Indian Journal of Medical Microbiology IAMM  | About us |  Subscription |  e-Alerts  | Feedback |  Login   
  Print this page Email this page   Small font sizeDefault font sizeIncrease font size
 Home | Ahead of Print | Current Issue | Archives | Search | Instructions  
Users Online: 2215 Official Publication of Indian Association of Medical Microbiologists 
  Search
 
  
 ~  Similar in PUBMED
 ~  Search Pubmed for
 ~  Search in Google Scholar for
 ~Related articles
 ~  Article in PDF (1,276 KB)
 ~  Citation Manager
 ~  Access Statistics
 ~  Reader Comments
 ~  Email Alert *
 ~  Add to My List *
* Registration required (free)  

 
 ~  Abstract
 ~ Introduction
 ~ Case Report
 ~ Discussion
 ~  References
 ~  Article Figures

 Article Access Statistics
    Viewed2408    
    Printed62    
    Emailed0    
    PDF Downloaded107    
    Comments [Add]    

Recommend this journal

 


 
  Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 34  |  Issue : 3  |  Page : 382-384
 

Post-traumatic endophthalmitis caused by Streptococcus parauberis: First human case report


1 Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission20-Oct-2015
Date of Acceptance30-Jun-2016
Date of Web Publication12-Aug-2016

Correspondence Address:
P Ray
Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.188360

Rights and Permissions

 ~ Abstract 

A 12-year-old boy presented with trauma to left eye with a wooden stick. On examination, there was full thickness corneal laceration with cataractous lens behind the laceration. The laceration was sutured, and intravitreal injections of vancomycin, ceftazidime and clindamycin were administered. Vitreous tap grew Streptococcus parauberis. The isolate was sensitive to amoxicillin, erythromycin and vancomycin, and topical vancomycin was used to treat the infection. We present the first case of human post-traumatic infective endophthalmitis caused by the rare agent S. parauberis.


Keywords: Infective endophthalmitis, post-traumatic, Streptococcus parauberis, vancomycin


How to cite this article:
Zaman K, Thakur A, Sree V L, Kaushik S, Gautam V, Ray P. Post-traumatic endophthalmitis caused by Streptococcus parauberis: First human case report. Indian J Med Microbiol 2016;34:382-4

How to cite this URL:
Zaman K, Thakur A, Sree V L, Kaushik S, Gautam V, Ray P. Post-traumatic endophthalmitis caused by Streptococcus parauberis: First human case report. Indian J Med Microbiol [serial online] 2016 [cited 2020 Oct 21];34:382-4. Available from: https://www.ijmm.org/text.asp?2016/34/3/382/188360



 ~ Introduction Top


Streptococcus parauberis and Streptococcus uberis are the primary causative agents of bovine mastitis. S. parauberis aquatic infections have been a major concern of economic loss in marine aquaculture system. S. parauberis was first reported from cultured turbot (Scophthalmus maximus) in Spain followed by the increase in frequency of infection of olive flounder (Paralichthys olivaceus) in the aquaculture industries of North-eastern Asia. Till date, in literature, no case of human infection by S. parauberis has been reported. We present the first case of human post-traumatic infective endophthalmitis caused by the rare agent S. parauberis.


 ~ Case Report Top


A 12-year-old boy complained of eye pain and watering following trauma to the left eye with a wooden stick while playing. He was prescribed some topical eye drops by a local doctor and presented to our centre 6 days after the injury, with no relief of symptoms. On examination of the left eye, the visual acuity was limited to perception of light (PL) with inaccurate projection of rays, and there was a full-thickness corneal laceration involving the pupillary area 6 mm in horizontal diameter sparing the limbus with corneal infiltrates surrounding the lacerated margins. The injury was categorised Type B, Zone I, Grade IV with cataractous lens behind laceration. The corneal laceration was sutured under general anaesthesia, and empirical intravitreal antibiotics, vancomycin 1 mg, ceftazidime 2.25 mg and clindamycin 1 mg were injected. A vitreous tap 0.2 ml was taken through pars plana route and the clear yellow aspirated fluid was sent for microbiological examination.

