Endogenous endophthalmitis: diagnosis, management, and prognosis

Sadiq, Mohammad Ali; Hassan, Muhammad; Agarwal, Aniruddha; Sarwar, Salman; Toufeeq, Shafak; Soliman, Mohamed Kamel; Hanout, Mostafa; Sepah, Yasir J.; Diana, V.; Nguyen, Quan Dong

doi:10.1186/s12348-015-0063-y

Cited by 153 publications

(162 citation statements)

References 94 publications

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“…Despite the severity of the condition the diagnosis is often delayed, with a mean delay of 3.2 days 1. Delay in diagnosis, as was the case with the above patient, is a poor prognostic indicator 2. Other poor prognostic indicators include poor initial visual acuity, centrally located lesions, presence of a hypopyon, and rapid onset of symptoms, unilateral involvement and panophthalmitis.…”

Section: Descriptionmentioning

confidence: 76%

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Endogenous bacterial endophthalmitis and subretinal abscess complicating diabetic ketoacidosis

Harvey

2018

BMJ Case Reports

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Section: Descriptionmentioning

confidence: 76%

“…Risk factors for the development of EBE include hospitalisation, diabetes, immunosuppression, urinary tract infection, neutropenia, HIV, intravenous drug use and indwelling catheters 2. It has been suggested that diabetes induces increased blood-retinal barrier permeability and subsequent risk of development of EBE 3…”

Section: Descriptionmentioning

confidence: 99%

Endogenous bacterial endophthalmitis and subretinal abscess complicating diabetic ketoacidosis

Harvey

2018

BMJ Case Reports

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“…pneumoniae infections, having only been described in isolated case reports [14]. Endogenous endophthalmitis occurs when bacteria reach the eye via bloodstream infection or through central nervous infection spread via the optic nerve [15, 16]. It is often associated with chronic predisposing conditions such as those that cause a baseline immunodeficient state (i.e., diabetes mellitus, HIV, and ESRD).…”

Section: Discussionmentioning

confidence: 99%

“…Fungal infections have also been implicated quite often. The right eye is more often affected than the left due to a more direct route through the right carotid artery [12, 16]. Diagnosis is made with high clinical suspicion in the setting of other risk factors such as systemic infection and imaging concerning for intraocular infection.…”

Section: Discussionmentioning

confidence: 99%

“…Vitreous aspiration and cultures, as well as RT-PCR of vitreous fluid, can identify a specific organism. Diagnostic vitrectomy has a higher rate of positive cultures than does aspiration, but it is not required for diagnosis [16]. According to Okada et al (1994), diagnosis is correctly made only 50% of the time and is delayed up to four days in 29% of patients [12].…”

Section: Discussionmentioning

confidence: 99%

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A Case of Invasive Pneumococcal Infection with Septic Shock and Rare Complications

Woytanowski

Hakim

Deering

et al. 2017

Case Reports in Critical Care

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Invasive pneumococcus is a serious illness with potentially devastating outcomes. A 64-year-old female with a medical history of psoriatic arthritis and diabetes was transferred from an outside hospital for ventilator dependent respiratory failure and altered mental status. She initially presented with worsening back pain and was found to have leukocytosis with bandemia and acute renal failure but she was in septic shock upon arrival to our tertiary care center. Her blood cultures grew Streptococcus pneumoniae and MRI of the brain revealed pus within the posterior lateral ventricles and multiple infarcts. MRI of the spine revealed a psoas abscess. Transesophageal echocardiogram revealed mitral valve vegetation and her right eye developed endogenous endophthalmitis. She was treated with intravenous and intravitreal antibiotics and underwent drainage of the abscess with no improvement in mental status. Repeat imaging revealed multiple new thalamic, basal ganglia, and parietal lobe infarcts likely from septic emboli. After a protracted ICU stay, the patient's family opted for comfort care. The incidence of invasive pneumococcal infections has declined rapidly since the advent of antibiotics and vaccines. With the growing incidence of antibiotic resistance as well as the emergence of new immunomodulating drugs for various pathologies, there is a concern that invasive infections will reemerge. Ventriculitis and endogenous endophthalmitis are very rare complications of pneumococcal bacteremia.

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Reduced Visual Acuity Following Kidney Stone Extraction

2016

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A man in his 60s presented with subacute vision loss in his right eye for the prior 3 weeks. His medical history was significant for diabetes without retinopathy and radial keratotomy in both eyes for moderate myopia. The patient had undergone 2 ureterorenoscopies over a 2-week period with laser fragmentation for nephrolithiasis. A ureteral stent was placed followed by systemic ciprofloxacin. The patient's urinary symptoms subsequently improved. In the ensuing days to weeks after these urologic procedures, the patient reported fever, weakness, and decreased appetite, which resolved spontaneously after several days but resulted in persistent weight loss of approximately 15 lb. Three months following this episode, visual symptoms developed.On examination, visual acuity was 20/400 OD and 20/20 OS. Intraocular pressure, pupils, visual fields, and ocular motility were normal. On slitlamp examination of the right eye, trace conjunctival hyperemia was present, the anterior chamber had occasional cells, the lens had mild nuclear/cortical cataract, and the anterior vitreous had 2+ cells. Dilated fundus examination of the right eye showed grade 2 vitreous haze, mild optic disc edema, scattered elevated white chorioretinal lesions-some with mild surrounding intraretinal and subretinal hemorrhage-and a prominent macular lesion (Figure 1). In the left eye, there were 3 small white chorioretinal lesions inferiorly and no other abnormalities.

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Endogenous endophthalmitis: diagnosis, management, and prognosis

Cited by 153 publications

References 94 publications

Endogenous bacterial endophthalmitis and subretinal abscess complicating diabetic ketoacidosis

Endogenous bacterial endophthalmitis and subretinal abscess complicating diabetic ketoacidosis

A Case of Invasive Pneumococcal Infection with Septic Shock and Rare Complications

Reduced Visual Acuity Following Kidney Stone Extraction

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