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[Ocular bacteriosis in a patient with aplastic anemia]
C W Spraul1, H J Roth, P Möller
1Universitäts-Augenklinik Ulm. christoph.spraul@medizin.uni-ulm.de
Background:
For more than a century it has been recognized that bacteria may infect the eye by way of the blood stream. Until fifty years ago, eyes so afflicted nearly always were blinded and a majority of the victims died from overwhelming sepsis. Although effective antibiotics are available today the prognosis is still guarded.
Case Report:
A 39-year-old physician died 6 years after he was diagnosed for idiopathic aplastic anemia. He had developed pseudomonas aeruginosa bacteremia and later a therapy refractive pneumonia caused by aspergillus which had led to respiratory failure. The patient had experienced a marked loss of visual acuity in his left eye ten days before he died. Ophthalmic examination at that point displayed signs of endophthalmitis, hyphaema, and heterochromic irises. The eyes were obtained postmortem and histologic examination of the left eye displayed numerous bacilli forming cuffs around blood vessels and a sheet between the necrotic retinal pigment epithelium and Bruch's membrane. No inflammatory response to the bacilli was present. The bacilli could be demonstrated with a Giemsa stain and could also be identified with electron microscopic examination.
Discussion:
The histologic results in our patient displayed numerous bacilli without inflammatory reaction which was a result of the aplastic state. Therefore, this disease was classified as "ocular bacteriosis". The blood-ocular barrier undergoes direct assault with intraocular inflammation and the impermeability to blood-borne antibiotics is lost. However, with the lack of an inflammatory reaction the permeability to antibiotics may be too low and the achieved concentration insufficient.
Insights
Bacterial eye infections can lead to blindness and sepsis. In an aplastic patient, ocular bacteriosis occurred without inflammation, hindering antibiotic effectiveness.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Hematology
Background:
- Bacterial eye infections from bloodstream seeding have historically led to poor outcomes.
- Despite modern antibiotics, prognosis for ocular bacterial infections remains guarded.
- Idiopathic aplastic anemia presents a unique challenge in managing systemic and ocular infections.
Observation:
- A physician with aplastic anemia developed Pseudomonas aeruginosa bacteremia and Aspergillus pneumonia.
- Prior to death, the patient experienced vision loss, endophthalmitis, and hyphema.
- Postmortem examination revealed bacilli within the eye tissues without an inflammatory response.
Findings:
- Histologic examination showed numerous bacilli forming cuffs around ocular blood vessels.
- Bacilli were located between the retinal pigment epithelium and Bruch's membrane.
- The absence of inflammation was attributed to the patient's aplastic state, leading to the classification of 'ocular bacteriosis'.
Implications:
- The blood-ocular barrier's integrity is compromised during intraocular inflammation, affecting antibiotic penetration.
- A lack of inflammatory response in ocular bacteriosis may limit antibiotic permeability, resulting in insufficient therapeutic concentrations.
- This case highlights the critical need to consider the host's immune status when treating severe ocular infections.