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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)