Skip to content

Advertisement

  • Original research
  • Open Access

Ocular involvement in melioidosis: a 23-year retrospective review

Journal of Ophthalmic Inflammation and Infection20188:5

https://doi.org/10.1186/s12348-018-0147-6

  • Received: 5 October 2017
  • Accepted: 6 March 2018
  • Published:

Abstract

Background

Ocular involvement in melioidosis is rare and has devastating outcomes. Although there have been few reports on the condition, Khon Kaen, a city in northeast Thailand, has been called the “capital of melioidosis” due to the high prevalence of the condition in the region. We retrospectively reviewed all admitted cases of melioidosis with ocular involvement from the two largest hospitals in Khon Kaen. We reviewed cases from Srinagarind Hospital (a university hospital) of patients admitted between 1993 and 2016 and from Khon Kaen Hospital (a provincial hospital) of patients who presented from 2012 to 2016.

Results

We identified 16 cases of ocular involvement. Eight of these cases were proven from positive culture, and the remaining eight were implied from high melioidosis titer. The prevalence was estimated as being from 0.49 to 1.02%. Most patients had underlying diseases (14, 88%), of which diabetes mellitus was the most prevalent (12, 75%). Nine cases (56%) were part of disseminated septicemia. Patients suffered from blindness in 11 (73%) of the 15 cases in which visual acuity was recorded. Orbital cellulitis was the most common manifestation (7, 44%) followed by endophthalmitis (4, 25%). Interestingly, all patients with necrotizing fasciitis (100%) developed septic shock as a consequence. In most of the cases, patients underwent surgery (13, 81%) including incision and drainage, debridement, and pars plana vitrectomy. Despite appropriate management, the visual outcomes were disappointing (9, 64%).

Conclusion

To summarize, ocular melioidosis is a highly destructive disease. Early detection and prompt surgical management may reduce morbidity and mortality from septic shock.

Keywords

  • Melioidosis
  • Burkholderia pseudomallei
  • Glanders
  • Orbital cellulitis
  • Endophthalmitis

Background

Melioidosis is caused by a gram-negative, motile, non-spore forming facultative anaerobic bacillus known as Burkholderia pseudomallei. The organism is found in soil and surface water and is widely distributed in Southeast Asia, especially in northeast Thailand and northern Australia [1].

Melioidosis presents with broad spectrums of clinical presentations and organ involvement. However, there are few case reports of ocular involvement in melioidosis, and most of these are single-case report or small case series.

In northeast Thailand, there are around 2000 culture-positive melioidosis cases per year [2]. Khon Kaen, one of the largest cities in northeast Thailand, has been called “the capital of melioidosis” due to the high prevalence of the disease in the region. Ocular involvement in these cases has not been investigated. The primary objective of this study was to estimate the prevalence and investigate ocular manifestations of melioidosis in Khon Kaen. Management and visual outcomes in these patients were also reviewed.

Results

We identified 16 cases of ocular involvement, 13 out of the 1270 melioidosis cases admitted to Srinagarind Hospital (prevalence 1.02%; 95% confidence interval from 0.58 to 1.76%) and three out of the 607 admitted cases at Khon Kaen Hospital (prevalence 0.49%; 95% confidence interval from 0.10 to 1.51%). Overall, the estimated prevalence of ocular involvement in cases of melioidosis was from 0.49 to 1.02% (Table 1).
Table 1

Data collection and prevalence (95%CI) calculation

Tertiary hospital

Srinagarind University Hospital

Khon Kaen Provincial Hospital

Total from all data

Total from 2012 to 2016

Date

January 1993 to April 2016

January 2012 to April 2016

January 1993 to April 2016

January 2012 to April 2016

Length

23 years and 4 months

4 years and 4 months

23 years and 4 months

4 years and 4 months

Total melioidosis (cases)

1270

607

1877

859

Total ocular involvement (cases)

13

3

16

8

Prevalence

(95% CI)

