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This case report describes three eyes of two patients, who were diagnosed to have endogenous fungal endophthalmitis post coronavirus disease 2019 (COVID-19) infection. Both patients underwent vitrectomy with intravitreal anti-fungal injection. Intra-ocular samples confirmed the fungal etiology by conventional microbiological investigations and polymerase chain reaction in both cases. The patients were treated with multiple intravitreal and oral anti-fungal agents; however, vision could not be salvaged.
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Purpose: COVID?19 infection is being increasingly identified as a risk factor for the development of ocular infections, especially endogenous endophthalmitis. Current studies primarily report cases among survivors, and the overall prevalence, especially amongst patients admitted with active sepsis is unknown. We report on the fundus and systemic findings of inpatients who were being treated for post?COVID?19 systemic secondary infections in a tertiary intensive care unit. Methods: Retrospective observational study based on chart review. Results: A total of 24 patients were identified. These included 21 (87.5%) males and 3 (12.5%) females with ages ranging from 33 to 72 years (mean 54.1 years). Pre?existing risk factors included type 2 diabetes mellitus, systemic hypertension, chronic kidney disease, multiple myeloma, and patients on long?term corticosteroid/immunosuppressive treatment. Nine patients (37.5%) died and 15 (62.5%) survived. Of a total of 48 eyes, observed fundus lesions included endogenous endophthalmitis (4 eyes of 2 patients, 8.3%), preretinal hemorrhages (4 eyes of 2 patients, 8.3%), optic disc pallor (2 eyes of 1 patient, 4.1%), moderate non?proliferative diabetic retinopathy (4 eyes of 2 patients, 8.3%), Roth spots (2 eyes of 1 patient, 4.1%), and 2 eyes of 1 patient (4.1%) with evidence of previous pan?retinal photocoagulation. Conclusion: Two patients had evidence of endogenous endophthalmitis. These findings suggest that the actual incidence of ocular lesions, especially infections is higher than that reported. Fundus examination should form a part of the management protocol for patients being treated for post?COVID?19 systemic infections
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Systemic corticosteroids and immunocompromised state following SARS?CoV?2 infection can predispose individuals to endogenous endophthalmitis. A 66?year?old gentleman presented with complaints of diminution of vision and redness one week post discharge after hospitalization for COVID?19 infection. Clinical examination suggested fulminant endogenous endophthalmitis which responded poorly even after aggressive treatment requiring evisceration. Culture and gene sequenced analysis confirmed Aspergillus fumigatus to be the causative organism. A high degree of suspicion is warranted in the presence of recent onset of floaters in COVID?19?infected individuals to facilitate early diagnosis and outcomes.
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A 62-year-old female diabetic recovered from COVID-19 pneumonia after receiving a prolonged course of steroids. She presented with a clinical picture of left-eye panuveitis with white cotton ball chorioretinal lesions and RAPD suggesting an optic neuropathy (VA HM). Diagnostic vitrectomy was performed to take samples for infective screen and to give intravitreal voriconazole empirically. Smear, culture, and PCR for viral DNA confirmed mixed infection of endogenous Candida endophthalmitis and incidental CMV infection. With further treatment, her corrected vision improved to 6/18 with regressing fungal lesions in serial fundus photographs. Prompt diagnosis and intervention preserved her vision and prevented potential life-threatening complications
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La endoftalmitis endógena es responsable del 2-15 % de las endoftalmitis, se relaciona con una infección sistémica hasta en un 52-90% de los casos, en el contexto de infecciones sistémicas como abscesos hepáticos, neumonia, infecciones de vias urinarias, meningitis, usurios de drogas endovenosas y fungémias. Haemophilus influenzae es un agente etiológico inusual de esta patología, hay pocos casos reportados a nivel mundial y no se han reportado casos en nuestro país; las endoftalmitis por Haemophilus se caractererizan por tener un pronóstico visual sombrio, ya que pueden presentar complicaciones severas y comprometer permanentemente la visión. A continuación, se describe un caso de endoftalmitis endogéna como primera manifestación de meningitis asociada a H. Influenzae en una paciente inmunocompetente y sin factores de riesgo.
