Clinical profile and outcomes of pediatric endogenous endophthalmitis: A report of 11 cases from South India

Abstract

AIMTo study the clinical profile and outcomes of pediatric endogenous endophthalmitis from a tertiary eye hospital in South India.METHODSA total of 13 eyes of 11 children presented to us with varied symptoms and presentations of endogenous endophthalmitis, over a five-year period from January 2010 to December 2015 were studied. Except for two eyes of a patient, vitreous aspirates were cultured from all 11 eyes to isolate the causative organism. These eleven eyes also received intravitreal injections. All patients were treated with systemic antibiotics.RESULTSTwo cases had bilateral endophthalmitis. Ages ranged from 4 d to 11 years. Five cases were undiagnosed and treated, before being referred to our center. Ten of the 13 eyes underwent a core vitrectomy. The vitrectomy was done at an average on the second day after presenting (range 0-20 d). Five of the 11 vitreous aspirates showed isolates. The incriminating organisms were bacteria in three and fungus in two. An underlying predisposing factor was found in seven patients. At a mean follow-up 21.5 mo, outcome was good in 7 eyes of 6 cases (54%), five eyes of four cases (38%) ended up with phthisis bulbi while one child died of systemic complications.CONCLUSIONEndogenous endophthalmitis is a challenge for ophthalmologists. Early diagnosis and intervention is the key for a better outcome.

Endogenous endophthalmitis in children and adolescents: Case series and literature review

“…[27] Organisms reported to be commonly causing endophthalmitis in children are Pseudomonas aeruginosa, Neisseria meningitides , and Gram-positive bacteria. [817] Although in our series, Gram-negative organisms were not the most frequent cause, among the Gram-negative bacteria, both pseudomonas and E. coli contributed equally. An interesting observation in our series was the presence of uncommon less virulent organisms causing endophthalmitis like Alkaligenes spp, Staphylococcus epidermidis, Moraxella , and Micrococci .…”

“…While the clinical features are of help in identifying patients with EE, the most commonly reported misdiagnosis in children is retinoblastoma. [171819]…”

“…Previous studies have investigated various factors which could affect the visual outcome. These included delay in diagnosis,[1734] use of inappropriate antibiotics,[34] diffuse infection of the vitreous and retina, or panophthalmitis,[8] infection with virulent organisms, and Gram-negative infection. [10]…”

Etiology, microbiological isolates, and antibiotic susceptibilities in culture-proven pediatric endophthalmitis: a 9-year review

“…The incidence is estimated at 2.8-54.2% in the pediatric age group with ocular trauma, which varies by country [3][4][5]. Children endogenous endophthalmitis is rare; it constitutes only 0.1-4% of all cases of endogenous endophthalmitis [6]. Although the clinical features and microbiological profile of pediatric endophthalmitis are different from those of adult endophthalmitis [3,7], few studies have focused on the pediatric form.…”

“…Recent reports on pediatric endophthalmitis mostly focused on endophthalmitis due to a specific etiology such as pediatric cataract surgery [ 8 ], trauma [ 3 , 9 ], and endogenous infection [ 6 ] or focused on a specific type of endophthalmitis caused by a certain pathogen [ 10 ]. Only a few studies focused on pediatric endophthalmitis from all causes.…”