Endogenous endophthalmitis: Difference between revisions
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Endogenous endophthalmitis is commonly associated with [[immunosuppression]] or procedures that increase the risk for blood-borne infections, such as [[diabetes]], [[HIV]], [[malignancy]], [[intravenous drug use]], [[transplantation]], [[immunosuppressive therapy]], and [[catheterization]]. | Endogenous endophthalmitis is commonly associated with [[immunosuppression]] or procedures that increase the risk for blood-borne infections, such as [[diabetes]], [[HIV]], [[malignancy]], [[intravenous drug use]], [[transplantation]], [[immunosuppressive therapy]], and [[catheterization]]. | ||
Under normal circumstances, the [[blood-ocular barrier]] provides a natural resistance against invading organisms. | Under normal circumstances, the [[blood-ocular barrier]] provides a natural resistance against invading organisms. | ||
Following [[bacteremia]] | Following [[bacteremia]] or [[fungemia]]. The blood-borne organisms permeate the [[blood-ocular barrier]] by:<ref name="pmid23438028">{{cite journal| author=Durand ML| title=Endophthalmitis. | journal=Clin Microbiol Infect | year= 2013 | volume= 19 | issue= 3 | pages= 227-34 | pmid=23438028 | doi=10.1111/1469-0691.12118 | pmc=3638360 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23438028 }} </ref><ref name="pmid20390032">{{cite journal| author=Kernt M, Kampik A| title=Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives. | journal=Clin Ophthalmol | year= 2010 | volume= 4 | issue= | pages= 121-35 | pmid=20390032 | doi= | pmc=2850824 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20390032 }} </ref><ref name="pmid10919895">{{cite journal| author=Wong JS, Chan TK, Lee HM, Chee SP| title=Endogenous bacterial endophthalmitis: an east Asian experience and a reappraisal of a severe ocular affliction. | journal=Ophthalmology | year= 2000 | volume= 107 | issue= 8 | pages= 1483-91 | pmid=10919895 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10919895 }} </ref> | ||
*Direct invasion ([[septic emboli]]) | *Direct invasion ([[septic emboli]] reaches the eye through the posterior segment vasculature) | ||
*Direct spread from contagious sites (in cases of [[central nervous systemcentral nervous system CNS]] infection via the [[optic nerve]]) | |||
*Change in vascular endothelium (caused by [[inflammatory mediators]] released during infection) | *Change in vascular endothelium (caused by [[inflammatory mediators]] released during infection) | ||
====Gross Pathology==== | ====Gross Pathology==== | ||
| Line 46: | Line 47: | ||
Common risk factors in the development of endogenous bacterial endophthalmitis include:<ref name="pmid23438028">{{cite journal| author=Durand ML| title=Endophthalmitis. | journal=Clin Microbiol Infect | year= 2013 | volume= 19 | issue= 3 | pages= 227-34 | pmid=23438028 | doi=10.1111/1469-0691.12118 | pmc=3638360 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23438028 }} </ref><ref name="pmid20390032">{{cite journal| author=Kernt M, Kampik A| title=Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives. | journal=Clin Ophthalmol | year= 2010 | volume= 4 | issue= | pages= 121-35 | pmid=20390032 | doi= | pmc=2850824 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20390032 }} </ref><ref name="pmid10919895">{{cite journal| author=Wong JS, Chan TK, Lee HM, Chee SP| title=Endogenous bacterial endophthalmitis: an east Asian experience and a reappraisal of a severe ocular affliction. | journal=Ophthalmology | year= 2000 | volume= 107 | issue= 8 | pages= 1483-91 | pmid=10919895 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10919895 }} </ref> | Common risk factors in the development of endogenous bacterial endophthalmitis include:<ref name="pmid23438028">{{cite journal| author=Durand ML| title=Endophthalmitis. | journal=Clin Microbiol Infect | year= 2013 | volume= 19 | issue= 3 | pages= 227-34 | pmid=23438028 | doi=10.1111/1469-0691.12118 | pmc=3638360 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23438028 }} </ref><ref name="pmid20390032">{{cite journal| author=Kernt M, Kampik A| title=Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives. | journal=Clin Ophthalmol | year= 2010 | volume= 4 | issue= | pages= 121-35 | pmid=20390032 | doi= | pmc=2850824 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20390032 }} </ref><ref name="pmid10919895">{{cite journal| author=Wong JS, Chan TK, Lee HM, Chee SP| title=Endogenous bacterial endophthalmitis: an east Asian experience and a reappraisal of a severe ocular affliction. | journal=Ophthalmology | year= 2000 | volume= 107 | issue= 8 | pages= 1483-91 | pmid=10919895 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10919895 }} </ref> | ||
*Recent hospitalization | *Recent hospitalization | ||
*[[Immunosuppression]] | *[[Immunosuppression]] | ||
*[[Diabetes mellitus]] | *[[Diabetes mellitus]] | ||
| Line 54: | Line 55: | ||
*[[Catheterization]] | *[[Catheterization]] | ||
*Long-term use of [[broad-spectrum antibiotics]] or [[immunosuppressive drugs]] | *Long-term use of [[broad-spectrum antibiotics]] or [[immunosuppressive drugs]] | ||
*[[Liver | *[[Liver abscess]] | ||
*[[Infective endocarditis|[Infective endocarditis (IE)]] | *[[Infective endocarditis|[Infective endocarditis (IE)]] | ||
===Endogenous fungal endophthalmitis=== | ===Endogenous fungal endophthalmitis=== | ||
Revision as of 19:28, 1 August 2016
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]
Overview
Endogenous endophthalmitis (EE) also termed metastatic endophthalmitis, is caused by the hematologic dissemination of bacterial or fungal infection to the eyes. Most common extraocular foci of infection include liver abscess, pneumonia, endocarditis, and soft tissue infection. Endogenous endophthalmitis is less common than exogenous endophthalmitis and has been reported to account for 2–8%.