On the 1 st post-operative day, there was no PL and there were dense corneal infiltrates around the sutured ends. The cataractous lens was bulging behind the sutures, shallowing the anterior chamber [Figure 1]. Ultrasound examination revealed vitreous cavity full of infiltrates suggestive of endophthalmitis. The patient was started on intravenous ciprofloxacin (10 mg/kg body weight 12 hourly) with topical moxifloxacin 0.5%, topical atropine 1%, topical betamethasone 0.1%, along with topical carboxymethylcellulose 0.5%. Vitrectomy was not done due to poor prognosis.
Figure 1: Post-operative day 1 photograph showing corneal infiltrates around the sutured ends

Click here to view


Microscopic examination of vitreous fluid revealed pus cells. The sample was inoculated on 5% sheep blood agar, chocolate agar and MacConkey agar. The culture grew 2-3 mm, smooth, creamy white colonies with alpha haemolysis on blood agar. Gram-stain from the colonies showed Gram-positive cocci in chains. The isolate was subjected to identification by MALDI-TOF MS (Bruker Daltonics, Bremen, Germany). Bruker MALDI Biotyper 3.0 software package was used to analyse the mass spectrum generated and compared with the available reference spectrum database. A score of ≥2 provided species level identification as per the manufacturer's recommendation and available literature. The isolate was identified as S. parauberis with a score of 2.1. The standard Kirby-Bauer disc diffusion method was used for antibiotic susceptibility testing as per CLSI guidelines (CLSI 2015). The isolate was sensitive to amoxicillin, erythromycin and vancomycin, and resistant to co-trimoxazole and clindamycin. Microscopy and culture were negative for fungal pathogens.

Topical vancomycin 5% was added to the above treatment. After 4 days of starting topical vancomycin, there was a decrease in corneal infiltrates [Figure 2]. Visual acuity was still documented as no perception of light. Ultrasonography revealed retinal detachment with vitreous haemorrhage. The patient was discharged, and 'no visual prognosis' was explained and advised for follow-up.
Figure 2: Photograph at the time of discharge showing reduced corneal infiltrates

Click here to view



 ~ Discussion Top


Paediatric infectious endophthalmitis is a devastating condition. It is mainly caused by open-globe injuries and glaucoma surgery. [1] Open-globe injury is the most common cause of endophthalmitis in children, with an estimated incidence range of 2-54.2%. [2] Post-traumatic endophthalmitis is often polymicrobial in nature compared to other forms of exogenous endophthalmitis.

The culture positivity for exogenous infectious endophthalmitis ranges from 44% to 75% and the most common organisms recovered are Gram-positive bacteria, [3] mostly sensitive to vancomycin. Staphylococcus spp., especially coagulase negative staphylococci, are the most common followed by Streptococcus spp. and Bacillus spp. [4] Streptococci are more common causes in the paediatric age group, whereas in adults, it is Staphylococcus epidermidis. Among the Streptococcus species, viridans streptococci are the most common, followed by Streptococcus pneumoniae and β-haemolytic streptococci. [5] Patients with streptococcal endophthalmitis have poorer visual outcomes compared to that of staphylococcal infection.

S. parauberis is a Gram-positive coccus, non-motile, non-sporing and catalase negative. They are facultatively anaerobic and grow at 30-37°C. Of the phylogenetic groups of genus Streptococcus, S. parauberis belongs to the pyogenic group and Lancefield E serogroup. When compared to other pyogenic streptococci, S. uberis and S. parauberis are alpha- or non-haemolytic [Figure 3]. [6] The only phenotypic test to differentiate S. uberis and S. parauberis is the enzyme β-D-glucuronidase activity. [7] Even the literature reports the difficulty in establishing the identification of these species. [8] Isolation of a non-haemolytic Streptococcus species especially in mixed culture may be dismissed as an insignificant contaminant. In the present case, identification was established by mass spectrometry-based MALDI-TOF. Various studies have shown that MALDI-TOF MS has better efficacy in identifying the alpha haemolytic streptococci. [9]
Figure 3: Growth on blood agar showing alpha haemolysis

