Endogenous endophthalmitis due to Roseomonas mucosa presenting as a subretinal abscess
© The Author(s). 2017
Received: 6 July 2016
Accepted: 20 January 2017
Published: 28 January 2017
Endogenous bacterial endophthalmitis is an infrequently reported entity. Although Roseomonas mucosa has been reported to cause systemic infections in immunosuppressed individuals, ocular infection due to Roseomonas has been rarely reported in literature previously.
A 74-year-old diabetic was diagnosed to have Klebsiella urinary tract infection and septicemia following which he developed ocular pain and redness. Further investigation revealed endophthalmitis with subretinal abscess and retinal detachment. The patient underwent pars plana vitrectomy with drainage of the abscess and silicone oil tamponade. The subretinal aspirate was found to contain R. mucosa confirmed on culture and PCR.
Microbiological evaluation of the subretinal purulent material revealed pink-colored colonies. Nested PCR was positive for detection of the eubacterial genome as well as for detection of the Mycobacterium tuberculosis genome (Ref)-targeting MPB64 gene. PCR examination of the subretinal pus sample ruled out M. tuberculosis and confirmed R. mucosa. The occurrence of Roseomonas endogenous endophthalmitis presenting as a subretinal abscess has not yet been reported in English literature so far to the best of our knowledge.
KeywordsRoseomonas mucosa Subretinal abscess Endogenous endophthalmitis Vitrectomy
Endogenous bacterial endophthalmitis is a rare entity with an incidence of 2 to 8% of all cases of endophthalmitis [1–4]. Roseomonas mucosa is an extremely uncommon cause of endophthalmitis with scarce reports in literature. We report a subretinal abscess in an elderly diabetic male, presumably endogenous, caused by R. mucosa and its successful management.
A 74-year-old diabetic gentleman presented with redness, pain, and diminution of vision in the left eye since 2 weeks. There was no history of trauma or ocular surgery. Past history was significant for hospitalization for urinary tract infection and septicemia during which he developed the ocular symptoms. The urine and blood cultures were positive for Klebsiella species—further identification was not available. The patient had received one intravitreal injection of ceftazidime (2.25 mg/0.1 ml) in the left eye and was on oral cefotaxime (500 mg TDS) and topical moxifloxacin 0.5%, tobramycin 0.3%, homatropine hydrobromide 2%, and prednisolone acetate 1% eye drops.
Endogenous endophthalmitis is an uncommon entity , and subretinal abscess as a prominent feature is infrequently reported in literature. The most common organism reported to cause subretinal abscess is Nocardia [6–8], more so in immunocompromised patients. There are case reports of other organisms such as Pseudomonas aeruginosa , Streptococcus viridans , and Klebsiella pneumoniae  causing subretinal abscess.
The bacterial genus Roseomonas was first reported by Rihs et al.  in 1993 though the natural reservoir of the organism is unclear. Roseomonas genus is typically described as a slow-growing, pink, pigmented, aerobic, Gram-negative bacteria. This genus includes ten species, one of which is R. mucosa. This organism has been incriminated as the causative agent in catheter-related bacteremia. Literature reports have shown various instances where it has been isolated from blood, urine, and catheter samples [8, 13–17]. However, there is no report of R. mucosa being isolated from a subretinal abscess.
A case reported by Chen et al.  in 2008 showed that Roseomonas was the causative organism in the case of chronic postoperative endophthalmitis in an 83-year-old patient. However, in their report since the sample was not preserved, further subtyping of the species was not done. The final visual outcome was unsatisfactory.
The antibiotic sensitivity pattern of Roseomonas has been studied by Han et al.  in 2003. The choice of treatment for Roseomonas species is difficult as the susceptibility varies among different species with R. mucosa showing the highest risk of resistance. The organism has been found to be sensitive to broad-spectrum antibiotics including aminoglycosides, ciprofloxacin, imipenem, and ticarcillin but resistant to third- or fourth-generation cephalosporins such as ceftazidime [12, 14, 19].
Our case is unique in that the organism was found to be different from that predicted based on the clinical condition. PCR helped identify the organism [20, 21]. Almost complete drainage of the purulent material probably also contributed to the satisfactory outcome.
R. mucosa is a rare cause of endophthalmitis, and this is the first time the organism has been isolated from a subretinal abscess. Internal drainage of the abscess with identification of the organism and treatment with the appropriate antibiotics led to a satisfactory outcome in this patient.
The authors would like to acknowledge the support of the microbiology department in the diagnosis.
MB was the operating surgeon and handled the preparation and finalization of the manuscript. AK was the assisting surgeon and handled the collection of the data and the preparation of the manuscript. SA handled the collection of the data and the preparation of the manuscript. KLT handled the microbiological diagnosis and data collection. JB reviewed the manuscript. All authors read and approved the final manuscript.
The authors declare that they have no competing interests.
