Clinical profile and outcome of endogenous endophthalmitis at a quaternary referral centre in south India

Abstract

Purpose: The purpose of this study is to evaluate the clinical profile, visual, anatomical and survival outcome of patients with endogenous endophthalmitis. Methods: Retrospective chart review of consecutive cases with endogenous endophthalmitis presenting from 2009-2016. Results: In our study, 41 eyes of 34 patients were included. Most common co-morbidity associated with endogenous endophthalmitis was Diabetes Mellitus (70.7%) and most common infective foci was UTI (73.2%). Among the culture positive cases, fungi and bacteria were evenly distributed, 76.93% were Gram positive bacteria and 23.07% were Gram negative. Fungal endogenous endophthalmitis was more commonly seen in immunosuppressed state (72.7%) and bilateral cases (66.7%). The mean presenting vision (log MAR) of patients who died during the study were poor compared to those who survived ( P = 0.014) Poor mean visual acuity at presentation was associated with more death ( P = 0.014). Eyes with poor presenting vision, fungal isolates, culture positivity and immune suppression had poor visual and survival outcome. Poor visual outcome was observed more frequently in eyes with Aspergillus infection (85.7%) compared to Candida (75%) and bacteria (58.3%). Evisceration was done for 5 out of 41 eyes (12.2%). Vitrectomy rate was 53.7% in our study, with 40% of them showing overall improvement in vision. Conclusion: Endogenous endophthalmitis is a sight threatening condition associated with high mortality particularly when caused by Aspergillus spp. in immunocompromised patients. Contrary to the prior published reports of endogenous endophthalmitis outside India, we found an equal distribution of fungal and bacterial organisms among our cases, with predominance of Aspergillus among fungal isolates and Gram-positive organism among bacteria. Fungal infections, especially with Aspergillus spp., resulted in poor visual and survival outcome.

Bilateral endogenous fungal endophthalmitis: A case report

“…Bilateral eye involvement was more prevalent in endogenous fungal endophthalmitis than in bacterial endophthalmitis. [ 4 ]…”

“…According to the literature, endogenous endophthalmitis made up approximately 5.0% to 10% of all endophthalmitis case. [1][2][3] Of the endogenous cases, approximately 20% to 60% were caused by fungi, [3][4][5] with Candida albicans and Aspergillus flavus being the most common pathogens, together accounting for about 50% to 70% of fungal endophthalmitis. [3,6,7] In most cases, endogenous fungal endophthalmitis is the result of immunosuppression coinciding with fungemia.…”

Metastatic subretinal abscess in a patient with perinephric abscess

“…[ 2 ] A retrospective review from a quaternary referral center in south India reported an even distribution of fungi and bacteria among the culture-positive cases of EE. [ 3 ] 76.93% bacterial isolates were attributed to Gram-positive bacteria, of which Staphylococcus aureus was the most common and 23.07% were due to Gram-negative bacteria. Aspergillus species was the most common fungus that was isolated (53.8%) followed by Candida albicans (30.7%).…”

“…Aspergillus species was the most common fungus that was isolated (53.8%) followed by Candida albicans (30.7%). [ 3 ] Further, perinephric abscess is usually due to Gram-negative enteric bacilli or a polymicrobial infection due to Escherichia coli, Staphylococcus aureus , and Klebsiella pneumonia . [ 3 4 5 ] Candida albicans and Aspergillus are commonly seen fungi which account for 11.1% to 17.54% of total EE cases in the Asian population.…”

“…[ 1 2 ] Recent work by Pillai GS and colleagues have suggested that approximately 90.24% of the patients with EE have at least one systemic co-morbid condition, of which the most common co-morbidity is diabetes mellitus. [ 3 ] Development of a metastatic subretinal abscess is relatively rare but may become more common as the number of chronically debilitated patients and use of invasive procedures are in increasing trend. The diagnosis is mostly clinical while awaiting the results from intraocular and/or blood culture.…”