From: Ocular involvement in melioidosis: a 23-year retrospective review
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) |