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Photomicrograph ofhistological section ofthe enucleated right eye. The retina is totally detached, and there is an acute inflammatory exudate through all coats ofthe eye. (Haematoxylin and eosin, x3).
Source publication
The literature on Clostridium perfringens infections is reviewed up to 1983. An additional case is reported with bilateral clostridial infections of the eye and orbit. One eye followed the classical course of relentless panophthalmitis, amaurosis, and orbital cellulitis ending in enucleation. The second eye contained intracameral mud and gas bubble...
Citations
... The patient did not have any additional risk factors to accelerate the gangrene process, including immunosuppression, diabetes mellitus, systemic vascular diseases, and globe laceration (a route for entrance of microorganisms to the globe especially of Clostridium perfringens, resulting in gas gangrene infection, defined as wet gangrene). [2,3] Reported cases of accidental traumatic enucleation are rare. [4,5] To my knowledge, This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. ...
... It may result in death due to the effects of potent exotoxins like lecithinase, phospholipase, neuraminidase, collagenase, and DNAase. [1] It is a highly lethal infection of bone and soft tissue and is synonymous with myonecrosis, characterized by rapidly progressive gangrene of the injured tissue along with the production of foul-smelling gas and characteristic crepitus. [2] Orbital infection due to clostridia is scarcely reported. ...
... [11] Very few cases of ocular gas gangrene conclud in eye salvage, Crock et al reported one such case of uniocular visual improvement. [1] Abu el Asrar et al., [8] Wiles et al. [9] reported vision salvage post vitrectomy in case of gas gangrene endophthalmitis. Our case series had orbital involvement rather than intraocular infection, which, as described by Rosenblum et al., [5] is a case of sinus gas gangrene with radiological features of sinus opacification and calcification, with bone demineralization. ...
... When the eye is unsalvageable, complete surgical removal by evisceration surgery is performed to prevent fatal infections, gas gangrene, orbital cellulitis and a chance of cavernous sinus thrombosis [4,5]. It is advised to start ocular prosthesis rehabilitation immediately after surgical removal to obtain the best possible aesthetic results, to avoid contracture of soft tissue, reduced socket size and depth, eyelid constriction, eyelid incompetence, and decreased residual muscle movement [6]. ...
Background:
Two patients received ocular injuries from rusted metallic projectiles at their industrial workplaces. Said injuries resulted in the loss of their eyes by evisceration surgeries to prevent fatal infections.
Case description:
The first case, a man in his twenties, received a stock conformer immediately after surgery and started prosthetic therapy within 2 months. The second case, a man in his forties, started prosthetic therapy after 10 years. Definitive custom ocular prostheses were fabricated and relined according to conventional protocol.
Results:
On issue of the prosthesis, there was adequate retention, aesthetics and stability to extra-ocular movements and treatment was considered successful for both cases. However, follow-ups showed noticeable prosthetic eye movements for case 1 which, to some extent mimicked the physiologic movement of its fellow natural eye. Case 1 adjusted to his prosthesis better while case 2 was still adjusting with little to no physiologic movement.
Conclusion:
Prosthetic rehabilitation should be started as early as possible to obtain optimum rehabilitative results.
... This was because of late presentation in the form of panophthalmitis. 2, 3 Wiles and Ide 6 in 1991 reported a case of endophthalmitis after an open-globe injury with a metal nail. The patient was noted to have endophthalmitis with a corneal laceration, infiltrate around the laceration, and a presenting vision of counting fingers close to face. ...
... More literature exists on cases of clostridial intraocular infection that presented as panophthalmitis. [2][3][4][17][18][19] The clinical course and outcomes of these cases have been found to be uniformly poor, and they were excluded none of the cases in the current series presented at the stage of panophthalmitis. ...
Purpose:
To describe the clinical presentations, diagnosis and management outcomes of clostridial endophthalmitis, and a review of the previous literature.
Design:
Retrospective, interventional case series from January 2005 to March 2018 and a literature review.
Methods:
The study included seven eyes of seven patients with culture-proven Clostridium sp. endophthalmitis. Identification of Clostridium sp. was confirmed by the VITEK 2 system using the ANC card. When VITEK failed to identify the organism, MALDI-TOF was used. Data regarding demography, clinical presentations, interventions received, and final visual and anatomical outcomes were noted.
Results:
THE: mean age of the patients was 28.28 ± 22.35 years (median 21 years). By the etiology of infection, 5 (75%) eyes were post-open-globe injury, 1 (12.5%) was post-trabeculectomy, and 1 (12.5%) was postintravitreal injection. The mean follow-up was 9.71 ± 12.03 months, median 6 months. Two samples were positive for Clostridium perfringens, one each for C. subterminale, C. difficile, and C. tertium, and two were unidentified clostridial species. Favorable anatomical outcome was seen in 3/7 eyes (42.85%). Favorable functional outcome was seen in 2/7 eyes (28.57%). These were comparable with the outcomes of the pooled pre-existing literature. There was a trend toward better functional and anatomical outcomes and lesser evisceration/enucleation rates with vitrectomy instead of a vitreous tap, although not statistically significant. All cases showed susceptibility to empirically used intravitreal antibiotic vancomycin.
Conclusion:
Commonest setting of clostridial endophthalmitis is post-open-globe injury. Despite treatment with appropriate antibiotics, the visual and anatomical outcome is unsatisfactory because of high organism virulence. Early vitrectomy may allow for globe salvage and potential vision.
