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Published on: February 6, 2021
Endogenous endophthalmitis caused by group B streptococcus; case reports and review of 35 reported cases
Masaaki Yoshida1, Shunji Yokokura2, Takashi Nishida3
1Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
Background:
Group B streptococcus (GBS), a gram-positive coccus that occasionally causes neonatal sepsis or invasive infection in the elderly, has been considered a rare cause of endogenous bacterial endophthalmitis (EBE). However, the number of invasive GBS infections is increasing, particularly in elderly patients with underlying conditions such as diabetes mellitus (DM), cardiovascular disease and cancer. We report 6 cases of EBE caused by GBS and review the literature.
Methods:
Retrospective case series and literature review.
Results:
In the current case series, 6 eyes of 6 patients developed EBE caused by GBS. The average age was 73.5 years. The focus of infection included the urinary tract, cellulitis, arthritis, peritonitis, catheter-associated infection and endocarditis. Four patients had DM. While all 6 strains were sensitive to β-lactams (penicillins and cephems), 4 strains were resistant to levofloxacin (no data for 1 isolate). Each case was treated with the systemic antibiotic to which the individual strain was sensitive. All cases showed poor visual acuity at presentation (decimal visual acuity: less than 0.03). Vitrectomy with intravitreal antibiotics injection was performed in 4 cases. Visual acuity recovered in 4 cases and did not recover in 2 cases, even after vitrectomy. The literature review of 53 eyes of 41 patients revealed that 60% of eyes finally lost all vision, and death occurred in 2 cases. Initial visual acuity of less than counting fingers was associated with a final outcome of lost vision. Of 41 patients, 13 (32%) had DM as an underlying medical condition. The most common extra-ocular infection focus was endocarditis (37%).
Conclusions:
DM is common in patients with EBE caused by GBS. While the 4 cases in the current report had a relatively good visual acuity outcome, despite poor initial visual acuity, the literature review indicated that EBE caused by GBS is generally a severe condition with a poor prognosis. The current study also indicates the importance of considering the possibility of endocarditis on encountering EBE caused by GBS.
Insights
Group B Streptococcus (GBS) is an increasing cause of endogenous bacterial endophthalmitis (EBE), especially in elderly patients with diabetes mellitus (DM). While some cases show visual recovery, GBS EBE often leads to severe vision loss and warrants consideration of endocarditis.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Group B Streptococcus (GBS) is increasingly implicated in invasive infections among the elderly, including endogenous bacterial endophthalmitis (EBE).
- Underlying conditions like diabetes mellitus (DM), cardiovascular disease, and cancer are common in affected elderly patients.
- GBS EBE, once considered rare, is now recognized as a growing concern in specific patient populations.
Observation:
- A case series of 6 patients with GBS EBE revealed a mean age of 73.5 years, with 4 patients having DM.
- Infection foci included urinary tract, cellulitis, arthritis, peritonitis, catheter-associated infection, and endocarditis.
- All GBS strains were sensitive to β-lactams, but resistance to levofloxacin was noted in some isolates.
Findings:
- Patients presented with poor visual acuity (<0.03 decimal).
- Systemic antibiotics based on sensitivity testing were administered; 4 cases underwent vitrectomy with intravitreal antibiotics.
- Visual acuity recovered in 4 cases, but 2 had no recovery. Literature review of 41 patients showed 60% vision loss and 2 deaths, with initial poor vision correlating with worse outcomes.
Implications:
- Diabetes mellitus is a significant comorbidity in GBS EBE.
- While this series showed some visual recovery, GBS EBE generally carries a poor prognosis.
- Endocarditis should be considered when encountering GBS EBE due to its frequent association.
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