1.02% (0.58, 1.76%)

0.49% (0.10, 0.51%)

0.85% (0.51, 1.39%)

0.93% (0.44, 1.86%)

Of those 16 cases, there were 8 with positive cultures. In the remaining eight cases, melioidosis was implied from the high titer for melioidosis in the bloodstream. Clinical descriptions of all cases are summarized in Table 2.
Table 2

Clinical descriptions of all cases

Year

Age

Sex

Occupation

Symptom

Laterality

Initial VA

Ocular positive finding

Ocular diagnosis

Risk factor

Type of melioidosis

Primary organ

Associated symptoms

Investigations

Treatments

Outcomes

2007

70

F

None

Progressive painful proptosis with fever 10 days, S/P IV cloxacillin at provincial hospital (onset = 10 days)

OD

No LP

Complete ptosis, mark eyelid swelling, IOP 21/13, marked chemosis, clear cornea, no C/F, positive RAPD, EOM 0% all direction, pale disc with choroidal fold

Orbital cellulitis

History of eye scratching with dirty hand

Disseminated

Eye

Acute sphenoidal sinusitis, meningitis, septic arthritis, melioidosis septicemia

Hemoculture: B. pseudomellei, LP: eosinophilic meningitis, MRI orbit: right orbital cellulitis with extraconal abscess latero-superior aspect

FESS, I&D, IV ceftazidime then oral bactrim, tarsorhaphy

VA no LP, limit EOM 90% at lateral gaze OD, other EOM are full, normal anterior segment, pale disc, attenuated vessel (No LP at initial)

2007

64

M

Farmer

Progressive proptosis 10 days PTA, S/P IV ceftazidime, IV clindamycin at provincial hospital

OS

CF 2 ft

Lid swelling, proptosis, chemosis, clear cornea, no C/F, positive RAPD, EOM 10% all direction

Orbital cellulitis

DM without DR, CKD

Disseminated

Eye

Pansinusitis, subcutaneous abscess at inferolateral of the eye

Hemoculture: B. pseudomellei, pus culture: B. pseudomellei. CT orbit: pansinusitis with severe orbital cellulitis

I&D, FESS, IV ceftazidime then oral bactrim, topical antibiotic

VA 6/24, VA with pinhole 6/12, less chemosis, less proptosis, normal anterior segment, EOM limit at downgaze

(onset = 10 days)

(improve)

2008

61

M

Farmer

Progressive painful visual loss 2 weeks

OS

No LP

Generalized bedewing cornea, hypopyon 2-mm, shallow AC, C/F 3+/2+, positive RRAPD, EOM 50% all direction, B scan: generalized vitreous opacity, intra-op findings: dense vitreous abscess, subretinal abscess rupture to vitreous

Panophthalmitis

DM without DR, CKD

Localized

Eye

 

Hemoculture: no growth, melioid titer 1:5122, CT orbit: swelling of periorbital tissue

PPV, ECCE, topical vancomycin, topical ceftazidime, oral bactrim

VA no LP, conjunctival less chemosis, AC deep with plasmoid and hyphema, no record about posterior segment

(onset = 2 weeks)

 

(No LP at initial)

2008

51

F

Teacher

Fever with dyspnea 12 days PTA, left eye inflammation was found during admission

OS

HM, good PJ

Corneal bedewing, C/F 4+/4+, positive RRAPD, intra-op findings: attenuated vessels, subretinal gliosis, shallow RD

Endogenous endopthalmitis

DM without DR

Disseminated

Hematogenous

Pulmonary edema

Hemoculture: no growth, melioid titer 1:5122, MRI orbit: preseptal cellulitis

PPV with silicone oil, ECCE, IV ceftazidime then oral bactrim, topical vancomycin, topical ceftazidime

VA HM poor PJ, AC deep with plasmoid, attach retina

(onset = NA)

 

(stable)