Endogenous endophthalmitis is responsible for 2-15% of endophthalmitis, it is associated with a systemic infection in up to 52-90% of cases, in the context of systemic infections such as liver abscesses, pneumonia, urinary tract infections, meningitis, intravenousdrug users and fungaemia. Haemophilus influenzae is an unusual etiologic agent of this pathology, there are few cases reported worldwide and no cases have been reported in our country. The endophthalmitis due to Haemophilus are characterized by having a somber visual prognosis, since they can present severe complications and can permanently affect vision. Mentioned hereinafter, a case of endogenous endophthalmitis is described as the first manifestation of meningitis associated with H.Influenzae in an immunocompetent patient with no risk factors.
Subject(s)
Humans , Female , Aged , Endophthalmitis , Pneumonia , Haemophilus influenzae , Abscess , Eye , Infections , MeningitisABSTRACT
A 43-year-old male presented with left eye foveal retinits causing an acute visual loss following influenza virus type A infection (H1N1 infection or Swine flu). Considering viral (influenza) etiology, a prompt treatment with oral corticosteroids was started. But an initial poor response prompted an immediate diagnostic vitrectomy, which revealed Candida albicans. The retinitis healed with scar formation following anti-fungal therapy. This case highlights that even in the setting of an acute retinitis in an immunocompetent patient with recent history of viral systemic illness, a high index of suspicion of a fungal (rather than viral) infection should be kept in mind.
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Purpose: To study the clinical and microbiological profile, treatment modalities, and anatomical and functional outcomes among children and adolescents with endogenous endophthalmitis (EE) at a tertiary eye care centre in India. Methods: Medical records of subjects <18 years, presenting with EE from 1997 to 2007 were reviewed. Cases where the causative organism was identified were included. Treatment regimen included systemic antibiotics, vitrectomy, intravitreal antibiotics, and enucleation. Systemic evaluation to identify the source of infection was done by an internist. Microbiological analysis of blood, urine, and ocular specimens was done. The favorable anatomical outcome was defined as the attached retina, with controlled intraocular pressure and clear media at the last follow up. The favorable functional outcome was defined as vision >3/60 on the final follow up. Univariate regression analysis was done to identify factors predicting functional outcome. Results: Thirty eyes of 30 subjects (23 (77%) males) were studied. The mean age at presentation was 6.8 years (range=1–16 years). Fever was evident in four (13%) and blood culture was negative in all cases. Gram-positive organisms were identified in 11 (37%) eyes, fungi in 3 (10%), and toxocara in 8 (27%) eyes. Twenty-three (77%) eyes underwent vitrectomy. Favorable functional and anatomical outcomes were achieved in 9 (30%) and 12 (40%) eyes, respectively. Eyes undergoing vitrectomy showed significant correlation with good functional outcome (P = 0.05). Conclusion: EE is under-reported and not well studied in children. The absence of systemic features may be evident in a developing country with over the counter availability of antibiotics. Gram-positive infections are common and vitrectomy is a beneficial modality of treatment.
ABSTRACT
Fungal endogenous endophthalmitis (EE) secondary to contaminated intravenous fluid infusion is frequently seen in developing countries. Molds and yeasts are commonly implicated as the causative agents. Dematiaceous fungi such as Lecythophora have been linked to exogenous endophthalmitis but have never been reported to cause EE. We report a case of Lecythophora EE that was successfully managed with pars plana vitrectomy along with intravitreal and systemic voriconazole. Endogenous endophthalmitis (EE) is a potentially devastating intraocular infection caused by intraocular spread of pathogens through blood stream. It generally accounts for 2%�% of all reported endophthalmitis cases.[1] Predisposing risk factors include diabetes mellitus, malignancies, intravenous drug use, organ abscess, immunosuppressive therapy, indwelling catheters, urinary tract infection, organ transplant, end-stage renal or liver disease, and endocarditis.[2] It may occur in patients with no overt signs of systemic infection, particularly in the setting of contaminated intravenous fluid infusion in a rural setting.[3] Among the three broad categories of pathogens responsible for EE-bacteria, yeast, and molds, cases caused by molds are most infrequent and have the worst outcomes.[4] While Candida and Aspergillus are the most common species among fungal causes of EE, Lecythophora has been rarely reported as a cause of endophthalmitis due to exogenous causes.[5],[6],[7],[8] We, herein, report a case of EE caused by Lecythophora species.
