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

Abstract

Purpose: To study the clinical and microbiological profile, treatment modalities, and anatomical and functional outcomes among children and adolescents with endogenous endophthalmitis (EE) at a tertiary eye care centre in India. Methods: Medical records of subjects <18 years, presenting with EE from 1997 to 2007 were reviewed. Cases where the causative organism was identified were included. Treatment regimen included systemic antibiotics, vitrectomy, intravitreal antibiotics, and enucleation. Systemic evaluation to identify the source of infection was done by an internist. Microbiological analysis of blood, urine, and ocular specimens was done. The favorable anatomical outcome was defined as the attached retina, with controlled intraocular pressure and clear media at the last follow up. The favorable functional outcome was defined as vision >3/60 on the final follow up. Univariate regression analysis was done to identify factors predicting functional outcome. Results: Thirty eyes of 30 subjects (23 (77%) males) were studied. The mean age at presentation was 6.8 years (range=1–16 years). Fever was evident in four (13%) and blood culture was negative in all cases. Gram-positive organisms were identified in 11 (37%) eyes, fungi in 3 (10%), and toxocara in 8 (27%) eyes. Twenty-three (77%) eyes underwent vitrectomy. Favorable functional and anatomical outcomes were achieved in 9 (30%) and 12 (40%) eyes, respectively. Eyes undergoing vitrectomy showed significant correlation with good functional outcome ( P = 0.05). Conclusion: EE is under-reported and not well studied in children. The absence of systemic features may be evident in a developing country with over the counter availability of antibiotics. Gram-positive infections are common and vitrectomy is a beneficial modality of treatment.

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

“…Our study found that fungi accounted for half of the isolated organisms in endogenous endophthalmitis, similar to other studies in predominantly adult populations in China and the USA [28,29]. However, fungal infection was reported in 14.2-40% of pediatric endogenous endophthalmitis patients in India, although the sample size was small [6,20]. The higher rate of fungal infection in our study may be related to the small number of cases and geographic differences.…”

A 14-Year Retrospective Analysis of Endogenous Endophthalmitis in a Tertiary Referral Center of Southern Thailand

“…Vitrectomy can mechanically remove infecting bacteria, toxins, cytokines, inflammatory cells, and membranes. Excellent visual outcomes following vitrectomy have previously been reported, especially in cases of fungal endogenous endophthalmitis [ 4 , 13 , 14 , 16 ]. However, many critically ill patients in this study were contraindicated for surgery due to multiple comorbidities, and 41.4% of eyes received at least one injection prior to the vitrectomy or evisceration/enucleation.…”

“…It is a rare, but sight-threatening, condition characterized by severe inflammation of the intraocular spaces. This condition is usually caused by hematogenous spread of organisms from a distant source through the blood-ocular barrier; it is associated with underlying factors such as diabetes mellitus, indwelling catheters, malnourishment, immunocompromised hosts, and intravenous drug abuse [ 1 – 4 ]. Clinical course of the condition is typically acute with rapid progression, requiring prompt diagnosis and management to preserve acceptable vision.…”

“…A positive blood culture was reported in 37.1%–94% of patients with endogenous endophthalmitis, whereas a positive intraocular culture was reported in 22.3%–58% [ 1 – 3 , 6 , 7 ]. However, in a series of endophthalmitis cases in children, the number of positive blood cultures was as low as zero [ 4 ].…”

“…The mainstay of treatment for most patients usually involves the administration of both intraocular and systemic antibiotics [ 1 , 2 , 4 ]. Favorable outcomes can be achieved by early intravitreal and systemic antibiotics only without routine vitrectomy [ 8 ].…”