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Published on: February 6, 2021
Pediatric endogenous endophthalmitis: Clinical features and treatment outcomes
Ridham Nanda1,2, Taraprasad Das3, Tapas Ranjan Padhi1
1Department of Ophthalmology, LV Prasad Eye Institute, Mithu Tulasi Chanrai Campus, Anant Bajaj Retina Institute, Bhubaneswar, Odisha, India.
Insights
Endogenous endophthalmitis in children, particularly those under 5 with systemic illness, carries a poor visual prognosis. Prompt ophthalmic evaluation is crucial for any child with redness and systemic infection.
Area of Science:
- Ophthalmology
- Pediatric Infectious Diseases
- Microbiology
Background:
- Endogenous endophthalmitis is a severe intraocular infection originating from a distant systemic source.
- Pediatric cases present unique diagnostic and therapeutic challenges.
- Gram-negative bacilli are a frequent cause of infection in this population.
Purpose of the Study:
- To analyze the demographics, clinical-microbiological profiles, and treatment outcomes of pediatric patients diagnosed with endogenous endophthalmitis.
- To identify risk factors associated with poor visual prognosis in children with this condition.
Main Methods:
- Retrospective analysis of electronic medical records from 2016 to 2023 at a tertiary eye care center in India.
- Inclusion criteria: patients under 18 years diagnosed with endogenous endophthalmitis.
- Data collected: demographics, clinical presentation, microbiological findings, treatment, and visual outcomes.
Main Results:
- 48 pediatric patients (average age 5.4 years) were analyzed, representing 20.8% of pediatric endophthalmitis cases.
- Common symptoms included redness (62.5%) and vitritis (89.58%) was the most frequent sign.
- Gram-negative bacilli (35%) were the most common isolates; systemic infection (72.9%) was prevalent, often respiratory tract infections.
- Worse visual prognosis was observed in children under 5 with systemic illness; Gram-positive bacilli and fungal infections were linked to unfavorable outcomes.
Conclusions:
- Redness in a child with concurrent systemic infection necessitates immediate ophthalmic assessment.
- Young children (under 5) with systemic illness face a poorer visual prognosis.
- Specific microbial profiles, including Gram-positive bacilli and fungi, are associated with unfavorable outcomes in pediatric endogenous endophthalmitis.
Context:
Forty-eight pediatric patients treated for endogenous endophthalmitis were analyzed. Redness and vitritis were the common symptom and sign, respectively; infection with Gram-negative bacilli was frequent. Children under 5 and with systemic illness had poorer visual prognosis.
Purpose:
To Analyze the demographics, clinical-microbiological profiles, and treatment outcomes of pediatric patients with endogenous endophthalmitis.
Methods:
We conducted a retrospective analysis of electronic medical records covering 8 years from 2016 to 2023 at a tertiary eye care center in India, focusing on patients of age <18 years diagnosed with endogenous endophthalmitis. Data extraction included demographic variables, clinical presentations, microbiological analyses, therapeutic interventions, and visual outcomes.
Results:
The analysis included 48 patients with an average age of 5.4 ± 4.98 years and an equal gender ratio. During the study period, 48 children with endogenous endophthalmitis were treated; it was 5% (48 of 961) of all endophthalmitis patients and 20.8% (48 of 231) of pediatric endophthalmitis patients. Common symptoms included redness (62.5%), reduced vision (20.8%), leucocoria (27.08%), pain (22.91%), and watering/discharge (29.16%). Clinical signs included vitritis (89.58%) and anterior chamber exudates/hypopyon (47.91%). Vitreous culture positivity was 54.05%; common isolates were Gram-negative bacilli (35%), Gram-positive cocci (25%), and Gram-positive bacilli and fungi (20% each). Systemic infection was present in 72.9% (35 of 48) of patients, with respiratory tract infection being the most common (39.5%). All eyes received intravitreal antibiotic injections, and 28 (75.7%) received vitrectomy. Children under 5 with systemic illness had a worse visual prognosis. Unfavorable outcomes were associated with Gram-positive bacilli and fungal infection. Approximately 45% of eyes worsened to phthisis.
Conclusions:
Any redness in a child with systemic infection warrants prompt ophthalmic evaluation. Children under 5 with systemic illness are associated with a worse visual prognosis. Unfavorable outcomes are linked to Gram-positive bacilli and fungal infection.
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