Ethics approval and consent to participate
Institution review board of Medical and Vision Research Foundations approved the study.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
- Bohigian GM, Olk RJ (1986) Factors associated with a poor visual result in endophthalmitis. Am J Ophthalmol 101(3):332–41View ArticlePubMedGoogle Scholar
- Diamond JG (1981) Intraocular management of endophthalmitis. A systematic approach. Arch Ophthalmol 99(1):96–9View ArticlePubMedGoogle Scholar
- Rowsey JJ, Newsom DL, Sexton DJ, Harms WK (1982) Endophthalmitis: current approaches. Ophthalmology 89(9):1055–66View ArticlePubMedGoogle Scholar
- Shrader SK, Band JD, Lauter CB, Murphy P (1990) The clinical spectrum of endophthalmitis: incidence, predisposing factors, and features influencing outcome. J Infect Dis 162(1):115–20View ArticlePubMedGoogle Scholar
- Harris EW, D’Amico DJ, Bhisitkul R, Priebe GP, Petersen R (2000) Bacterial subretinal abscess: a case report and review of the literature. Am J Ophthalmol 129(6):778–85View ArticlePubMedGoogle Scholar
- Ferry AP, Font RL, Weinberg RS, Boniuk M, Schaffer CL (1988) Nocardial endophthalmitis: report of two cases studied histopathologically. Br J Ophthalmol 72(1):55–61View ArticlePubMedPubMed CentralGoogle Scholar
- Gregor RJ, Chong CA, Augsburger JJ, Eagle RC Jr, Carlson KM, Jessup M et al (1989) Endogenous Nocardia asteroides subretinal abscess diagnosed by transvitreal fine-needle aspiration biopsy. Retina Phila Pa 9(2):118–21View ArticleGoogle Scholar
- Mamalis N, Daily MJ, Ross D (1988) Presumed intraocular nocardiosis in a cardiac-transplant patient. Ann Ophthalmol 20(7):271–3, 276PubMedGoogle Scholar
- Webber SK, Andrews RA, Gillie RF, Cottrell DG, Agarwal K (1995) Subretinal Pseudomonas abscess after lung transplantation. Br J Ophthalmol 79(9):861–6View ArticlePubMedPubMed CentralGoogle Scholar
- Rimpel NR, Cunningham ET Jr, Howes EL Jr, Kim RY (1999) Viridans group Streptococcus subretinal abscess. Br J Ophthalmol 83(3):373–4View ArticlePubMedPubMed CentralGoogle Scholar
- Yarng SS, Hsieh CL, Chen TL (1997) Vitrectomy for endogenous Klebsiella pneumoniae endophthalmitis with massive subretinal abscess. Ophthalmic Surg Lasers 28(2):147–50PubMedGoogle Scholar
- Rihs JD, Brenner DJ, Weaver RE, Steigerwalt AG, Hollis DG, Yu VL (1993) Roseomonas, a new genus associated with bacteremia and other human infections. J Clin Microbiol 31(12):3275–83PubMedPubMed CentralGoogle Scholar
- Dé I, Rolston KVI, Han XY (2004) Clinical significance of Roseomonas species isolated from catheter and blood samples: analysis of 36 cases in patients with cancer. Clin Infect Dis Off Publ Infect Dis Soc Am 38(11):1579–84View ArticleGoogle Scholar
- Lewis L, Stock F, Williams D, Weir S, Gill VJ (1997) Infections with Roseomonas gilardii and review of characteristics used for biochemical identification and molecular typing. Am J Clin Pathol 108(2):210–6View ArticlePubMedGoogle Scholar
- Boyd MA, Laurens MB, Fiorella PD, Mendley SR (2012) Peritonitis and technique failure caused by Roseomonas mucosa in an adolescent infected with HIV on continuous cycling peritoneal dialysis. J Clin Microbiol 50(11):3801–4View ArticlePubMedPubMed CentralGoogle Scholar
- Al-Anazi KA, AlHashmi H, Abdalhamid B, AlSelwi W, AlSayegh M, Alzayed A et al (2013) Roseomonas bacteremia in a recipient of an allogeneic hematopoietic stem cell transplantation. Transpl Infect Dis Off J Transplant Soc 15(4):E144–147View ArticleGoogle Scholar
- Bard JD, Deville JG, Summanen PH, Lewinski MA (2010) Roseomonas mucosa isolated from bloodstream of pediatric patient. J Clin Microbiol 48(8):3027–9View ArticlePubMedPubMed CentralGoogle Scholar
- Chen K-J, Lai C-C, Kuo Y-H, Wu W-C, Chen T-L (2009) Chronic postoperative Roseomonas endophthalmitis. J Clin Microbiol 47(1):266–7View ArticlePubMedGoogle Scholar
- Han XY, Pham AS, Tarrand JJ, Rolston KV, Helsel LO, Levett PN (2003) Bacteriologic characterization of 36 strains of Roseomonas species and proposal of Roseomonas mucosa sp nov and Roseomonas gilardii subsp rosea subsp nov. Am J Clin Pathol 120(2):256–64View ArticlePubMedGoogle Scholar
- Therese KL, Anand AR, Madhavan HN (1998) Polymerase chain reaction in the diagnosis of bacterial endophthalmitis. Br J Ophthalmol 82(9):1078–82View ArticlePubMedPubMed CentralGoogle Scholar
- Therese KL, Jayanthi U, Madhavan HN (2005) Application of nested polymerase chain reaction (nPCR) using MPB 64 gene primers to detect Mycobacterium tuberculosis DNA in clinical specimens from extrapulmonary tuberculosis patients. Indian J Med Res 122(2):165–70PubMedGoogle Scholar