Chronic postoperative endophthalmitis caused by Actinomyces neuii

Abstract

Uneventful phacoemulsification with implantation of a foldable, acrylic posterior chamber intraocular lens was performed in the right eye of a 73-year-old white man. Postoperatively, the patient developed a chronic, low-grade intraocular inflammation. Cultures from the aqueous specimen grew Actinomyces neuii, an unusual gram-positive bacillus. The low-grade intraocular inflammation persisted with intensive topical steroid-antibiotic medication and systemic antibiotics. A diagnostic, 3-port, pars plana vitrectomy was performed, and aqueous aspirate specimens were sent for culture and sensitivity and to look for abnormal cells. Intracameral antibiotics were not injected. The specimens were sterile to culture, and chronic inflammatory cells were reported on the vitreous specimen. On examination 6 months later, inflammation had not recurred and the best corrected visual acuity was 6/18.

Actinomyces and Related Organisms in Human Infections

“…Of these, the most common infection is postoperative endophthalmitis after an ocular procedure, where A. neuii (164)(165)(166), A. meyeri (167), and "A. viscosus" (168) have been detected, while in cases of endogenous endophthalmitis, which is far less common, A. neuii (169) and A. israelii (170) have been detected. A. israelii has also been isolated from cases of postoperative keratitis (171) and primary infections of the lacrimal duct, i.e., canaliculitis (172)(173)(174).…”

Soft Tissue Infections Caused by Actinomyces neuii , a Rare Pathogen

“…It also appears in patients with diabetic foot osteomyelitis (14), genitourinary infections (8,13), bloodstream infections and native valve endocarditis (3,8), pericarditis (12), and biomaterial infections (1,9,15,16,18). Treatment consists of surgical debridement.…”

Actinomyces neuii: review of an unusual infectious agent

“…Endophthalmitis Endophthalmitis following phacoemulsification and lens implantation has been reported in three publications [25][26][27], although more isolates of A. neuii from eyes have been recorded without details [5,8]. Intraocular, topical, and systemic application of antibiotics led to successful outcomes in two cases [26,27], while one patient developed a central vein occlusion [25].…”