Nontuberculous mycobacterial endophthalmitis: case series and review of literature

Abstract

Background To report three cases of nontuberculous mycobacterial (NTM) endophthalmitis following multiple ocular surgeries and to review previous literature in order to study the clinical profile, treatment modalities, and visual outcomes among patients with NTM endophthalmitis. Methods Clinical manifestation and management of patients with NTM endophthalmitis in the Department of Ophthalmology, Faculty of Medicine, Siriraj hospital, Mahidol University, Bangkok, Thailand were described. In addition, a review of previously reported cases and case series from MEDLINE, EMBASE, and CENTRAL was performed. The clinical information and type of NTM from the previous studies and our cases were summarized. Results We reported three cases of NTM endophthalmitis caused by M. haemophilum, M. fortuitum and M. abscessus and a summarized review of 112 additional cases previously published. Of 115 patients, there were 101 exogenous endophthalmitis (87.8%) and 14 endogenous endophthalmitis (12.2%). The patients’ age ranged from 13 to 89 years with mean of 60.5 ± 17.7 years with no gender predominance. Exogenous endophthalmitis occurred in both healthy and immunocompromised hosts, mainly caused by cataract surgery (67.3%). In contrast, almost all endogenous endophthalmitis patients were immunocompromised. Among all patients, previous history of tuberculosis infection was identified in 4 cases (3.5%). Rapid growing NTMs were responsible for exogenous endophthalmitis, while endogenous endophthalmitis were commonly caused by slow growers. Treatment regimens consisted of macrolides, fluoroquinolones or aminoglycosides, which were continued for up to 12 months. Initial and final vision were generally worse than 6/60. Conclusions NTM endophthalmitis is a serious intraocular infection that leads to irreversible loss of vision. The presentation can mimic a chronic recurrent or persistent intraocular inflammation. History of multiple intraocular surgeries or immune-deficiency in patient with chronic panuveitis should raise the practioner’s suspicion of NTM endophthalmitis. Appropriate diagnosis and treatment are important to optimize visual outcome.

Ocular infections associated with atypical mycobacteria: A review

“…[ 42 43 ] Since its first report in 1973, endophthalmitis due to NTM has been increasingly reported because of awareness about this possibility, increase in immunocompromised hosts, and improved microbiologic testing. [ 44 ]…”

“…Nodule formation composed of epithelioid cells/histiocytes showing granulomatous inflammation has been reported. [ 44 68 ]…”

Omadacycline for management of Mycobacterium abscessus infections: a review of its effectiveness, place in therapy, and considerations for use

“…Related subspecies including M. massiliense and M. bolletii, together with M. abscessus, make up the Mycobacterium abscessus complex (MABC). MABC can cause a variety of human diseases including pulmonary [3][4][5][6][7], skin and skin structure infections (SSSI) [8][9][10][11], central nervous system [12][13][14][15], ocular [16][17][18][19][20][21], and disseminated infections [22][23][24][25]. Disseminated disease most commonly affects patients that are immunocompromised or have underlying comorbidities [26].…”