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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 1  |  Issue : 3  |  Page : 554-556

Acute endophthalmitis caused by Ochrobactrum anthropi following cataract surgery in an immunocompetent patient – A case report


1 Shri Bhagwan Mahavir Department of Vitreo Retinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
2 Department of Microbiology, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India

Date of Submission27-Sep-2020
Date of Acceptance01-Feb-2021
Date of Web Publication02-Jul-2021

Correspondence Address:
Dr. Aditya Verma
Shri Bhagwan Mahavir Department of Vitreo Retinal Services , Medical Research Foundation, Sankara Nethralaya, 18 College Road, Nungambakkam, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_3080_20

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  Abstract 


A 54-year-old man developed left eye inflammation three days after cataract surgery and was diagnosed with endophthalmitis. Aqueous culture revealed Ochrobactrum anthropi resistant to vancomycin and cephalosporin. Systemic and intravitreal ciprofloxacin injections caused only transient improvement and eventually, pars plana vitrectomy was done. There was complete resolution, good visual recovery, and no recurrence. O.anthropi is an uncommon organism with a characteristic resistance to empirical antibiotics and usually causes chronic infection in immunocompromised. We report a rare case of acute endophthalmitis in an immunocompetent patient. To the best of our knowledge, this is the first report of O. anthropi endophthalmitis from India.

Keywords: Acute endophthalmitis, cataract surgery, immunocompetent, Ochrobactrum anthropi, pars plana vitrectomy


How to cite this article:
Nag A, Verma A, Anand A R. Acute endophthalmitis caused by Ochrobactrum anthropi following cataract surgery in an immunocompetent patient – A case report. Indian J Ophthalmol Case Rep 2021;1:554-6

How to cite this URL:
Nag A, Verma A, Anand A R. Acute endophthalmitis caused by Ochrobactrum anthropi following cataract surgery in an immunocompetent patient – A case report. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Jul 26];1:554-6. Available from: https://www.ijoreports.in/text.asp?2021/1/3/554/320103



Ochrobactrum anthropi is a Gram-negative aerobic bacillus that has been infrequently implicated in postoperative endophthalmitis. It has been reported in extremely rare cases of endogenous and exogenous endophthalmitis.[1],[2],[3],[4],[5],[6] Patients with compromised immune systems are at increased risk.[1],[2],[6],[7] We report clinical features of such a case in an immunocompetent individual.


  Case Report Top


A 54-year-old man presented with sudden onset of painful diminution of vision in his left eye 3 days after an uneventful phacoemulsification surgery with intraocular lens (IOL) operated elsewhere. Past ocular and medical history was unremarkable. His right eye was within normal limits. The left eye had a best-corrected visual acuity (BCVA) of counting fingers (CF) at presentation. Slit-lamp examination revealed mild corneal edema and numerous greyish-white large greasy keratic precipitates over the endothelium with moderate-grade anterior chamber inflammation (2 + cells and flare) but no hypopyon [Figure 1]a. Dense vitritis precluded thorough fundus examination, with a barely visible optic disc.
Figure 1: (a) Slit lamp photograph of the left eye at presentation showing mild corneal edema, diffuse large greasy keratic precipitates and absence of hypopyon. Inset: Direct Gram stain of vitreous aspirate showing Gram-negative bacilli (blue arrows) along with inflammatory cells. (b) Ultra-widefield colored fundus pictures of the left eye after initial treatment showing relatively clear media with plenty of retinal exudates scattered all over the posterior pole till mid periphery. (c) Slit lamp image of the left eye showing a clear cornea with no keratic precipitates at 1 month after surgery. (d) Ultra-widefield colored fundus image of the left eye showing a complete resolution of retinal exudates at 1 month after surgery

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Ultrasound scan of the left eye showed attached retina with plenty of vitreous echoes and he was diagnosed with acute endophthalmitis. An initial aqueous tap was performed and the specimen was sent for microbiological investigations. Culture of the aqueous aspirate revealed the growth of pale yellow colonies on Blood agar and non-lactose fermenting colonies on MacConkey agar. The organism was characterized as Gram-negative oxidase-positive bacillus and was subsequently identified as Ochrobactrum anthropi using the automated VITEK-2 ID/AST instrument (Biomerieux, France). The organism was sensitive to ciprofloxacin and amikacin but resistant to ceftazidime, cefotaxime and vancomycin. The patient was administered 3 consecutive daily intravitreal injections of ciprofloxacin (100 μg/0.1 ml). Eye drops ciprofloxacin hydrochloride (0.3%), prednisolone acetate (1%) and homatropine hydrobromide (2%) were advised. Raised intraocular pressure (IOP) was controlled using topical timolol maleate (0.5%) and dorzolamide hydrochloride (2%). A thorough laboratory workup by an infectious disease specialist failed to reveal any systemic focus of infection or immunosuppression. Intravenous ciprofloxacin (200 mg BD) infusion was also started for 7 days followed by oral ciprofloxacin (200 mg BID) after a week. Fundus visibility considerably improved with this treatment course, revealing diffuse white exudates scattered uniformly over the entire retinal surface [Fig. 1b]. By the end of 2 weeks, BCVA was 20/50 with a near-complete resolution of retinal exudates. He was advised to continue oral ciprofloxacin (500 mg BD) and topical eyedrops with weekly follow up.