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La endoftalmitis endógena bacteriana es una enfermedad ocular de difícil manejo y tratamiento. Es grave, con importante compromiso de la función visual y de la integridad anatómica del globo ocular en la mayoría de los pacientes, por lo que es crucial la intervención temprana de un equipo multidisciplinario para erradicar el foco primario conocido o no, así como para tratar de preservar la función visual. Se realizó una búsqueda de diversos artículos publicados en los últimos doce años, utilizando la plataforma Infomed, específicamente la Biblioteca Virtual de Salud, con el objetivo de conocer los principales factores de riesgo, el diagnóstico y los tratamientos actualizados de la enfermedad(AU)
Endogenous bacterial endophthalmitis is an eye disease of difficult management and treatment. It is a serious condition with considerable compromise of the visual function and the anatomical integrity of the eye globe in most patients. Therefore, early intervention by a multidisciplinary team is crucial to eradicate the known or unknown primary focus and try to preserve visual function. A search was conducted in various papers published in the past twelve years, mainly on the Infomed platform, particularly the Virtual Health Library, with the purpose of learning about the main risk factors, diagnosis and updated treatments for the disease(AU)
Subject(s)
Humans , Endophthalmitis/diagnosis , Endophthalmitis/therapy , Risk Factors , Review Literature as Topic , Databases, Bibliographic/statistics & numerical data , Libraries, Digital/statistics & numerical dataABSTRACT
We report a case of a 35-year-old male with a pancreatic pseudocyst, who developed bilateral endogenous endophthalmitis, 4 days after surgical drainage of the pseudocyst. Bacterial cultures of the pancreatic drain fluid and the vitreous tap showed the growth of Klebsiella pneumoniae. The cultured organism was resistant to all the tested antibiotics except colistin. Intravenous colistin was instituted and three injections of intravitreal colistin were given in the left eye of the patient. Complete resolution of infection was seen and visual acuity of 6/6 was regained in both eyes, which was maintained at 4-month follow-up.
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A 36-year-old immunocompetent man developed endogenous endophthalmitis 1 week after intravenous fluid infusion in a rural setting. Large submacular abscess with posterior hypopyon warranted urgent vitrectomy which revealed Aspergillus terreus on fungal culture. Intravitreal and oral antifungals lead to resolution of inflammation with satisfactory anatomic outcome but poor visual outcome due to submacular scar.
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PURPOSE: To report a case of candida endogenous endophthalmitis in healthy women who had received extraction of wisdom tooth. CASE SUMMARY: A 65-year-old medically healthy woman who had received extraction of wisdom tooth two weeks ago, presented with floater symptoms in her left eye. Best-corrected visual acuity was 20/40 and intraocular pressure was 17 mmHg in her left eye. Inflammatory cells were found in the anterior chamber and vitreous. Fluorescein angiography showed multiple hypofluorescence without vascular leakage. With provisional diagnosis of intermediate uveitis, she was prescribed oral steroid for two weeks. After that, inflammatory cells in anterior chamber was reduced but vitreous imflammatory cell was increased and fundus examination detected newly developed infiltrated lesion at superotemporal area. The patient was presumed to have fungal endophthalmitis and immediate intravitreal voriconazole injection was performed. Three days after intravitreal voriconazole injection, diagnostic vitrectomy and intravitreal voriconazole injection were performed. Vitreous cultures revealed the growth of Candida albicans. Despite the treatment, inflammatory response in anterior chamber and vitreous rapidly increased and visual acuity was decreased to hand movement. We changed anti-fungal agent, voriconazole to Amphotericin B. Additional three-time intravitreal injection was done and therapeutic vitrectomy with oil injection were performed. After treatment, the patient's fundus markedly improved and inflammatory response was decreased. CONCLUSIONS: This case report shows candida endophthalmitis in healthy woman who had received extraction of wisdom tooth. So to diagnose endophthalmitis, patient's medical history should carefully be checked including dental care history who presented with vitreous inflammation and inflammatory infiltrated lesion at fundus.
