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Review

Bacterial and Fungal Endophthalmitis

Marlene L. Durand
Marlene L. Durand
Departments of Medicine and Ophthalmology, Harvard Medical School, and Infectious Disease Service, Massachusetts Eye and Ear Infirmary, and Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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DOI: 10.1128/CMR.00113-16
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    FIG 1

    A hypopyon is seen as a layer of white blood cells in the aqueous in this eye with endogenous S. aureus endophthalmitis. (Republished from reference 66 with permission of Springer.)

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    FIG 2

    Fungal endophthalmitis from Scedosporium. Note the “clumped” appearance of the intraocular inflammation. (Republished from reference 66 with permission of Springer.)

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    FIG 3

    Vitreous sampling by needle aspirate (A) or vitrectomy (B).

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    FIG 4

    Gram stain of an intraocular sample demonstrating abundant pigment granules but no organisms. Pigment granules usually appear purple on Gram stain (a) and can be mistaken for Gram-positive cocci unless the fine-focus knob is rotated back and forth, which shows the hyperrefractile (coppery) color of the pigment granules (b).

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    FIG 5

    Endophthalmitis resulting from extension of Alternaria keratitis. Note the irregular borders of the corneal infiltrate and satellite lesions, both typical of mold keratitis.

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    FIG 6

    Endogenous Candida albicans endophthalmitis following illicit injection drug use. A vitreous aspirate was culture negative, so a vitrectomy was performed, and this yielded the diagnosis. Note white lesions overlying the retina, typical of endogenous fungal endophthalmitis.

Tables

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  • TABLE 1

    Major categories of endophthalmitis

    CategoryRisk factorRelative frequency (% of all endophthalmitis cases)Major pathogens
    Acute postcataractCataract surgery40–80Coagulase-negative staphylococci (70% of cases), Staphylococcus aureus (10%), streptococci (9%)
    PostinjectionIntravitreal injection0–50Coagulase-negative staphylococci, streptococci
    PosttraumaticPenetrating eye trauma2–15Coagulase-negative staphylococci, Bacillus, streptococci, Gram-negative bacilli, fungi
    Bleb relatedFiltering bleb (for glaucoma)0–5 Streptococcus pneumoniae and other streptococci, enterococci, Haemophilus influenzae
    Keratitis relatedCorneal infection0–10Fungi (Aspergillus, Fusarium) in 50%, S. aureus, streptococci, Pseudomonas
    EndogenousBacteremia or fungemia0–20 Klebsiella pneumoniae (especially in East Asian nations), Candida, streptococci, S. aureus, Escherichia coli
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Bacterial and Fungal Endophthalmitis
Marlene L. Durand
Clinical Microbiology Reviews Mar 2017, 30 (3) 597-613; DOI: 10.1128/CMR.00113-16

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Bacterial and Fungal Endophthalmitis
Marlene L. Durand
Clinical Microbiology Reviews Mar 2017, 30 (3) 597-613; DOI: 10.1128/CMR.00113-16
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  • Top
  • Article
    • SUMMARY
    • INTRODUCTION
    • PATHOGENESIS
    • CLINICAL FEATURES
    • DIAGNOSIS
    • POSTOPERATIVE ENDOPHTHALMITIS
    • POSTINJECTION ENDOPHTHALMITIS
    • POSTTRAUMATIC ENDOPHTHALMITIS
    • BLEB-RELATED ENDOPHTHALMITIS
    • KERATITIS-RELATED ENDOPHTHALMITIS
    • ENDOGENOUS ENDOPHTHALMITIS
    • VISUAL OUTCOMES AND MICROBIOLOGY
    • PREVENTION
    • CONCLUSION
    • REFERENCES
    • Author Bios
  • Figures & Data
  • Info & Metrics
  • PDF

KEYWORDS

Bacterial Infections
endophthalmitis
Mycoses
endophthalmitis
bacterial endophthalmitis
fungal endophthalmitis
endophthalmitis prophylaxis
Candida endophthalmitis
bleb-related endophthalmitis
keratitis-related endophthalmitis
posttraumatic endophthalmitis
postoperative endophthalmitis

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