Department of Ophthalmology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
BMC Infect Dis. 2023 Aug 9;23(1):522. doi: 10.1186/s12879-023-08489-1.
Septicemia that leads to ocular involvement mostly presents as endophthalmitis or panophthalmitis. Contrarily, septicemia without intraocular involvement, known as hematogenous orbital cellulitis (HOC), involves only the orbit and is an extremely rare complication of septicemia and a rare type of orbital cellulitis.
Four male patients with septicemia presented with orbital involvement without intraocular infection were described in this study. They were 22 (case 1), 15 (case 2), 79 (case 3), and 30 (case 4) years old, with a mean age of 29.75 years. All patients were immunocompromised except for case 2. Cases 1 and 3 had a history of steroid use, whereas case 4 was in a post-chemotherapy myelosuppression phase. Septicemia in case 1 was community-acquired, cases 3 and 4 were hospital-acquired, and case 2 was secondary to acne squeezing. Blood cultures from cases 1, 2, and 3 were positive for Candida albicans, methicillin-resistant Staphylococcus aureus, and Klebsiella pneumoniae, respectively. Case 4 had negative cultures; however, next-generation sequencing reported the presence of Enterococcus faecalis and Rhizopus oryzae. Case 1 had right eye involvement, and both eyes were involved in the other three cases. According to Chandler's classification, case 1 was type 2, case 2 was type 2 (OD) and type 4 (OS), and cases 3 and 4 were type 1 orbital infections. All patients had eyelids erythema, and cases 1 and 2 had mildly decreased visual acuity, proptosis, and painful and restricted ocular motility. Hospital stays ranged from 13 to 43 days (mean, 24 days). All patients received systemic antibiotic therapy based on drug sensitivity and next-generation sequencing results, in combination with multidisciplinary treatment, resulting in complete recovery of ocular and systemic signs and symptoms; no ocular surgical interventions were performed. Extraocular muscle palsy was the last symptom to resolve.
HOC is predominantly seen in immunocompromised individuals with a high proportion of hospital-acquired infections and positive cultures for pathogens. Infection control using systemic antibiotics targeted at the causative organism guarantees a favorable prognosis.
导致眼部受累的败血症主要表现为眼内炎或全眼球炎。相反，无眼内感染的败血症，即血源性眼眶蜂窝织炎（HOC），仅累及眼眶，是败血症的一种极其罕见的并发症，也是一种罕见的眼眶蜂窝织炎类型。
本研究描述了 4 名患有败血症且眼部受累而无眼内感染的男性患者。他们的年龄分别为 22 岁（病例 1）、15 岁（病例 2）、79 岁（病例 3）和 30 岁（病例 4），平均年龄为 29.75 岁。除病例 2 外，所有患者均存在免疫功能低下。病例 1 和 3 有类固醇使用史，而病例 4 处于化疗后骨髓抑制期。病例 1 的败血症为社区获得性，病例 3 和 4 为医院获得性，病例 2 继发于痤疮挤压。病例 1、2 和 3 的血培养均为白色念珠菌、耐甲氧西林金黄色葡萄球菌和肺炎克雷伯菌阳性，病例 4 的培养为阴性；然而，下一代测序报告了粪肠球菌和米根霉的存在。病例 1 右眼受累，其他 3 例双眼受累。根据 Chandler 分类，病例 1 为 2 型，病例 2 为 2 型（OD）和 4 型（OS），病例 3 和 4 为 1 型眼眶感染。所有患者均有眼睑红斑，病例 1 和 2 视力轻度下降，眼球突出，眼球运动疼痛且受限。住院时间为 13 至 43 天（平均 24 天）。所有患者均根据药敏试验和下一代测序结果接受了全身抗生素治疗，并结合多学科治疗，眼部和全身症状均完全恢复；未行眼部手术干预。眼外肌瘫痪是最后一个缓解的症状。
HOC 主要发生在免疫功能低下的个体中，其中大多数为医院获得性感染，病原体培养阳性。针对病原体的全身抗生素感染控制可保证良好的预后。