Click here to view


S. parauberis and S. uberis are the primary causative agents of bovine mastitis. [7] Marine streptococcosis is a major concern of economic loss in marine aquaculture system. S. parauberis was first reported from cultured turbot (S. maximus) in Spain followed by the increase in frequency of infection of olive flounder (P. olivaceus) in the aquaculture industries of North-eastern Asia. Recently, in the USA, natural infection by S. parauberis was reported in wild striped finfish (Morone saxatilis). [10] Most of the isolates are sensitive to penicillin, ampicillin, oxacillin, amoxicillin/clavulanic acid and cephalosporins. Resistance has been noted to co-trimoxazole (SXT) and ciprofloxacin. [11] In our study, the isolate was resistant to co-trimoxazole (SXT), ciprofloxacin and clindamycin and was sensitive to vancomycin. The patient was initially treated with ciprofloxacin with no clinical improvement, and later on the basis of the susceptibility report topical vancomycin was used to treat the infection. Till date, in literature, no case of human infection by S. parauberis has been reported. We present the first case of human post-traumatic infective endophthalmitis caused by the rare agent S. parauberis. Knowledge of the causal rather than casual association of newer species will broaden the list of possible aetiological agents, and their susceptibility profile will help in forming antibiotic treatment policy to target the bacteria empirically as well as definitively.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 ~ References Top

1.
Brophy M, Sinclair SA, Hostetler SG, Xiang H. Pediatric eye injury-related hospitalizations in the United States. Pediatrics 2006;117:e1263-71.  Back to cited text no. 1
    
2.
Junejo SA, Ahmed M, Alam M. Endophthalmitis in paediatric penetrating ocular injuries in Hyderabad. J Pak Med Assoc 2010;60:532-5.  Back to cited text no. 2
    
3.
Al-Rashaed SA, Abu El-Asrar AM. Exogenous endophthalmitis in pediatric age group. Ocul Immunol Inflamm 2006;14:285-92.  Back to cited text no. 3
    
4.
Jindal A, Pathengay A, Mithal K, Jalali S, Mathai A, Pappuru RR, et al. Endophthalmitis after open globe injuries: Changes in microbiological spectrum and isolate susceptibility patterns over 14 years. J Ophthalmic Inflamm Infect 2014;4:5.  Back to cited text no. 4
    
5.
Kuriyan AE, Weiss KD, Flynn HW Jr., Smiddy WE, Berrocal AM, Albini TA, et al. Endophthalmitis caused by streptococcal species: Clinical settings, microbiology, management, and outcomes. Am J Ophthalmol 2014;157:774-780.e1.  Back to cited text no. 5
    
6.
Facklam R. What happened to the streptococci: Overview of taxonomic and nomenclature changes. Clin Microbiol Rev 2002;15:613-30.  Back to cited text no. 6
    
7.
Williams AM, Collins MD. Molecular taxonomic studies on Streptococcus uberis types I and II. Description of Streptococcus parauberis sp. nov. J Appl Bacteriol 1990;68:485-90.  Back to cited text no. 7
    
8.
Toma L, Di Domenico EG, Prignano G, Ensoli F. Comment on "intravitreal ampicillin sodium for antibiotic-resistant endophthalmitis: Streptococcus uberis first human intraocular infection report". J Ophthalmol 2014;2014:395480.  Back to cited text no. 8
    
9.
Davies AP, Reid M, Hadfield SJ, Johnston S, Mikhail J, Harris LG, et al. Identification of clinical isolates of α-hemolytic streptococci by 16S rRNA gene sequencing, matrix-assisted laser desorption ionization-time of flight mass spectrometry using MALDI Biotyper, and conventional phenotypic methods: A comparison. Clin Microbiol 2012;50:4087-90.  Back to cited text no. 9
    
10.
Haines AN, Gauthier DT, Nebergall EE, Cole SD, Nguyen KM, Rhodes MW, et al. First report of Streptococcus parauberis in wild finfish from North America. Vet Microbiol 2013;166:270-5.  Back to cited text no. 10
    
11.
Gülen D, Kaya AD, Aydin M, Tanriverdi Y. Urinary tract infections caused by Streptococcus uberis: A pathogen of bovine mastitis report of seven cases. Afr J Microbiol Res 2013;7:3908-12.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
Print this article  Email this article
 

    

2004 - Indian Journal of Medical Microbiology
Published by Wolters Kluwer - Medknow

Online since April 2001, new site since 1st August '04