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REVIEW ARTICLE
Year : 2018  |  Volume : 7  |  Issue : 6  |  Page : 234-240

Endogenous endophthalmitis secondary to melioidosis in paediatric patients: Case series and review article


1 Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150 Kelantan; Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan; Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
2 Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
3 Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150 Kelantan; Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia

Correspondence Address:
Dr. Wendy Ong Chin Feng
Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150 Kelantan
Malaysia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2221-6189.248027

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Endogenous endophthalmitis is a devastating infection of the eye which can lead to permanent blindness. We report two rare cases of paediatric endogenous endophthalmitis secondary to melioidosis with contrasting visual outcomes. Both patients presented with acute painful visual loss with poor vision on presentation after exposure to open water sources (swimming at two separate locations with waterfalls). Both were diagnosed to have melioidosis endogenous endophthalmitis based on the ocular features clinically and via positive melioidosis serology. They otherwise did not exhibit any symptoms and signs suggestive of systemic melioidosis infection. Even though the two children demonstrated severe ocular involvement, ocular culture from vitreous and aqueous sampling taken from one of the patients did not yield any positive results. No ocular sampling was taken from the other patient. After standard antimicrobial treatment, the first patient responded well with good visual recovery without requiring any surgical intervention for the endophthalmitis. In contrast, our second patient ended up with poor visual outcome despite undergoing multiple intravitreal antibiotic injections and early pars plana vitrectomy. This is because he developed extensive retinal detachment due to the aggressive ocular infection. The diagnosis of endogenous endophthalmitis due to ocular melioidosis remains challenging and requires a high index of suspicion in areas endemic for the causative organism. Early empirical antibiotic treatment should be initiated in suspicious cases, even though the treatment outcomes may vary greatly.


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