2009

39

F

Farmer

Eye pain with fever 2 weeks

OD

6/24

Marked eyelid swelling and erythema, fluctuation, no discharge, clear cornea, no C/F, negative RAPD, normal posterior segment

Preseptal cellulitis

DM without DR

Multifocal

Eye

Pneumonia, subcutaneous abscess at right thigh

Pus culture: B. pseudomellei, melioid titer 1/640, hemoculture: NG, CT orbit: preseptal cellulitis

I&D upper eyelid, I&D right thigh, oral bactrim

VA 6/9, normal anterior and posterior segment

(onset = 2 weeks)

(improve)

2011

46

M

Labor

Fever with constitutional symptoms 2 weeks then visual loss 3 days

OS

CF 2 ft

Conjunctival chemosis, corneal stromal edema, hypopyon, hyphema, C/F 4+/2+, retinal infiltration

Endogenous endophthalmitis

DM without DR

Multifocal

Hematogenous

Liver abscesses, splenic abscess

Hemoculture: no growth, melioid titer 1:5122, CT abdomen: multiple liver abscesses, splenic abscess

IV ceftazidime then oral bactrim

VA 3/60, VA with pinhole 4/60, contracted hypopyon, vitreous opacity grade 1

(onset = 3 days)

 

(improve)

2011

43

F

Farmer

Painful proptosis 8 days PTA, S/P IV antibiotic at provincial hospital then alteration of consciousness 1 day

OS

Not done due to alteration of consciousness

Necrotizing fasciitis at left upper eyelid size 1 × 8 cm, purulent discharge, ciliary injection, clear cornea, no C/F, clear vitreous

Orbital cellulitis, necrotizing fasciitis

First dx DM without DR

Disseminated

Eye

Pansinusitis, melioidosis septic shock

Hemoculture: B. pseudomellei, pus culture: B. pseudomellei, CT orbit: orbital abscess at the superomedial wall of orbit, medial rectus muscle, lateral rectus muscle

Debridement of necrotic wound, IV ceftazidime then oral bactrim

Good wound, less swelling, no record about VA

(onset = 8 days)

(NA)

2011

46

M

Labor

Painless visual loss 1 month PTA then painful proptosis 2 days

OS

LP, poor PJ

IOP 32, bedewing cornea, hypopyon with plasmoid in AC, negative RAPD, intra-op finding: subretinal abscess

Endogenous endopthalmitis

DM without DR

Multifocal

Eye, liver

Liver abscess

Hemoculture: NG, melioid titer 1:640

PPV with silicone oil, oral bactrim

Painful red eye 1 week after discharge, VA no LP, IOP 40, shallow AC, iris bombe end up with enucleation, intra-op finding: flank pus in the vitreous cavity

(onset = 1 month)

(enucleated)

2012

63

M

Farmer

Painful proptosis 2 weeks

OD

20/200

Marked eyelid swelling, no discharge, conjunctival injection, keratic precipitates at the cornea, peripheral synechiae 360 degrees, C/F 4+/2+, vitreous opacity grade 4

Panuveitis, preseptal cellulitis

MDS, leukemia

Disseminated

Eye

Spondylodiscitis, epidural and paravertebral abscess

Hemoculture: no growth, melioid titer 1: 5120

IV ceftazidime, 1% prednisolone acetate eye drop RE qid

VA 20/200, peripheral synechiae 360 degrees, vitreous opacity grade 1

(onset = 2 weeks)

  

(stable)

2012

54

M

Farmer

Fever with left side headache 1 week PTA then left facial edema 5 days PTA then painful proptosis 3 days

OS

No LP

Marked eyelid swelling, erythema and tender, copious pus and discharge, marked chemosis, clear cornea, no C/F, positive RRAPD, B scan: vitreous opacity, intra-op finding: pus 1 ml in the vitreous cavity, flame shape hemorrhage, disc swelling, venous congestion, drusen

