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Gram-Negative Endogenous Endophthalmitis: A Systematic Review. Microorganisms 2022; 11:microorganisms11010080. [PMID: 36677371 PMCID: PMC9860988 DOI: 10.3390/microorganisms11010080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/20/2022] [Accepted: 12/24/2022] [Indexed: 12/29/2022] Open
Abstract
Background: Gram-negative bacteria are causative agents of endogenous endophthalmitis (EBE). We aim to systematically review the current literature to assess the aetiologies, risk factors, and early ocular lesions in cases of Gram-negative EBE. Methods: All peer-reviewed articles between January 2002 and August 2022 regarding Gram-negative EBE were included. We conducted a literature search on PubMed and Cochrane Controlled Trials. Results: A total of 115 studies and 591 patients were included, prevalently Asian (98; 81.7%) and male (302; 62.9%). The most common comorbidity was diabetes (231; 55%). The main aetiologies were Klebsiella pneumoniae (510; 66.1%), Pseudomonas aeruginosa (111; 14.4%), and Escherichia coli (60; 7.8%). Liver abscesses (266; 54.5%) were the predominant source of infection. The most frequent ocular lesions were vitreal opacity (134; 49.6%) and hypopyon (95; 35.2%). Ceftriaxone (76; 30.9%), fluoroquinolones (14; 14.4%), and ceftazidime (213; 78.0%) were the most widely used as systemic, topical, and intravitreal anti-Gram-negative agents, respectively. The most reported surgical approaches were vitrectomy (130; 24.1%) and evisceration/exenteration (60; 11.1%). Frequently, visual acuity at discharge was no light perception (301; 55.2%). Conclusions: Gram-negative EBEs are associated with poor outcomes. Our systematic review is mainly based on case reports and case series with significant heterogeneity. The main strength is the large sample spanning over 20 years. Our findings underscore the importance of considering ocular involvement in Gram-negative infections.
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Ramamurthy S, Joseph J, Dave VP. Candida Albicans Sub-Retinal Abscess following COVID-19. Indian J Ophthalmol 2022; 70:3707-3709. [PMID: 36190078 PMCID: PMC9789817 DOI: 10.4103/ijo.ijo_1363_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 42-year-old male post-renal transplantation presented with sudden diminution of vision in the left eye. The right eye was lost following a failed vitreoretinal surgery 5 years ago. The patient had been hospitalized 4 months prior for coronavirus disease 2019 infection with a good recovery. The presenting visual acuity was 20/600 in the right eye and 20/250 in the left eye. Fundus examination revealed a sub-macular sub-retinal abscess in the left eye. Sub-retinal aspiration of the abscess revealed Candida albicans. The patient was managed with repeated intravitreal amphotericin B injections, following which the abscess resolved with scarring and vision improving to 20/60.
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Affiliation(s)
- Srishti Ramamurthy
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Anant Bajaj Retina Insitute, Kallam Anji Reddy Campus, L. V. Prasad Eye Institute, Hyderabad, Telangana, India,Correspondence to: Dr. Srishti Ramamurthy, Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Anant Bajaj Retina Insitute, Kallam Anji Reddy Campus, L. V. Prasad Eye Institute, Hyderabad, Telangana, India. E-mail:
| | - Joveeta Joseph
- Jhaveri Microbiology Center, Kallam Anji Reddy Campus, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Vivek Pravin Dave
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Anant Bajaj Retina Insitute, Kallam Anji Reddy Campus, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
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Gallo B, Testi I, Clare G, Pavesio C. Resolution of Isolated Subretinal Abscess with Systemic Antibiotic Treatment. Ocul Immunol Inflamm 2022; 31:861-864. [PMID: 35404746 DOI: 10.1080/09273948.2022.2054825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To describe clinical features and therapeutic management of a case of isolated subretinal abscess (SRA) in an immunocompetent male patient with no predisposing conditions or risk factors. METHODS Clinical data, including medical history, clinical findings and results of systemic investigations, were retrospectively collected in a 40-year-old man diagnosed with unilateral focal SRA. RESULTS Systemic investigations did not reveal any extraocular infective focus. Prompt diagnosis of SRA and aggressive systemic antibiotic treatment averted breakthrough into the vitreous cavity and led to clinical resolution with preservation of visual acuity. No local recurrences or distal spread of the infection were found at follow-up. CONCLUSIONS In isolated SRA, timely systemic antibiotic treatment can lead to an excellent clinical outcome. Close monitoring is essential to prevent potential progression of SRA to a sight-threatening endophthalmitis, which would prompt an urgent shift in the therapeutic approach.