However, the patient presented after 3 weeks with worsening of inflammation in his left eye, along with a rise in IOP to 34 mm Hg. The BCVA had dropped to CF again. He underwent IOL sparing pars plana vitrectomy (PPV) in the left eye under local anesthesia with intravitreal ciprofloxacin (100 μg/0.1 ml), amikacin (250 μg/0.1 ml) and dexamethasone (mixed with amikacin) on the same day. Microbiological investigations of the vitreous aspirate revealed the presence of many Gram-negative bacilli along with pus cells [Fig. 1a Inset]. Culture revealed growth of the same organism, O. anthropi, after 24 hours of incubation. IOP spike was controlled by a fixed combination of brimonidine tartrate (0.2%)/timolol maleate (0.5%) along with dorzolamide hydrochloride (2%) eye drops. Topical ciprofloxacin, tobramycin sulfate (0.3%), prednisolone and homatropine eye drops were continued in the post-operative period for a month. He also received intravenous ciprofloxacin (200 mg BD) for one week, followed by oral ciprofloxacin (500 mg BD) for another 10 days. He was monitored closely. By the end of 1 month, there was a gradual but marked clinical improvement. The anterior chamber was quiet with no corneal edema and retinal exudates had completely cleared [Fig. 1c and d]. There was no recurrence during the follow-up period of 6 months. At the last follow-up, his left eye had a BCVA of 20/30 and IOP was 14 mm Hg with a clear vitreous cavity, attached retina and mild optic disc pallor.


  Discussion Top


This case highlights the importance of considering an uncommon organism like Ochrobactrum anthropi in the differential diagnosis of postoperative endophthalmitis, due to the unique characteristics of this pathogen.

Ochrobactrum spp belongs to the family  Brucella More Detailsceae, of which 3 species, O. anthropi, O. intermedium and O. pseudintermedium, have been reported to cause infections in humans. O. anthropi is an aerobic, oxidase positive, urease positive Gram-negative motile non-lactose fermenting bacillus. It usually causes human infections in immunocompromised hosts and those with permanent medical devices or indwelling venous catheters.[1],[7] It has the ability to adhere to synthetic materials like prosthetic devices, IOLs or silicon tubings which enables it to infect ocular structures. The organism has been detected in hospital water sources including irrigating fluids (normal saline), antiseptic agents and dialysis liquids.[1],[5],[7]

Another crucial concern about this pathogen stems from its resistance patterns to various broad-spectrum antibiotics.[3],[4] Conventional antibiotics like penicillins or cephalosporins are usually ineffective while it is usually sensitive to quinolones and amikacin.[4]

Literature search to date revealed only 24 cases of endophthalmitis caused by O. anthropi, implicating its rarity.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10] The endophthalmitis cases were mostly chronic in nature; 20 cases were post-cataract surgery,[3],[4],[5],[6],[8],[9] 3 cases were endogenous,[1],[2],[7] and 1 case was reported following Boston type 1 keratoprosthesis implantation [Table 1].[10]
Table 1: Review of literature of the reported cases of O. anthropi endophthalmitis

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O. anthropi endophthalmitis cases have been conventionally treated with vitrectomy and IOL removal.[2],[6],[7],[8],[9] But in recent years, PPV without IOL removal has been attempted with final BCVAs reported from CF to 20/30.[3],[5] Our patient responded well to IOL sparing vitrectomy, which gives the advantage of early post-operative visual rehabilitation.


  Conclusion Top


To the best of our knowledge, this is the first case report of Ochrobactrum anthropi acute endophthalmitis from India. The important differences in our case were an acute presentation and a healthy immunocompetent patient.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Berman AJ, Del Priore LV, Fischer CK. Endogenous ochrobactrum anthropi endophthalmitis. Am J Ophthalmol 1997;123:560-2.  Back to cited text no. 1
    
2.
Chiang C, Tsai Y, Lin J, Chen W. Chronic endophthalmitis after cataract surgery secondary to Ochrobactrum anthropi. Eye (Lond) 2009;23:1237-8.  Back to cited text no. 2
    
3.
Song S, Ahn JK, Lee GH, Park YG. An epidemic of chronic pseudophakic endophthalmitis due to ochrobactrum anthropi: Clinical findings and managements of nine consecutive cases. Ocul Immunol Inflamm 2007;15:429-34.  Back to cited text no. 3
    
4.
Kanjee R, Koreishi AF, Tanna AP, Goldstein DA. Chronic postoperative endophthalmitis after cataract surgery secondary to vancomycin-resistant Ochrobactrum anthropi: Case report and literature review. J Ophthalmic Inflamm Infect 2016;6:25.  Back to cited text no. 4
    
5.
Mattos FB, Saraiva FP, Angotti-Neto H, Passos AF. Outbreak of ochrobactrum anthropi endophthalmitis following cataract surgery. J Hosp Infect 2013;83:337-40.  Back to cited text no. 5
    
6.
Braun M, Jonas JB, Schönherr U, Naumann GO. Ochrobactrum anthropi endophthalmitis after uncomplicated cataract surgery. Am J Ophthalmol 1996;122:272-3.  Back to cited text no. 6
    
7.
Inoue K, Numaga J, Nagata Y, Sakurai M, Aso N, Fujino Y. Ochrobactrum anthropi endophthalmitis after vitreous surgery. Br J Ophthalmol 1999;83:502.  Back to cited text no. 7
    
8.
Greven CM, Nelson KC. Chronic postoperative endophthalmitis secondary to Ochrobactrum anthropi. Retina 2001;21:279-80.  Back to cited text no. 8
    
9.
Kim KS, Han JW, Lee WK. A case of ochrobactrum anthropi endophthalmitis after cataract surgery. J Korean Ophthalmol Soc 2003;44:1943-7.  Back to cited text no. 9
    
10.
Chan CC, Holland EJ. Infectious endophthalmitis after boston type 1 keratoprosthesis implantation. Cornea 2012;31:346-9.  Back to cited text no. 10
    


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