Orbital cellulitis

DM without DR

Disseminated

Maxillary sinus

Maxillary sinusitis, melioidosis septicemia

Hemoculture: B. pseudomellei, pus culture: B. pseudomellei, CT orbit: maxillary sinusitis

I&D, orbital decompression, IV ceftazidime then oral bactrim

VA no LP, less swelling periorbital area, conjunctival chemosis, normal anterior segment, limit EOM all direction, fundus: disc swelling, flame shape hemorrhage

(onset = 1 week)

(No LP at initial)

2012

65

M

House keeper

Fever with chill 3 days PTA then alteration of consciousness 1 day, then right upper eyelid swelling at the emergency department

OD

6/6

Upper eyelid swelling, erythema and tender, conjunctival chemosis, clear cornea, no C/F, negative RAPD, normal posterior segment, full EOM

Preseptal cellulitis

DM without DR

Disseminated

Hematogenous

Hemoculture: no growth, melioid titer 1:640

IV ceftazidime then oral azithromycin

VA 6/6, no lid swelling, mild erythema, normal anterior and posterior segment

(onset = < 1 day)

 

(improve)

2013

57

M

Thai massager

Pain at the left temporal area 3 week PTA then painful proptosis 3 days, S/P IV antibiotic at primary care hospital, S/P I&D temporal space abscess at provincial hospital

OS

20/200

Proptosis, chemosis, clear cornea, no C/F, negative RAPD, EOM 10-20% all direction, fundus: macular striae, mild pale disc

Orbital cellulitis

DM without DR

Localized

Temporal space abscess

Temporal space abscess, subperiosteal abscess

Pus culture: B. pseudomellei, hemoculture: NG, CT orbit: left panophthalmitis with subperiosteal abscess

I&D temporal space abscess, lateral and medial orbitotomy, I&D orbital abscess, IV ceftazidime then oral bactrim

VA 6/9, no sign of inflammation, residual ptosis, normal anterior segment, no record about posterior segment

(onset = 3 weeks)

(improve)

2014

42

M

Farmer

Right eye contact with wood particle 10 days PTA then drop of breast milk into the eye 4 days PTA then acute visual loss 2 days, S/P IVT vancomycin, ceftazidime at provincial hospital

OD

HM at provincial hospital then no LP

Multiple keratic precipitates at the cornea, C/F 4+/4+, positive RAPD, vitreous opacity grade 4, B scan: loculated vitreous haze, membrane-like lesion attach to disc, moderate to high spike, intra-op finding: yellow pus with blood clot

Endogenous endophthalmitis

CKD, chronic alcoholism, wood particle contact, breast milk instillation

Multifocal

Eye

Splenic abscess

Gram stain from pus: gram-negative rod safety pin, pus culture: no growth, hemoculture: no growth, melioid titer 1:5122, ultrasound abdomen: splenic abscess

Enucleation, IV ceftazidime then oral bactrim

Good enucleation wound

(onset = 10 days)

 

(enucleated)

2014

45

M

Officer

Proptosis 4 days PTA, S/P FESS, orbital decompression at private hospital

OS

CF

Marked eyelid swelling, fluctuation, chemosis, limit EOM at upper and lateral gaze, clear cornea, no C/F, negative RAPD, normal posterior segment, intra-op finding: loculated abscess at left upper eyelid 5 ml

Orbital cellulitis

DM without DR

Multifocal

Sinus

Abscess at right leg

Pus culture from the eye: B. pseudomellei, pus culture from the right leg: B. pseudomellei, hemoculture: no growth, ultrasound abdomen: no liver or splenic abscess

I&D, IV ceftazidime then oral bactrim

Less swelling, less chemosis, normal anterior segment, EOM improve, no record of VA and posterior segment

(onset = 4 days)

 

(NA)

2015

50

M

Farmer

Low-grade fever 2 weeks PTA, right eye pain 9 days PTA, painful proptosis with visual loss 7 days PTA, S/P IV ceftazidime, IV metronidazole at provincial hospital, progressive proptosis in this admission