Subject(s)
Aged , Female , Humans , Amphotericin B , Anterior Chamber , Candida , Candida albicans , Dental Care , Diagnosis , Endophthalmitis , Fluorescein Angiography , Hand , Inflammation , Intraocular Pressure , Intravitreal Injections , Molar, Third , Uveitis, Intermediate , Visual Acuity , Vitrectomy , VoriconazoleABSTRACT
Objective To investigate the etiological features and visual outcomes of endogenous endophthalmitis (EE).Methods A retrospective consecutive case series of 19 patients (23 eyes) presenting with presumed EE from 2009 to 2016 in the Ophthalmology Department of Zhongshan Hospital and Huashan Hospital,Fudan University were included.Patients' medical history (main risk factors),microbial culture results,treatment regimen and visual outcomes were evaluated.Results In total,19 patients (23 eyes) were identified,including 7 female (8 eyes) and 12 male (15 eyes).Mean age was 54.0 ±17.9,ranging from 24 to 85.Most patients had severe underlying diseases,mainly diabetic mellitus (9/19) and liver abscess (8/19).Twenty vitreous samples from 17 cases were cultured,and 12 eyes from 10 cases were positive with a positive rate of 12/20.Fifteen cases had blood or body fluids cultures and 10 were positive,with the positivity rate of 10/15.Candida albicans (5/6) was the most common pathogen isolated in fungal endophthalmitis,and Klebsiella pneumonia (7/13) was the most common pathogen in bacterial endophthalmitis.Patients mainly received vitrectomy,intravitreal injection,and systemic/local antibiotic therapy.Only five eyes had improved visual acuities,and 6 eyes were enucleated or eviscerated.Among the 10 eyes from 8 cases who were treated within one week after onset,5 eyes from 3 cases (5/10) had improved visual acuities;one eye from one case had no visual improvement;four eyes from four cases had no light perception or enucleated.No improved visual acuity occurred in patients who were treated after one week.Conclusions Although the incidence is low,EE has poor visual outcomes.Timely diagnosis and treatment may be helpful to maximize the recovery of vision.
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PURPOSE: To report an unusual case of endogenous endophthalmitis in a patient with Klebsiella pneumoniae primary liver abscess. CASE SUMMARY: A-54-year-old man with diabetes mellitus and liver abscess was referred to us for consultation of visual loss in his left eye for 2 days. On the first examination, the patient's left visual acuity was hand motion and the left intraocular pressure was 13 mmHg. Vitreous opacity and inflammatory membrane were detected with increased echogenicity using ultrasonography. Vitectomy and intravitreous antibiotic injection were performed under the impression of endogenous endophthalmitis caused by liver abscess on the day of the first visit. Culture revealed Klebsiella pneumoniae from blood and liver abscess. After vitrectomy, the patient showed improvement. However, on the 20th and 40th postoperative days, the patient complained of blurred vision, and inflammation and hypopyon were observed in the anterior chamber. An intracameral antibiotic injection and anterior chamber washing were performed. The patient has not complained of any other symptoms to date. CONCLUSIONS: In this patient with endophthalmitis, inflammation and hypopyon in the anterior chamber were evident three times after vitrectomy. Ultimately, the inflammation was effectively controlled by intracameral antibiotic injection and anterior chamber washes.
