Ophthalmologic Manifestations of Escherichia Coli

Updated: Feb 05, 2016
  • Author: Donny W Suh, MD, FAAP; Chief Editor: Hampton Roy, Sr, MD  more...
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Overview

Background

The genus Escherichia is named after Theodor Escherich who isolated the type species of the genus in 1885. Escherichia coli is a gram-negative rod that is found as a normal commensal in the GI tract, which can produce ocular infection including corneal ulcer and endophthalmitis, which can result in a devastating outcome. Early recognition and appropriate treatment is crucial. These infections most commonly occur in patients who are debilitated, immunocompromised, or diabetic or in corneas with an underlying pathologic condition.

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Pathophysiology

E coli is rarely found in the normal flora of the conjunctiva. It is most commonly seen as a source of infection in ophthalmia neonatorum. Low birth weight and low gestational age in infants with clinical signs of conjunctivitis should raise the suspicion for a gram-negative cause. [1] E coli endophthalmitis is a rare complication of E coli septicemia. Antimicrobial resistance occurs through plasmid-mediated determinants. These multiresistant plasmids can be transferred by conjugation. It has a poor prognosis, and early diagnosis and treatment are essential to retain useful vision.

These infections most commonly occur in patients who are debilitated, immunocompromised, or diabetic or in corneas with an underlying pathologic condition. Exogenous endophthalmitis is usually associated with trauma or intraocular surgery. In endogenous endophthalmitis, urinary tract infection was the most common primary site of infection and nearly all patients are diabetic.

Early recognition and appropriate treatment is crucial because E coli endophthalmitis has an extremely poor prognosis. Depending on the severity, most patients need aggressive management and early medical and surgical intervention.

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Epidemiology

Frequency

United States

Approximately 5-10% of endogenous bacterial endophthalmitis is due to E coli. Exogenous endophthalmitis associated with intraocular surgery is 0.1-0.5%. Of these infections, E coli is rare a cause.

Endophthalmitis occurs following 2-7% of penetrating injuries. Incidence is higher in association with intraocular foreign body. Of these infections, E coli is a rare cause.

International

International frequency is unknown.

Mortality/Morbidity

In endophthalmitis, the course of illness is very rapid, and complete destruction of intraocular tissues occurs. Corneal infection due to E coli produce indolent corneal ulcers with poor prognosis because most of these patients of have an underlying immunocompromised disorder or have abnormal corneal surface with compromised protective barrier.

Sex

Men are 4 times more likely to have ocular trauma than women, which may lead to bacterial endophthalmitis. For corneal ulcer due to E coli, no difference is noted in frequency between the sexes.

Age

E coli may be seen as a source of infection in ophthalmia neonatorum in neonates. Also, endophthalmitis may occur in neonates following meningitis. However, almost all cases of E coli endophthalmitis have been in adults with an immunocompromised state or with diabetes.

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