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Affiliation(s)
| | - Ilaria Testi
- Uveitis Service, Moorfields Eye Hospital, London, UK
| | - Gerry Clare
- Uveitis Service, Moorfields Eye Hospital, London, UK
| | - Carlos Pavesio
- Uveitis Service, Moorfields Eye Hospital, London, UK
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK
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Cruzado-Sánchez D, Barrios-Borjas DA, Sapaico-Vicuña AR, Tellez WA, Holguín-Ruiz AM. Subretinal abscess due to Candida tropicalis in a patient with acute myeloid leukaemia: Case report. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:100-103. [PMID: 35152944 DOI: 10.1016/j.oftale.2020.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 12/15/2020] [Indexed: 06/14/2023]
Abstract
A 54-year-old female patient with a history of acute myeloid leukaemia and receiving maintenance chemotherapy had a systemic relapse. She also had candidaemia caused by Candida tropicalis. Her blood cultures were negative after receiving antifungal treatment. Later, she had an ophthalmological assessment as part of the protocol, without ocular discomfort. In the fundoscopic examination, a whitish chorioretinal lesion was found in the left eye in relation to subretinal abscess, which correlated with retinal angiography and optical coherence tomography. The patient was treated with systemic antifungals with a favourable resolution of the lesion.
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Affiliation(s)
- D Cruzado-Sánchez
- Servicio de Retina, Servicio de oncología ocular, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru.
| | - D A Barrios-Borjas
- Universidad Nacional San Luis Gonzaga de Ica, Sociedad Científica de Estudiantes de Medicina de Ica (SOCEMI), Ica, Peru
| | - A R Sapaico-Vicuña
- Universidad Peruana Cayetano Heredia, Hospital Nacional Arzobispo Loayza, Lima, Peru
| | - W A Tellez
- Sociedad Científica de Estudiantes de Medicina Villarrealinos (SOCEMVI), Universidad nacional Federico Villarreal, Lima, Peru
| | - A M Holguín-Ruiz
- Servicio de infectología, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru
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5
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Cao Y, Fan Y, Wang Y, Liu X, Xie W. Acute-on-chronic Liver Failure in a Patient with Candida Endophthalmitis: A Case Report. J Clin Transl Hepatol 2021; 9:447-451. [PMID: 34221931 PMCID: PMC8237134 DOI: 10.14218/jcth.2020.00092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/19/2021] [Accepted: 03/01/2021] [Indexed: 12/14/2022] Open
Abstract
Acute-on-chronic liver failure (ACLF) is a risk factor for fungal infection. Endogenous fungal endophthalmitis is a serious, sight-threatening disease. Common causes include immunocompromised state and intravenous drug use, permitting opportunistic pathogens to reach the eye through the blood stream. We report a case of Candida endophthalmitis in a 47 year-old woman who was admitted to our hospital with ACLF and poorly controlled diabetes. In addition, she was treated with glucocorticoids due to severe jaundice. After treatment for ACLF, the patient experienced fever with blurred vision in the left eye and was diagnosed with candidemia, endogenous Candida endophthalmitis in the left eye, and chorioretinitis in the right eye. Systemic and topical antifungal treatment was administered based on the positive Candida albicans test in intraocular fluid using second-generation sequencing. The patient underwent vitrectomy in the left eye and C. albicans was confirmed in vitreous cultures. Follow-up visit, at 6 weeks after the operation, showed only light perception in the left eye and stable visual acuity in the right eye. Physicians should be aware of endogenous fungal endophthalmitis in patients with ACLF, especially those with Candida infection, a history of glucocorticoid use, and diabetes. A dilated retinal examination should be performed by an ophthalmologist if ACLF patients develop fever and fungal infection.
