ro13-9904 and Endophthalmitis

A 68-year-old Japanese man was admitted to our hospital with right eye pain, a sudden worsening of his eyesight, and a fever. He was diagnosed with endogenous bacterial endophthalmitis due to infectious endocarditis (IE) of Group B Streptococcus (GBS) on the day of admission. He recovered systemically, but his right eye became phthisical only with the administration of antibiotics. We conducted a review of the reported cases of IE caused by GBS complicated with endogenous bacterial endophthalmitis. IE should be considered when an undetermined etiology of endogenous endophthalmitis is encountered. The prompt diagnosis and treatment of IE will improve patients' outcomes.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Early Diagnosis; Endocarditis, Bacterial; Endophthalmitis; Eye Infections, Bacterial; Humans; Male; Streptococcal Infections; Streptococcus agalactiae; Treatment Outcome; Vancomycin

Endophthalmitis due to gram-negative bacilli has been associated with a high degree of vision loss. We report three cases due to the nonenteric gram-negative bacilli Moraxella nonliquefaciens, Haemophilus paraphrophilus, and multidrug-resistant Haemophilus influenzae. The features of these cases are compared with those of other reported cases of endophthalmitis due to unusual nonenteric gram-negative bacilli. Fifty-eight percent of patients had no vision in the affected eye after treatment. Early surgical intervention with vitrectomy and intravitreous antibiotics in addition to parenteral antibiotics should be included in the treatment of endophthalmitis due to gram-negative bacilli.

Topics: Actinobacillus Infections; Adult; Aged; Aggregatibacter actinomycetemcomitans; Ampicillin; Ceftriaxone; Endophthalmitis; Female; Gentamicins; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Middle Aged; Moraxella; Neisseriaceae Infections; Postoperative Complications; Vitrectomy

We prospectively analysed a total of 21 baby-mother pairs with culture-proven Neisseria gonorrhoeae treated with a single low dose of ceftriaxone, namely 62.5 mg for babies and 125 mg for mothers respectively. N. gonorrhoeae was eradicated from all babies' eyes with no residual damage, as well as from the mothers' cervixes. A single low dose of 62.5 mg ceftriaxone has emerged as the treatment of choice for gonococcal ophthalmia neonatorum because of its excellent activity against N. gonorrhocae, including penicillinase-producing strains.

Topics: Adult; Ceftriaxone; Cephalosporins; Cervix Uteri; Endophthalmitis; Eye; Female; Gonorrhea; Humans; Infant, Newborn; National Health Programs; Neisseria gonorrhoeae; Prospective Studies; Rectum; Sexually Transmitted Diseases; South Africa; Urethra

Syphilis is a sexually transmitted disease. All organs might be affected, but ocular syphilis occurs only in 0.6 percent of patients. A resurgence of syphilis cases has been observed for several years in many countries, especially in HIV-infected subjects. These patients often present with concomitant primary and secondary lesions or extensive presentations of syphilis.. We report 2 patients with syphilitic uveitis diagnosed and treated at the department of infectious diseases at the University hospital of Marrakech. Ocular involvement was inaugural in both HIV patients. Each had a specific treatment, but none had a complete recovery of visual function; the first patient was treated by ceftriaxone and the second one was treated by penicillin.. Syphilis must be discussed in all patients diagnosed with uveitis or papillitis. The diagnosis should be suspected in cases of eye inflammation even in the absence of favourable clinical presentation or anamnesis. Search for HIV co-infection should be systematic. Although not evidence-based, prompt therapy may lead to functional recovery. Ceftriaxone could be a suitable alternative to penicillin in the treatment of early syphilis in HIV-infected patients. This treatment has a concomitant effectiveness even for asymptomatic forms of neurosyphilis. Ocular syphilis is a form of neurosyphilis and requires neurosyphilis therapy regardless of when it develops after primary infection.Conventional syphilis staging is of little use in understanding ocular syphilis. Co-infection between HIV and ocular syphilis is common, but does not affect response to a neurosyphilis regimen of penicillin in the short term.

