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Table 2 Clinical descriptions of all cases

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)