Historical Perspective
Classification
endogenous enophthalmitis may be classified according to causative organisms into 2 subtypes: bacterial or fungal.
Pathophysiology
Pathogenesis
Endogenous endophthalmitis is caused by the hematologic dissemination of an infection to the eyes. Most common extraocular foci of infection include liver abscess, pneumonia, endocarditis, and soft tissue infection. Endogenous endophthalmitis is commonly associated with immunosuppression or procedures that increase the risk for blood-borne infections, such as diabetes, HIV, malignancy, intravenous drug use, transplantation, immunosuppressive therapy, and catheterization. Under normal circumstances, the blood-ocular barrier provides a natural resistance against invading organisms. Following bacteremia or fungemia. The blood-borne organisms permeate the blood-ocular barrier by:[1][2][3]
- Direct invasion (septic emboli reaches the eye through the posterior segment vasculature)
- Direct spread from contagious sites (in cases of central nervous systemcentral nervous system CNS infection via the optic nerve)
- Change in vascular endothelium (caused by inflammatory mediators released during infection)
Gross Pathology
On gross pathology, findings in endogenous endophthalmitis may be similar to those in infections of exogenous origin.
Microscopic histopathological analysis
On microscopic histopathological analysis, infiltration of polymorphonuclear leukocytes or chronic inflammatory cells (depending on the duration of the inflammation) and destruction of ocular structures are characteristic findings of bacterial endophthalmitis.
Causes
Common causes of endogenous endophthalmitis include:[1][2][3]
Bacterial
- Gram-positive bacteria
- Streptococcus pneumoniae
- Staphylococcus aureus
- Bacillus cereus (primary bacterial cause in intravenous drug abusers)
- Gram-negative bacteria
- Neisseria meningitidis (pre-antibiotic era)
- Escherichia coli
- Klebsiella (in the Asian population with liver abscess)
Fungal
Differentiating endogenous Endophthalmitis from Other Diseases
Epidemiology and Demographics
Risk Factors
Endogenous bacterial endophthalmitis
Common risk factors in the development of endogenous bacterial endophthalmitis include:[1][2][3]
- Recent hospitalization
- Immunosuppression
- Diabetes mellitus
- Urinary tract infection
- Immunosuppression (associated with underlying malignancy, neutropenia, and HIV)
- Intravenous drug use
- Catheterization
- Long-term use of broad-spectrum antibiotics or immunosuppressive drugs
- Liver abscess
- [Infective endocarditis (IE)
Endogenous fungal endophthalmitis
Common risk factors in the development of endogenous fungal endophthalmitis include:
- Chemotherapy
- Organ transplantation (cardiac and liver transplants)
- Immunosuppressive therapy for hematopoietic stem cell transplantation (HSCT)
- Lung involvement by Aspergillus
Screening
Natural History, Complications, and Prognosis
Natural History
Complications
Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Imaging Findings
X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Prevention
References
- ↑ 1.0 1.1 1.2 Durand ML (2013). "Endophthalmitis". Clin Microbiol Infect. 19 (3): 227–34. doi:10.1111/1469-0691.12118. PMC 3638360. PMID 23438028.
- ↑ 2.0 2.1 2.2 Kernt M, Kampik A (2010). "Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives". Clin Ophthalmol. 4: 121–35. PMC 2850824. PMID 20390032.
- ↑ 3.0 3.1 3.2 Wong JS, Chan TK, Lee HM, Chee SP (2000). "Endogenous bacterial endophthalmitis: an east Asian experience and a reappraisal of a severe ocular affliction". Ophthalmology. 107 (8): 1483–91. PMID 10919895.