eMedicine Specialties > Ophthalmology > Infectious Disease

Escherichia Coli: Differential Diagnoses & Workup

Author: Donny W Suh, MD, FAAP, Clinical Assistant Professor, Pediatric Ophthalmology Service, University of Nebraska Medical Center; Pediatric Ophthalmologist, Adult Strabismus Specialist, Wolfe Eye Clinic, PC; Consulting Staff, Blank Children's Hospital, Mercy Medical Center of Des Moines, Iowa Methodist Hospital of Des Moines, and Marshalltown Medical Center
Contributor Information and Disclosures

Updated: Feb 8, 2010

Differential Diagnoses

Corneal Edema, Postoperative
Corneal Foreign Body
Corneal Melt, Postoperative
Endophthalmitis, Bacterial
Endophthalmitis, Fungal
Endophthalmitis, Postoperative

Other Problems to Be Considered

  • Anterior segment involvement
    • Bacterial corneal ulcer
    • Fungal corneal ulcer (eg, following trauma)
    • Acanthamoeba corneal ulcer
    • Viral corneal ulcer (eg, herpes simplex, herpes zoster)
    • Atypical mycobacteria corneal ulcer
    • Sterile ulcer (collagen vascular disease)
    • Staphylococcal hypersensitivity
  • Posterior segment involvement
    • Retinochoroidal fungal endophthalmitis
    • Retinochoroidal infection (eg, toxoplasmosis, toxocariasis)
    • Noninfectious posterior uveitis (eg, sarcoidosis, pars planitis)
    • Neoplastic conditions

Workup

Laboratory Studies

The following studies are indicated in patients with suspected E coli infection:

  • CBC count with cell differentials
  • Blood agar
  • Sabouraud dextrose agar without cycloheximide
  • Thioglycolate broth
  • Chocolate agar
  • Löwenstein-Jensen medium
  • Nonnutrient agar with E coli overlay
  • Slides
    • Gram stain
    • Giemsa stain

Imaging Studies

  • CT scan of the orbit and head may be helpful in case of trauma to look for foreign body.

Procedures

  • Corneal ulcer: Anesthetize the cornea with topical drops, and, at the slit lamp, scrape the base and the leading edge of the infiltrate with the Kimura spatula, and place on the culture medium or slide.
  • Endophthalmitis: Diagnostic and therapeutic vitrectomy to confirm the diagnosis and to evaluate the organisms' sensitivity to antibacterial agents.

Histologic Findings

  • E coli is a gram-negative rod.
  • E coli has a fermentative and respiratory type of metabolism.

More on Escherichia Coli

Overview: Escherichia Coli
Differential Diagnoses & Workup: Escherichia Coli
Treatment & Medication: Escherichia Coli
Follow-up: Escherichia Coli
Multimedia: Escherichia Coli
References
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References

  1. Chen CJ, Starr CE. Epidemiology of gram-negative conjunctivitis in neonatal intensive care unit patients. Am J Ophthalmol. Jun 2008;145(6):966-970. [Medline].

  2. Raju B, Bali T, Thiagarajan G, Rao V, Das T, Sharma S. Physicochemical properties and antibacterial activity of the precipitate of vancomycin and ceftazidime: implications in the management of endophthalmitis. Retina. Feb 2008;28(2):320-5. [Medline].

  3. Amini E, Ghasemi M, Daneshjou K. A five-year study in Iran of ophthalmia neonatorum: prevalence and etiology. Med Sci Monit. Feb 2008;14(2):CR90-96. [Medline].

  4. Aronson SB, Elliott JH. Ocular Inflammation. St. Louis, MO: CV Mosby; 1972:103-5, 112-4.

  5. Balestrazzi A, Blasi MA, Primitivo S, Balestrazzi E. Escherichia coli endophthalmitis after trans-scleral resection of uveal melanoma. Eur J Ophthalmol. Sep-Oct 2002;12(5):437-9. [Medline].

  6. Bonadio WA, Smith DS, Madagame E, et al. Escherichia coli bacteremia in children. A review of 91 cases in 10 years. Am J Dis Child. Jun 1991;145(6):671-4. [Medline].

  7. Charoo NA, Kohli K, Ali A, Anwer A. Ophthalmic delivery of ciprofloxacin hydrochloride from different polymer formulations: in vitro and in vivo studies. Drug Dev Ind Pharm. Feb 2003;29(2):215-21. [Medline].

  8. Cordido M, Fernandez-Vigo J, Cordido F, Rey AD. Bilateral metastatic endophthalmitis in diabetics. Acta Ophthalmol (Copenh). Apr 1991;69(2):266-7. [Medline].

  9. Eisenstein BI. Escherichia coli infections. In: Harrison's Principles of Internal Medicine. 1994:661-3.

  10. Epstein SP, Bottone EJ, Asbell PA. Susceptibility testing of clinical isolates of pseudomonas aeruginosa to levofloxacin, moxifloxacin, and gatifloxacin as a guide to treating pseudomonas ocular infections. Eye Contact Lens. Sep 2006;32(5):240-4. [Medline].

  11. Fanning WL, Stubbert J, Irwin ES, Aronson MD. A case of bilateral Escherichia coli endogenous endophthalmitis. Am J Med. Aug 1976;61(2):295-7. [Medline].

