Today’s pt was a middle-aged man with fever, unilateral pain w eye movement and decreased visual acuity. On ophthalmologic exam, he had decreased visual acuity, hyphema and vitreous opacification. He was found to have K pneumoniae endophthalmitis based on vitreous aspiration/culture without signs of invasive Klebsiella syndrome.
TOP PEARLS: Tomales Bay up in here! —————————————————————–
Uvea pathology and pain: Anterior uveal tract pathology tends to be painful, and posterior uveal pathology tends to be painless.
Uvea inflammation vs infection: Anterior uveitis is predominantly inflammatory in origin and posterior uveitis is predominantly infectious.
More Details ————————————————————————————————-
Endophthalmitis aka vitritis
Etiology: Bacterial or fungal infection
– Endogenous, hematogenously spread: strep species, staph, candida
– Exogenous, complication of ophthalmic surgery, penetrating injury, extension of keratitis: gram + (bacillus species) or candida
Tx: Remember how poor antibiotic penetration is of vitreous region. Often need intravitreal abx in addition to systemic therapy (and occasionally need vitreous removal- vitrectomy).
Invasive Klebsiella syndrome: Typically we think of community-acquired K pneumoniae infections as causes of PNA or UTI. However, increasingly, particularly among Asian populations, there have been growing reports of an invasive syndrome.
Definition: Caused by hypermucoviscous phenotype assoc with serotypes K1/K2. Causes liver abscess and bacteremia (transient or sustained) with disseminated complications including endophthalmitis, meningitis, necrotizing fasciitis.
Epidemiology and risk factors: More prevalent in South Korea/Taiwan but in US about 1/2 of pts are non-Asian.
Dx: If a patient presents with K pneuomoniae bacteremia, endophthalmitis or meningitis, a search for occult liver abscesses is indicated! Should also have lab evaluate K pneumoniae for hypermucoviscous phenotype.
Management: Cephalosporins are mainstay; carbapenem if ESBL. Lots more intricacy here based on where infection has metastasized. For all the deets, check out the attached article.