Topics: Ceftriaxone; Coinfection; Endophthalmitis; Eye Infections, Bacterial; HIV Infections; Humans; Morocco; Neurosyphilis; Penicillins; Syphilis; Uveitis

Streptococcus pneumoniae endophthalmitis is clinically more severe, more difficult to treat, and carry a higher risk of vision loss, evisceration, or enucleation. This study is to investigate the clinical settings, antibiotic susceptibility, and visual outcomes of S. pneumoniae endophthalmitis at a tertiary referral center in Taiwan. S. pneumoniae endophthalmitis was diagnosed in 38 eyes of 38 patients. The main clinical features were postcataract endophthalmitis (n = 13, 34%) and endophthalmitis associated with corneal ulcer (n = 12, 32%), trauma (n = 6, 16%), endogenous etiology (n = 4, 11%), trabeculectomy (n = 2, 5%), and pterygium excision-related scleral ulcer (n = 1, 3%). Presenting visual acuity ranged from counting fingers to no light perception. Pars plana vitrectomy with intravitreal antibiotics was performed in 17 eyes (39%) in primary or secondary treatments. S. pneumoniae isolates were susceptible to vancomycin (38/38, 100%), penicillin (37/38, 97%), ceftriaxone (37/38, 97%), cefuroxime (12/15, 80%), levofloxacin (13/15 ,87%), and moxifloxacin (15/17, 88%). Final visual acuity was better than 20/400 in 3 of 38 eyes (8%), 5/200 to hand motions in 3 eyes (8%), and light perception to no light perception in 32 eyes (84%). Ten eyes (26%) underwent evisceration or enucleation. Although S. pneumoniae isolates were susceptible to vancomycin, S. pneumoniae endophthalmitis had a very poor visual prognosis.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Cataract; Cataract Extraction; Ceftriaxone; Cefuroxime; Corneal Ulcer; Endophthalmitis; Eye Enucleation; Eye Injuries; Female; Humans; Levofloxacin; Male; Microbial Sensitivity Tests; Middle Aged; Moxifloxacin; Penicillins; Pneumococcal Infections; Retrospective Studies; Severity of Illness Index; Streptococcus pneumoniae; Taiwan; Tertiary Care Centers; Trabeculectomy; Treatment Outcome; Vancomycin; Vitrectomy

Ocular involvement in

Topics: Administration, Oral; Adult; Anti-Bacterial Agents; Ceftriaxone; Chorioretinitis; Doxycycline; Endophthalmitis; Eye Infections; Female; HIV Infections; Humans; Injections, Intravenous; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

A 70-year-old man presented with acute wrist pain concerning for septic arthritis. Shortly thereafter, he developed acute monocular vision loss and was diagnosed with endogenous endophthalmitis. Subsequent imaging revealed numerous visceral abscesses and a mycotic abdominal aortic aneurysm. Cultures, in conjunction with the clinical syndrome, were strongly suggestive of hypervirulent

Topics: Administration, Intravenous; Aged; Arthritis, Infectious; Ceftriaxone; Diagnosis, Differential; Endophthalmitis; Humans; Klebsiella Infections; Klebsiella pneumoniae; Liver Abscess; Male; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Cornea; Endophthalmitis; Exophthalmos; Eyelids; Gentamicins; Humans; Intracranial Hemorrhages; Male; Serratia Infections; Serratia marcescens; Tomography, X-Ray Computed; Unconsciousness

Topics: Anti-Bacterial Agents; Arthritis; Ceftriaxone; Endocarditis; Endophthalmitis; Epididymitis; Humans; Male; Middle Aged; Myositis; Orchitis; Whipple Disease

Endophthalmitis is a feared complication of pyogenic liver abscesses caused by hypervirulent Klebsiella pneumoniae strains. First described in East Asia in the 1980s, this invasive syndrome is only recently emerging in Europe and America.. We describe an 84-year-old man who presented to the emergency department with fever, orbital cellulitis, and bilateral visual loss. Although the patient had no overt abdominal symptoms, computed tomography scan revealed a pyogenic liver abscess. Blood cultures were positive for K. pneumoniae. Initial treatment consisted of intravenous ceftriaxone and intravitreal ceftazidime. A unilateral vitrectomy was performed. The patient survived with severe visual sequelae. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: K. pneumoniae pyogenic liver abscess with metastatic endophthalmitis is a relatively new syndrome that should be considered in patients presenting with acute vision loss who appear septic, with or without abdominal complaints. Early recognition prohibits delays in lifesaving treatment.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Emergency Service, Hospital; Endophthalmitis; Fever; Humans; Klebsiella Infections; Klebsiella pneumoniae; Liver Abscess, Pyogenic; Male; Vision Disorders

A 67-year-old man was transported to our hospital and diagnosed with pneumococcal meningitis. We immediately administered ceftriaxone and vancomycin according to the guidelines, but did not administer dexamethasone to him because he had been previously administered antibiotics. His left eye became complicated by endogenous endophthalmitis on the next day, which resulted in blindness, although his meningitis rapidly ameliorated. In comparison to other patients who have been reported to recover from complications with endophthalmitis after the combination therapy of antibiotics, corticosteroids and vitreous surgery, we consider that this patient's poor visual outcome may have been caused by severe inflammation or the breakdown of the blood ocular barrier due to the action of S. pneumoniae. Corticosteroids may be able to successfully treat such inflammation or disruption of the blood ocular barrier.