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Affiliation(s)
- Ying Cao
- Center of Liver Diseases, Capital Medical University Affiliated to Beijing Ditan Hospital, Beijing, China
| | - Ying Fan
- Center of Liver Diseases, Capital Medical University Affiliated to Beijing Ditan Hospital, Beijing, China
| | - Yanbin Wang
- Center of Liver Diseases, Capital Medical University Affiliated to Beijing Ditan Hospital, Beijing, China
| | - Xiyao Liu
- Department of Ophthalmology, Capital Medical University Affiliated to Beijing Ditan Hospital, Beijing, China
| | - Wen Xie
- Center of Liver Diseases, Capital Medical University Affiliated to Beijing Ditan Hospital, Beijing, China
- Correspondence to: Wen Xie, Center of Liver Diseases, Capital Medical University Affiliated to Beijing Ditan Hospital, No. 8, Jingshun East Street, Chaoyang District, Beijing 100015, China. ORCID: https://orcid.org/0000-0002-7314-8175. Tel: +86-10-84322816, Fax: +86-10-84322818, E-mail:
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Cruzado-Sánchez D, Barrios-Borjas DA, Sapaico-Vicuña AR, Tellez WA, Holguín-Ruiz AM. Subretinal abscess due to Candida tropicalis in a patient with acute myeloid leukaemia: case report. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 97:S0365-6691(21)00027-7. [PMID: 33627240 DOI: 10.1016/j.oftal.2020.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
A 54-year-old female patient with a history of acute myeloid leukaemia and receiving maintenance chemotherapy had a systemic relapse. She also had candidaemia caused by Candida tropicalis. Her blood cultures were negative after receiving antifungal treatment. Later, she had an ophthalmological assessment as part of the protocol, without ocular discomfort. In the fundoscopic examination, a whitish chorioretinal lesion was found in the left eye in relation to subretinal abscess, which correlated with retinal angiography and optical coherence tomography. The patient was treated with systemic antifungals with a favourable resolution of the lesion.
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Affiliation(s)
- D Cruzado-Sánchez
- Servicio de Retina. Servicio de oncología ocular. Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Perú.
| | - D A Barrios-Borjas
- Universidad Nacional San Luis Gonzaga de Ica. Sociedad Científica de Estudiantes de Medicina de Ica (SOCEMI), Ica, Perú
| | - A R Sapaico-Vicuña
- Universidad Peruana Cayetano Heredia. Hospital Nacional Arzobispo Loayza, Lima, Perú
| | - W A Tellez
- Sociedad Científica de Estudiantes de Medicina Villarrealinos (SOCEMVI), Universidad nacional Federico Villarreal, Lima, Perú
| | - A M Holguín-Ruiz
- Servicio de infectología. Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Perú
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Yeşiltaş YS, Özcan G, Demirel S, Yalçındağ N. Culture-Proven Candida Albicans Endogenous Endophthalmitis in a Patient with Onychomycosis. Ocul Immunol Inflamm 2019; 28:178-181. [PMID: 30794483 DOI: 10.1080/09273948.2019.1568503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To report a case of Candida albicans endogenous endophthalmitis in an immunocompetent patient with onychomycosis.Methods: Retrospective case report.Results: A 40-year-old man with onychomycosis presented with C. albicans subretinal abscess in the left eye. Systemic and intravitreal injections did not prevent further progression of the infection. The patient underwent pars plana vitrectomy. One month after surgery, the intraocular inflammation gradually subsided. However, his visual acuity stayed at counting fingers as a result of macular scarring.Conclusion: The aim of this case presentation is to emphasize that endogenous fungal endophthalmitis can be seen in an immunocompetent patient. The use of systemic steroids in the past was the main reason for the progression of the disease in this case. In these situations, when the clinical findings suggest a fungal etiology, it should keep in mind that endogenous candida endophthalmitis can be a result of fungal infections from distant sites such as the toenails and systemic steroids should not be started before definite diagnosis.
