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Ophthalmological findings of case 1 at onset. a US showed no retinal detachment but an aggregated intravitreal mass in the right eye. b Ophthalmoscopy showed a white mass on the fovea in the left eye. c Optical coherence tomography showed that the white mass shown in b was continuous with the outer retinal layer. d Single-flash ERG showed almost no response in the right eye and normal responses in the left eye.
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Background
Endogenous endophthalmitis is a rare disease and its visual prognosis is poor.
Case Reports
We present two patients, a 60-year-old man and a 53-year-old man, who developed endogenous endophthalmitis caused by Gram-positive organisms but recovered good vision after antibiotics and vitrectomy.
Results
The first patient complained of ocul...
Citations
... It was reported in association with infective endocarditis, sinusitis, orbital cellulitis, intraorbital abscess formation, and cavernous sinus thrombosis [5][6][7]. EBE resulting from SMG was rarely reported previously [2,[8][9][10][11]. Table 1summarizes 6 cases (5 males) who were diagnosed with SA-associated EE. ...
We report the long-term follow-up of an immunocompetent patient who presented with slowly progressive endogenous endophthalmitis secondary to Streptococcus anginosus. A 46-year-old healthy man presented with a two-month history of right eye iritis. On examination, visual acuity was 20/60 with intraocular pressure of 6 mm Hg. There was a small layer of hypopyon with non-granulomatous anterior uveitis and vitritis. On funduscopy, fluffy white peripheral retinal and pre-retinal lesions were noted in superonasal periphery. The patient denied any present or past illness. Diagnostic pars plana vitrectomy was performed. Culture and polymerase chain reaction of the vitreous sample were positive for Streptococcus anginosus. Intravitreal vancomycin and ceftazidime and systemic ceftriaxone were administered. Work-up which included blood and urine cultures, chest x-ray, echocardiography and abdominal ultrasound was unyielding. Subsequently and because of persistent post-infectious inflammatory reaction, intravitreal and oral steroids were administered in addition to oral azathioprine later on. After one year of follow-up, visual acuity was 20/20 with near vision of Jaeger 3 + and no signs of active uveitis were seen. Therefore, Streptococcus anginosus should be considered in the differential diagnosis of a slowly progressive endophthalmitis also in immunocompetent individuals.
... However, PPV may aid in reducing and removing the nidus of intraocular infection [13]. At present, there are many studies and reports available that demonstrated good and favorable outcomes with a combination of systemic antibiotics with vitrectomy [17][18][19][20]. ...
Endogenous endophthalmitis (EE) is an ocular infection resulting from hematogenous spread from the remote primary source. Risk factors include endocarditis, bacteria meningitis, immunosuppressive state, and invasive procedures in patients with sepsis. We present a case of a 43-year-old gentleman with poorly controlled diabetes mellitus who was admitted for bilateral nasoseptal cellulitis with a right nasal wall abscess and right vocal cord palsy. At presentation, he just had preseptal cellulitis without any posterior segment involvement. He underwent incision and drainage under the Otorhinolaryngology team. Unfortunately, postoperatively he developed sepsis with a hematogenous spread of infection systemically involving his right eye (endophthalmitis) and his heart valve (infective endocarditis). Blood culture revealed Methicillin Sensitive Staphylococcus Aureus (MSSA) infection. He had six weeks of intravenous cloxacillin and three times intravitreal injections of vancomycin and ceftazidime with complete resolution of signs and symptoms. In the case of a poorly controlled diabetic patient with an extensive regional infection, the presence of ocular symptoms and signs that are suggestive of EE must be taken seriously and warrant a complete eye examination as early detection and treatment of EE is crucial for better prognosis.
... The vitreous biopsy revealed many bacterial colonies, which might explain the severity of his disease. Streptococcus anginosus has been reported in only 2 cases endogenous endophthalmitis that resulted in relatively good visual outcomes [10][11] . In those cases, the pathogenic bacteria were confirmed only in the blood sample, and no bacteria were identified in the vitreous sample. ...
... Therefore, when mediastinal abscesses occur, treatment is relatively difficult, and early active intervention should be taken to reduce the mortality. In addition, S. anginosus bacteremia can also contribute to other infections without abscess formation, such as infective endocarditis [16], osteomyelitis [17], gas gangrene [18], endogenous endophthalmitis [19], and acute glomerulonephritis [20]. ...
Organ abscesses caused by Streptococcus anginosus are relatively rare. We report the case of an elderly woman with splenic abscess caused by S. anginosus bacteremia after urinary tract infection. An 82-year-old woman had a history of frequency of urination, urgency, and fever with chills for over 10 days prior to admission. An abdominal computed tomography (CT) scan performed in the emergency room revealed a low-density lesion in the spleen, kidney cysts, some exudation around the kidney, and cystitis should be valued. She was treated with ceftriaxone and imipenem/cilastatin. After admission, the blood culture yielded positive results for S. anginosus. A contrast-enhanced abdominal CT scan showed that the low-density lesion previously found in the spleen was smaller than before. After percutaneous drainage of the splenic abscess and treatment with piperacillin/tazobactam based on the antibiotic sensitivity pattern, repeated abdominal CT scan revealed a significant reduction in the low-density lesion. The patient was discharged without recurrence or complications. A systematic review of organ abscess caused by S. anginosus bacteremia was performed. To our knowledge, there has been no report of splenic abscess caused by S. anginosus bacteremia secondary to urinary system tract infection, although urinary tract infections are also an important source.