Subject(s)
Humans , Anterior Chamber , Diabetes Mellitus , Endophthalmitis , Hand , Inflammation , Intraocular Pressure , Klebsiella pneumoniae , Klebsiella , Liver Abscess , Membranes , Pneumonia , Ultrasonography , Visual Acuity , VitrectomyABSTRACT
La endoftalmitis endógena es una enfermedad ocular infrecuente pero grave. Su manejo ha de ser necesariamente multidisciplinario por la complejidad de la afección sistémica, dirigido a erradicar el foco infeccioso primario, conocido o no, así como a preservar la función visual. Se presenta a un paciente masculino diabético de 66 años, ingresado en un hospital general para tratamiento quirúrgico de úlcera séptica del pie derecho, quien debutó con endoftalmitis endógena anterior difusa por Staphylococcus aureus confirmado mediante cultivos de humor acuoso y sangre. Aunque inicialmente se pensó en uveítis anterior aguda, la presencia de foco séptico en partes blandas y el empeoramiento del cuadro clínico oftalmológico fueron los elementos que condujeron al diagnóstico de la endoftalmitis endógena. La actuación conjunta de varias especialidades médicas hizo posible el manejo satisfactorio del paciente(AU)
Endogenous endophthalmitis is a rare but serious pathology. A multidisciplinary care team should lead the treatment because of the complexity of the systemic affection, in order to eradicate the primary infectious focus, either known or not, and to preserve the visual function. This a 66 years old male diabetic patient who was admitted to a general hospital with the purpose of practicing surgery of the right foot septic ulcer, who began suffering diffuse anterior endogenous endophthalmitis caused by Staphylococcus aureus, and confirmed through aqueous humor and blood cultures. Although the initial diagnosis was acute anterior uveitis, the presence of a septic focus in the soft tissue and the worsening of clinical ophthalmological symptoms led to finally diagnose him with endogenous endophthalmitis. The joint performance of several medical specialists made the satisfactory management of this patient possible(AU)
Subject(s)
Humans , Male , Aged , Corneal Edema/therapy , Endophthalmitis/diagnosis , Staphylococcus aureus/cytology , Ultrasonography/methodsABSTRACT
Se presentan los casos de tres pacientes con endoftalmitis endógena asociada a absceso hepático por Klebsiella pneumoniae, atendidos en el Hospital Universitario San Vicente Fundación, de Medellín. Esta complicación forma parte del síndrome de absceso hepático criptogénico invasor por K. pneumoniae, entidad descrita hace 25 años y cuya prevalencia parece ir en aumento. Para cada paciente se describen los síntomas y signos, el aislamiento microbiológico, el tratamiento, la evolución y el desenlace visual. Es la primera vez que se informa esta enfermedad en Colombia...
We describe three patients with endogenous endophthalmitis associated with Klebsiella pneumoniae liver abscess, treated at Hospital Universitario San Vicente Fundación (Medellín, Colombia). This complication is part of a syndrome described 25 years ago, whose prevalence seems to be rising: cryptogenic invasive K. pneumoniae liver abscess. Symptoms and signs, microbiological isolates, treatment, evolution and visual outcome are described for each patient.It is the first report of this disease in Colombia...
Apresenta o caso de três pacientes com endoftalmite endógena associadas com abscesso hepático por Klebsiella pneumoniae tratados no Hospital Universitário San Vicente Foundación, de Medellín. Esta complicação faz parte da síndrome, abscesso hepático criptogênica invasora por K. Pneumoniae, entidade descrita há 25 anos e cuja prevalência parece estar aumentando. Para cada paciente descreve os síntomas e sinais, o isolamento microbiológico, o tratamento, a evolução e o resultado visual. Esta é a primeira vez que se informa dessa doença na Colômbia...