  12. Faraawi R, Fong IW. Escherichia coli emphysematous endophthalmitis and pyelonephritis. Case report and review of the literature. Am J Med. Mar 1988;84(3 Pt 2):636-9. [Medline].

  13. Glasser DB, Baum J. Antibacterial agents. In: Infections of the Eye. 1996:207-30.

  14. Hyndiuk RA, Cokington CD. Bacterial keratitis. In: Infections of the Eye. 1996:323-47.

  15. Katz HR. A retrospective study of endophthalmitis rates comparing quinolone antibiotics. Am J Ophthalmol. Oct 2005;140(4):771-2; author reply 772-3. [Medline].

  16. Ko KS, Lee MY, Song JH, et al. Prevalence and characterization of extended-spectrum beta-lactamase-producing Enterobacteriaceae isolated in Korean hospitals. Diagn Microbiol Infect Dis. Aug 2008;61(4):453-9. [Medline].

  17. Munoz Morente A, Baron Ramos MA, Mateos Fernandez S, Reguera Iglesias JM. Endogenous bacterial endophthalmitis: a case report and brief review [in Spanish]. An Med Interna. Dec 2004;21(12):597-8. [Medline].

  18. Park SB, Searl SS, Aquavella JV, Erdey RA. Endogenous endophthalmitis caused by Escherichia coli. Ann Ophthalmol. Mar 1993;25(3):95-9. [Medline].

  19. Regnier A, Schneider M, Concordet D, Toutain PL. Intraocular pharmacokinetics of intravenously administered marbofloxacin in rabbits with experimentally induced acute endophthalmitis. Am J Vet Res. Mar 2008;69(3):410-5. [Medline].

  20. Sanford JP, Gilbert DN, Sande MA. Antimicrobial. In: Guide to Antimicrobial Therapy. 1997:47.

  21. Sekimoto M, Hayasaka S, Setogawa T, Shigeno K. Endogenous Escherichia coli endophthalmitis in a patient with autosomal-dominant polycystic kidney disease. Ann Ophthalmol. Dec 1991;23(12):458-9. [Medline].

  22. Shammas HF. Endogenous E. coli endophthalmitis. Surv Ophthalmol. Mar-Apr 1977;21(5):429-35. [Medline].

  23. Sim DA, Feasey N, Wren S, Breathnach A, Thompson G. Cross-infection risk of felt-tipped marker pens in cataract surgery. Eye. Jul 11 2008;[Medline].

  24. Starr MB. A retrospective study of endophthalmitis rates comparing quinolone antibiotics. Am J Ophthalmol. Oct 2005;140(4):769-70; author reply 770-1. [Medline].

  25. Sunakawa K, Nonoyama M, Ooishi T, et al. The trend of childhood bacterial meningitis in Japan (2000-2002) [in Japanese]. Kansenshogaku Zasshi. Oct 2004;78(10):879-90. [Medline].

  26. Tseng CY, Liu PY, Shi ZY, et al. Endogenous endophthalmitis due to Escherichia coli: case report and review. Clin Infect Dis. Jun 1996;22(6):1107-8. [Medline].

  27. Turck M, Schaberg D. Infections due to enterobacteriaceae. In: Harrison's Principles of Internal Medicine. 1980:629-34.

  28. Walmsley RS, David DB, Allan RN, Kirkby GR. Bilateral endogenous Escherichia coli endophthalmitis: a devastating complication in an insulin-dependent diabetic. Postgrad Med J. Jun 1996;72(848):361-3. [Medline].

  29. Wann SR, Liu YC, Yen MY, et al. Endogenous Escherichia coli endophthalmitis. J Formos Med Assoc. Jan 1996;95(1):56-60. [Medline].

  30. Zhang YQ, Wang WJ. Treatment outcomes after pars plana vitrectomy for endogenous endophthalmitis. Retina. Sep 2005;25(6):746-50. [Medline].

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Further Reading

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Keywords

ocular infections, corneal ulcers,  endophthalmitis, endophthalmitis, urinary tract infection, conjunctivitis, conjunctivitis, treatment, symptoms

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Contributor Information and Disclosures

Author

Donny W Suh, MD, FAAP, Clinical Assistant Professor, Pediatric Ophthalmology Service, University of Nebraska Medical Center; Pediatric Ophthalmologist, Adult Strabismus Specialist, Wolfe Eye Clinic, PC; Consulting Staff, Blank Children's Hospital, Mercy Medical Center of Des Moines, Iowa Methodist Hospital of Des Moines, and Marshalltown Medical Center
Donny W Suh, MD, FAAP is a member of the following medical societies: American Academy of Ophthalmology, American Academy of Pediatrics, and American Medical Association
Disclosure: Alcon  Honoraria Speaking and teaching

Medical Editor

Kilbourn Gordon III, MD, FACEP, Urgent Care Physician
Kilbourn Gordon III, MD, FACEP is a member of the following medical societies: American Academy of Ophthalmology and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

J James Rowsey, MD, Former Director of Corneal Services, St Luke's Cataract and Laser Institute, Florida
J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Pan-American Association of Ophthalmology, Sigma Xi, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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