OD

HM

Proptosis, marked chemosis, AC deep with C/F 4+/3+, positive RAPD, peripheral synechiae, vitreous opacity grade 4, EOM minimal limit all direction, B scan: vitreous opacity, subretinal abscess, intra-op finding: yellow pus 0.2 ml

Panopthalmitis

Disseminated

Hematogenous

Liver abscess, ethmoid sinusitis

Hemoculture: no growth, melioid titer 1:5122, vitreous culture: no growth

PPV, IV ceftazidime

No LP, normal globe contour, no record about anterior and posterior segment

(onset = 9 days)

 

(worse)

2015

45

M

Farmer

Painful proptosis with fever 2 weeks, S/P IV antibiotic at primary care hospital

OD

1/60 at primary care hospital then LP

Marked eyelid and periorbital area swelling, vesicle at medial canthus, marked bloody chemosis, clear cornea, no C/F, positive RAPD, EOM 0% all direction, necrotic skin at forehead 2 × 3 cm

Orbital cellulitis, Necrotizing fasciitis

DM without DR, psoriasis, chronic alcoholism

Disseminated

Eye

Sinusitis, septic arthritis, splenic abscess, septic shock

Hemoculture: B. pseudomellei x II, pus culture from the eye: B. pseudomellei, pus culture from the right knee: B. pseudomellei

I&D, FESS, skin debridement, IV ceftazidime

VA no LP, chemosis, normal anterior segment, RAPD positive, no record of posterior segment

(onset = 2 weeks)

(worse)

Baseline characteristics of the patients were comparable to general melioidosis patients. The male to female ratio was 3 to 1 with a median age of 50.5 years old (39–70). The most common occupation was farmer (nine cases, 56%). Most patients had underlying diseases (14 cases, 88%), of which diabetes mellitus was the most common (12 cases, 75%). Ocular involvement was part of dissemination in nine cases (56%), which were classified as disseminated septicemic melioidosis.

The majority of ocular melioidosis patients (10 cases, 63%) presented with eye symptoms. Interestingly, the other six cases initially presented with fever or a headache. Out of the 15 cases for which there were records of visual acuity, 11 (73%) presented with blindness. The ocular manifestations of melioidosis were classified as orbital cellulitis (seven cases, 44%), preseptal cellulitis (two cases, 13%), endophthalmitis (four cases, 25%), panophthalmitis (two cases, 13%), and panuveitis (one case, 6%).

In most cases, the definitive management was surgery (13 cases, 81%) including incision and drainage, debridement (eight cases, 62%), pars plana vitrectomy (three cases, 23%), and enucleation (two, 15%). There were only three cases (19%) in which the patients were able to be treated without surgery.

Despite adequate surgical intervention, the visual outcomes of ocular melioidosis were disappointing. Out of the 14 cases for which there were records of final visual acuity, nine (64%) patients ended up legally blind. Three of these patients (20%) presented with no light perception at the beginning, two had to be enucleated, two (14%) were stable, and two (14%) had progressive loss of vision. Patients had improved vision after treatment in only five cases (36%).

Discussion

To our knowledge, this is the first and largest case series of ocular involvement in melioidosis. A comprehensive literature review revealed only 14 cases from 12 reports [314], including 7 cases of orbital cellulitis (50%), 3 cases of endophthalmitis (21%), 3 cases of corneal ulcer (21%), and 1 case of acute dacryocystitis (7%). Most of the reports were single-case reports, and the largest one had only three cases.

In Thailand, especially in the northeast, there has been an increase in the reported cases of melioidosis. This is likely due to increasing awareness of the condition and increased sensitivity of the technology used to detect the organism. The mortality rate in these areas is around 40%. It is the third highest cause of mortality after acquired immune deficiency syndrome and tuberculosis [2]. Although ocular involvement in melioidosis is rare, the effects on patients’ vision are devastating. Most patients with this condition ended up becoming legally blind. In our series of 16 cases, there were only 5 (36%) in which patients had improved vision after treatment.