Topics: Aged; Anti-Bacterial Agents; Blindness; Blood-Retinal Barrier; Ceftriaxone; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Bacterial; Humans; Male; Meningitis, Pneumococcal; Streptococcus pneumoniae; Vancomycin

Klebsiella pneumoniae liver abscess has a tendency to spread to distant sites early in the course of disease and to involve multiple organs synchronously. A 59-year-old male was admitted because of liver abscess accompanied by fever and abdominal pain. The patient underwent percutaneous catheter drainage and received intravenous antibiotics. Symptom relief was achieved after the treatment as well as marked reduction in the size of the abscess. Despite proper treatment of the liver abscess, however, patient developed multiple metastatic infections in a non-concurrent manner: left and right endophthalmitis, psoas abscess, and infectious spondylitis at 5, 23, 30 and 65 days after initial manifestations of liver abscess, respectively. Each infectious episode followed one another after resolution of the former one. For each episode of metastatic infections, the patient promptly underwent treatment with systemic and local antibiotics, interventional abscess drainage, and surgical treatments as needed. The patient fully recovered without sequelae after the use of intravenous antibiotics for an extended period of time. Herein, we report a case of K. pneumoniae liver abscess complicated with delayed-onset multiple metastatic infections.

Topics: Anti-Bacterial Agents; Ceftriaxone; Drainage; Endophthalmitis; Humans; Injections, Intravenous; Klebsiella Infections; Klebsiella pneumoniae; Liver Abscess; Male; Middle Aged; Psoas Abscess; Spondylitis; Tomography, X-Ray Computed

Topics: Abscess; Alkylating Agents; Anti-Bacterial Agents; Ceftriaxone; Collagen; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Bacterial; Glaucoma, Open-Angle; Glycosaminoglycans; Humans; Male; Mitomycin; Prostheses and Implants; Scleral Diseases; Staphylococcal Infections; Trabeculectomy; Vancomycin; Young Adult

Endogenous endophthalmitis is a rare complication of pyogenic liver abscess. It is a devastating intraocular infection which constitutes a vision-threatening emergency. Recently, a significant increase in the incidence of endogenous endophthalmitis associated with pyogenic liver abscess has been reported in East Asia. In this study, the authors investigated the incidence, risk factors, clinical features, and treatment outcomes of endogenous endophthalmitis arising as a complication of pyogenic liver abscess.. The medical records of 8 cases of endogenous endophthalmitis associated with a pyogenic liver abscess treated from 1997 to 2013 at a single tertiary hospital in Korea were retrospectively reviewed.. Median patient age was 71.1 ± 9.8 years. The most common underlying disease was diabetes mellitus (4 patients, 50%). Klebsiella pneumoniae was isolated from all patients, and all were treated with intravenous antibiotics including ceftriaxone. Seven patients received an intravitreal injection. Four patients needed additional surgical interventions. Outcomes were generally poor; only 1 patient achieved a slight improvement in visual outcome.. Old age, diabetes mellitus, and K. pneumoniae infection could predispose the development of endogenous endophthalmitis in patients with a pyogenic liver abscess. Physicians should pay attention to ocular symptoms as early diagnosis and intensive treatment are required to achieve improvements in visual outcome.

Topics: Age Factors; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Diabetes Complications; Endophthalmitis; Female; Humans; Imipenem; Incidence; Klebsiella Infections; Klebsiella pneumoniae; Liver Abscess, Pyogenic; Male; Middle Aged; Risk Factors; Treatment Outcome

Topics: Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Bacterial; Frontal Lobe; Humans; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Metronidazole; Middle Aged; Streptococcal Infections; Streptococcus constellatus; Visual Acuity; Vitrectomy

Topics: Anti-Infective Agents; Aortic Valve; Aortic Valve Insufficiency; Aza Compounds; Blindness; Ceftriaxone; Cough; Echocardiography, Transesophageal; Endophthalmitis; Fever; Fluoroquinolones; Hearing Loss, Sensorineural; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Moxifloxacin; Pneumococcal Infections; Quinolines; Streptococcus pneumoniae; Vancomycin; Vision Disorders