Subject(s)
Male , Female , Adult , Liver Abscess , Endophthalmitis , Klebsiella pneumoniae , ColombiaABSTRACT
PURPOSE: To report a case of endogenous endophthalmitis due to Klebsiella ozaenae, which is a rare causative organism of endophthalmitis. CASE SUMMARY: A 61-year-old male who was undergoing chemotherapy for hepatocellular carcinoma complained of sudden visual loss and ocular pain in his left eye for 2 days. On the first examination, the patient's visual acuity was counting fingers at 10 cm and the intraocular pressure was elevated to 29 mm Hg. Partial scleral rupture and choroidal prolapse were observed. Subretinal abscess was detected with increased echogenicity using ultrasonography. The patient complained of burning sensation on voiding and urinary frequency; subsequent urinalysis showed pyuria and bacteriuria. Intravitreal and systemic antibiotics were administered under the impression of endogenous endophthalmitis caused by urinary tract infection. Despite treatment, visual acuity decreased to no light perception in 4 days and intraocular pressure and pain was uncontrollable. Enucleation was performed and pus culture from the eye during surgery revealed Klebsiella ozaenae. CONCLUSIONS: Klebsiella ozaenae is a rare causative organism of endophthalmitis and shows a rapid progress and poor prognosis. Endogenous endophthalmitis must be highly suspected in patients with urinary tract infection as well as pyogenic liver abscess.
Subject(s)
Humans , Male , Middle Aged , Abscess , Anti-Bacterial Agents , Bacteriuria , Burns , Carcinoma, Hepatocellular , Choroid , Drug Therapy , Endophthalmitis , Fingers , Intraocular Pressure , Klebsiella , Liver Abscess, Pyogenic , Prognosis , Prolapse , Pyuria , Rupture , Sensation , Suppuration , Ultrasonography , Urinalysis , Urinary Tract Infections , Visual AcuityABSTRACT
Systemic infections that are caused by various types of pathogenic organisms can be spread to the eyes as well as to other solid organs. Bacteria, parasites, and viruses can invade the eyes via the bloodstream. Despite advances in the diagnosis and treatment of systemic infections, many patients still suffer from endogenous ocular infections; this is particularly due to an increase in the number of immunosuppressed patients such as those with human immunodeficiency virus infection, those who have had organ transplantations, and those being administered systemic chemotherapeutic and immunomodulating agents, which may increase the chance of ocular involvement. In this review, we clinically evaluated posterior segment manifestations in the eye caused by hematogenous penetration of systemic infections. We focused on the conditions that ophthalmologists encounter most often and that require cooperation with other medical specialists. Posterior segment manifestations and clinical characteristics of cytomegalovirus retinitis, endogenous endophthalmitis, toxoplasmosis, toxocariasis, and ocular syphilis are included in this brief review.
Subject(s)
Humans , Bacteria , Cytomegalovirus Retinitis , Diagnosis , Endophthalmitis , Eye Infections , HIV , Inflammation , Organ Transplantation , Parasites , Specialization , Syphilis , Toxocariasis , Toxoplasmosis , Toxoplasmosis, Ocular , TransplantsABSTRACT
Endogenous endophthalmitis is a rare but devastating disease that may frequently result in visual loss despite appropriate and early antibiotic treatment. Recent reports have suggested an increased incidence of endogenous endophthalmitis in East Asia, particularly in Taiwan, where the major source of infection has been liver abscess secondary to Klebsiella pneumoniae. Here we report three cases who presented in Qatar with severe endogenous endophthalmitis associated with Klebsiella pneumonia septicemia secondary to pyogenic liver abscess in a diabetes mellitus underlying.
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We report a rare case of Aspergillus terreus endogenous endophthalmitis in an immunocompetent patient with subretinal abscess and also review the reported cases. A 50-year-old healthy male presented with sudden painful loss of vision in right eye. He was diagnosed with endogenous endophthalmitis and underwent urgent vitrectomy. Aspergillus terreus growth was obtained in culture. At fi nal follow-up, there was complete resolution of the infection but visual acuity was poor due to macular scar. Aspergillus terreus is a rare cause of endophthalmitis with usually poor outcomes. Newer antifungals like Voriconazole can be sometimes associated with better prognosis.