Panophthalmitis caused by Streptococcus dysgalactiae subsp. equisimilis: A case report and literature review.

Lancefield group G ß-hemolytic Streptococcus dysgalactiae subspecies equisimilis (SDSE) has become a leading causative pathogen of invasive streptococcal infection. In this report, we describe a case of disseminated SDSE infection complicated by endogenous endophthalmitis, resulting in panophthalmitis and blindness. A 65-year-old man who underwent mitral valve replacement surgery two months previously was hospitalized due to high fever and right visual loss. A systemic investigation revealed endophthalmitis complicated by mediastinal abscess, prosthetic infective endocarditis, cerebral emboli and hemorrhage, and multiple arthritis. The patient underwent various surgeries, including vitrectomy, mediastinal lavage, mitral valve replacements, joint lavages, as well as an intensive antibiotic treatment. His general condition gradually improved, but the ocular infection developed to panophthalmitis, which ultimately required ophthalmectomy. A literature review regarding Group G-associated endogenous endophthalmitis suggested that the disease occurs in elderly people, is frequently complicated with endocarditis, and yields poor visual prognosis regardless of appropriate antibiotic treatment and surgical therapies. In this aging society, invasive infections with SDSE should be much more recognized among medical practitioners in order to improve patient prognosis.

Endogenous Klebsiella panophthalmitis: atypical presentation.

Endogenous endophthalmitis caused by K. pneumoniae was considered to be a rare cause of endogenous endophthalmitis. Most of the patients had prior medical conditions, and diabetes is the most common underlying condition. Patients with a K. pneumoniae liver abscess are at risk of developing endogenous Klebsiella pneumoniae endophthalmitis (EKE). Clinical manifestation of K. pneumoniae endophthalmitis are unique with posterior chamber becomes full of pus while anterior segment seem quiet. The authors presented a case of extremely rare presentation of endogenous bacterial endophthalmitis, who presented with choroidal mass. After receiving pars plana vitrectomy and intravitreal antibiotic injection, clinical condition improved. Despite aggressive treatment, the final visual outcome was generally poor.

Suprachoroidal septic effusion leading to panophthalmitis following strabismus surgery.

We describe a case of endophthalmitis following strabismus surgery. Drainage of the suprachoroidal effusion with injection of antibiotics was unsuccessful in salvaging vision. Endophthalmitis following strabismus surgery may present with findings simulating a choroidal effusion or hemorrhage. Treating physicians should be alert to signs and symptoms of this severe complication of strabismus surgery in preverbal children.

Panophthalmitis due to clostridium septicum.

PURPOSE: To describe patient survival in a rare case of endogenous Clostridium septicum sepsis with panophthalmitis. DESIGN: Observational case report. METHODS: Both eyes of a female patient were examined in a hospital setting. RESULTS: A 68-year-old woman had right orbital pain, proptosis, panophthalmitis, mental confusion and fever for 2 days. Blood cultures were significant for Clostridium septicum. The patient did not improve after treatment with intravenous broad-spectrum antibiotics and the right eye was enucleated. The patient survived the acute infection and extensive systemic evaluation revealed an undiagnosed colon carcinoma that may have been responsible for colonization and vascular dissemination of Clostridium septicum. CONCLUSIONS: Clostridium septicum panophthalmitis and sepsis can be the presenting sign in patients with unsuspected malignancies, particularly colon cancer. Patients can survive the infection with aggressive therapy with systemic antibiotics combined with removal of the infected tissue.

[Case of anaerobic infection in penetrating injury of the eye]. / Sluchai anaérobnoi infektsii pri pronikaiushchem ranenii glaza.

A patient with penetrating wound of the eye is described, whose wound has been contaminated with anaerobic infection. Clinical picture of anaerobic panophthalmitis has been rather typical, with the infection penetrating into soft tissues of the orbit. Evisceration of the eyeball was performed. Multiple-modality treatment was carried out. The infectious process has not progressed beyond the orbit. The diagnosis has been confirmed bacteriologically.

Endogenous Bacillus cereus panophthalmitis.