To study risk factors, clinical features, treatment, and visual outcomes in patients with endogenous Klebsiella pneumoniae endophthalmitis (EKE) associated with K. pneumoniae-induced pyogenic liver abscess, and to investigate contributing factors in successfully treated cases.. Retrospective, noncomparative, interventional case series.. Review of medical records of 22 consecutive patients with EKE and pyogenic liver abscess.. The affected eyes of 22 consecutive patients (n = 27) with EKE, who presented to our ophthalmic service during a recent 8-year period, were studied retrospectively.. Best-corrected visual acuity (VA) at end of follow up.. Diabetes mellitus was the most common comorbid risk factor (n = 15 [68%]). Five patients (23%) had bilateral eye involvement. On initial presentation, characteristic pupillary hypopyon was observed in 12 eyes. Diagnosis was confirmed by blood culture in 8 patients, culture of liver aspirate in 17 patients, and vitreous culture in 11 patients. Other associated septic metastatic lesions included pulmonary abscess or emboli in 6 cases, brain abscess or meningitis in 3 cases, and prostate and kidney abscesses in 1 case. Despite aggressive intravenous and intravitreal antibiotic therapy, final VA of light perception or worse affected 24 eyes (89%), of which 11 (41%) were eventually eviscerated or enucleated. Successful treatment with retained useful vision better than 6/60 was achieved in 3 eyes, of which 2 received early intravitreal corticosteroid injections. However, the other remaining eye had a focal subretinal abscess.. Physicians should be alert to the development of EKE when patients with diabetes along with K. pneumoniae-induced pyogenic liver abscess complain of ocular symptoms. In the majority of patients with EKE associated with pyogenic liver abscess, visual outcome is generally poor despite aggressive antibiotic therapy. Early diagnosis and prompt intervention with intravitreal antibiotics within 48 hours may salvage useful vision in some patients with EKE.

Topics: Adult; Aged; Aminoglycosides; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Diabetes Complications; Drug Therapy, Combination; Endophthalmitis; Eye Enucleation; Eye Infections, Bacterial; Female; Follow-Up Studies; Gallstones; Humans; Klebsiella Infections; Klebsiella pneumoniae; Liver Abscess, Pyogenic; Male; Middle Aged; Retrospective Studies; Risk Factors; Visual Acuity

Endogenous endophthalmitis is a potentially blinding condition that occurs after the spread of organisms to the eye from a focus of infection elsewhere in the body. The holmium laser has gained increasing acceptance as being safe and effective for endoscopic lithotripsy. We report what we believe to be the first time endogenous endophthalmitis has been described as occurring after holmium laser lithotripsy, although it has been reported after extracorporeal shock wave lithotripsy. This 55-year-old woman developed infections in both eyes 2 to 3 weeks after the lithotripsy, with a good response to appropriate antibiotic treatment.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacteremia; Ceftazidime; Ceftriaxone; Cephalexin; Drug Therapy, Combination; Endophthalmitis; Female; Gentamicins; Holmium; Humans; Lithotripsy, Laser; Middle Aged; Pseudomonas Infections; Ureteral Calculi; Urinary Tract Infections; Vancomycin

We report the case of an elderly woman presenting with group G streptococcal septicaemia associated with osteomyelitis and endophthalmitis.

Topics: Administration, Topical; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Blindness; Ceftriaxone; Chloramphenicol; Clindamycin; Dexamethasone; Endophthalmitis; Eye Enucleation; Female; Humans; Injections, Intravenous; Metatarsal Bones; Ofloxacin; Osteomyelitis; Streptococcal Infections; Streptococcus; Treatment Outcome

Topics: Abscess; Anti-Bacterial Agents; beta-Lactamases; Ceftazidime; Ceftriaxone; Drug Therapy, Combination; Endophthalmitis; Female; Humans; Middle Aged; Moraxella; Moraxellaceae Infections; Retinal Diseases; Vancomycin; Vitreous Body

Ocular manifestations of Lyme borreliose present with unusual forms of conjunctivitis, keratitis, optic nerve disease, uveitis, vitritis and rarely endophthalmitis.. A 57-year-old man working as logger in Sax-ony-Anhalt suffering from an endophthalmitis on his left eye was referred to us. The vision of his left eye was intact light perception and hand motions. The slit-lamp examination revealed severe inflammation of the anterior chamber with hypopyon, posterior synechiae, and opacity of the posterior lens capsule. Funduscopy showed no red reflex, no retinal details. In the local hospital serum analysis was performed and showed in Western-Blot IgM- and IgG-antibodies against Borrelia burgdorferi. Despite of intravenous application of ceftriaxon for 14 days panuveitis persisted, and endophthalmitis developed when antibiotic therapy was finished.. During pars plana vitrectomy a sharply delineated cystic lesion containing yellowish fluid was revealed, and creamy yellow fluid was aspirated. Microscopically in hematoxylineosin stained slides of the aspirate structures consistent with Borrelia burgdorferi were found. Postoperatively vision increased to 1/15. Despite of a second intravenous ceftriaxon treatment for 14 days we observed a retinal vasculitis in the follow up of 6 months.. Despite intravenous ceftriaxon-therapy borrelia burgdorferi must have survived in the vitreous body. Further investigations are required with respect to the use of other antibiotics or immunosuppressives.

