Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand.
BMC Infect Dis. 2020 Nov 23;20(1):877. doi: 10.1186/s12879-020-05606-2.
To report three cases of nontuberculous mycobacterial (NTM) endophthalmitis following multiple ocular surgeries and to review previous literature in order to study the clinical profile, treatment modalities, and visual outcomes among patients with NTM endophthalmitis.
Clinical manifestation and management of patients with NTM endophthalmitis in the Department of Ophthalmology, Faculty of Medicine, Siriraj hospital, Mahidol University, Bangkok, Thailand were described. In addition, a review of previously reported cases and case series from MEDLINE, EMBASE, and CENTRAL was performed. The clinical information and type of NTM from the previous studies and our cases were summarized.
We reported three cases of NTM endophthalmitis caused by M. haemophilum, M. fortuitum and M. abscessus and a summarized review of 112 additional cases previously published. Of 115 patients, there were 101 exogenous endophthalmitis (87.8%) and 14 endogenous endophthalmitis (12.2%). The patients' age ranged from 13 to 89 years with mean of 60.5 ± 17.7 years with no gender predominance. Exogenous endophthalmitis occurred in both healthy and immunocompromised hosts, mainly caused by cataract surgery (67.3%). In contrast, almost all endogenous endophthalmitis patients were immunocompromised. Among all patients, previous history of tuberculosis infection was identified in 4 cases (3.5%). Rapid growing NTMs were responsible for exogenous endophthalmitis, while endogenous endophthalmitis were commonly caused by slow growers. Treatment regimens consisted of macrolides, fluoroquinolones or aminoglycosides, which were continued for up to 12 months. Initial and final vision were generally worse than 6/60.
NTM endophthalmitis is a serious intraocular infection that leads to irreversible loss of vision. The presentation can mimic a chronic recurrent or persistent intraocular inflammation. History of multiple intraocular surgeries or immune-deficiency in patient with chronic panuveitis should raise the practioner's suspicion of NTM endophthalmitis. Appropriate diagnosis and treatment are important to optimize visual outcome.
报告三例非结核分枝杆菌（NTM）眼内炎病例，这些病例均继发于多次眼部手术，并对以往文献进行复习，以研究 NTM 眼内炎患者的临床特征、治疗方式和视力预后。
描述泰国曼谷玛希隆大学 Siriraj 医院眼科患者的 NTM 眼内炎的临床表现和治疗方法。此外，还对 MEDLINE、EMBASE 和 CENTRAL 中以前报道的病例和病例系列进行了综述。总结了以往研究和我们病例中的临床信息和 NTM 类型。
我们报告了三例由嗜血分枝杆菌、脓肿分枝杆菌和偶然分枝杆菌引起的 NTM 眼内炎，并对以前发表的 112 例病例进行了综述。115 例患者中，有 101 例为外源性眼内炎（87.8%），14 例为内源性眼内炎（12.2%）。患者年龄为 13 至 89 岁，平均 60.5 ± 17.7 岁，无性别优势。外源性眼内炎发生于健康和免疫功能低下的宿主，主要由白内障手术引起（67.3%）。相比之下，几乎所有内源性眼内炎患者均有免疫功能低下。所有患者中，有 4 例（3.5%）有结核病感染史。快速生长的 NTM 引起外源性眼内炎，而内源性眼内炎则常见于缓慢生长的 NTM。治疗方案包括大环内酯类、氟喹诺酮类或氨基糖苷类药物，持续时间长达 12 个月。初始和最终视力普遍差于 6/60。
NTM 眼内炎是一种严重的眼内感染，可导致视力不可逆转的丧失。其表现可模仿慢性复发性或持续性眼内炎症。对于患有慢性全葡萄膜炎且有多次眼内手术史或免疫功能低下的患者，应提高对 NTM 眼内炎的怀疑。适当的诊断和治疗对于优化视力预后非常重要。
