An Unusual Encounter: Endophthalmitis Associated with Flavobacterium lindanitolerans

Introduction

Endophthalmitis refers to an infection, either bacterial or fungal, occurring within the eye and involving the vitreous and/or aqueous humor [1]. Exogenous endophthalmitis is the more common form, where microorganisms are introduced into the eye through trauma, surgical procedures, or an infected cornea. On the other hand, endogenous endophthalmitis occurs when the eye becomes seeded with microorganisms via the bloodstream. Patients often exhibit symptoms related to their underlying systemic infection, although some may present solely with eye symptoms [1]. It is important to note that endophthalmitis does not act as a source of bacteremia or fungemia; the infection remains localized within the eye. However, if left untreated or inadequately treated, it progresses to panophthalmitis, spreading beyond the globe to the surrounding soft tissues of the orbit. Acute presentation is typical for most endophthalmitis cases, with symptoms emerging within hours to a few days. Due to the potential for irreversible vision loss, prompt treatment is imperative, making these cases medical emergencies [1].

A recent study investigating the microbial causes of endophthalmitis across all variants found that 85.1% of the identified isolates were attributed to gram-positive bacteria, 10.3% to gram-negative bacteria, and fungi accounted for 4.6% of all cases [2]. Among the bacterial pathogens, the most commonly isolated species were Staphylococcus epidermidis (30.3%), other coagulase-negative Staphylococcus strains (9.1%), Streptococcus viridans (12.1%), Staphylococcus aureus (11.1%), Enterobacteriaceae (3.4%), and Pseudomonas aeruginosa (2.5%) [2]. The predominance of a specific organism in endophthalmitis cases can be influenced by various factors such as the source of infection (e.g., vegetable matter or retained intraocular foreign body), the route of spread (e.g., post-surgery, trauma, delayed onset, or hematogenous dissemination), geographic location, and patient-specific characteristics.

In 2008, a previously unknown species of Flavobacterium, named Flavobacterium lindanitolerans sp. nov, was discovered in soil samples collected from a heavily hexachlorocyclohexane-contaminated waste site in Ummari village, India [3]. To the best of our knowledge, there is only one study documenting the isolation of F. lindanitolerans from clinical samples, particularly from a human ascites sample [4]. Our study aims to present the inaugural case of postoperative endophthalmitis associated with this exceedingly uncommon pathogen.

Publication History

Received: 12 July 2023

Accepted: 27 August 2023

Article published online:
19 October 2023

• References

• 1 Durand ML. Endophthalmitis. Clin Microbiol Infect 2013; 19: 227-234
• 2 Gentile RC, Shukla S, Shah M. et al. Microbiological spectrum and antibiotic sensitivity in endophthalmitis: a 25-year review. Ophthalmology 2014; 121: 1634-1642
• 3 Jit S, Dadhwal M, Prakash O. et al. Flavobacterium lindanitolerans sp. nov., isolated from hexachlorocyclohexane-contaminated soil. Int J Syst Evol Microbiol 2008; 58: 1665-1669
• 4 Tian GZ, Piao DR, Zhao HY. et al. A Flavobacterium lindanitolerans strain isolated from the ascites sample of a Chinese patient with EV71 virus infection. Biomed Environ Sci 2011; 24: 694-696
• 5 Endophthalmitis Vitrectomy Study Group. Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Arch Ophthalmol 1995; 113: 1479-1496
• 6 Kuhn F, Gini G. Ten years after… are findings of the Endophthalmitis Vitrectomy Study still relevant today?. Graefes Arch Clin Exp Ophthalmol 2005; 243: 1197-1199
• 7 Deramo VA, Ting TD. Treatment of Propionibacterium acnes endophthalmitis. Curr Opin Ophthalmol 2001; 12: 225-229
• 8 Kalogeropoulos D, Asproudis I, Stefaniotou M. et al. The Large Hellenic Study of Uveitis: Diagnostic and Therapeutic Algorithms, Complications, and Final Outcome. Asia Pac J Ophthalmol (Phila) 2023; 12: 44-57
• 9 Aber RC, Wennersten C, Moellering jr. RC. Antimicrobial susceptibility of flavobacteria. Antimicrob Agents Chemother 1978; 14: 483-487