We suspect that the number of ocular melioidosis cases might be underestimated. Most of the melioidosis patients admitted to the hospital had disseminated septicemic melioidosis and were treated for life-threatening symptoms. Mild ocular symptoms might be easily overlooked, and ophthalmologists were not consulted in all cases.

The prevalence of ocular melioidosis in Srinagarind Hospital (1.02%) was about twice that in Khon Kaen Hospital (0.49%). The discrepancy might be due to the differences between the two hospitals. Srinagarind Hospital is the largest university hospital in northeast Thailand, and many severe cases of systemic melioidosis are referred to Srinagarind Hospital. Since more organs are affected in severe disseminated melioidosis, ocular involvement is more likely in these cases.

We suspect that the recent prevalence of ocular melioidosis in Srinagarind Hospital might be much higher than what we have found. From 2007 to April 2016, there were 264 cases of melioidosis at Srinagarind Hospital, of which 13 had ocular involvement. According to this finding, the prevalence during this time interval was as high as 4.9% (95% confidence interval from 2.82 to 8.32%).

This study led to some interesting findings. Ten patients (63%) presented with eye symptoms, which later resulted in systemic spreading. On the other hand, there were six patients (38%) whose first symptoms were not eye symptoms; four patients (25%) presented with fever and two (13%) presented with a headache. In most cases, diabetes mellitus was the underlying disease (12 cases, 75%), but none of the patients in those cases had diabetic retinopathy.

Interestingly, we found that most cases of ocular melioidosis were classified as disseminated septicemic melioidosis (nine cases, 56%) which means that there was a bloodstream infection. This is unlike other gram-positive organisms, which usually cause orbital cellulitis and commonly result in a negative hemoculture. The explanation for this finding may be attributable to the nature of Bulkholderia pseudomallei infection, which generally presents with bloodstream infection.

In our study, orbital cellulitis was the most common manifestation (seven cases, 44%). Usually, orbital cellulitis is caused by gram-positive organisms and can be cured only by intravenous antibiotics, unlike orbital cellulitis caused by melioidosis. All of these patients ended up undergoing surgical intervention (100%). The abscess-forming activity of Burkholderia pseudomallei may be the reason why intravenous antibiotics alone did not work to treat the condition.

Moreover, there were two cases (29%) of orbital cellulitis that progressed to necrotizing fasciitis, which is uncommon in other types of bacterial orbital cellulitis. This is similar to the results of a previous case report by Saonanon P [13]. Unfortunately, all of our patients (100%) with necrotizing fasciitis subsequently developed septic shock. Early suspicion and prompt surgical debridement may improve mortality in these patients.

We also found that even if systemic ceftazidime was used, the occurrence of endogenous endophthalmitis caused by melioidosis was not preventable, as stated in a previous report [10]. Most of the cases diagnosed as endophthalmitis and panophthalmitis required surgical intervention (five out of six cases, 83%), including pars plana vitrectomy (three out of five cases, 60%) and enucleation (two out of five cases, 40%).

Two cases (50%) of endophthalmitis were enucleated. The first case, from 2011, had a delayed presentation. The patient had experienced loss of vision for 1 month prior to admission, which was the longest onset in any of the cases. In the second case, from 2014, the patient exhibited two risk factors for the condition, including wood particle contact and breast milk instillation into the eye, as a result of local traditional treatment practices.

There were three cases that were cured without any surgical intervention. In one case, this was due to the patient seeking early treatment for endogenous endophthalmitis. The other two patients had diagnoses that did not require an operation (namely, panuveitis and preseptal cellulitis).