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Affiliation(s)
- Yağmur Seda Yeşiltaş
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Gökçen Özcan
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Sibel Demirel
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Nilüfer Yalçındağ
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
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Xu H, Fu B, Lu C, Xu L, Sun J. Successful treatment of endogenous endophthalmitis with extensive subretinal abscess: a case report. BMC Ophthalmol 2018; 18:238. [PMID: 30185150 PMCID: PMC6125994 DOI: 10.1186/s12886-018-0908-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/28/2018] [Indexed: 11/17/2022] Open
Abstract
Background Endogenous endophthalmitis could lead to a devastating outcome without a prompt and appropriate management. We report a case of advanced endogenous Klebsiella pneumoniae endophthalmitis with extensive subretinal abscess that was successfully treated with a vitrectomy. Case presentation A systemically well 61-year-old man complained of ocular pain and visual decrease in his right eye for eighteen days. Ophthalmic examination showed dense inflammation in the anterior chamber and vitreous body. Systemic investigations discovered diabetes and no specific site of systemic infection was found after hospitalization. The inflammation continued to worsen after the intravitreal antibiotic injection. Therefore, a pars plana vitrectomy combined with phacoemulsification was performed. Intraoperatively, a white elevated, fluffy mass with the overlying retinal whitening and necrosis was revealed in superior periphery. In addition to this, extensive retinal hemorrhages and five adjacent subretinal whitish masses with exudative retinal detachment were observed in the posterior pole and inferior quadrants, which were suggestive of extensive subretinal abscess with intense overlying retinal inflammation. The excision of white fluffy mass superiorly was performed without retinotomy and aspiration of extensive subretinal abscess. The polymerase chain reaction of vitreous samples was positive for Klebsiella pneumonia. Intravitreal 2 mg/0.1 ml ceftazidime were repeated. Nine days after the surgery, the inflammation significantly subsided and the retina reattached. The patient was in a stable condition at subsequent visit eight months later. Conclusion The delay in an accurate diagnosis and treatment caused extensive subretinal abscess combined with endogenous endophthalmitis. The treatment modality of subretinal abscess is typically individualized to the patient’s presentation. If the retina overlying the abscess is not necrotic, the extensive subretinal abscess can quickly absorbed after vitrectomy, retinotomy with aspiration of the abscess should be avoided to decrease the risk of retinal detachment.
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Affiliation(s)
- He Xu
- Department of Ophthalmology, The 4th People's Hospital of Shenyang, Shenyang, Liaoning, People's Republic of China
| | - Bo Fu
- Department of Ophthalmology, The 4th People's Hospital of Shenyang, Shenyang, Liaoning, People's Republic of China
| | - Chunguang Lu
- Department of Ophthalmology, The 4th People's Hospital of Shenyang, Shenyang, Liaoning, People's Republic of China
| | - Li Xu
- Department of Ophthalmology, The 4th People's Hospital of Shenyang, Shenyang, Liaoning, People's Republic of China
| | - Jing Sun
- Departments of Gastroenterology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China.
