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Clinico-Microbiological Correlation in Salmonella Endophthalmitis: Case Series and Review of Literature
Sanchita Mitra1, Bhagyashree Meshram2, Subhadra Jalali2
1Jhaveri Microbiology Centre and Prof. Brien Holden Eye Research Centre, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India.
Purpose:
To report two rare cases of Salmonella endogenous endophthalmitis in an immunocompromised premature baby and an immunocompetent adult and do a brief literature review of related cases. Diagnosis in both cases was confirmed only after the pathogen grew from ocular samples, in the absence of clear signs of enteric fever.
Methods:
Retrospective analysis of medical and microbiology records.
Results:
Both of our cases of Salmonella endophthalmitis had poor visual outcome, despite timely and aggressive management and irrespective of immune status of the patient. Salmonella infection being a rare cause of endophthalmitis was not initially suspected as the adult had minimal systemic symptoms 2 weeks before presentation, while the preterm baby was still on milk feeds. These were just two microbiologically confirmed cases of Salmonella endophthalmitis at our institute over the past 10 years, though enteric fever due to Salmonella species is endemic in Asian countries.
Conclusions:
Salmonella endophthalmitis, though rare, leads to poor visual outcomes despite early recognition and aggressive management and may be confused with other infections or non-infectious entities such as necrotizing retinoblastoma in babies, in the absence of clear systemic signs of the disease.
Insights
Salmonella endophthalmitis, a rare infection, leads to poor vision in both immunocompromised and immunocompetent patients. Early diagnosis is challenging due to subtle systemic symptoms.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Endogenous endophthalmitis is a severe intraocular infection.
- Salmonella species are a rare cause of endogenous endophthalmitis.
Observation:
- Two cases of Salmonella endophthalmitis are presented: one in a premature infant and another in an immunocompetent adult.
- Diagnosis was confirmed by microbial culture of ocular samples.
- Neither patient presented with clear signs of enteric fever.
Findings:
- Both patients experienced poor visual outcomes despite prompt and aggressive treatment.
- The rarity of Salmonella endophthalmitis and minimal systemic symptoms delayed initial suspicion in both cases.
Implications:
- Salmonella endophthalmitis, though infrequent, is associated with poor visual prognosis.
- It can be misdiagnosed, especially in infants, potentially mimicking conditions like retinoblastoma.
- Increased clinical suspicion is warranted in cases of endophthalmitis, even with subtle systemic signs.