Topics: Borrelia burgdorferi Group; Ceftriaxone; Combined Modality Therapy; Endophthalmitis; Humans; Lyme Disease; Male; Middle Aged; Occupational Diseases; Treatment Failure; Vitrectomy

Pharmacologic considerations suggest that third-generation cephalosporins might penetrate the vitreous humor better after periocular injection and might be eliminated less readily after intravitreous injection than older agents. We studied the sodium salts of ceftizoxime, ceftriaxone, and ceftazidime, and of an investigational cephalosporin, cefepime, in rabbits. After a single subconjunctival injection in animals with normal eyes, vitreous levels ranged from 3 to 13 mg/L. After five subconjunctival injections in rabbits with infected eyes, vitreous concentrations ranged from 12 to 34 mg/L. These concentrations are not appreciably greater than those found with older beta-lactams. The vitreous half-life of the four drugs after intravitreous injection varied from 5.7 to 20 hours in rabbits with uninflamed eyes and from 9.4 to 21.5 hours in rabbits with infected eyes. Except for ceftizoxime, the half-lives were substantially longer than those for older beta-lactams and suggest predominantly anterior route elimination. Vitreous penetration of these new agents after subconjunctival injection does not appear to be sufficient to overcome the need for intravitreous injections in the treatment of endophthalmitis. However, the longer vitreous half-lives of some of the newer agents may be useful if the drugs are to be given intravitreally.

Topics: Animals; Cefepime; Ceftazidime; Ceftizoxime; Ceftriaxone; Cephalosporins; Colony Count, Microbial; Conjunctiva; Disease Models, Animal; Endophthalmitis; Eye Infections, Bacterial; Half-Life; Rabbits; Staphylococcal Infections; Vitreous Body

Topics: Ceftriaxone; Endophthalmitis; Eye Infections, Bacterial; Gonorrhea; Humans; Neisseria gonorrhoeae; Penicillin Resistance

Four patients from Caribbean and Central American countries with ocular disease and serologic evidence of Lyme borreliosis are discussed. To our knowledge this is the first report of Lyme disease from this geographic area. Two patients exhibited ocular inflammatory disease, and two patients developed optic neuropathy. A brief discussion of Lyme borreliosis, its serologic diagnosis, and its treatment is presented.

Topics: Adult; Aged; Borrelia Infections; Ceftriaxone; Child; Endophthalmitis; Eye Diseases; Humans; Intraocular Pressure; Lyme Disease; Male; Middle Aged; Optic Nerve Diseases; Penicillins; Tetracycline; Visual Acuity; West Indies

Endophthalmitis is a well-recognized complication of intraocular surgery, penetrating ocular trauma and systemic infection. Metastatic bacterial endophthalmitis is rare. However, once it happens, the visual outcome is very poor. In order to prevent visual damage, early diagnosis and treatment is essential. Due to the blood-ocular barrier, intravitreal drug concentrations are low after systemic administration. Strong antibiotics with good penetration into the vitrous humor are needed to obtain adequate bactericidal concentrations. We report two cases with liver abscess complicated by septic events to the eye. One was uveitis, and the other was endophthalmitis. They were diagnosed early and were successfully treated with parenteral ceftriaxone and good vision was preserved.

Topics: Adult; Ceftriaxone; Endophthalmitis; Enterobacteriaceae Infections; Fluorescein Angiography; Humans; Klebsiella Infections; Liver Abscess; Male; Middle Aged; Sepsis; Sulfamethoxazole; Trimethoprim; Ultrasonography; Uveitis; Visual Acuity

Aeromonas hydrophila as the etiologic agent of endophthalmitis is rare, having only been reported in association with a perforating injury of the eye. We describe a case of isolated spontaneous, endogenous endophthalmitis due to this agent, with no apparent source.

Topics: Aeromonas; Bacterial Infections; Ceftriaxone; Endophthalmitis; Humans; Male; Middle Aged

Topics: beta-Lactamases; Ceftriaxone; Doxycycline; Drug Resistance, Microbial; Endophthalmitis; Female; Gonorrhea; Humans; Infant, Newborn; Information Systems; Neisseria gonorrhoeae; Pelvic Inflammatory Disease; Population Surveillance; Tetracycline; United States