Endogenous endophthalmitis: Difference between revisions

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==Overview==
==Overview==
Endogenous endophthalmitis is caused either by the [[Disseminated disease|hematologic dissemination]] of [[bacterial]] and [[fungal]] infection to the eyes or direct spread from adjacent infectious sites. Most common extraocular foci of infection include [[liver abscess]], [[pneumonia]], [[endocarditis]], and soft tissue infection.
Endogenous endophthalmitis is caused by either the [[Disseminated disease|hematologic dissemination]] of [[bacterial]] and [[fungal]] infection to the eyes or direct spread from adjacent infectious sites. Most common extraocular foci of infection include [[liver abscess]], [[pneumonia]], [[endocarditis]], and soft tissue infection.




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==Pathophysiology==
==Pathophysiology==
====Pathogenesis====
====Pathogenesis====
Endogenous bacterial endophthalmitis is caused by the [[Disseminated disease|hematologic dissemination]] of an infection to the eyes or direct spread from adjacent infectious sites.
Endogenous bacterial endophthalmitis is caused by either the [[Disseminated disease|hematologic dissemination]] of an infection to the eyes or direct spread from adjacent infectious sites.
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]].
Most common extraocular foci of infection include [[liver abscess]], [[pneumonia]], [[endocarditis]], and soft tissue infection.
Most common extraocular foci of infection include [[liver abscess]], [[pneumonia]], [[endocarditis]], and soft tissue infection.
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Direct spread from contagious sites can also occur in cases of [[central nervous system|central nervous system (CNS)]] infection via the [[optic nerve]].
Direct spread from contagious sites can also occur in cases of [[central nervous system|central nervous system (CNS)]] infection via the [[optic nerve]].


The exact pathogenesis of endogenous candida endophthalmitis is not fully understood. It is though endogenous candida endophthalmitis is commonly associated with [[abdominal surgery]] or [[diabetes mellitus]]. It is thought [[immunosuppression]] alone does not increase the risk of [[fungemia]] and subsequent fungal endophthalmitis.  
The exact pathogenesis of endogenous candida endophthalmitis is not fully understood. Endogenous candida endophthalmitis is commonly associated with [[abdominal surgery]] or [[diabetes mellitus]]. It is thought [[immunosuppression]] alone does not increase the risk of [[fungemia]] and subsequent fungal endophthalmitis.  


Following inhalation of the airborne organisms, the aspergilli spores enter the [[Alveoli|terminal alveoli]] of the lung.
Following inhalation of the airborne organisms, the [[aspergillus|aspergilli]] spores enter the [[Alveoli|terminal alveoli]] of the lung.
Under normal circumstances, the lung provides a natural resistance against invading organisms.
Under normal circumstances, the lung provides a natural resistance against invading organisms.
However, in the high risk patients, such as those patients with history of chronic pulmonary diseases,  history of [[organ transplant]], [[intravenous drug use|intravenous drug abuse]], [[cardiac surgery]], and [[alcoholism]], [[Disseminated disease|disseminated aspergillosis]] may result in endogenous aspergillus endophthalmitis.
However, in the high risk patients, such as those patients with history of chronic pulmonary diseases,  history of [[organ transplant]], [[intravenous drug use|intravenous drug abuse]], [[cardiac surgery]], and [[alcoholism]], [[Disseminated disease|disseminated aspergillosis]] may result in endogenous aspergillus endophthalmitis.

Revision as of 15:41, 2 August 2016

{SI}} Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]

Overview

Endogenous endophthalmitis is caused by either the hematologic dissemination of bacterial and fungal infection to the eyes or direct spread from adjacent infectious sites. Most common extraocular foci of infection include liver abscess, pneumonia, endocarditis, and soft tissue infection.


Historical Perspective

Classification

endogenous enophthalmitis may be classified according to causative organisms into 2 subtypes: bacterial or fungal.

Pathophysiology

Pathogenesis

Endogenous bacterial endophthalmitis is caused by either the hematologic dissemination of an infection to the eyes or direct spread from adjacent infectious sites. 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. Most common extraocular foci of infection include liver abscess, pneumonia, endocarditis, and soft tissue infection. Under normal circumstances, the blood-ocular barrier provides a natural resistance against invading organisms. In the high risk patients, following bacteremia the blood-borne organisms permeate the blood-ocular barrier by:[1][2][3]

Direct spread from contagious sites can also occur in cases of central nervous system (CNS) infection via the optic nerve.

The exact pathogenesis of endogenous candida endophthalmitis is not fully understood. Endogenous candida endophthalmitis is commonly associated with abdominal surgery or diabetes mellitus. It is thought immunosuppression alone does not increase the risk of fungemia and subsequent fungal endophthalmitis.

Following inhalation of the airborne organisms, the aspergilli spores enter the terminal alveoli of the lung. Under normal circumstances, the lung provides a natural resistance against invading organisms. However, in the high risk patients, such as those patients with history of chronic pulmonary diseases, history of organ transplant, intravenous drug abuse, cardiac surgery, and alcoholism, disseminated aspergillosis may result in endogenous aspergillus endophthalmitis.

Gross Pathology

Microscopic histopathological analysis

Causes

Common causes of endogenous endophthalmitis include:[1][2][3]

Bacterial

Fungal

Differentiating endogenous Endophthalmitis from Other Diseases

Endogenous bacterial endophthalmitis

  • Aspergillus endophthalmitis
  • Candida endophthalmitis

Candida endophthalmitis

Aspergillus endophthalmitis

Epidemiology and Demographics

Risk Factors

Endogenous bacterial endophthalmitis

Common risk factors in the development of endogenous bacterial endophthalmitis include:[1][2][3]

Endogenous fungal endophthalmitis

Common risk factors in the development of endogenous fungal endophthalmitis include:

Screening

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Candida endophthalmitis

Aspergillus endophthalmitis

  • Anterior chamber and vitreous aspiration alone are unreliable
  • Pars plana vitreous biopsy and cultures (Grocott or periodic acid Schiff stains)
  • Coexisting systemic aspergillosis

Imaging Findings

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Prevention

References

  1. 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. 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. 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.
  4. Rao, Narsing A., and Ahmed A. Hidayat. "Endogenous mycotic endophthalmitis: variations in clinical and histopathologic changes in candidiasis compared with aspergillosis." American journal of ophthalmology 132.2 (2001): 244-251.
  5. Rao, Narsing A., and Ahmed A. Hidayat. "Endogenous mycotic endophthalmitis: variations in clinical and histopathologic changes in candidiasis compared with aspergillosis." American journal of ophthalmology 132.2 (2001): 244-251.
  6. Hunt, LCDR Kerry E., and Ben J. Glasgow. "Aspergillus endophthalmitis: an unrecognized endemic disease in orthotopic liver transplantation." Ophthalmology 103.5 (1996): 757-767.


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