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Zafar S, Siddiqui MAR. Sub-retinal abscess as presenting feature of endogenous Candida endophthalmitis. BMC Res Notes 2018; 11:598. [PMID: 30119688 PMCID: PMC6098582 DOI: 10.1186/s13104-018-3682-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 08/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sub-retinal abscess as the presenting feature in the setting of endogenous fungal endophthalmitis is extremely infrequent. Immunodeficiency states are major predisposing risk factors. To the best of our knowledge, this is the first case report of Candida sub-retinal abscess as initial presentation in an immunocompetent patient. CASE PRESENTATION A 32-year old, generally fit and well, female presented to us with gradually deteriorating vision in her right eye. Visual acuity was counting fingers in the right eye and, 20/30 in the left eye. Right eye fundus examination showed a full thickness, yellowish-white foveal lesion, and significant vitreous haze. Left eye examination was normal. Upon direct questioning, the patient disclosed history of backstreet abortion 3 weeks prior to the onset of her ocular symptoms. She underwent vitreous tap and intravitreal antibiotics (amphotericin B, 5 μg/0.5 ml). Vitreous culture showed profuse growth of Candida albicans. Because her condition was progressively deteriorating, she underwent 25 g vitrectomy plus repeat intravitreal amphotericin B under general anaesthesia. Three weeks post-vitrectomy, vitreous inflammation resolved completely, and the sub-retinal abscess healed with a macular scar formation. Over a follow-up of 4 years, no recurrences were observed. CONCLUSION Our case highlights the importance of considering Candida albicans infection in the differential diagnosis of sub-retinal abscesses. Although immunocompromised states are traditionally identified as predisposing factors for fungal infections, fungal endogenous endophthalmitis can occur in healthy individuals as well.
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Affiliation(s)
- Sidra Zafar
- Section of Ophthalmology, Aga Khan University Hospital, Stadium Road Karachi, Karachi, Pakistan.
| | - M A Rehman Siddiqui
- Section of Ophthalmology, Aga Khan University Hospital, Stadium Road Karachi, Karachi, Pakistan.,Section of Ophthalmology, South City Hospital, Karachi, Pakistan
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Abstract
PURPOSE To report on a case of Fusarium solani subretinal abscess in a patient with acute myeloid leukemia treated with an allogenic bone marrow transplant. METHODS A 47-year-old male with a history of acute myeloid leukemia with intermediate cytogenetic risk was admitted in our hospital. The disease relapsed after two cycles of chemotherapy. He was then treated with an allogenic bone marrow transplant, with busulfan, cyclophosphamide, and thymoglobulin. One week after the procedure, a sepsis of unknown origin in neutropenia occurred. Blood cultures and sputum were negative for bacteria and fungi. At the eighth week after the procedure, the patient had acute vision loss of the right eye. Funduscopy in the right eye revealed an inferior temporal yellowish white elevated lesion of approximately 10 disk areas and superficial perifoveal and perilesional hemorrhages. RESULTS Vitrectomy was performed and samples from the vitreous and the subretinal abscess material were sent for analysis. Vitreous and subretinal specimens grew colonies of a fungus morphologically consistent with F. solani. CONCLUSION Fusarium solani should be included in the differential diagnosis of subretinal abscesses.
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11
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Diagnostic and Therapeutic Challenges. Retina 2018; 39:1424-1429. [PMID: 29746404 DOI: 10.1097/iae.0000000000002189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dutta Majumder P, Biswas J, Bansal N, Ghose A, Sharma H. Clinical Profile of Patients with Tubercular Subretinal Abscess in a Tertiary Eye Care Center in Southern India. Ocul Immunol Inflamm 2016; 26:353-357. [PMID: 27437721 DOI: 10.1080/09273948.2016.1199709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To retrospectively analyze clinical features, laboratory investigations, treatment and visual outcomes in patients with tubercular subretinal abscess. METHODS A total of 12 eyes of 12 patients receiving a diagnosis of subretinal abscess, between 2004 and 2014, were included for this retrospective study. RESULTS The mean age of the presentation was 29.75 ± 16.72 years (range: 14-62 years) and seven (58.3%) were male. The most common anterior segment presentation was anterior uveitis (75%). The mean BCVA at presentation was 1.62 (in logMAR). A tuberculin skin test was positive in seven patients (58.3%) and five patients had a history of pulmonary tuberculosis. Polymerase chain reaction for the Mycobacterium tuberculosis genome was positive in 6 of 11 eyes from aqueous aspirate (54%) and 4 of 7 eyes from vitreous aspirates (57.14%). All patients were started on systemic steroids and an anti-tubercular regimen. The mean duration of follow-up was 134.28 days. The mean BCVA at final presentation was 1.19 (in logMAR). Chorioretinal scar was the most common finding after resolution. CONCLUSIONS Subretinal abscess is a rare manifestation of ocular tuberculosis. A high degree of suspicion and timely management of the condition can prevent loss of vision.