... These ubiquitous Gram-positive bacilli found in soil and bowel flora generate gas, whose presence is advised by soft tissue crepitating at palpation. [80][81][82] There is another peculiar disease in the spectrum of cellulitis, called erysipeloid, from the causative Gram-positive rod Erysipelothrix rhusiopathiae. 83 It is an unusual pathology, due to the exposure to contaminated materials derived from animals or fish, configuring an occupational disease in veterinarians, meat packers, and fisherman. ...
Cellulitis is a severe infection of the soft tissues, with a variable aetiology from Gram-positive to Gram-negative bacteria and deep fungal infections, whose early recognition is mandatory to avoid potentially life threatening complications. Some pathogens might cause very similar clinical entities, and cellulitis differentiation at presentation towards abscess, necrotising fasciitis, and gangrene, requires expertise. Many mimics are also to be excluded, conditioning the treatment and patient’s prognosis. The dermatologist is in a lead position to avoid misdiagnosis, to evaluate the type of assessment, and address initial treatment. Besides, skin and soft tissue infections are a common reason for emergency room visits and hospital admission, lacking precise clinical definition and managed with empirical antibiotic treatments. History, physical examination and laboratory data can help characterise the severity of the disease, and the probability of complications development, mainly necrotising fasciitis. Several admittance scores have been proposed to address the emergency decisions, and guidelines for treatment proposed. The present review will focus on clinical challenges and actual open questions on cellulitis management.
... C. perfringens infections following a penetrating injury of the orbit have been discussed [3,[12][13][14], but on overviewing the literature, we found no reference to C. septicum gas gangrene in an orbital localization without endophthalmitis. ...
Our report presents a case of Clostridium septicum gas gangrene in an unusual, orbital localization. The predisposing factors are typical: colon tumour and lymphatic malignancy. Most probably bacteria from the intestinal flora entered the bloodstream through the compromised intestinal wall and settled in the orbit resulting in the development of an abscess containing gas. At the site of the gas gangrene, an indolent B cell lymphoma was present. After surgery and antibiotic treatment, the patient healed from the C. septicum infection; but subsequently died as a consequence of the tumour.
... The presence of visible gas on radiography, computed tomography (CT), or magnetic resonance imaging (MRI) is associated with various pathological conditions, ranging from severe infections caused by gas-producing organisms to cutaneous and subcutaneous tissue disruption that allows an interface with the air [1]. A high index of suspicion surrounds the finding of gas because of the virulence of conditions such as gas gangrene and necrotizing fasciitis123456789101112. Gas dissecting into the orbital soft tissues as a result of bacterial activity is a rapidly progressive, extremely serious, life-threatening ophthalmological emergency123456789101112 . ...
... A high index of suspicion surrounds the finding of gas because of the virulence of conditions such as gas gangrene and necrotizing fasciitis123456789101112. Gas dissecting into the orbital soft tissues as a result of bacterial activity is a rapidly progressive, extremely serious, life-threatening ophthalmological emergency123456789101112 . Gas gangrene (myonecrosis ) and necrotizing fasciitis can cause necrosis of tissues and systemic shock with multiorgan failure, sometimes within a matter of hours123 13]. ...
... No study has reported its frequency, pathogenesis , or exact origin (i.e., whether it was a primary or secondary condition). In our review of the literature, we found that 67 cases of gas-forming clostridial infection of the eyes and orbit had been reported between 1904 and 1985 [8]. Poor outcome in the affected eye(s), with severe consequences to the functional and anatomical integrity of eyesight, is common. ...
... Ocular infections caused by C perfringens are rare. They include endogenous postoperative or posttraumatic panophthalmitis [11][12][13][14] and gas gangrene of the orbit, 15 causing rapid destruction of ocular tissues. Clostridium perfringens has also been reported as the causative organism in anaerobic keratitis. ...
We report a case of bacterial keratitis that occurred after implantation of intrastromal corneal ring segments (Intacs). The patient presented with decreased vision, inflammation, and stromal infiltrates localized at the extremity of an Intacs channel 3 months after surgery. Culture were positive for Clostridium perfringens and Staphylococcus epidermidis. The infiltrates progressed despite treatment with topical fortified and systemic antibiotics. The Intacs were removed. The keratitis slowly resolved, and the patient recovered a best corrected visual acuity of 20/20.
... .12 It is appropriate to consider Bacillus spp.in particular since they are expected to cause 43% of endophthalmitis cases. The authors concede that data from the United Kingdom are sparse but experience suggests that the spectrum of infection is similar.Dosages for vancomycin and clindamycin are as follows: The combination of gentamicin and vancomycin gives broad spectrum prophylaxis against all bacteria listed in Tables II and III. ...
Published opinion supports the early use of prophylactic antibiotics soon after presentation of a potentially contaminated intraocular foreign body (IOFB) in the posterior segment, preferably within 12 hours of trauma when the visual acuity is still good. Recommended treatment includes topical, subconjunctival, parenteral and especially intravitreal antibiotic therapy to reduce the chance of endophthalmitis. Intravitreal therapy should include gentamicin with vancomycin or clindamycin to cover Bacillus spp., since this organism is responsible for half the endophthalmitis cases and produces beta-lactamase giving resistance to penicillins and cephalosporins. Intravitreal therapy is important because systemic and topical antibiotics do not penetrate the globe in sufficient concentration to control a fulminant infection associated with damaged tissue. Early therapy is essential, as delaying treatment until endophthalmitis occurs is less likely to save useful vision. All vitreous aspirated, plus pus if present, and the IOFB should be cultured for bacteria and fungi to identify pathogens and gain antibiotic sensitivities. The prevention of IOFB-associated endophthalmitis requires early recognition of the IOFB and enthusiastic antibiotic therapy at the time of its removal.
