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CASE REPORT
Year : 2020  |  Volume : 68  |  Issue : 1  |  Page : 232-233

Post cataract Pseudomonas stutzeri endophthalmitis: Report of a case and review of literature


Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India

Date of Submission18-Feb-2019
Date of Acceptance30-Jul-2019
Date of Web Publication19-Dec-2019

Correspondence Address:
Dr. Rupak Roy
Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M. Bypass, Kolkata - 700 099, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_334_19

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  Abstract 


We report a rare case of Pseudomonas stutzeri endophthalmitis in an immunocompetent individual along with the review of the literature. A 39-year-old healthy lady presented with sudden painful loss of vision in her right eye. She was diagnosed with postcataract surgery acute endophthalmitis and underwent vitrectomy, intraocular lens explantation and intravitreal antibiotics. P. stutzeri was isolated from vitreous. Though the infection was controlled, the anatomy of the eye could not be salvaged and the right eye became phthisical. P. stutzeri is a rare cause of endophthalmitis with usually poor outcomes.

Keywords: Acute endophthalmitis, immunocompetent, postcataract surgery endophthlamitis, Pseudomonas stutzeri


How to cite this article:
Shah A, Senger D, Garg B, Mishra S, Goel S, Saurabh K, Roy R. Post cataract Pseudomonas stutzeri endophthalmitis: Report of a case and review of literature. Indian J Ophthalmol 2020;68:232-3

How to cite this URL:
Shah A, Senger D, Garg B, Mishra S, Goel S, Saurabh K, Roy R. Post cataract Pseudomonas stutzeri endophthalmitis: Report of a case and review of literature. Indian J Ophthalmol [serial online] 2020 [cited 2020 Oct 20];68:232-3. Available from: https://www.ijo.in/text.asp?2020/68/1/232/273236



Pseudomonas species are known to cause devastating ocular infections including endophthalmitis and bacterial keratitis.[1],[2] Among its various species, Pseudomonas aeruginosa has been mainly implicated as the cause of endophthalmitis. Pseudomonas stutzeri as an etiological microorganism for delayed onset of endophthalmitis has been sparingly described in the literature.[3] To the best of our knowledge, present report was the first to describe acute endophthalmitis by P. stutzeri in a patient who underwent extra capsular cataract extraction with intraocular lens implantation.


  Case Report Top


A 39-year-old lady presented with sudden painful decrease in vision in the right eye for two days. She had undergone extracapsular cataract extraction with intraocular implantation 12 days back elsewhere. The best corrected visual acuity (BCVA) in the right eye was perception of light with accurate projection of rays. Anterior segment examination showed circumciliary congestion, corneal haze, 3+ anterior chamber cells, and exudative plaque covering the pupil intraocular pressure with applanation tonometer was 10 mm of Hg. Left eye was normal. Fundus of left eye was not visible due to pupillary exudates. Ultrasound B scans showed plenty of dot echoes. A provisional diagnosis of acute postcataract surgery endophthalmitis was made. A complete systemic examination that included routine blood investigations, and urine and blood culture along with a physician evaluation was done. No active systemic foci of infection were detected. The patient underwent standard three port 23-gauge pars plana vitrectomy, intraocular lens explantation, and intravitreal antibiotics (vancomycin 1 mg/0.1 ml and amikacin 0.4 mg/0.1 ml). Undiluted vitreous aspirate and intraocular lens were sent for microbiological tests. In view of recurrent exudates at pupil and no view of fundus again in postoperative period, the right eye received two more intravitreal injection of vancomycin and amikacin. No organism was identified on Gram's stain, 10% KOH mount and calcofluor-white stain. Vitreous culture revealed P. stutzeri causative organism. Antibiotic sensitivity testing was performed by the Kirby-Bauer disc diffusion method. The organism was sensitive to gentamicin, ciprofloxacin, amikacin and resistant to cefotaxime, ceftazidime, and vancomycin. Based on the sensitivity report, the patient further received two more intravitreal injections of amikacin and ciprofloxacin (0.1 mg/0.1 ml). However, at the end of follow-up of nine months, the eye became phthisical.


  Discussion Top


P. stutzeri is an aerobic, gram negative bacteria first described by Burri and Stutzer in 1895. It is usually found in the soil, manure, pond water, and sewage. It is ubiquitous in hospital environment and is a rare opportunistic human pathogen. Though it has been isolated from surgical wounds, blood, sputum, and urine, isolation from the eye is extremely rare.[4] Most patients in whom the organism has been isolated have been elderly and in poor health.[4],[5] Review of the literature shows that only a few isolated cases of ocular infections by P. stutzeri have been reported [Table 1]. In 1977, Brinzer [6] reported the first ever case of corneal ulcer due to P. stutzeri in a scarred cornea secondary to previous herpetic infection. In 2001, Lebowitz et al.[1] reported a single case of late onset panophthalmitis with orbital abscess due to P. stutzeri. One case of delayed onset endophthalmitis following cataract surgery has been reported in 1998 by Jiraskova et al.[3] The patient was elderly and in poor health. The organism was sensitive to tetracycline, gentamicin, amoxicilin, and ofloxacin, and resistant to oxacillin, chloramphenicol, vancomycin and cefalotin. P. stutzeri was identified as the cause of conjunctivitis in an eye with preexisting corneal opacity in a 66-year-old female by Malhotra et al.[7] In the current case, we report an acute onset postcataract surgery endophthalmitis due to P. stutzeri in a relatively young and immunocompetent patient. Report suggested that the organism was susceptible to gentamicin, ciprofloxacin, and amikacin whereas resistant to cefotaxime, ceftazidime, and vancomycin. The current case for the first time reports P. stutzeri as the cause of acute endophthalmitis following cataract surgery. Authors also intend to highlight the significance of early detection of causative microorganism and antibiotic sensitivity test in prompt management of endophthalmitis.
Table 1: Review of literature of P. stutzeri ocular infection

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  Conclusion Top


Though rare, P. stutzeri should be considered in the list of microorganisms responsible for acute postcataract surgery endophthalmitis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lebowitz D, Gürses-Ozden R, Rothman RF, Liebmann JM, Tello C, Ritch R. Late-onset bleb-related panophthalmitis with orbital abscess caused by Pseudomonas stutzeri. Arch Ophthalmol 2001;119:1723-5.  Back to cited text no. 1
    
2.
Kalra D, Sati A, Shankar S, Jha A. Corneal infection by Pseudomonas stutzeri following excision of trigeminal nerve schwannoma. BMJ Case Rep 2015;2015:1-4.  Back to cited text no. 2
    
3.
Jiraskova N, Rozsival P. Delayed-onset Pseudomonas stutzeri endophthalmitis after uncomplicated cataract surgery. J Cataract Refract Surg 1998;24:866-7.  Back to cited text no. 3
    
4.
Bisharat N. 10-years hospital experience in pseudomonas stutzeri and literature review. Open Infect Dis J 2012;6:21-4.  Back to cited text no. 4
    
5.
Maalouf F, Abdulaal M, Hamam RN. Chronic postoperative endophthalmitis: A review of clinical characteristics, microbiology, treatment strategies, and outcomes. Int J Inflam 2012;2012:6-11.  Back to cited text no. 5
    
6.
Brinser JH, Torczynski E. Unusual pseudomonas corneal ulcers. Am J Ophthalmol 1977;84:462-6.  Back to cited text no. 6
    
7.
Malhotra S, Singh K. Pseudomonas stutzeri associated conjunctivitis. Indian J Pathol Microbiol 2008;5:572.  Back to cited text no. 7
    



 
 
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