.2–16% in patients with candidemia [2,3]. Non-albicans species of candida infections are very rare. In particular, C. lusitaniae is found in only approximately 1% of patients with candida blood stream infections [4]. Treating candida ophthalmologic infections usually requires expertise of both ophthalmology and infectious diseases. Patients who have evidence of only chorioretinitis should be treated with systemic antifungal agents. Intravitreal injection in combination with systemic antifungals is recommended for patients with infections involving the macula or vitreous humor. Vitrectomy along with intravitreal injection and systemic antibiotic therapy is needed for patients with heavy vitritis [5]. The duration of treatment is decided on a case-by-case basis but typically consists of four to six weeks of systemic antifungal therapy.