Endogenous endophthalmitis caused by group B streptococcus; case reports and review of 35 reported cases

• Published in: BMC ophthalmology Vol. 20; no. 1; p. 126
• Main Authors: Yoshida, Masaaki, Yokokura, Shunji, Nishida, Takashi, Mochizuki, Kiyofumi, Suzuki, Takashi, Maruyama, Kazuichi, Otomo, Takaaki, Nishiguchi, Koji M, Kunikata, Hiroshi, Nakazawa, Toru
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 31-03-2020; BioMed Central; BMC
• Subjects: Acuity; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Antibiotics; Arthritis; Cardiovascular diseases; Case reports; Cellulitis; Cephems; Diabetes; Diabetes mellitus; Diabetes Mellitus - etiology; Endocarditis; Endogenous bacterial endophthalmitis; Endophthalmitis; Endophthalmitis - diagnosis; Endophthalmitis - drug therapy; Endophthalmitis - microbiology; Eye; Eye Infections, Bacterial - diagnosis; Eye Infections, Bacterial - drug therapy; Eye Infections, Bacterial - microbiology; Female; Geriatrics; Group B streptococcus (GBS; Hospitals; Humans; Infection; Invasiveness; Lactams; Levofloxacin; Literature reviews; Male; Middle Aged; Neonates; Ophthalmology; Patients; Penicillin; Peritonitis; Pneumonia; Quinolone-resistant GBS; Retrospective Studies; Sepsis; Strains (organisms); Streptococcal Infections - diagnosis; Streptococcal Infections - drug therapy; Streptococcal Infections - microbiology; Streptococcus; Streptococcus agalactiae; Streptococcus agalactiae - isolation & purification; Streptococcus infections; Urinary tract; Urinary tract infections; Vision; Visual Acuity; β-Lactam antibiotics; East Asia; United Kingdom; Japan; United States > US; Quinolone-resistant GBS; Endogenous bacterial endophthalmitis; Streptococcus agalactiae; Group B streptococcus (GBS; Diabetes mellitus; Endocarditis
• ISSN: 1471-2415; 1471-2415
• DOI: 10.1186/s12886-020-01378-0

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.
Retrospective case series and literature review.
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%).
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.