Ophthalmologic Manifestations of Escherichia Coli 

  • Author: Donny W Suh, MD, FAAP; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Mar 9, 2012
 

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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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

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

J James Rowsey, MD  Former Director of Corneal Services, St Luke's Cataract and Laser Institute

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.

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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