Elsevier

Ophthalmology

Volume 109, Issue 10, October 2002, Pages 1879-1886
Ophthalmology

Group B Streptococcus endogenous endophthalmitis: Case reports and review of the literature

https://doi.org/10.1016/S0161-6420(02)01225-3Get rights and content

Abstract

Purpose

To report five cases of group B Streptococcus endogenous endophthalmitis (GBSEE) and to review the literature.

Design

Retrospective, noncomparative, interventional case series and literature review.

Patients

All patients with this condition treated at the Singapore National Eye Centre from 1994 through 2001.

Interventions

Core or complete vitrectomy and intravitreal and systemic antibiotics.

Methods

A review of the systemic and ocular characteristics and treatment.

Main outcome measure

Visual outcome.

Results

Group B Streptococcus endogenous endophthalmitis developed in four patients after the onset of septic arthritis and in one patient with cervical epidural abscess after acupuncture, presenting as a diffuse endophthalmitis. Group B Streptococcus was isolated in the blood, vitreous, and joints. Despite the use of high-dose intravenous antibiotics within 72 hours of ocular presentation, intravitreal antibiotic injection, and vitrectomy (two eyes), all eyes lost light perception and became phthisical. A survey of the literature revealed that GBSEE is rare and that 17 cases have been reported since 1985. For purposes of analysis, four of these cases were excluded because of inadequate details and our five cases were included. Group B Streptococcus endogenous endophthalmitis was found to arise from hematogenous spread from cutaneous sites of infection (16.7%), pharyngitis (11.1%), and pneumonia (11.1%). Septic arthritis (38.9%) and endocarditis (33.3%) were concomitant sites of infection along with endophthalmitis. The septic arthritis typically involved multiple joints. Four patients (22.2%) had diabetes mellitus and three had other underlying predisposing illness. Although most patients received intravenous (83.3%) and intravitreal (55.6%) antibiotics and four eyes underwent therapeutic vitrectomy, useful vision was preserved in only four eyes. Two patients died of sepsis.

Conclusions

Group B Streptococcus endogenous endophthalmitis is a devastating condition often associated with septic arthritis. The visual prognosis is poor, despite therapy.

Section snippets

Materials and methods

We reviewed the records of all patients seen at the Singapore National Eye Centre with a diagnosis of GBSEE between January 1994 and September 2001. The ocular and systemic characteristics, treatment, and final outcome of cases with GBSEE were studied. A MEDLINE literature search of all years available (1966 through 2001) was performed, and all reported cases were reviewed and tabulated (Table 1), together with our series of patients, in this report.

Patient 1

A 55-year-old, previously fit Malay male (shown as patient 18 in Table 1) reported floaters in the left eye of 2 days duration, followed by sudden, painless loss of vision. He had multiple joint pains and swelling accompanied by febrile episodes for 2 weeks. At presentation, his visual acuities were 20/40 in the right eye and light perception (LP) in the left eye. The right eye was normal. The left conjunctiva was injected and the anterior chamber was shallow. Anterior chamber cells, fibrin,

Discussion

Endogenous endophthalmitis is an uncommon, devastating disease, often associated with poor visual prognosis. Frequently, an associated underlying septic focus, such as a liver abscess, cellulitis, or urinary tract infection, is present.1, 2, 3 It usually occurs in immunocompromised patients, but may occur in healthy individuals.4, 5 A literature search from 1966 through 2001 using MEDLINE revealed that GBS as a cause of EE is rare. In 1986, Greenwald et al3 published a review of 72 cases of

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The authors have no proprietary interests in the equipment or drugs used in this paper.

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