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Affiliation(s)
- Parthopratim Dutta Majumder
- a Medical and Vision Research Foundations, Sankara Nethralaya , Sankara Nethralaya , Chennai , Tamil Nadu , India
| | - Jyotirmay Biswas
- a Medical and Vision Research Foundations, Sankara Nethralaya , Sankara Nethralaya , Chennai , Tamil Nadu , India
| | - Nishat Bansal
- a Medical and Vision Research Foundations, Sankara Nethralaya , Sankara Nethralaya , Chennai , Tamil Nadu , India
| | - Avirupa Ghose
- a Medical and Vision Research Foundations, Sankara Nethralaya , Sankara Nethralaya , Chennai , Tamil Nadu , India
| | - Hitesh Sharma
- a Medical and Vision Research Foundations, Sankara Nethralaya , Sankara Nethralaya , Chennai , Tamil Nadu , India
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Siu GDJY, Lo ECF, Young A. Endogenous endophthalmitis with a visual acuity of 6/6. BMJ Case Rep 2015; 2015:bcr-2014-205048. [PMID: 25786816 DOI: 10.1136/bcr-2014-205048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 43-year-old man suffering from Klebsiella liver abscess and bacteraemia presented with left eye visual disturbance a few days after admission. His visual acuity was 6/6. There was a whitish subretinal mass located at the temporal periphery without vitritis. His visual acuity dropped to 6/120 with marked vitritis 1 day later and a diagnosis of a subretinal abscess was made. The vitreous cultures were negative. Response was suboptimal with intravitreal antibiotics, and retinotomy, vitrectomy, antibiotic irrigation and silicone oil tamponade were required. His vision gradually improved to 6/60 with silicone oil in situ. This case illustrates the rare presentation of a subretinal abscess in endogenous endophthalmitis with no initial associated vitritis, and the importance of maintaining a high level of suspicion despite good visual acuity on presentation in cases with relevant history. Early detection and intervention, and close monitoring may salvage the patient's vision in such cases.
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Affiliation(s)
| | | | - Alvin Young
- The Chinese University of Hong Kong, Shatin, Hong Kong
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14
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Arai Y, Sato Y, Yoshida A, Kawashima H, Kaburaki T, Gomi H. Bilateral endogenous Candida albicans subretinal abscess with suspected mixed bacterial infection. Clin Ophthalmol 2014; 8:2151-4. [PMID: 25378901 PMCID: PMC4213137 DOI: 10.2147/opth.s70289] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose Candida albicans subretinal abscess is extremely rare. To our knowledge, only one unilateral case has been reported. Herein, we report one bilateral case. Mixed bacterial infection was also suspected based on broad-range real-time polymerase chain reaction. Methods A 64-year-old man being treated with oral corticosteroids for interstitial pneumonia visited us for visual loss in the left eye. Best corrected visual acuity (BCVA) was 20/20 in the right eye and 8/200 in the left eye. Funduscopy revealed round yellowish-white subretinal lesions with retinal hemorrhage in both eyes. Results Broad-range polymerase chain reaction of the vitreous fluid from the left eye showed a high copy count of bacterial 16s ribosome RNA. Despite large doses of antibiotics, the abscess expanded and vision decreased to light perception in the left eye. Exenteration of the left eye was performed followed by microscopic examination showing Gram-negative bacilli, and C. albicans was also cultured. Antibiotics and the maximum doses of antifungal drugs were administered. However, the abscess in the right eye expanded, and BCVA decreased to 2/200. Vitrectomy and silicone oil tamponade were performed. Vitreous fluid culture revealed C. albicans. At 16 months follow-up, BCVA was stable at 4/200 with healing of the subretinal abscess under silicone oil. Conclusion Since C. albicans subretinal abscess is extremely rare and there was a concurrent mixed bacterial infection, diagnostic procedures in our bilateral case were more complicated than usual. C. albicans infection should be included in the differential diagnosis of subretinal abscesses.