... A similar proportion of blood (57%) and ocular (50%) cultures yielded growth. These results are similar to prior studies that have reported culture-positive rates for intraocular specimens ranging from 24% 9 to 64%. 10 Consistent with prior studies, 11,12 the diagnostic yield of vitrectomy concentrate was the highest, whereas the yield of aqueous samples was notably poor. Patients were treated according to the results of their systemic cultures. ...
Purpose
This work compares clinical presentation and course of bacterial and fungal causes of endogenous endophthalmitis (EE).
Methods
A single-institutional study of consecutive patients diagnosed with EE was conducted at the University of Pittsburgh Medical Center between September 2015 and September 2018. Exclusion criteria included history of ocular trauma, intraocular surgery or injection 6 months before presentation, or primary external ocular infection. Data included demographics, medical and ocular history, clinical examination, culture data, therapeutic interventions, final corrected visual acuity (VA), and mortality.
Results
Thirty-six eyes of 26 patients were diagnosed with EE during a 3-year period. Median age at diagnosis was 55.5 years (range, 19-86 years). Based on ocular and systemic cultures, 19 patients had bacterial EE and 6 patients had fungal EE; findings from all cultures remained negative in 1 patient. All patients had risk factors for EE. Presenting VA, subjective symptom report, and objective measures of intraocular inflammation were similar between bacterial and fungal causes. Overall, EE presented indolently and was initially misdiagnosed in 19% of cases. Complications including final VA less than 20/200, retinal detachment, enucleation, or death within 6 months of diagnosis were equivalent between bacterial and fungal cases.
Conclusions
The presentation of EE is remarkably different from that of exogenous endophthalmitis. Without a high index of suspicion, the indolent presentation of EE may lead to misdiagnosis. No clinical features reliably differentiated bacterial and fungal sources. This highlights the importance of considering empiric therapy for antibacterial and antifungal coverage on initial presentation.
... The patient was treated with PPV and systemic imipenem. The patient achieved good vision of 6/ 7.5 [24]. ...
... In 2010, Itoh et al reported a similar case treated with intravitreal ceftazidime + vancomycin and systemic imipenem. The patient's visual outcome was 6/ 4.8 [24]. ...
Endogenous endophthalmitis, EE, a less common form of endophthalmitis, occurs when the microorganisms spread to the eye through the bloodstream, from a septic focus elsewhere in the body, that breaches into the integrity of the eyeball itself. The etiopathogenesis of endogenous endophthalmitis has changed over the past two decades, the aim of this review being to study the changing trends in causative organism in the era of modern antibiotics.
... This is well above the percentage of patients reported with similar improvement before this study [11]. Itoh et al. also reported that early aggressive treatment can lead to good visual outcomes [89]. Early vitrectomy within 2 weeks of presentation, especially in severe cases or when suspecting a highly virulent organism, can lead to a good overall outcome [79,82,83,86,90]. ...
Endogenous endophthalmitis is an ophthalmic emergency that can have severe sight-threatening complications. It is often a diagnostic challenge because it can manifest at any age and is associated with a number of underlying predisposing factors. Microorganisms associated with this condition vary along a broad spectrum. Depending upon the severity of the disease, both medical and surgical interventions may be employed. Due to rarity of the disease, there are no guidelines in literature for optimal management of these patients. In this review, treatment guidelines based on clinical data and microorganism profile have been proposed.
In this article, we report a 10-year-old boy with acute bacteremia and left eye blindness. Culture from abscess drainage was positive for Streptococcus constellatus. Infection caused by S. constellatus is rare among children, and to our knowledge, this is the first report of this pathogen causing blindness. The rapidness of progression in this case is alarming. We also summarize other cases of S. constellatus infection.
Purpose
The purpose of this study was to present a case of indolent endogenous endophthalmitis in a young, seemingly healthy woman.
Methods
This study is a retrospective case report.
Results
A 25-year-old woman with no significant medical history presented with vision loss in the left eye over the course of 1 month. Examination showed vitritis and a white–yellow lesion overlying the macula and optic nerve in the left eye. Initial laboratory testing for infectious and inflammatory causes was unrevealing. A diagnostic vitrectomy was performed, and the patient was found to have presumed endogenous endophthalmitis due to Streptococcus anginosus , an extremely uncommon bacterium. Subsequent workup did not reveal evidence of bacteremia, endocarditis, or orbital infection. This case is unique because, unlike the three previously reported cases of S. anginosus endophthalmitis, this patient was seemingly healthy, never had an elevated white blood cell count, never had documented bacteremia, had a normal echocardiogram, and had normal orbital findings on magnetic resonance imaging and computed tomography scans. Further questioning revealed a remote history of facial cellulitis and possible sinusitis treated with oral antibiotics, which are the presumed etiology.
Conclusion
Streptococcus anginosus endophthalmitis can occur in young, seemingly healthy patients. Endogenous endophthalmitis should be considered in the differential diagnosis even without systemic comorbidities or other risk factors. Detailed questioning about medical history and thorough review of systems, including nonocular symptoms, are essential.