Conclusions

In summary, ocular involvement in melioidosis was rare, but the outcomes were devastating. The most common ocular involvements were orbital cellulitis and endophthalmitis. The morbidity in these cases was high, so it is critical to employ a high index of suspicion. Ocular melioidosis should be considered when the ocular infection does not respond to conventional antibiotic therapy, especially in hyperendemic regions for melioidosis. Early consultation with an ophthalmologist and prompt surgical intervention may significantly improve the final visual outcomes, as well as mortality rates.

Methods

We retrospectively reviewed all admitted cases of melioidosis with ocular involvement from two tertiary hospitals in Khon Kaen using electronic databases. The first is Srinagarind Hospital, which is a university hospital. We searched the hospital’s electronic database for cases of this condition from January 1993 to April 2016 (23 years and 4 months). The second is Khon Kaen Hospital, which is a provincial hospital. We searched the hospital’s electronic database for cases that presented between January 2012 and April 2016 (4 years and 4 months). The data were retrieved using the ICD10 code for melioidosis (all A24 codes) and all diseases of the eye and adnexa (code H00 to H59).

This manuscript adheres to the guidelines and principles laid out in the Declaration of Helsinki. Institutional review board (IRB) approval was obtained from the Khon Kaen University and Khon Kaen Hospital, Thailand. The clinical trial was registered in Thai Clinical Trials Registry (study ID: TCTR20160818004).

We only included cases in which there were positive cultures for melioidosis or high blood titer according to indirect hemagglutination (IHA). The cutoff point for positive antibody titers has been determined to be 1:160 in endemic areas [15]. Irrelevant ocular diagnoses, such as cataracts, glaucoma, diabetic retinopathy, or other underlying eye diseases, were excluded. The prevalence and 95% confidence intervals (95% CI) were calculated using the modified Wald method. Other results were summarized as proportions and percentages.

Abbreviations

AC: 

Anterior chamber

B. pseudomellei

Bulkholderia pseudomallei

C/F: 

Cell/flare

CF: 

Counting fingers

CKD: 

Chronic kidney disease

DM: 

Diabetes mellitus

DR: 

Diabetic retinopathy

ECCE: 

Extracapsular cataract extraction

EOM: 

Extraocular movement

F: 

Female

FESS: 

Functional endoscopic sinus surgery

HM: 

Hand motion

I&D: 

Incision and drainage

IOP: 

Intraocular pressure

LP: 

Light perception

LP: 

Lumbar puncture

M: 

Male

MDS: 

Myelodysplastic syndrome

MRI: 

Magnetic resonance imaging

NA: 

Not available

OD: 

Right eye

OS: 

Left eye

PJ: 

Light projection

PPV: 

Pars plana vitrectomy

RAPD: 

Relative afferent pupillary defect

RD: 

Retinal detachment

RRAPD: 

Reverse relative afferent pupillary defect

VA: 

Visual acuity

Declarations

Acknowledgements

We would like to thank our clinical colleagues at the Srinagarind hospital and Khon Kaen Hospital for their expertise with regard to the detection of ocular involvement, diagnosis, and management of the patients in this study. We would also like to thank our coders for the complete diagnosis records that lead to the discoveries described in this paper.

Funding

This work was supported by the Faculty of Medicine, Khon Kaen University.

Authors’ contributions

SY carried out the ophthalmology studies, participated in the research design, participated in the data acquisition at the university hospital, participated in the data interpretation, and drafted the manuscript. SA carried out the ophthalmology practices, participated in the research design, participated in the statistical analysis, and helped to draft the manuscript. PC carried out the infectious practices, provided expertise regarding melioidosis, participated in the research design, helped facilitate the coordination between two hospitals in the study, and drafted the manuscript. SW carried out the microbiological studies, provided expertise with regard to melioidosis, participated in the data acquisition and coordination between departments, and helped to draft the manuscript. PP carried out the ophthalmology practices at the provincial hospital and participated in the data acquisition at the provincial hospital. All authors read and approved the final manuscript.

