eMedicine Specialties > Ophthalmology > Infectious Disease

Escherichia Coli

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

Introduction

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.

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.

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.

Clinical

History

Assess the following in suspected E coli infection:

  • Past ocular history
    • Previous eye injury
    • Infection
    • Surgery
    • Diabetic eye disease
  • Past medical history
    • Diabetes
    • Immunocompromised host
    • Intravenous drug abuser
    • Urinary tract infection
  • Visual complaints
    • Decreased vision
    • Eyelid edema
    • Diplopia red eye
    • Mild-to-severe ocular pain
    • Photophobia
    • Discharge

Physical

  • Signs
    • Focal white opacity in the corneal stroma
    • Epithelial defect that stains fluorescent
    • Stroll edema and inflammation surrounding the infiltrate
    • Conjunctival injection
    • Corneal thinning
    • Anterior chamber reaction
    • Hypopyon (as is shown in the image below)

    • Bacterial corneal ulcer with hypopyon.

      Bacterial corneal ulcer with hypopyon.

      [ CLOSE WINDOW ]
      Bacterial corneal ulcer with hypopyon.

      Bacterial corneal ulcer with hypopyon.

    • Mucopurulent discharge
    • Upper eyelid edema
    • Posterior synechiae
    • Hyphema
    • Glaucoma

Causes

  • Exogenous causes
    • Immunocompromised state
    • Irregular corneal epithelium
    • Trauma
    • Ocular surgery
  • Endogenous causes
    • Urinary tract infection
    • Endocarditis
    • Meningitis
    • Systemic infection

More on Escherichia Coli

Overview: Escherichia Coli
Differential Diagnoses & Workup: Escherichia Coli
Treatment & Medication: Escherichia Coli
Follow-up: Escherichia Coli
Multimedia: Escherichia Coli
References
[ CLOSE WINDOW ]

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].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

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

[ CLOSE WINDOW ]

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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.