A rare ocular complication of septicemia: a case series report and literature review.
Hematogenous
Immunocompromised
Orbital Cellulitis
Septicemia
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
09 Aug 2023
09 Aug 2023
Historique:
received:
06
12
2022
accepted:
27
07
2023
medline:
11
8
2023
pubmed:
10
8
2023
entrez:
9
8
2023
Statut:
epublish
Résumé
Septicemia that leads to ocular involvement mostly presents as endophthalmitis or panophthalmitis. Contrarily, septicemia without intraocular involvement, known as hematogenous orbital cellulitis (HOC), involves only the orbit and is an extremely rare complication of septicemia and a rare type of orbital cellulitis. Four male patients with septicemia presented with orbital involvement without intraocular infection were described in this study. They were 22 (case 1), 15 (case 2), 79 (case 3), and 30 (case 4) years old, with a mean age of 29.75 years. All patients were immunocompromised except for case 2. Cases 1 and 3 had a history of steroid use, whereas case 4 was in a post-chemotherapy myelosuppression phase. Septicemia in case 1 was community-acquired, cases 3 and 4 were hospital-acquired, and case 2 was secondary to acne squeezing. Blood cultures from cases 1, 2, and 3 were positive for Candida albicans, methicillin-resistant Staphylococcus aureus, and Klebsiella pneumoniae, respectively. Case 4 had negative cultures; however, next-generation sequencing reported the presence of Enterococcus faecalis and Rhizopus oryzae. Case 1 had right eye involvement, and both eyes were involved in the other three cases. According to Chandler's classification, case 1 was type 2, case 2 was type 2 (OD) and type 4 (OS), and cases 3 and 4 were type 1 orbital infections. All patients had eyelids erythema, and cases 1 and 2 had mildly decreased visual acuity, proptosis, and painful and restricted ocular motility. Hospital stays ranged from 13 to 43 days (mean, 24 days). All patients received systemic antibiotic therapy based on drug sensitivity and next-generation sequencing results, in combination with multidisciplinary treatment, resulting in complete recovery of ocular and systemic signs and symptoms; no ocular surgical interventions were performed. Extraocular muscle palsy was the last symptom to resolve. HOC is predominantly seen in immunocompromised individuals with a high proportion of hospital-acquired infections and positive cultures for pathogens. Infection control using systemic antibiotics targeted at the causative organism guarantees a favorable prognosis.
Sections du résumé
BACKGROUND
BACKGROUND
Septicemia that leads to ocular involvement mostly presents as endophthalmitis or panophthalmitis. Contrarily, septicemia without intraocular involvement, known as hematogenous orbital cellulitis (HOC), involves only the orbit and is an extremely rare complication of septicemia and a rare type of orbital cellulitis.
CASE PRESENTATION
METHODS
Four male patients with septicemia presented with orbital involvement without intraocular infection were described in this study. They were 22 (case 1), 15 (case 2), 79 (case 3), and 30 (case 4) years old, with a mean age of 29.75 years. All patients were immunocompromised except for case 2. Cases 1 and 3 had a history of steroid use, whereas case 4 was in a post-chemotherapy myelosuppression phase. Septicemia in case 1 was community-acquired, cases 3 and 4 were hospital-acquired, and case 2 was secondary to acne squeezing. Blood cultures from cases 1, 2, and 3 were positive for Candida albicans, methicillin-resistant Staphylococcus aureus, and Klebsiella pneumoniae, respectively. Case 4 had negative cultures; however, next-generation sequencing reported the presence of Enterococcus faecalis and Rhizopus oryzae. Case 1 had right eye involvement, and both eyes were involved in the other three cases. According to Chandler's classification, case 1 was type 2, case 2 was type 2 (OD) and type 4 (OS), and cases 3 and 4 were type 1 orbital infections. All patients had eyelids erythema, and cases 1 and 2 had mildly decreased visual acuity, proptosis, and painful and restricted ocular motility. Hospital stays ranged from 13 to 43 days (mean, 24 days). All patients received systemic antibiotic therapy based on drug sensitivity and next-generation sequencing results, in combination with multidisciplinary treatment, resulting in complete recovery of ocular and systemic signs and symptoms; no ocular surgical interventions were performed. Extraocular muscle palsy was the last symptom to resolve.
CONCLUSION
CONCLUSIONS
HOC is predominantly seen in immunocompromised individuals with a high proportion of hospital-acquired infections and positive cultures for pathogens. Infection control using systemic antibiotics targeted at the causative organism guarantees a favorable prognosis.
Identifiants
pubmed: 37558992
doi: 10.1186/s12879-023-08489-1
pii: 10.1186/s12879-023-08489-1
pmc: PMC10413699
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Review
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
522Subventions
Organisme : Scientific Research Fund of Zhejiang Provincial Education Department
ID : Y202147619
Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
J Ophthalmol. 2020 Oct 23;2020:8869590
pubmed: 33149945
J Clin Med. 2022 Feb 23;11(5):
pubmed: 35268274
J Infect. 2012 Feb;64(2):148-55
pubmed: 22101078
Laryngoscope. 1970 Sep;80(9):1414-28
pubmed: 5470225
Indian J Med Microbiol. 2015 Oct-Dec;33(4):538-46
pubmed: 26470961
GMS Ophthalmol Cases. 2019 Aug 20;9:Doc30
pubmed: 31531276
J Antimicrob Chemother. 2017 Mar 1;72(suppl_1):i39-i47
pubmed: 28355466
J Pediatric Infect Dis Soc. 2018 May 15;7(2):159-164
pubmed: 29294067
Int J Ophthalmol. 2022 Oct 18;15(10):1676-1682
pubmed: 36262866
Korean J Intern Med. 2010 Mar;25(1):114-7
pubmed: 20195414
Clin Infect Dis. 2005 Sep 1;41(5):634-53
pubmed: 16080086
Ophthalmology. 2007 Feb;114(2):345-54
pubmed: 17270683
Semin Ophthalmol. 2019;34(4):223-231
pubmed: 31170015
Surv Ophthalmol. 2018 Jul - Aug;63(4):534-553
pubmed: 29248536
Indian J Ophthalmol. 2016 Aug;64(8):609-11
pubmed: 27688288
Mycoses. 2009 Jul;52(4):379-81
pubmed: 18983432
Clin Epidemiol. 2011;3:175-91
pubmed: 21750627
Trans Am Ophthalmol Soc. 2006;104:322-45
pubmed: 17471350
Saudi J Ophthalmol. 2011 Jan;25(1):21-9
pubmed: 23960899
Scand J Infect Dis. 2006;38(10):950-1
pubmed: 17008248
J Ophthalmol. 2018 Oct 02;2018:4237573
pubmed: 30370149
Cureus. 2019 Jul 6;11(7):e5087
pubmed: 31516796
J Med Microbiol. 2008 Oct;57(Pt 10):1259-1268
pubmed: 18809555
Int J Pediatr Otorhinolaryngol. 2009 Sep;73(9):1183-6
pubmed: 19249108
Ann Ophthalmol. 1986 May;18(5):194-5
pubmed: 3087259
Clin Infect Dis. 1999 Dec;29(6):1483-8
pubmed: 10585800
PLoS One. 2018 Sep 27;13(9):e0204036
pubmed: 30260969
Sci Rep. 2019 Jan 29;9(1):844
pubmed: 30696908
Semin Ophthalmol. 2022 Feb 17;37(2):208-214
pubmed: 34280072