Ethics approval and consent to participate

The manuscript adheres to the guidelines and principles by the Declaration of Helsinki. Institutional review board (IRB) approval was obtained from Khon Kaen University, Thailand, numbered HE581497 and Khon Kaen Hospital, Thailand, numbered KE59045.

The clinical trial was registered in Thai Clinical Trials Registry study ID: TCTR20160818004.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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.

Authors’ Affiliations

(1)
Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
(2)
Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
(3)
Melioidosis Research Center, Khon Kaen University, Khon Kaen, Thailand
(4)
Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
(5)
Department of Ophthalmology, Khon Kaen Hospital, Khon Kaen, Thailand

References

  1. Wiersinga WJ, Currie BJ, Peacock SJ (2012) Melioidosis. N Engl J Med 367:1035–1044View ArticlePubMedGoogle Scholar
  2. Limmathurotsakul D, Wongratanacheewin S, Teerawattanasook N et al (2010) Increasing incidence of human melioidosis in northeast Thailand. Am J Trop Med Hyg 82:1113–1117View ArticlePubMedPubMed CentralGoogle Scholar
  3. Yospaiboon Y, Sangveejit J (1987) Orbital cellulitis due to Pseudomonas pseudomallei. Thai J Ophthalmol 1:51–54Google Scholar
  4. Suwanwatana C (1990) Acute dacrocystitis due to Pseudomonas pseudomallei. Srinakarin Hosp Med J 5:56–58Google Scholar
  5. Siripanthong S, Teerapantuwat S, Prugsanusak W et al (1991) Corneal ulcer caused by Pseudomonas pseudomallei: report of three cases. Rev Infect Dis 13:335–337View ArticlePubMedGoogle Scholar
  6. Wong PK, Ng PH (1996) Melioidosis presenting with orbital cellulitis. Singap Med J 37:220–221Google Scholar
  7. Srimuang S et al (1996) Immunobiological diagnosis of tropical ocular diseases: Toxocara, Pythium insidiosum, Pseudomonas (Burkholderia) pseudomallei, Mycobacterium chelonei and Toxoplasma gondii. Int J Tissue React 18(1):23–25PubMedGoogle Scholar
  8. Abdul Rani MF, Samad Cheung H, Mohd. Shah A, Mahmood T (2002) Melioidosis presenting as orbital and parotid abscesses with intracranial extension. Int Med J Malaysia 1(2).www.e-imj.com
  9. Yang IH, Lee JJ, Liu JW et al (2006) Melioidosis with endophthalmitis. Arch Ophthalmol 124:1501–1502View ArticlePubMedGoogle Scholar
  10. Chen K, Sun M, Hou C, Sun C, Chen T (2007) Burkholderia pseudomallei endophthalmitis. J Clin Microbiol 45(12):4073–4074View ArticlePubMedPubMed CentralGoogle Scholar
  11. Shawarinin J, Bakiah S, Shatriah I (2009) Successfully treated rare presentation of orbital melioidosis. Int J Ophthalmol 2:90–92Google Scholar
  12. Tirakunwichcha S, Vaivanijkul J (2009) Melioidosis presenting as orbital apex syndrome. Asian J Ophthalmol 11:40–42Google Scholar
  13. Saonanon P, Tirakunwichcha S, Chierakul W (2013) Case report of orbital cellulitis and necrotizing fasciitis from melioidosis. Ophthal Plast Reconstr Surg 29(3):e81–e84View ArticlePubMedGoogle Scholar
  14. Kogilavaani J, Shatriah I, Regunath K, Helmy A (2014) Bilateral orbital abscesses with subdural empyema and cavernous sinus thrombosis due to melioidosis in a child. Asian Pac J Trop Dis 4:S851–S853View ArticleGoogle Scholar
  15. Naigowit P, Maneeboonyoung W, Wongroonsub P et al (1992) Serosurveillance for Pseudomonas pseudomallei infection in Thailand. Jpn J Med Sci Biol 45:215–230View ArticlePubMedGoogle Scholar

Copyright

Advertisement