Acute postoperative morganella morganii panophthalmitis

Acute postoperative morganella morganii panophthalmitis


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MAIN Sir, Endophthalmitis is an uncommon but serious complication of intraocular surgery, often resulting in severe visual loss.1 The endophthalmitis may progress to panophthalmitis if


medical or surgical therapy cannot control the infection. Strains of the _Morganella_ genus are a rare cause of panophthalmitis following trauma and cataract surgery.2 We describe a patient


who developed fulminant _Morganella morganii_ panophthalmitis following vitrectomy with resultant loss of vision. To our knowledge, this is the first reported case of _M. morganii_


panophthalmitis. CASE REPORT A 46-year-old Taiwanese male had sudden loss of vision in right eye for a day due to vitreous haemorrhage. On day 1 after pars plana vitrectomy, the fundus was


visible and the retina was well attached. Unfortunately, his visual acuity decreased to no light perception, and severe ocular pain with eyelid swelling developed rapidly within 2 days after


the operation. He was transferred to our hospital on day 4. On presentation, the patient eyelid appeared to be severely swollen and haemorrhagic chemosis was noted. Mucopurulent pus exuded


from the right eye. Acute postoperative panophthalmitis was diagnosed. Haemogram revealed leukocytosis (16 700/_μ_l) with neutrophils predominant by 80.9%. Pars plana vitrectomy with


anterior chamber irrigation and intravitreal delivery of vancomycin and ceftazidime was performed on day 5. Profuse pus was noted during the operation. Vitreous specimens were obtained for


smear and culture. Intravitreal injections of vancomycin (1 mg/0.1 ml) and ceftazidime (2 mg/0.1 ml) and subconjunctival injections of vancomycin (50 mg/0.5 cm3) and ceftazidime (125 mg/0.5 


cm3) were given at the end of the operation. Diffuse retinal whitening and hyperemic disc were noted intraoperatively. The patient's postoperative treatment regimen consisted of: (1)


subconjunctival vancomycin (50 mg/0.5 cm3) and ceftazidime (125 mg/0.5 cm3) every other day (2) intravenous cefazolin (1 g every 8 h) and gentamicin (80 mg every 12 h) and (3) topical


fortified vancomicin (50 mg/cm3) and ceftazidime (50 mg/cm3) every 1 h. However, his eye became more inflamed with mucopurulent discharge, and the ophthalmic examination was difficult to


perform due to severe periorbital swelling (Figure 1). Gram stain of vitreous specimens revealed numerous Gram negative rods (Figure 2), and culture of the anterior chamber aspirates and


vitreous specimens grew many _Morganella morganii_ colonies that were resistant to ampicillin and cefazolin using the disk diffusion method. The extraocular extension was noted by computed


tomography. The systemic antibiotic was then shifted to intravenous ceftriaxone (2 g every 12 h) 1 week after operation. Periorbital swelling with mucopurulent discharge decreased


dramatically after intravenous ceftriaxone use. His eye appeared quiet after a 2-week course of systemic and topical antibiotics with third-generation cephalosporin. Unfortunately, the


patient did not regain any vision despite this aggressive treatment. COMMENT _M. morganii_ is a Gram negative bacillus that belongs to the Enterobacteriaceae family. Within the


Enterobacteriaceae, the genus _Morganella_ is one member of the tribe Proteeae, which includes also the genera _Proteus_ and _Providencia_.3 _M. morganii_ is highly resistant bacillus


susceptible only to _β_-lactamase inhibitors. Strains are often resistant to first-generation cephalosporins.3 _M. morganii_ is a rare but usually devastating cause of postoperative


endophthalmitis.4, 5 In our patient, the clinical picture was fulminating. Even though the early intervention was performed, panopthalmitis with extraocular extension still developed


rapidly. The inflammation did not subside even with aggressive treatment till the third-generation cephalosporin was given intravenously. To our knowledge, this is the first reported case of


_M. morganii_ panophthalmitis. _M morganii_ is a rare aetiologic infectious agent. Very early intensive treatment including systemic antibiotic therapy with the third-generation


cephalosporin is the most important factor in the possible success of avoiding an eye with _M. morganii_ panophthalmitis from evisceration/enucleation. REFERENCES * Nick M, Laura K, Eric B .


Postoperative endophthalmitis. _Curr Opin Ophthalmol_ 2002; 13: 14–18. Article  Google Scholar  * Irvine WD, Flynn HW, Miller D, Pflugfelded SC . Endophthalmitis caused by gram-negative


organisms. _Arch Ophthalmol_ 1992; 110: 1450–1454. Article  CAS  Google Scholar  * Stock I, Wiedemann B . Identification and natural antibiotic susceptibility of _Morganella morganii_.


_Diagn Microbiol Infect Dis_ 1998; 30: 154–165. Article  Google Scholar  * Cunningham ET, Whitcher JP, Kim RY . _Morganella morganii_ postoperative endophthalmitis [letter]. _Br J


Ophthalmol_ 1997; 81: 170–171. Article  Google Scholar  * Tsanaktsidis G, Anarwal SA, Maloof AJ, Chandra J, Mitchell P . Postoperative _Morganella morganii_ endophthalmitis associated with


subclinical urinary tract infection. _J Cataract Refract Surg_ 2003; 29: 1011–1013. Article  Google Scholar  Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of


Ophthalmology, National Taiwan University Hospital, # 7 Chung-Shan South Rd., Taipei, Taiwan T-J Wang & J-S Huang * Department of Laboratory Medicine and Internal Medicine, National


Taiwan University Hospital, Taipei, Taiwan P-R Hsueh Authors * T-J Wang View author publications You can also search for this author inPubMed Google Scholar * J-S Huang View author


publications You can also search for this author inPubMed Google Scholar * P-R Hsueh View author publications You can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR


Correspondence to J-S Huang. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Wang, TJ., Huang, JS. & Hsueh, PR. Acute postoperative _Morganella


morganii_ panophthalmitis. _Eye_ 19, 713–715 (2005). https://doi.org/10.1038/sj.eye.6701613 Download citation * Published: 27 August 2004 * Issue Date: 01 June 2005 * DOI:


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