Endogenous Endophthalmitis in the Developing World

Abstract

Endophthalmitis is a rare but potentially devastating intraocular infection that can result from exogenous spread after intraocular surgery, a complication of ocular trauma or from an adjacent ocular interface. A less common form of endophthalmitis; endogenous endophthalmitis is caused by the hematogenous spread of organisms from a remote infectious site to the eye, resulting in severe visual loss. Several large series estimate that endogenous endophthalmitis accounts for 2% to 15% of all cases of endophthalmitis. 1 The possible range of infectious agents is broad and includes Grampositive bacteria, Gram-negative bacteria, and fungi. However, there is considerable variation in the frequency of these pathogens between different geographic areas. Earlier published series of patients with endogenous endophthalmitis have reported the most common bacterial organism as Staphylococcus aureus and the most common fungal organism as Candida species. 2 Endogenous endophthalmitis has been associated with many systemic risk factors, including chronic immune-compromising illnesses (diabetes mellitus, renal failure), indwelling or long-term intravenous catheters, immunosuppressive diseases and therapy [malignancies, www.internat-ophthalmology.com | 173

Endogenous Endophthalmitis Associated With Intravenous Drug Abuse

“…This is especially relevant in this subset, as C. albicans is the most common causative agent in patients with EE. 10,11 Initiation of steroids for presumed inflammatory posterior segment inflammation in a nonsurgical eye can worsen the course.…”

Blood–Retinal Barrier Compromise and EndogenousStaphylococcus aureusEndophthalmitis

“…Endogenous bacterial endophthalmitis is a potentially blinding disease that is linked to a number of underlying conditions, with diabetes ranking as one of the primary risk factors for contracting EBE. 1,[4][5][6][7] During the progression of diabetes, changes in the vascular architecture occur that result in the breakdown and increased permeability of the BRB. We hypothesized that compromise of the blood-retinal barrier created a favorable environment for blood-borne pathogens to enter the eye.…”

“…3 Currently, diabetes mellitus ranks among the leading predisposing diseases for EBE and is associated with 33% of cases. 1,[4][5][6][7] Staphylococcus aureus accounts for nearly 10% of EBE cases worldwide 1 and is the leading cause of EBE in the Western hemisphere and Europe, comprising approximately 25% of these cases. [1][2][3] In the United States, approximately 40% of EBE cases are associated with endocarditis, which is usually caused by S. aureus.…”

Endogenous Endophthalmitis in the Korean Population

“…[4][5][6][7][8] Because of a longer life span of patients with chronic diseases and a rising prevalence of long-term intravenous access, endophthalmitis may become more common in clinical practice. 9 Previous reported East Asian cases were from the 1990s to the early 2000s. 2,4,8 Klebsiella pneumoniae is a leading causative organism of endogenous endophthalmitis in East Asia.…”