Over the past seven years we have treated three cases of drug abusers in whom endogenous Bacillus cereus endophthalmitis rapidly progressed to panophthalmitis. Ocular features of infection with this organism include severe pain, chemosis, proptosis, corneal infiltration and ring abscess, subretinal exudation, retinal hemorrhages, and perivasculitis. The process becomes fulminant in an explosive manner and may be accompanied by fever and leukocytosis. Ophthalmologists should be cognizant of the apparent susceptibility of drug abusers to Bacillus cereus infections and should consider this organism in any severe, rapidly evolving intraocular infectious process.

Metastatic bacterial endophthalmitis: a contemporary reappraisal.

Metastatic bacterial endophthalmitis remains a challenge to the clinician despite the success of antibiotics in reducing its frequency and severity. Controversy currently surrounds the management of this condition because of uncertainty about the value of and indications for vitreous surgery. We review 72 cases of metastatic endophthalmitis from the past decade, including five not previously published. The spectrum of causative bacteria changed significantly during this period, with displacement of meningococcus by Bacillus cereus as the most frequently reported agent and an increasing incidence of infection by organisms of low pathogenicity in immunologically compromised hosts. We propose a new classification scheme for metastatic endophthalmitis based on the location (anterior or posterior segment) and extent (focal or diffuse) of the primary intraocular infection. Focal and anterior cases appear to have a good prognosis, while posterior diffuse disease nearly always leads to blindness. Our analysis of outcomes suggests that systemic antibiotics are more valuable in metastatic than in postoperative or traumatic endophthalmitis and that intraocular antibiotic injection and vitrectomy make only a limited contribution to successful treatment in metastatic infection. We recommend a clinical approach to metastatic endophthalmitis that minimizes exposure of patients to the risks of invasive procedures.

[Pneumococcal postoperative endophthalmitis]. / Endophtalmies post-opératoires à pneumocoques.

Three cases of pneumococcal endophthalmitis proven by paracentesis and direct bacteriologic evaluation were studied. Cultures were positive for pneumococcus in two the three cases. The fulminant course, and poor visual outcome emphasize the urgency of proper diagnosis by microscopic identification, and of intra-vitreal of injection of antibiotics sometimes associated with vitrectomy. Subconjunctival gentamicin commonly used in ophthalmologic surgery as prophylactic treatment, is often not effective against pneumococcus. It seems advisable to associate subconjunctival chloramphenicol with the gentamicin to help prevent this bacterial infection.

Bacterial endophthalmitis following cutting of sutures after cataract surgery.

Bacterial endophthalmitis developed in four patients after cataract surgery sutures were cut. Wound dehiscence was present in three cases, but in one the wound remained intact. Vitreous cultures identified Streptococcus viridans in two cases and Staphylococcus aureus and St. epidermidis in one case each. Antibiotic therapy was administered by intraocular, periocular, topical and systemic routes and three patients underwent vitrectomy. Visual function recovered to 20/50 in two cases and to 20/100 in a third. Retinal detachment in the fourth case resulted in loss of all visual function.

Bilateral metastatic endophthalmitis.

A case of bilateral metastatic endophthalmitis secondary to Staphylococcus aureus urinary tract infection is presented. Systemic antibiotic therapy was used to treat the bilateral and endophthalmitis. Anterior chamber and vitreous aspirations as well as later enucleation of the fellow eye confirmed the diagnosis of S. aureus endophthalmitis. The case is most unusual in that the patient developed a rhegmatogenous retinal detachment in one of the involved eyes. The detachment was successfully repaired, and the patient has maintained useful visual acuity.

[Gas gangrene panophthalmitis (author's transl)]. / Panophthalmie durch Gasbranderreger

Gas gangrene panophthalmitis is a rare condition of penetrating injury to the globe. The infecting organism is usually Clostridium perfringens. Characteristic symptoms are a brawny swelling of the lids, marked chemosis, coffee-coloured discharge, hypopyon, ring abscess of the cornea, formation of gas bubbles in the anterior chamber, rise of intraocular tension and early amaurosis. Treatment consists in the evisceration or enucleation of the globe, rarely in the exenteration of the orbit. Antibiotics along (Penicillin, Tetracyclines) are insufficient. Administration of antiserum is almost completely abandoned, it is probably more dangerous than helpful. The use of hyperbaric oxygen is not indicated in cases of gas gangrene panophthalmitis. Extraocular extension of the infection and its danger for the individual is prevented by well-times surgical procedure.