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Affiliation(s)
- Yusuke Arai
- Department of Ophthalmology, Jichi Medical University, Tochigi, Japan
| | - Yukihiro Sato
- Department of Ophthalmology, Jichi Medical University, Tochigi, Japan
| | - Atsushi Yoshida
- Department of Ophthalmology, Jichi Medical University, Tochigi, Japan
| | | | - Toshikatsu Kaburaki
- Department of Ophthalmology, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | - Harumi Gomi
- Center for Clinical Infectious Diseases, Jichi Medical University, Tochigi, Japan
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15
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Matthews BJ, Partridge D, Sheard RM, Rennie IG, Mudhar HS. A unique case of phaeohyphomycosis subretinal abscess in a patient with arthropathy and lung pathology. Indian J Ophthalmol 2014; 61:763-5. [PMID: 24413827 PMCID: PMC3917400 DOI: 10.4103/0301-4738.124773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 67-year-old former gold miner with rheumatoid arthritis, treated with steroids and methotrexate, presented to eye casualty with a painful right eye. Examination revealed an anterior uveitis and despite an initial response to topical steroids, the intraocular inflammation worsened with anterior and posterior uveitis development. Re-examination showed a white mass in the peripheral nasal retina initially suspected of being active Toxoplasmosis infection and anti-toxoplasmosis treatment commenced. After improvement and tapering of this treatment, the intraocular inflammation reoccurred. Cytopathological examination of a pars plana vitrectomy obtained vitreous sample that showed a non-diagnostic non-infectious chronic vitritis. The vitreoretinal surgeons elected to do a direct biopsy of the white subretinal mass in the peripheral nasal area. This revealed, quite unexpectedly, an abscess containing pigmented phaeohyphomycosis fungi. This case report documents the multidisciplinary approach that assisted in clinching a final diagnosis and the role of sub-retinal biopsy in this unprecedented scenario.
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Affiliation(s)
| | | | | | | | - Hardeep Singh Mudhar
- National Specialist Ophthalmic Pathology Laboratory (NSOPS), Histopathology Department, E-Floor, Royal Hallamshire Hospital, Sheffield S10 2JF, Sheffield, United Kingdom
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17
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Abstract
Visual loss in infectious posterior uveitis or panuveitis can occur if proper therapy is delayed because of diagnostic uncertainty. Some disorders, such as acute retinal necrosis and bacterial endophthalmitis, can be rapidly progressive, and therefore require prompt and accurate diagnosis to guide initial therapy. Other more slowly evolving infections, such as toxoplasmic chorioretinitis or fungal endophthalmitis, can be worsened by empiric use of corticosteroids without specific antimicrobial coverage. Key ocular diagnostic features are helpful but highly variable with overlap with both non-infectious uveitis and neoplastic masquerades, even for key signs such as hypopyon. Close examination of the fundus with attention to color, location, size, border, and opacity of lesions and associated arteriolitis or frosted branch angiitis is helpful in the diagnosis of chorioretinitis. Ultrasonography is an important tool in the evaluation of eyes with suspected endophthalmitis, especially those with intracapsular infection or focal infected deposits. Testing of intraocular fluid can be extremely useful but suffers from inaccessibility, poor sensitivity, and test selections dependent on a presumptive diagnosis, which may be wrong. The dilemma for clinician is to make the correct diagnosis of a rare, blinding, variegated disease quickly enough to intercede with specific therapy or to apply empiric therapy in a sufficiently skilled manner to avert disaster and confirm the diagnosis by response to treatment. When non-infectious uveitis is in the differential, empiric corticosteroids must sometimes be used, at great risk, if clinical examination, ancillary testing, and any available intraocular diagnostic tests have failed to confirm a diagnosis.
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Affiliation(s)
- J L Davis
- University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Miami, FL 33136, USA.
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